Musculoskeletal Flashcards
a. Joint replacement i. Hip ii. Knee b. Traumatic orthopedic injuries c. Compartment syndrome d. Osteomyelitis
1
Q
A patient presents with a crush injury to the leg. You suspect compartment syndrome. Which of the following is the most reliable clinical finding to confirm your suspicion?
Group of answer choices:
* Weak distal pulses
* Pain out of proportion to the injury
* Pallor of the affected extremity
* Pulselessness in the affected extremity
A
Answer: Pain out of proportion to the injury
2
Q
In a patient with a suspected femur fracture, which of the following interventions is a priority?
Group of answer choices:
* Administer broad-spectrum antibiotics
* Check compartment pressures
* Apply a splint to stabilize the limb
* Perform an emergent fasciotomy
A
Answer: Apply a splint to stabilize the limb
3
Q
What is the primary purpose of rocking the pelvis during the assessment of a patient with a crush injury?
Group of answer choices:
* To identify vascular injuries
* To assess pelvic stability
* To evaluate neurological function
* To measure compartment pressures
A
Answer: To assess pelvic stability
4
Q
Which diagnostic test is most appropriate to assess for vascular injury in a patient with a lower extremity crush injury?
Group of answer choices:
* Serum lactate
* Ankle-brachial index (ABI)
* CT angiography
* Venous duplex ultrasound
A
Answer: CT angiography
5
Q
A patient with a crush injury requires blood transfusion. Which lab value is most critical to monitor during the resuscitation process?
Group of answer choices:
* Serum creatinine
* Serum potassium
* Hemoglobin
* White blood cell count
A
Answer: Hemoglobin
6
Q
A patient presents with erythematous macules and blistering skin. The Nikolsky sign is positive. What is the most likely diagnosis?
Group of answer choices:
* Allergic contact dermatitis
* Staphylococcal scalded skin syndrome
* SJS/TENS
* Erythema multiforme
A
Answer: SJS/TENS
7
Q
What is the priority intervention for a patient diagnosed with SJS/TENS due to a sulfonamide antibiotic?
Group of answer choices:
* Administer antihistamines
* Stop the offending agent immediately
* Start systemic corticosteroids
* Administer intravenous immunoglobulin (IVIG)
A
Answer: Stop the offending agent immediately
8
Q
Which of the following would warrant admission to a burn or ICU unit for a patient with SJS/TENS?
Group of answer choices:
* Fever > 100.4°F
* 30% epidermal detachment
* Positive Nikolsky sign
* Presence of erythematous macules
A
Answer: >30% epidermal detachment
9
Q
When managing SJS/TENS, why is it essential to start nutrition early?
Group of answer choices:
* To prevent further skin detachment
* To reduce electrolyte imbalances
* To meet the increased metabolic demands
* To improve renal function
A
Answer: To meet the increased metabolic demands
10
Q
A patient with suspected SJS/TENS requires wound care. Which intervention is most appropriate?
Group of answer choices:
* Apply dry dressings to affected areas
* Use topical silver sulfadiazine
* Keep wounds moist and covered
* Perform daily debridement of necrotic tissue
A
Answer: Keep wounds moist and covered
11
Q
Which of the following laboratory findings would be most concerning in a patient with a suspected crush injury?
Group of answer choices:
* Elevated lactate and creatine kinase (CK)
* Decreased hemoglobin and hematocrit
* Elevated blood urea nitrogen (BUN) and creatinine
* Hypocalcemia and hyperphosphatemia
A
Answer: Elevated lactate and creatine kinase (CK)
12
Q
A patient with a crush injury to the lower extremity requires placement of a Foley catheter. Which finding would contraindicate this procedure?
Group of answer choices:
* Positive blood at the urethral meatus
* Hematuria on urinalysis
* Urinary output less than 30 mL/hr
* Elevated serum creatinine
A
Answer: Positive blood at the urethral meatus
13
Q
What is the definitive treatment for compartment syndrome?
Group of answer choices:
* Application of a compression dressing
* Fasciotomy
* Elevation of the affected extremity
* Administration of diuretics
A
Answer: Fasciotomy
14
Q
Which imaging studies are most appropriate for a patient with suspected lower extremity fractures following a crush injury?
Group of answer choices:
* X-rays (AP, lateral, oblique views)
* CT scan of the pelvis and lower extremities
* MRI of the lower extremities
* Doppler ultrasound
A
Answer: X-rays (AP, lateral, oblique views)
15
Q
In addition to orthopedic consultation, which specialty referral is critical for a patient with a crush injury and suspected vascular compromise?
Group of answer choices:
* Nephrology
* Vascular surgery
* Physical therapy
* Psychiatry
A
Answer: Vascular surgery
16
Q
Which of the following is a hallmark finding in SJS/TENS that differentiates it from erythema multiforme?
