Musculoskeletal

Question 1

T2DM with worsening shoulder pain difficult to localize and decreased active and passive ROM; how is it treated?

Answer 1

adhesive capsulitis; PT, oral/intra-articular injection, acupuncture or hydrodilatation

Question 2

What treatment has been shown to reduce pain and disability in patients with chronic nonspecific low back pain

Answer 2

Physical therapy; some evidence is also supportive of yoga/tai chi/core strengthening exercises

Question 3

What situations do you use prophylactic antibiotic for dental procedure in patient with hx of prosthetic joint?

Answer 3

Previous hx of joint infection or immunocompromised state

Question 4

Proximal numeral epiphysiolysis: what is the common name of the diagnosis; what is the first step in diagnosis; first step in management; best preventative practice

Answer 4

Other name is little league shoulder; diagnose with bilateral shoulder X-ray and will see widening of the physis (Salter Harris injury); start with 3-4 months of rest then address proper technique and start PT; prevent with rest cycles throughout the year

Question 5

acute low back pain with urinary retention (diagnosis concerned for?)

Answer 5

cauda equina syndrome

Question 6

which nerve is likely entrapped based on this description:
a. paresthesia of 4th/5th fingers and hypothenar eminence, weakness of pincer mechanism
b. decreased sensation/pain over lateral shoulder and weakness of shoulder external rotation
c. paresthesia of first three fingers, thenar muscle atrophy
d. paresthesia/pain over posterior forearm and dorsal hand, weakness of finger/wrist extensors, wrist/finger drop

Answer 6

a. ulnar nerve entrapment
b. axillary nerve entrapment
c. median nerve entrapment
d. radial nerve entrapment

Question 7

pain relief treatment for acute vertebral compression fracture

Answer 7

immediate release class II narcotic like oxycodone (subQ calcitonin injection can also help)

Question 8

what is safest/first line treatment of Achilles tendinopathy?

Answer 8

PT/calf strengthening exercises (remember injection in this area increases risk for Achilles rupture)

Question 9

at what Cobb angle in child with scoliosis should prompt referral for treatment/specialist?; surgical intervention is usually done for angle >___?

Answer 9

> 20 degrees on x-ray; >40 degrees

Question 10

weakness of thumb and index finger pincer mechanism is indicative of injury to which nerve?

Answer 10

ulnar nerve

Question 11

how do you treat a buckle fracture and does it require X-ray follow up after 4 weeks if child is symptom free?

Answer 11

short arm immobilization for 4 weeks; NO

Question 12

what is the first line treatment for hallux rigidus usually caused by osteoarthritis of the MTP joint?

Answer 12

rigid shoe inserts, hard sole shoes, or custom orthotics

Question 13

first line treatment of trigger finger

Answer 13

splinting finger for 6 weeks to 3 months; 50% of cases resolve on their own at 1 year