MSK Flashcards
Which of the following is the most appropriate initial intervention for treatment of Complex Regional Pain Syndrome (CRPS)?
Sympathetic block
A patient presents with an injury to his nail bed and a subungual hematoma that covers >50 % of the nail matrix. What is the next step in the management of this patient?
Order an X-ray of his finger
In a patient with ankylosing spondylitis, which specialist should you refer the patient to for further evaluation and treatment?
rheumatology and ophthalmologist
How long are hip precautions routinely continued after a posterior approach total hip arthroplasty?
12 weeks
A 75-year-old patient was treated for local prostate cancer 15 years ago. He has received leuprolide (Lupron) for chemical castration since his diagnosis. He is currently asymptomatic with an undetectable prostate specific antigen and requests guidance in developing a comprehensive exercise program. Which study would be most useful in counseling this patient?
Dual energy x-ray absorptiometry
A young female with a history of oligoarticular juvenile idiopathic arthritis (JIA) presents with the following laboratory values: rheumatoid factor (RF) negative, antinuclear antibody (ANA) screen positive, and human leukoctye antigen (HLA) B-27 positive. Which of the following subspecialty referrals is mandatory?
ophtho
Which of the following imaging findings is most consistent with congenital cervical stenosis?
Shortened pedicles
What percent of rheumatoid arthritis patients are rheumatoid factor positive?
80%
In addition to mechanical nerve root compression, which of the following is an alternative explanation for symptomatic spinal stenosis?
venous engorgement
Which statement concerning patients with osteoarthritis (OA) is true?
Exercise contributes to OA-related pain reduction.
A 27-year-old manual laborer presents with a 6-month history of right shoulder pain. He has a past medical history of a traumatic right shoulder dislocation 3 years ago. On physical exam, he has normal strength and sensation with symmetric reflexes. The shoulder apprehension test is positive. Impingement tests and the O’Brien active compression test are negative. Which diagnosis is most consistent with this presentation?
Anterior-inferior labrum tear
A 23-year-old college football player presents to you with a complaint of right knee pain after planting his foot and cutting left in an attempt to avoid a tackle. On exam you note limited weight bearing on ambulation, swelling, decreased range of motion, a positive ballottement test, and a negative Lachman’s test. Which ligament is most likely injured?
ACL
Which of the following is commonly associated with sacroiliitis?
inflammatory bowel disease
A 40-year-old patient is consulting you for management of her fibromyalgia and has failed to improve in the past with SSRIs, SNRIs, TCAs and Gabapentin. She asks you about other medications that have been developed for treatment of his condition. Which of the following drugs currently has the strongest research backed evidence for treatment of fibromyalgia?
Gabapnetinoids (e.g. Gabapentin), TCAs (e.g. Nortryptiline) and SNRIs (e.g. Duloxetine) also all fall under evidence level 1A.(cannabinoids is answer for this question)
Dupuytren contracture is associated with which of the following?
smoking
what does Dupuytren contracture cause contracture of
flexion contracture of the MCP and PIP joints.
Radiographic evidence of 40% anterolisthesis of L5 on S1 vertebra is consistent with which severity grade in Meyerding’s classification of spondylolisthesis?
grade II
An adult patient is referred with a diagnosis of generalized hypermobility syndrome and a Beighton score of 8 points. A true statement about this situation is:
Physical therapy for strength, core stability and endurance training can be helpful.
An indicator of a poor outcome for juvenile idiopathic arthritis (JIA) is:
Early radiographic changes
What is the most likely cause of knee pain in a 40-year-old female patient reporting spontaneous onset of pain and swelling about the joint three weeks after attending a petting farm with their family?
reactive arthritis
The most common organism responsible for septic arthritis in a one-year-old is:
H.flu
What percent weight reduction in overweight patients has been shown to result in a moderate to large reduction in self-reported disability related to symptomatic knee arthritis ?
10%
Which of the following maneuvers can identify early clinical manifestations of congenital hip dysplasia?
Ortolani test
A 20-year-old college recreational athlete presents to your clinic after injuring his right ankle during a flag football game earlier in the day. On exam you note an antalgic gait with significant swelling, bruising, and tenderness to palpation at the anterior aspect of the lateral malleolus. No tenderness along the lateral and posterior aspect of the lateral malleolus, the medial malleolar region, or the foot. Regarding imaging, what should you order?
no imaging at this time
An 80-year-old female with osteoporosis and dementia trips and falls onto her hip. The patient was found on the ground with her limb in an externally rotated, abducted, and shortened position. X-rays of the hip most likely shows:
Femoral neck fracture
Lumbar spine radiographs demonstrate normal alignment, no fractures, multilevel lumbar disc height loss, and advanced facet hypertrophy. Which of the following terms best summarizes the pathology that presents with these imaging abnormalities?