Group of answer choices:
* Target lesions on the extremities
* Mucosal involvement with epidermal detachment
* Presence of bullae without systemic symptoms
* Rash that resolves without intervention
A
Answer: Mucosal involvement with epidermal detachment
17
Q
When managing fluid resuscitation in a patient with SJS/TENS, which intravenous fluid is preferred?
Group of answer choices:
* Normal saline
* Lactated Ringer’s
* Dextrose 5% in water (D5W)
* Half-normal saline
A
Answer: Lactated Ringer’s
18
Q
Which medication is most commonly implicated in causing SJS/TENS?
Group of answer choices:
* Metformin
* Sulfamethoxazole/trimethoprim
* Amoxicillin
* Clopidogrel
A
Answer: Sulfamethoxazole/trimethoprim
19
Q
What is the purpose of assessing the Nikolsky sign in a patient with suspected SJS/TENS?
Group of answer choices:
* To confirm the presence of epidermal detachment
* To identify secondary bacterial infection
* To assess the depth of skin involvement
* To evaluate the extent of vascular compromise
A
Answer: To confirm the presence of epidermal detachment
20
Q
A patient with SJS/TENS has a large percentage of epidermal detachment. What is the primary reason for ICU or burn unit admission?
Group of answer choices:
* To initiate systemic corticosteroids
* To manage potential respiratory complications
* To provide advanced wound care and fluid management
* To monitor for neurological deterioration
A
Answer: To provide advanced wound care and fluid management
21
Q
A patient presents with a crush injury to the leg and reports severe pain with passive stretch of the toes. What is the next best step?
Group of answer choices:
* Apply a compression dressing to reduce swelling
* Immediately consult orthopedics for a fasciotomy
* Start a continuous infusion of morphine
* Obtain compartment pressures
A
Answer: Obtain compartment pressures
22
Q
What is the primary concern in a patient with a pelvic fracture and significant hypotension?
Group of answer choices:
* Fat embolism
* Retroperitoneal hemorrhage
* Compartment syndrome
* Bowel perforation
A
Answer: Retroperitoneal hemorrhage
23
Q
A patient with SJS/TENS is noted to have sloughing skin and extensive mucosal involvement. What nutritional intervention is most appropriate?
Group of answer choices:
* High-calorie, high-protein enteral feeding
* Total parenteral nutrition (TPN)
* Low-protein, low-fat diet
* Initiate clear liquids
A
Answer: High-calorie, high-protein enteral feeding
24
Q
A crush injury patient is noted to have myoglobinuria. Which complication is most likely?
Group of answer choices:
* Rhabdomyolysis
* Fat embolism
* Osteomyelitis
* Venous thromboembolism
A
Answer: Rhabdomyolysis
25
Which of the following lab values is most concerning in a patient with compartment syndrome?
Group of answer choices:
* Elevated potassium
* Decreased lactate
* Elevated hemoglobin
* Low sodium
Answer: Elevated potassium
26
What is the first-line pharmacologic intervention for mild osteoarthritis?
Group of answer choices:
* Acetaminophen
* Tramadol
* Prednisone
* Celecoxib
Acetaminophen (Correct Answer)
Rationale: Acetaminophen is recommended as the first-line treatment for mild osteoarthritis due to its safety profile and effectiveness for pain relief.
27
What set of diagnostic tests and associated clinical findings would definitively support a diagnosis of compartment syndrome in an upper extremity?
Group of answer choices:
* Compartment pressure > 30 mmHg, pain with passive stretching
* Compartment pressure 8 mmHg, paresthesia of distal extremity
* X-ray positive for acute fracture, compartment pressure < 30 mmHg
* Elevated creatinine phosphokinase, powerlessness of muscle, and pain
Compartment pressure > 30 mmHg, pain with passive stretchin
Rationale: Compartment pressure >30 mmHg with pain on passive stretching is the definitive diagnostic criteria for compartment syndrome.
28
You are seeing a patient who suffered an open fracture of their left tibia. There is a significant laceration at the site of the injury, and it has been determined that the wound was contaminated on injury. Which of the following is the most appropriate course of treatment for this scenario?
Group of answer choices:
* Any broad-spectrum gram-positive antibiotic
* Both gram-positive and gram-negative antibiotic coverage
* Antibiotic rinse of the open wound
* No antibiotic therapy is necessary until signs and symptoms of infection develop
Both gram-positive and gram-negative antibiotic coverage (Correct Answer)
Rationale: Open fractures with contamination require broad-spectrum antibiotics covering both gram-positive and gram-negative organisms to prevent infection.
29
A 45-year-old male presents with a femur fracture. You are consulted by nursing staff because they noticed petechiae on the patient’s trunk, and O2 saturation of 87%. The nurse states the patient has become increasingly lethargic. What are you most concerned for?
Group of answer choices:
* Pulmonary embolism
* Fat embolism
* Hypovolemic shock
* Hemorrhage
Fat embolism (Correct Answer)
Rationale: Fat embolism syndrome is a potential complication of long bone fractures, characterized by petechiae, hypoxemia, and neurological changes.
