Musculoskeletal

Question 1

Back pain that is exacerbated by standing and walking and relieved w/ sitting and hyperflexion of the hips

Answer 1

Spinal stenosis

Question 2

Joints in the hand affected in RA

Answer 2

MCP and PIP joints; DIP joints 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 a/w multiple fx and blue sclerae and is commonly mistaken for child abuse

Answer 4

Osteogenesis imperfecta

Question 5

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

Answer 5

Suspect ankylosing spondylitis. Check HLA-B27.

Question 6

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

Answer 6

Reactive (Reiter’s) arthritis. Most commonly a/w Chlamydia. Also consider Campylobacter, Shigella, Salmonella, and Ureaplasma

Question 7

55 y/o man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Dx, workup, and chronic tx?

Answer 7

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic tx w/ allopurinol or probenecid

Question 8

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate

Answer 8

Pseudogout

Question 9

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

Answer 9

Polymyalgia rheumatica

Question 10

An active 13 y/o boy has anterior knee pain. Dx?

Answer 10

Osgood-Schlatter dz

Question 11

Bone is fx in a fall on an outstretched hand

Answer 11

Distal radius (Colles’ fx)

Question 12

A complication of scaphoid fx

Answer 12

Avascular necrosis

Question 13

Signs suggesting radial nerve damage w/ humeral fx

Answer 13

Wrist drop, loss of thumb abdution

Question 14

Young child presents w/ proximal muscle weakness, waddling gait, and pronounced calf muscles

Answer 14

Duchenne muscular dystrophy

Question 15

First-born female who was born in breech position is found to have asymmetric skin folds on newborn exam. Dx? Tx?

Answer 15

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

Question 16

An 11 y/o obese African American boy presents w/ sudden onset of limp. Dx? Workup?

Answer 16

Slipped capital femoral epiphysis. AP and frog-leg lateral x-rays

Question 17

Most common 1` malignant tumor of bone

Answer 17

Multiple myeloma