Spondylosis
Iliotibial Band Syndrome (ITBS) is associated with which of the following rotary motions?
Tibial internal rotation
The effect of aquatic therapy for patients with osteoporosis is:
Decreased fall risk
The American College of Rheumatology’s 2010 diagnostic criteria for fibromyalgia includes
Use of a Widespread Pain Index and Symptom Severity Scale to make the diagnosis
Which of the following is a poor prognostic indicator for seronegative spondyloarthropathies?
Low response to non-steroidal anti-inflammatory drugs
Which is the most common form of juvenile idiopathic arthritis?
oligoarticular
Dactylitis is a common finding in which of the following conditions?
psoriatic arthritis
The risk of hypertrophic scarring in children after burn injury is increased in a child with:
dark skin, young age, female gender, neck and upper limb burn sites, multiple surgical procedures (including meshed skin graft), as well as deeper wounds and longer healing time (over 3 weeks).
what is the initial deformity created in the cervical spine in a whiplash injury?
S-shaped deformation phase in the sagittal plane of the cervical spine, followed by a C-shaped in the sagittal plane phase.
Which of the following is optimal initial treatment for congenital hip dysplasia in infants less than 6 months?
pavlick harness
What is the minimum recommended rating of pressure garments to reduce hypertrophic scarring in a patient with a burn injury?
25mmHg
A 14-year-old quarterback suffers a type V acromioclavicular (AC) joint separation after being sacked. What is the recommended treatment for this athlete?
Referral to orthopaedic surgery for open reduction and internal fixation
A 22-year-old female runner presents to your clinic for right hip pain. She has been training hard for an upcoming half marathon. Recent MRI indicates a stress fracture at the superior aspect of the femoral neck. There is no clear cortical break. Based on these findings, what is the best next step in management?
Make her non-weight bearing on crutches and refer her to an orthopedic surgeon
how are Stress fractures of the inferior aspect of the femur managed?
non-operatively as this is the side of the femoral neck that is loaded in compression, which is relatively favorable for bone loading (exception: cortical breaks should be referred for evaluation).
Which of the following is the most frequent association of nerve injury and fracture?
radial nerve and humeral fracture
A 39-year-old male presents to your office after playing basketball with the inability to actively extend the DIP joint of his fourth finger. X-ray was negative for fracture. What would be your next step in the treatment of this patient?
Splint DIP into extension
Which of the following is a risk factor for plantar fasciitis?
Factors that increase the tension on the plantar fascia, such as obesity, decreased subtalar motion, pes cavus, pes planus, and a tight Achilles’ tendon,
Which of the following is true of hypertrophic scars following burns?
It is the most common complication after burn injury
In Clay shoveler’s fracture, what anatomic region of lower cervical and upper thoracic spine is affected?
spinous process
A 40-year-old male presents to your office with reduced grip strength and pain over the ulnar side of his wrist. The patient gives a history of being a professional cyclist with multiple falls in the past. X-rays show sclerosis and fragmentation of the lunate. This patient most likely has which disease?
Kienbock’s
what is a disease of the elbow seen in children under the age of 10 who are involved in throwing activities and gymnastics. There is lateral elbow pain and the disease is self- limited and thus conservative management is warranted.
Panner’s disease
Which rheumatic disease has a non-erosive arthritis and may also be caused by certain medications?
SLE
A 35-year-old patient presents to your clinic with a 3-month history of groin pain exacerbated by activity. Anteroposterior films of the hip were normal. The magnetic resonance imaging of the hip reported a bony prominence at the femoral head-neck junction. What clinical exam finding is most likely to correlate with these radiographic “abnormalities”?
Pain with hip flexion, internal rotation, and adduction
A 27-year-old golfer presents with pain on the volar ulnar aspect of his hand. X-ray shows he has a fracture of the hook of his hamate bone. What is the treatment of choice?
referral to hand surgeon (excision of hook)
A patient with lumbar radicular pain with weakness in the gluteus medius muscle and extensor hallucis longus. Which of the following imaging findings would correlate with these findings:
Right paramedian disc herniation at L4-L5
Which radiographic findings can be seen in Complex Regional Pain Syndrome?
Juxta-articular osteoporotic changes
What percentage of low back pain has a specific identifiable cause?