30
1. What is the most common indication for arthroplasty?
A) Trauma
B) Osteoarthritis
C) Inflammatory arthritis
D) Dysplasia
Answer: B) Osteoarthritis
31
2. What is required before a patient is considered for arthroplasty?
A) Failed conservative measures
B) Pain lasting less than 15 minutes
C) Use of opioids for pain management
D) Joint infection
Answer: A) Failed conservative measures
31
4. What diagnostic imaging is typically used to assess arthritic changes in joints?
A) MRI
B) Plain X-ray
C) CT scan
D) Bone scan
Answer: B) Plain X-ray
31
3. Which joints are most commonly replaced in arthroplasty?
A) Hip, knee, shoulder
B) Ankle, hip, wrist
C) Shoulder, elbow, hip
D) Knee, ankle, elbow
Answer: A) Hip, knee, shoulder
32
5. What is the typical infection rate following joint replacement surgery?
A) 1%-5%
B) 10%-15%
C) 0%-1%
D) 20%-25%
Answer: A) 1%-5%
33
6. What complication is more common in total hip replacement than knee replacement?
A) Prosthetic infection
B) Dislocation
C) Bleeding
D) Nerve damage
Answer: B) Dislocation
34
7. What is the primary goal of physical therapy after knee arthroplasty?
A) 90% flexion within 3 months post-op
B) Full extension within 1 month
C) Strengthening muscles within 6 weeks
D) 75% flexion within 2 months
Answer: A) 90% flexion within 3 months post-op
35
8. What is the recommended prophylaxis for MRSA in arthroplasty patients?
A) Vancomycin
B) Cefazolin
C) Clindamycin
D) Doxycycline
Answer: B) Cefazolin
36
9. What lifestyle change can improve knee pain and delay the need for arthroplasty?
A) Weight loss of at least 10%
B) Daily use of NSAIDs
C) High-protein diet
D) Aerobic exercises only
Answer: A) Weight loss of at least 10%
37
10. Which lab tests are important in a pre-op workup for arthroplasty?
A) CBC, BMP, EKG, coagulation studies
B) CMP, lipid panel, chest X-ray
C) Hemoglobin A1c, LFTs, urinalysis
D) D-dimer, CRP, ESR
Answer: A) CBC, BMP, EKG, coagulation studies
38
11. What is the primary management for a closed shoulder dislocation?
A) Open reduction
B) Immobilization
C) Closed reduction with sedation
D) Traction
Answer: C) Closed reduction with sedation
39
12. What is the main difference between a sprain and a strain?
A) Sprains affect ligaments, strains affect muscles or tendons
B) Sprains cause swelling, strains do not
C) Strains are more painful than sprains
D) Sprains require surgery, strains do not
Answer: A) Sprains affect ligaments, strains affect muscles or tendons
40
13. What is the primary treatment protocol for sprains and strains?
A) Physical therapy
B) RICE (rest, ice, compression, elevation)
C) Surgery
D) Long-term NSAID use
Answer: B) RICE
41
14. Which fracture complication occurs most commonly in long bone fractures before stabilization?
A) Fat embolism
B) Osteomyelitis
C) Compartment syndrome
D) Vascular injury
Answer: A) Fat embolism
42
15. What imaging is recommended for subtle fractures or suspected soft tissue injuries?
A) MRI
B) CT scan
C) Bone scan
D) X-ray
Answer: A) MRI
43
16. What is the preferred management for a pelvic fracture with hemodynamic instability?
A) External fixation
B) Skeletal traction
C) Angiography with embolization
D) Immediate surgical repair
Answer: C) Angiography with embolization
44
17. What is a key sign of compartment syndrome in a fractured limb?
A) Pain out of proportion to the injury
B) Bradycardia
C) Absence of bruising
D) Numbness only at the fracture site
Answer: A) Pain out of proportion to the injury
45
18. Which test is used to assess vascular injury in a lower extremity fracture?
A) Ankle-brachial index (ABI)
B) MRI with contrast
C) D-dimer test
D) Venous ultrasound
Answer: A) Ankle-brachial index (ABI)
