Ortho

Question 1

What lumbar puncture findings are associated with MS?

Answer 1

Pleocytosis and oligoclonal bands of immunoglobulin G

Question 2

What bones articulate proximally with the radius to form the radiocarpal joint?

Answer 2

Scaphoid and lunate bones

Question 3

What are the Kanavel signs?

Answer 3

Used to diagnose acute flexor tenosynovitis
Tenderness along the flexor tendon
Fusiform or symmetrical swelling of the finger
Pain with passive range of motion
Flexed posture of the finger

Question 4

What T scores are indicative of osteopenia and osteoporosis?

Answer 4

Osteopenia: –1 to –2.5 SD
Osteoporosis: score of less than –2.5 SD

Question 5

What muscles are most commonly used for biopsy in confirming the diagnosis of polymyositis?

Answer 5

Quadriceps femoris for LE weakness
Deltoid for UE weakness

Question 6

Pts with S1 radiculopathy have what signs/symptoms?

Answer 6

Pain that travels down the posterior leg and into the foot
Reduced sensation on the posterior leg and lateral foot
Weakness in plantar flexion

Question 7

What shoulder dislocation presents with an abducted, externally rotated, and occurred usually after a blow to an extended arm?

Answer 7

Anterior shoulder dislocation

Question 8

What is a Galeazzi test?

Answer 8

Test for an infant when there is concern for developmental dysplasia of the hip
Flexing the infant’s hips and knees, then looking level at the knee heights

Question 9

What radiologic finding is common in patients who have tibial tuberosity osteochondritis (Osgood-Schlatter disease (OSD))?

Answer 9

Heterotopic ossification

Question 10

If a patient has conditions which would limit their ability to take NSAIDs (CKD, PUD) what is the 1st line treatment for acute gout?

Answer 10

Steriods

Question 11

A patient presenting with an internally rotated and shortened leg has what condition?

Answer 11

Posterior hip dislocation

Question 12

What antibiotic is associated with spontaneous tendon rupture?

Answer 12

Fluoroquinolones (levofloxacin)

Question 13

The cauda equina is AKA what?

Answer 13

A collection of post-ganglionic nerves (lumbosacral nerve roots)

Question 14

What are the indications for imaging related to low back pain?

Answer 14

< 18 yo or > 50 yo
Hx of fever, weight loss, malignancy (e.g. history of prostate cancer)
IV drug use
Immunocompromised state
Trauma
Progressive neurologic deficits
Symptoms lasting > 4–6 weeks

Question 15

What exam findings are consistent with a posterior shoulder dislocation?

Answer 15

Flattening of the shoulder anteriorly
Prominent coracoid process
Inability to externally rotate the arm
Obvious prominence in the posterior shoulder girdle

Question 16

What is the treatment for a pulled elbow (nursemaid elbow)?

Answer 16

Hyperpronation method: apply pressure to the radial head and hyperpronating the forearm
Supination-flexion method: supinate and fully flex the elbow while applying pressure to the radial head and pulling with gentle traction

Question 17

Generally, is hydroxychloroquine safe if trying to conceive/in pregnancy?

Answer 17

Yes

Question 18

What medications can be used to treat Raynaud’s?

Answer 18

Aspirin
Prostaglandins
Vasodilators
Calcium-channel blockers (nifedipine) (esp when they have pulm. fibrosis)

Question 19

What is the Thessaly test?

Answer 19

Test used when suspected medial meniscus tear
The patient stands on one leg and flex the knee to 20°, then internally and externally rotate the knee (pain = positive)

Question 20

What are the Ottawa ankle criteria?

Answer 20

An ankle x-ray series is only required if there is pain in the malleolar zone AND any of these findings:
Bone tenderness at posterior edge or tip of lateral malleolus, OR
Bone tenderness at posterior edge or tip of medial malleolus, OR
Inability to bear weight both immediately after injury AND in ED.

A foot x-ray series is only required if there is pain in the midfoot zone AND any of these findings:
Bone tenderness at base of 5th metatarsal, OR
Bone tenderness at navicular, OR
Inability to bear weight both immediately after injury AND in ED.

Question 21

What causes the fibrous fascia of the palmar surface to shorten and thicken, and present with one or more small pitted nodules on the palm and may lead to finger contracture?

Answer 21

Dupuytren disease (Dupuytren contracture)

Question 22

What chronic disease is associated with Dupuytren contracture?

Answer 22

Diabetes

Question 23

What biomarker is the most specific for rheumatoid arthritis?

Answer 23

Anti-cyclic citrullinated peptide antibodies

Question 24

Patients with wrist drop who are unable to give a “thumbs up” sign likely have an injury to what nerve?

Answer 24

Radial nerve

Question 25

What area would you expect (use to test) sensation in a patient with suspected radial nerve injury?

Answer 25

Dorsal first web space

Question 26

What exam needs to be performed prior to starting a patient on hydroxychloroquine and why?

Answer 26

Eye exam because the med is retinal toxic
Pts should repeat eye exam q6-12 months while on the med

Question 27

Knee instability in multiple directions should raise suspicion for what?

Answer 27

Tibiofemoral dislocation (knee dislocation)

Question 28

What bone fracture is most commonly involved in acute compartment syndrome?

Answer 28

Tibia

Question 29

What infectious agent is commonly associated with reactive arthritis?

Answer 29

Chlamydia trachomatis

Question 30

What is the treatment of choice for osteomyelitis caused by Pasteurella multocida (cat bite)?

Answer 30

Ampicillin-sulbactam

Question 31

What is the most commonly fractured carpal bone?

Answer 31

Scaphoid

Question 32

Constant deep achy pain, especially in the nighttime hours and not relieved by rest, is the main symptom of what?

Answer 32

Bone malignancy

Question 33

What are the most common bone tumors in those over 40 years of age?

Answer 33

Metastases
Chondrosarcoma
Fibrosarcoma
Multiple myeloma

Question 34

What is a Lisfranc injury?

Answer 34

Fracture-dislocation of the tarsometatarsal joints

Question 35

What condition has an ESR ≥ 40 mm/hour?

Answer 35

Polymyalgia rheumatica (PMR)

Question 36

In the hemodynamically stable patient with a posterior hip dislocation, what is the treatment of choice?

Answer 36

Closed reduction

Question 37

How does a posterior hip dislocation present?

Answer 37

Fixed internal rotation position and adducted; shortened

Question 38

What is a greenstick fracture?

Answer 38

An incomplete fracture involving a break in one cortex (tension side) and deformation of the other cortex (compression side)
X-ray appearance resembles a broken branch of a young tree
Common in kids

Question 39

What is a long-term problem associated with greenstick fractures?

Answer 39

There are no long-term complications

Question 40

What do you call gout in the 1st MTP joint?

Answer 40

Podagra

Question 41

What is an anterior inferior articular glenoid fracture called?

Answer 41

Bankart lesion

Question 42

What is Sever disease?

Answer 42

Often seen in kids who play sports requiring cleats
Believed to be a traction apophysitis of the Achilles tendon at the calcaneal apophysis related to overuse
Pain with medial-lateral compression of the calcaneus (positive compression test) or pain with direct palpation over the apophysis

Question 43

What causes central cord syndrome?

Answer 43

Forced hyperextension of the neck

Question 44

What maneuver tests the meniscus of the knee?

Answer 44

McMurray test

Question 45

What do you see on exam with a positive straight leg raise?

Answer 45

The presence of pain in the back that radiates past the knee when the leg is elevated 30 to 70 degrees