5-15%
A 28-year-old female runner presents to you with increasing right foot pain. She recently read an article about barefoot running and so has transitioned to that over the last month. She runs six days a week, but more recently she has had to stop running due to pain and has pain throughout the day, worsened by any weight bearing. On exam, there is no swelling or redness. She has tenderness directly over the 3rd metatarsal. No tenderness elsewhere within the foot. Normal neurological exam. Pain with attempts to hop. For your initial management, you decide to:
Place her in a walking boot and follow up with her in 3 weeks
A 15-year-old high school football player sustains a direct hit to the shoulder. He feels immense shoulder pain and decreased range of motion with associated numbness in his hand. Sideline evaluation confirms a glenohumeral joint dislocation and neurological symptoms resolve after joint reduction. Post-reduction radiographs confirm reduction and reveal a sizeable osseous depression in the posterior-lateral aspect of the humeral head. After providing a sling for comfort, what is the next best step in evaluation?
Referral to orthopaedics for surgical consultation (hills Sachs lesion)
In young athletes, the likelihood of a 2nd shoulder dislocation after experiencing a first-time dislocation is:
greater than 60%
What is the most common congenital musculoskeletal deformity associated with myelomeningocele?
Equinovarus foot
A 65-year-old male presents to clinic with complaints of a chronic stiff neck and dysphagia. He is negative for HLA-B27, rheumatoid factor, and ANA. Which of the following diagnoses best explains the patient’s symptoms?
Diffuse idiopathic skeletal hyperostosis
A C6/C7 disc herniation into the neural foramen is most likely to produce paresthesias in which of the following areas?
The third digit
Along with nonuniform joint space narrowing, which of the following is a characteristic of osteoarthritis ?
bony sclerosis
The anterior interosseous nerve innervates which muscle?
Pronator quadratus
A factory assembly line worker presents to your office with lateral elbow pain for 3 months. What condition is commonly associated with lateral epicondylitis?
smoking and obesity
A 12-year-old baseball player had a twisting valgus deviation of the right knee during play. The MRI showed edema at the inferomedial patella and at the right lateral femoral condyle with ruptured fibers at the medial patellofemoral ligament. What is the most likely diagnosis based on MRI findings?
patellar dislocation
How long is an abduction pillow utilized after a posterior approach hip replacement?
6-12 weeks
Which stage of complex regional pain syndrome (CRPS 1) is characterized by burning pain, dependent edema, and vasomotor instability?
stage I
what stage of CRPS is characterized by severe pain, fixed edema, and cyanosis or pallor.
stage II
Which of the following conditions is an absolute contraindication to collision sports?
Odontoid hypoplasia
In patients with degenerative disc disease of the lumbar spine, what percentage of weight do the zygapophyseal joints bear?
70%
in a normal person, what percentage of weight do the zygapophyseal joints bear?
33%
An extraforaminal L4-5 disc protrusion is most likely to affect which nerve root?
L4
what are the 4 zones that a disc herniation can occur?
central, subarticular, foraminal, and extraforaminal zones
Why do disc herniations in the The extraforaminal zone effect the first nerve (ie: L4 when occurring at L4–L5)
The extraforaminal zone is beyond the parasagittal line of the lateral aspect of the pedicle, and if impacting a nerve root it will be the exiting nerve root at that level.
A patient who enjoys playing racquetball presents to your office with a trigger finger. You proceed with a corticosteroid injection. What would be your immediate next step in the treatment of this patient?
modify Raquel handle
Which risk factor is most clearly linked with developing subsequent osteoarthritis of the knee?
prior injury
When symptomatic Lumbar Spondylolisthesis occurs without a defect in the pars interarticularis, what is the most likely etiologic process?
degenerative
A 46-year-old healthy male recreational athlete presents to your clinic with a 3-day-old right Achilles tendon rupture. He asks about his treatment options. What do you tell him?
Re-rupture rates using functional bracing are similar to re-rupture rates after surgery.
The American Academy of Orthopedic Surgeons recommends weight loss to patients with symptomatic knee arthritis as a strategy to manage symptoms and improve function when the body mass index is calculated to be greater than or equal to ____ kg/m2:
25
Which of the following treatments has the greatest supportive evidence for producing pain relief at a myofascial trigger point?
dry needling
What is the normal bladder capacity for a two-year old?
4 (age + 2 ounces)
The most common bone for an osteoporotic fracture in women over age 65 is the:
vertebrae
A patient with shoulder pain is asked by a clinician to flex the elbow to 90 degrees, pronate the forearm, and keep the arm by their side. The patient is then asked to externally rotate the shoulder and supinate the forearm against the clinician’s resistance. If the patient experiences reproduction of their shoulder pain, the most likely diagnosis is:
biceps tendonitis (this is Yergesons test)
A patient presents with pain in his ring finger after an opponent tried to slap a basketball out of his hand. On exam flexion and extension of his DIP is intact. X-ray of his finger shows a non-displaced distal phalangeal fracture. What is the next step in his treatment?
splint and immobilize DIP only (allow early motion of uninjured joints)
Which of the following is the most common presenting symptom in patients with acquired cervical stenosis?
neck pain
Which of the following medications has been shown to decrease mortality and length of stay in patients with hypermetabolism associated with burns?