46
19. What is the first step in managing an open fracture?
A) Apply a splint
B) Flush the wound and cover with sterile dressing
C) Start IV antibiotics
D) Perform surgical fixation
Answer: B) Flush the wound and cover with sterile dressing
47
20. What antibiotic is added for anaerobic coverage in a contaminated open fracture?
A) Penicillin
B) Cefazolin
C) Gentamicin
D) Vancomycin
Answer: A) Penicillin
48
21. What is a hallmark symptom of fat embolism syndrome?
A) Petechiae on the trunk and skin folds
B) Fever above 39°C
C) Persistent hypertension
D) Joint swelling
Answer: A) Petechiae on the trunk and skin folds
49
22. When should surgical intervention for a hip fracture ideally occur in geriatric patients?
A) Within 48 hours
B) After 72 hours
C) Within 7 days
D) After 24 hours
Answer: A) Within 48 hours
50
23. What nutritional supplements are essential for healing in geriatric hip fracture patients?
A) Vitamin D and calcium
B) Iron and folate
C) Vitamin B12 and magnesium
D) Potassium and phosphorus
Answer: A) Vitamin D and calcium
51
24. What is the first-line pharmacologic VTE prophylaxis for post-op orthopedic patients?
A) Low molecular weight heparin
B) Aspirin
C) Warfarin
D) Dabigatran
Answer: A) Low molecular weight heparin
52
25. Which imaging is critical for diagnosing a pelvic fracture?
A) Anterior-posterior X-ray
B) Lateral X-ray
C) Ultrasound
D) Bone scan
Answer: A) Anterior-posterior X-ray
53
26. What is the recommended duration for prophylactic antibiotics in an open fracture?
A) 24 hours post-op
B) 48 hours post-op
C) 72 hours post-op for gross contamination
D) 7 days post-op
Answer: C) 72 hours post-op for gross contamination
54
27. What nerve assessment is crucial in a suspected pelvic fracture?
A) Sciatic nerve function
B) Ulnar nerve function
C) Radial nerve function
D) Cranial nerve function
Answer: A) Sciatic nerve function
55
28. What is the most common cause of death within one year following a hip fracture?
A) Cardiovascular complications
B) Pulmonary embolism
C) Infections
D) Malnutrition
Answer: A) Cardiovascular complications
56
29. What is the purpose of a pelvic binder in pelvic fractures?
A) Reduce pelvic volume and tamponade bleeding
B) Align the femoral neck
C) Immobilize the spine
D) Prevent nerve damage
Answer: A) Reduce pelvic volume and tamponade bleeding
57
30. What is the earliest intervention for a patient with a suspected hip fracture?
A) Pain control and immobilization
B) Early ambulation
C) Full physical therapy program
D) Discharge planning
Answer: A) Pain control and immobilization
58
1. What is the recommended management for a patient with a suspected prosthetic joint infection?
A) Immediate revision surgery
B) Six weeks of antibiotics before re-implantation
C) NSAIDs and physical therapy
D) Continuous irrigation of the joint
Answer: B) Six weeks of antibiotics before re-implantation
59
2. What is the purpose of using a spacer in knee replacement surgery?
A) To prevent infection
B) To maintain joint alignment
C) To allow smooth movement and reduce friction
D) To minimize blood loss during surgery
Answer: C) To allow smooth movement and reduce friction
60
3. Which complication is most commonly associated with early post-operative total hip arthroplasty?
A) Venous thromboembolism
B) Prosthetic loosening
C) Dislocation
D) Nerve injury
Answer: C) Dislocation
61
4. What is the primary goal of arthroplasty surgery?
A) To eliminate osteophytes
B) To restore a stable, pain-free joint with functional mobility
C) To avoid the need for pharmacologic pain management
D) To improve cosmetic appearance of the joint
Answer: B) To restore a stable, pain-free joint with functional mobility
62
5. What is the first imaging modality recommended for diagnosing a suspected fracture?
A) Plain X-ray
B) MRI
C) CT scan
D) Ultrasound
Answer: A) Plain X-ray
63
6. What physical exam finding is highly suggestive of a hip fracture?
A) Shortening of the affected leg with external rotation
B) Medial bruising and swelling
C) Limited dorsiflexion in the foot
D) Pain radiating to the lower back
Answer: A) Shortening of the affected leg with external rotation
64
7. What is a common complication associated with pelvic fractures?
A) Massive hemorrhage due to vascular injury
B) Severe nerve damage in the upper extremities
C) Chronic joint instability
D) Post-traumatic arthritis
Answer: A) Massive hemorrhage due to vascular injury
65
8. Which fracture type is most likely to lead to a fat embolism?
A) Long bone fractures (e.g., femur)
B) Pelvic fractures
C) Skull fractures
D) Clavicle fractures
Answer: A) Long bone fractures (e.g., femur)
66
9. Which sign is most indicative of acute compartment syndrome?
A) Pain unrelieved by narcotics
B) Cold, pale skin
C) Slow capillary refill
D) Minimal swelling
Answer: A) Pain unrelieved by narcotics
67
10. What initial management should be performed for an open fracture in the emergency department?
A) Immediate external fixation and vascular surgery
B) Irrigation, sterile dressing, and IV antibiotics
C) Reduction of the fracture followed by X-ray
D) Administering opioids and sending the patient home with follow-up
Answer: B) Irrigation, sterile dressing, and IV antibiotics
68
1. A 68-year-old woman presents with chronic knee pain unrelieved by NSAIDs, physical therapy, and weight loss. X-rays show severe joint space narrowing and osteophyte formation. The patient expresses difficulty walking and performing daily tasks. What is the next step in her management?
