Musculoskeletal

Question 1

Back pain that is exacerbated by standing and walking and relieved with siting and hyperflexion of the hips.

Answer 1

Spinal stenosis.

Question 2

Joints in the hand affected in rheumatoid arthritis.

Answer 2

MCP and PIP joints;DIP joint are spared.

Question 3

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

Answer 3

Osteoarthritis.

Question 4

A genetic disorder that is associated with multiple fractures and blue sclerae and is commonly mistaken for child abuse.

Answer 4

Osteogenesis imperfecta.

Question 5

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

Answer 5

Suspect ankylosing spondylitis. Check HLA-B27.

Question 6

Arthritis, conjunctivitis, and urethritis in young men. Associated organism?

Answer 6

Reactive (Reiter’s) arthritis. Most commonly associated with Chlamydia. Also consider campylobacter, shigella, Salmonella and Ureaplasma.

Question 7

A 55 year old man has sudden, excruciating firt MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

Answer 7

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid.

Question 8

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

Answer 8

Pseudogout.

Question 9

An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and elevated ESR.

Answer 9

Polymyalgia rheumatica.

Question 10

An active 13 year old boy has anterior knee pain. Diagnosis?

Answer 10

Osgood-Schlatter disease.

Question 11

Bone is fractured in a fall on an outstretched hand.

Answer 11

Distal radius (Colle’s fracture).

Question 12

A complication of scaphoid fracture.

Answer 12

Avascular necrosis.

Question 13

Signs suggesting radial nerve damage with humeral fracture.

Answer 13

Wrist drop, loss of thumb abduction.

Question 14

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

Answer 14

Duchenne muscular dystrophy.

Question 15

A first born female who was born in breech position is found to have asymmetric skin fold on newborn exam. Diagnosis? Treatment?

Answer 15

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction.

Question 16

An 11 year old obese African American boy presents with sudden onset of limp. Diagnosis? Workup?

Answer 16

Slipped capital femoral epiphysis. AP and frog leg lateral xrays.

Question 17

The most common primary malignant tumor of bone.

Answer 17

Multiple myeloma.