Oxandrolone (synthetic anabolic steroid)
A 12-year-old obese child presents with limp and decreased weight-bearing in the right lower extremity. Hip x-rays reveal abnormal positioning of the femoral head relative to the femoral neck. The most likely diagnosis is:
Slipped capital femoral epiphysis
A 19-year-old long-distance runner presents with an insidious onset of left hip pain one month after increasing her mileage from 25 to 50 miles weekly. After obtaining a thorough history and performing a physical examination, you obtain an anteroposterior radiograph of the pelvis to evaluate the hip. The film is unremarkable. What is the next most appropriate step?
Make her non-weight bearing with crutches and order a magnetic resonance image of the hip (concern for femoral neck stress fracture (bone stress injury))
A football player presents to your office with pain in his ring finger after trying to tackle his opponent. On exam you notice that he is unable to flex his DIP actively while holding the PIP in extension. The most likely diagnosis is:
jersey finger
A 55-year-old patient started yoga 2 months ago and is seeing you for right shoulder pain of 1-month duration. He is unable to lift the dorsum of his hand off his back with his arm fully extended and internally rotated. Based on this test, you suspect he may have a rotator cuff tear involving which of the following muscles:
subscapularis
Seat belt use during motor vehicle collisions has not reduced incidence of spinal injuries associated with:
Thoracic and lumbar spine fractures
A 55-year-old woman has undergone a right total hip replacement surgery. The physical exam notes the left hip now drops during right stance phase of the gait cycle. Where is the muscle weakness?
right glut med
A patient presents with symmetric inflammation of bilateral knee joints. Fluid aspirate microscopy reveals positive birefringent crystals. Which of the following conditions are associated with this synovitis ?
hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia, hemochromatosis, and amyloidosis.
Which of the following is a risk factor for congenital hip dysplasia (CHD)?
Breech positioning, female gender, and first born are known risk factors for CHD.
What percentage of fractures in people older than 45 are related to osteoporosis?
70%
What should the serum uric acid level (mg/dl) be lowered to in patients with joint pain symptoms related to gout ?
6
22-year-old patient fell on an outstretched right hand 3 weeks ago and complains of continued wrist pain. On examination, she has minimal swelling of the distal limb and is tender to palpation distal to the ulnar styloid between the flexor carpi ulnaris and extensor carpi ulnaris tendons. A plain radiograph was normal except for an ulnar plus variant. She failed conservative treatment with splinting and activity modification. The most appropriate imaging study to obtain would be:
MRI (sustained an injury to her triangular fibrocartilage complex (TFCC)
Which stage of Complex Regional Pain Syndrome may be the least painful but the most dysfunctional in terms of progressive vasomotor, motor and trophic changes?
stage 3
Which of the following is NOT a risk factor for the development of osteoporosis?
BMI >35
A 4-year-old child suffers an ankle inversion. When you examine him the following day, he has mild swelling laterally and is tender to palpation approximately 2-3 cm proximal to the distal aspect of the lateral malleolus and he reacts to pinch. The remainder of the examination is limited due to pain. Radiographs appear normal. What is the management of this patient?
Short leg non-weight bearing cast for 3 weeks (concern for Salter Harris I Fracture of the distal fibular physis)
What is a salter Harris fracture I
transverse fracture through the hypertrophic zone of the physis. typically not seen on plain radiograph
Which finding would suggest a diagnosis of tendinosis rather than tendonitis?
Histological absence of inflammatory cells
A 25-year-old male basketball player presents with right knee pain. On examination, the Lachman test is positive, and you suspect an anterior cruciate ligament tear. What other provocative maneuver supports your diagnosis?
Pivot-shift test, anterior drawer test
A football player complains of left neck pain and left shoulder burning and tingling after making a tackle. Sideline examination reveals decreased sensation over the lateral deltoid and weakness with abduction and elbow flexion. Spurling’s maneuver is negative. After 15 minutes the symptoms abate. Of note, the player had one previous episode with similar symptoms 2 weeks prior. The next best step in management of this player is:
Obtain imaging work-up prior to return to play
Patient is involved in a motor vehicle collision. CT scan shows a fracture at the base of the odontoid process. What is the classification or name of this odontoid fracture?
type 2