o A) Increase NSAID dosage
o B) Refer to orthopedics for evaluation of arthroplasty
o C) Start corticosteroid injections
o D) Recommend daily physical therapy
Answer: B) Refer to orthopedics for evaluation of arthroplasty
69
2. A 72-year-old man, six weeks post total hip arthroplasty, presents to the ER after a fall. He reports sudden hip pain and inability to bear weight. Physical exam reveals a shortened, externally rotated leg. What is the most appropriate initial imaging modality?
o A) MRI of the hip
o B) CT scan of the pelvis
o C) X-ray of the hip
o D) Bone scan
Answer: C) X-ray of the hip
70
3. A 60-year-old woman with controlled hypertension is being evaluated for knee replacement surgery. Which of the following is an essential pre-operative assessment?
o A) Pulmonary function testing
o B) Blood type and screen
o C) Stress echocardiography
o D) MRI of the knee
Answer: B) Blood type and screen
71
4. A 70-year-old man presents three months post total knee arthroplasty with fever, swelling, and redness around the knee. Labs show elevated ESR and CRP. What is the next best step?
o A) Oral antibiotics
o B) Joint aspiration for culture
o C) Increase physical therapy
o D) MRI of the knee
Answer: B) Joint aspiration for culture
72
5. A 65-year-old woman with ankylosing spondylitis and severe hip pain has failed conservative treatments, including NSAIDs and corticosteroid injections. What factor would most strongly support her candidacy for arthroplasty?
o A) Pain lasting more than 30 minutes in the morning
o B) Difficulty with daily activities and reduced quality of life
o C) Osteophyte formation visible on imaging
o D) History of inflammatory arthritis
Answer: B) Difficulty with daily activities and reduced quality of life
73
Traumatic Orthopedic Injuries Questions
6. A 30-year-old male presents with an open tibia fracture after a motorcycle accident. Bone is visible, and there is gross contamination with dirt and debris. What is the first step in management?
o A) Immediate surgical fixation
o B) Antibiotics and wound irrigation
o C) Apply a splint and discharge with follow-up
o D) Immobilize and perform MRI
Answer: B) Antibiotics and wound irrigation
74
7. A 45-year-old woman involved in a motor vehicle collision presents with hemodynamic instability, bruising over the pelvis, and scrotal/labial swelling. X-ray shows an open book pelvic fracture. What is the most appropriate initial stabilization?
o A) Pelvic binder application
o B) Immediate external fixation surgery
o C) Start anticoagulation therapy
o D) Foley catheter placement
Answer: A) Pelvic binder application
75
8. A 20-year-old male football player presents with severe right shoulder pain after a tackle. Physical exam reveals anterior bulging of the shoulder with limited range of motion. What is the most appropriate management?
o A) Immobilize the shoulder and discharge
o B) Closed reduction with moderate sedation
o C) Refer for surgical intervention
o D) MRI to assess for soft tissue injury
Answer: B) Closed reduction with moderate sedation
76
9. A 25-year-old woman with a femur fracture begins experiencing shortness of breath, confusion, and petechiae on her chest two days post-injury. What is the likely diagnosis?
o A) Acute respiratory distress syndrome (ARDS)
o B) Fat embolism syndrome
o C) Deep vein thrombosis (DVT)
o D) Pulmonary embolism
Answer: B) Fat embolism syndrome
77
10. A 50-year-old man presents after a crush injury to his lower leg. He complains of worsening pain despite pain medication, and his leg appears tight with diminished capillary refill. What is the next best step?
* A) Increase pain medication
* B) Immediate fasciotomy
* C) Apply a splint
* D) Perform an MRI
Answer: B) Immediate fasciotomy
78
1. What is the primary cause of compartment syndrome?
A) Excessive fluid intake
B) Increased pressure within an osseofascial compartment
C) Lack of oxygen delivery to large blood vessels
D) Excessive use of antibiotics
Answer: B) Increased pressure within an osseofascial compartment
79
2. Which is the most common site for compartment syndrome?
A) Abdomen
B) Calf and forearm
C) Shoulder and thigh
D) Buttocks
Answer: B) Calf and forearm
80
3. What is the most reliable clinical sign of compartment syndrome?
A) Paralysis
B) Pulselessness
C) Pain out of proportion to the injury
D) Paresthesia
Answer: C) Pain out of proportion to the injury
81
4. Which of the following is a late sign of compartment syndrome?
A) Paresthesia
B) Pain on passive stretch
C) Paralysis
D) Pulselessness
Answer: D) Pulselessness
82
5. What is the appropriate initial management for suspected compartment syndrome?
A) Apply tight compression to the affected limb
B) Elevate the affected extremity
C) Measure arterial blood pressure
D) Start IV antibiotics
Answer: B) Elevate the affected extremity
83
6. When is a fasciotomy indicated in compartment syndrome?
A) Compartment pressure minus diastolic blood pressure is less than 30 mmHg
B) The patient has a fever and swelling
C) Pulses are present but weak
D) Pain subsides with medication
Answer: A) Compartment pressure minus diastolic blood pressure is less than 30 mmHg
