Musculoskeletal_RR

Question 1

Back pain that is exacerbated by standing and walking, but relieved with sitting 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 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 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 organisms?

Answer 6

Reactive (Reiter’s) arthritis.
Most commonly associated organisms is Chlamydia, but Campylobacter, Shigella, Salmonella, and Ureaplasma are also associated.

Question 7

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis? Workup? Chronic management?

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 increased 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 (Colles’ 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 folds 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.

Anteroposterior (AP) and frog-leg lateral x-rays

Question 17

The most common primary malignant tumor of bone

Answer 17

Multiple myeloma