84
7. What is a potential consequence of untreated compartment syndrome?
A) Acute kidney injury due to rhabdomyolysis
B) Pulmonary embolism
C) Chronic migraines
D) Osteomyelitis
Answer: A) Acute kidney injury due to rhabdomyolysis
85
8. What is the definition of osteomyelitis?
A) Infection of the skin caused by burns
B) Infection of the bone via hematogenous or microbial spread
C) Necrosis of muscle tissue
D) Inflammation of joints from autoimmune disease
Answer: B) Infection of the bone via hematogenous or microbial spread
86
9. Which population is most commonly affected by osteomyelitis?
A) Children under five years
B) Patients with diabetes and neuropathies
C) Athletes with joint injuries
D) Pregnant women
Answer: B) Patients with diabetes and neuropathies
87
10. What is the gold-standard imaging technique for diagnosing osteomyelitis?
A) X-ray
B) Ultrasound
C) MRI
D) CT Scan
Answer: C) MRI
88
11. Which lab test is most indicative of inflammation in osteomyelitis?
A) Platelet count
B) C-reactive protein (CRP)
C) Fasting blood glucose
D) Hemoglobin A1C
Answer: B) C-reactive protein (CRP)
89
12. What is a common microorganism responsible for osteomyelitis in patients with joint replacements?
A) Staphylococcus aureus
B) Escherichia coli
C) Pseudomonas aeruginosa
D) Enterococcus
Answer: A) Staphylococcus aureus
90
13. What is the initial treatment for acute osteomyelitis with no bone necrosis?
A) Oral antibiotics
B) Surgical debridement
C) IV antibiotics
D) Amputation
Answer: C) IV antibiotics
91
14. In patients with chronic osteomyelitis, what additional intervention is often necessary?
A) Amputation of the affected limb
B) Prolonged use of oral antibiotics only
C) Surgical debridement and prolonged antibiotic therapy
D) Blood transfusions
Answer: C) Surgical debridement and prolonged antibiotic therapy
92
15. What is a classic sign of vertebral osteomyelitis?
A) Neurological deficits
B) Rash on the back
C) Severe fever with chills
D) Swelling around
the spine
Answer: A) Neurological deficits
93
16. Which antibiotic is typically used initially for suspected MRSA osteomyelitis?
A) Nafcillin
B) Ciprofloxacin
C) Vancomycin
D) Penicillin G
Answer: C) Vancomycin
94
17. What complication is most common with diabetic foot osteomyelitis?
A) Pulmonary embolism
B) Amputation
C) Chronic migraine
D) Gastrointestinal bleeding
Answer: B) Amputation
95
18. What is the primary goal in treating osteomyelitis?
A) Eliminate the pathogen and stabilize the area
B) Reduce pain and swelling only
C) Perform surgery on all affected bones
D) Avoid the use of antibiotics unless necessary
Answer: A) Eliminate the pathogen and stabilize the area
96
19. Which of the following is the most appropriate next step in a patient with a suspected joint prosthetic infection?
A) MRI
B) Joint aspiration for culture
C) Start oral antibiotics immediately
D) Remove the prosthetic joint
Answer: B) Joint aspiration for culture
97
20. What is the common causative agent of hematogenous osteomyelitis following a UTI?
A) Enterococcus
B) E. coli
C) Staphylococcus epidermidis
D) Streptococcus pneumoniae
Answer: B) E. coli
98
1. Which of the following is not one of the "5 P's" of compartment syndrome?
A) Paralysis
B) Pallor
C) Polycythemia
D) Pain out of proportion
Answer: C) Polycythemia
99
2. What is the first step in managing a suspected compartment syndrome?
A) Start IV fluids
B) Measure compartment pressure
C) Elevate the extremity
D) Apply a tourniquet
Answer: C) Elevate the extremity
100
3. Which diagnostic tool is used to confirm compartment syndrome when physical findings are inconclusive?
A) X-ray
B) MRI
C) Compartment pressure measurement
D) Arterial blood gas
Answer: C) Compartment pressure measurement
101
4. What surgical intervention is performed to relieve compartment syndrome?
A) Amputation
B) Fasciotomy
C) Debridement
D) Arthroscopy
Answer: B) Fasciotomy
102
5. Which complication of compartment syndrome can lead to acute kidney injury?
A) Vascular occlusion
B) Rhabdomyolysis
C) Osteomyelitis
D) Hemorrhagic shock
Answer: B) Rhabdomyolysis
103
6. What is the normal difference between compartment pressure and diastolic blood pressure?
A) Less than 10 mmHg
B) Greater than 30 mmHg
C) Less than 30 mmHg
D) Greater than 50 mmHg
Answer: C) Less than 30 mmHg
104
7. Which of the following would most likely cause compartment syndrome?
A) A minor sprain
B) A circumferential burn
C) A superficial skin infection
D) A hairline fracture
Answer: B) A circumferential burn
105
8. What is the most common site for osteomyelitis caused by diabetic foot ulcers?
A) Vertebrae
B) Long bones
C) Periprosthetic joint spaces
D) Foot
Answer: D) Foot
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9. Which microorganism is most commonly associated with osteomyelitis in patients with sternal wounds after cardiac surgery?
A) Staphylococcus aureus
B) Klebsiella pneumoniae
C) Pseudomonas aeruginosa
D) Streptococcus pyogenes
Answer: A) Staphylococcus aureus
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10. What is the most appropriate initial imaging modality for suspected osteomyelitis?
A) MRI
B) X-ray
C) CT scan
D) Ultrasound
Answer: B) X-ray
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11. What is the hallmark feature of chronic osteomyelitis on imaging?
A) Bone necrosis (sequestra)
B) Joint effusion
C) Subcutaneous edema
D) Normal bone density
Answer: A) Bone necrosis (sequestra)
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12. Which population is at highest risk for hematogenous osteomyelitis?
A) Children
B) Older adults
C) Athletes
D) Pregnant women
Answer: A) Children
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13. Which lab result would you expect to find elevated in a patient with osteomyelitis?
A) Platelet count
B) Erythrocyte sedimentation rate (ESR)
C) Serum sodium
D) Albumin
Answer: B) Erythrocyte sedimentation rate (ESR)
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14. What is the most common complication of untreated osteomyelitis in a diabetic foot ulcer?
A) Amputation
B) Sepsis
C) Pulmonary embolism
D) Stroke
Answer: A) Amputation
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15. Which of the following is the gold standard for diagnosing osteomyelitis?
A) CT scan with contrast
B) MRI
C) Bone biopsy
D) Ultrasound
Answer: C) Bone biopsy
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16. What is the most appropriate treatment for acute osteomyelitis with no bone necrosis?
A) Oral antibiotics for 4 weeks
B) IV antibiotics for 4-6 weeks
C) Debridement without antibiotics
D) Amputation
Answer: B) IV antibiotics for 4-6 weeks
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17. Which pathogen is most commonly associated with vertebral osteomyelitis?
A) Pseudomonas aeruginosa
B) Staphylococcus aureus
C) Streptococcus pyogenes
D) Escherichia coli
Answer: B) Staphylococcus aureus
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18. What is the key difference in treatment for osteomyelitis caused by a joint prosthesis compared to non-implant-related cases?
A) Immediate amputation
B) Extended use of antibiotics with debridement
C) Higher doses of oral antibiotics
D) Physical therapy only
Answer: B) Extended use of antibiotics with debridement
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1. A 25-year-old male presents with severe pain in his lower leg after a motorbike accident. The pain is disproportionate to his visible injury and worsens with passive movement of his foot. What is the most appropriate initial intervention?
A) Apply a tourniquet above the injury
B) Elevate the affected leg and remove any restrictive bandages
C) Start IV fluids and monitor blood pressure
D) Perform an immediate fasciotomy
Answer: B) Elevate the affected leg and remove any restrictive bandages
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2. A 40-year-old woman with a history of circumferential burns to her left forearm complains of numbness and tingling in her fingers. Her pulses are present, but capillary refill is delayed. What is the next step in her management?
A) Measure compartment pressures
B) Apply ice packs to the forearm
C) Start IV antibiotics
D) Observe for 24 hours
Answer: A) Measure compartment pressures
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3. A 30-year-old male presents to the ER following a crush injury to his right leg. His pain is severe, the leg is pale and cold, and he cannot move his toes. Which of the following is a late sign of compartment syndrome in this patient?
A) Pain out of proportion
B) Paresthesia
C) Pulselessness
D) Pallor
Answer: C) Pulselessness
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4. A patient diagnosed with compartment syndrome has undergone a fasciotomy. What is the nurse's priority in postoperative care?
A) Maintain limb elevation and monitor for signs of infection
B) Apply a tight dressing to the fasciotomy wound
C) Restrict fluid intake to reduce swelling
D) Discontinue all pain medication to assess sensation
Answer: A) Maintain limb elevation and monitor for signs of infection
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5. A 65-year-old male with poorly controlled diabetes presents with a non-healing ulcer on his foot. The wound is deep, exposing bone, and cultures reveal Staphylococcus aureus. What is the next best step in management?
A) Initiate oral antibiotics and schedule wound care follow-ups
B) Start IV antibiotics and consult orthopedic surgery
C) Perform an immediate amputation
D) Prescribe topical antibiotics and monitor for improvement
Answer: B) Start IV antibiotics and consult orthopedic surgery
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6. A patient presents with fever, localized back pain, and neurological deficits. MRI reveals vertebral osteomyelitis. What is the primary source likely causing the infection?
A) Skin infection
B) Urinary tract infection
C) Joint replacement infection
D) Burn injury
Answer: B) Urinary tract infection
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7. A 50-year-old male underwent a total knee replacement six months ago. He now presents with swelling, redness, and warmth around the joint, along with fever. What is the most likely diagnosis?
A) Gout
B) Septic arthritis
C) Prosthetic joint infection
D) Osteoarthritis flare
Answer: C) Prosthetic joint infection
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8. A patient with chronic osteomyelitis has developed necrotic bone (sequestra) visible on imaging. What is the most appropriate management?
A) IV antibiotics alone
B) Surgical debridement and IV antibiotics
C) Oral antibiotics and physical therapy
D) Observation and pain management
Answer: B) Surgical debridement and IV antibiotics
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9. A 45-year-old female with a diabetic foot ulcer is found to have osteomyelitis involving the metatarsal bone. Cultures reveal Pseudomonas aeruginosa. What antibiotic regimen is most appropriate?
A) Vancomycin
B) Cefepime followed by ciprofloxacin
C) Amoxicillin-clavulanate
D) Metronidazole
Answer: B) Cefepime followed by ciprofloxacin
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10. A 60-year-old male with osteomyelitis has been started on IV antibiotics. After two weeks of treatment, his pain persists, and imaging shows persistent infection. What is the next step in management?
A) Extend antibiotic therapy for an additional four weeks
B) Discontinue antibiotics and switch to pain management
C) Perform surgical debridement and consider removing infected hardware
D) Begin hyperbaric oxygen therapy
Answer: C) Perform surgical debridement and consider removing infected hardware
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1. A 20-year-old soccer player suffers a direct blow to his shin during a game. Four hours later, he complains of severe, unrelenting pain and numbness in his foot. On exam, his leg is tense and shiny, with intact pulses. What should the nurse prioritize?
A) Administer IV pain medication
B) Elevate the leg and apply ice
C) Prepare the patient for fasciotomy
D) Perform a neurovascular assessment every 4 hours
Answer: C) Prepare the patient for fasciotomy
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2. A 50-year-old male with a forearm fracture has worsening pain and swelling despite a splint being applied. His pain increases with passive finger extension. What is the most reliable indicator of compartment syndrome in this patient?
A) Pallor of the fingers
B) Pain out of proportion to the injury
C) Loss of distal pulses
D) Numbness in the hand
Answer: B) Pain out of proportion to the injury
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3. A nurse is assessing a patient with a recent fasciotomy for compartment syndrome. What is the most critical sign that the patient’s condition is worsening?
A) Increasing pain at the incision site
B) Persistent numbness and tingling
C) Decreasing urine output
D) Coolness and lack of capillary refill in the affected limb
Answer: D) Coolness and lack of capillary refill in the affected limb
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4. A patient with circumferential burns to the leg develops compartment syndrome. What is the immediate management?
A) Perform an escharotomy
B) Apply compression wraps
C) Administer IV antibiotics
D) Encourage active range of motion
Answer: A) Perform an escharotomy
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5. A 65-year-old male presents with a diabetic foot ulcer that has been present for three months. Imaging confirms osteomyelitis involving the metatarsal bones. What is the most appropriate next step in treatment?
A) Oral antibiotics for 2 weeks
B) Surgical debridement and IV antibiotics
C) Amputation of the affected toe
D) Hyperbaric oxygen therapy
Answer: B) Surgical debridement and IV antibiotics
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6. A patient with vertebral osteomyelitis presents with worsening back pain and signs of sepsis. Blood cultures reveal Staphylococcus aureus. What imaging study should be prioritized to confirm the extent of infection?
A) X-ray of the spine
B) CT scan with contrast
C) MRI of the spine
D) Bone scan
Answer: C) MRI of the spine
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7. A 70-year-old female presents with pain and swelling around her knee replacement two years after surgery. Imaging shows loosening of the prosthetic components. What is the likely cause?
A) Osteoarthritis
B) Prosthetic joint infection
C) Mechanical failure of the implant
D) Gout
Answer: B) Prosthetic joint infection
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8. A diabetic patient with osteomyelitis of the foot has been on IV antibiotics for one week, but imaging shows persistent infection and bone necrosis. What is the most appropriate next step?
A) Continue current antibiotics
B) Change to oral antibiotics
C) Surgical debridement of the affected bone
D) Start corticosteroid therapy
Answer: C) Surgical debridement of the affected bone
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9. A patient presents with an infected open fracture. Cultures reveal mixed bacterial growth, including MRSA and Pseudomonas aeruginosa. What initial antibiotic therapy is appropriate?
A) Vancomycin and cefepime
B) Amoxicillin-clavulanate
C) Ciprofloxacin alone
D) Piperacillin-tazobactam
Answer: A) Vancomycin and cefepime
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10. A patient with osteomyelitis has persistent fever and elevated inflammatory markers despite antibiotics. Imaging shows abscess formation around the infected bone. What is the best course of action?
A) Adjust the antibiotic regimen
B) Perform a biopsy of the abscess
C) Drain the abscess surgically
D) Continue current antibiotics and monitor
Answer: C) Drain the abscess surgically
