Ortho/MSK

Question 1

Carpal tunnel syndrome

Answer 1

Compression of the median nerve

Question 2

Carpal tunnel syndrome: tests

Answer 2

Tinel test
Phalen test

Diagnosis confirmed by median nerve-conduction studies

Question 3

Carpal tunnel syndrome: associated diseases

Answer 3

hypothyroidism
diabetes
pregnancy
obesity
amyloidosis
rheumatoid arthritis

Question 4

Tests to confirm ACL injury

Answer 4

Lachmann’s test
Anterior drawer test
Pivot-shift test

Question 5

Tests to confirm PCL injury

Answer 5

posterior drawer test

Question 6

Common mechanism of meniscus injury

Answer 6

twisting
overuse

Question 7

Tests to confirm meniscus tear

Answer 7

Laxity with valgus stress
Apley’s compression test
McMurray test
Cooper’s sign

Question 8

Paget’s disease

Answer 8

focal disorder of bone metabolism that is characterized by accelerated rates of bone remodeling that results in overgrowth of bone at single or multiple sites

Question 9

lateral epicondylitis

Answer 9

“tennis elbow”
Overuse tendinopathy of the common extensor tendon origin of the lateral elbow r/t excessive wrist extension

Question 10

lateral epicondylitis: management

Answer 10

Conservative care – offloading the involved tendons by modifying work, etc.

Question 11

fibromyalgia

Answer 11

chronic widespread musculoskeletal pain that is often accompanied by somatic symptoms, psychiatric symptoms, fatigue, cognitive disturbances

Question 12

fibromyalgia: management

Answer 12

education, nonpharmacologic measures (exercise)
tricyclic antidepressants (amitryptiline, duloxetine)
anticonvulsants
(gabapentin, pregabalin)

Question 13

Subacromial bursitis

Answer 13

Characterized by pain that is present at rest and exacerbated by the use or application of local pressure

Question 14

Subacromial bursitis: diagnosis

Answer 14

Symptoms improve after glucocorticoid injection

Question 15

adhesive capsulitis

Answer 15

AKA frozen shoulder
Pain and stiffness of the glenohumeral joint with reduced passive and active ROM

Question 16

most fractured bone in the wrist

Answer 16

scaphoid

Question 17

scaphoid fracture: mechanism

Answer 17

fall on outstretched hand

Question 18

scaphoid fracture: S/Sx

Answer 18

tenderness in the anatomic snuffbox

Question 19

DeQuervain’s tenosynovitis

Answer 19

Cumulative movement disorder due to chronic overuse of the wrist and hands

Entrapment of the abductor pollicis longus and extensor pollicis brevis at the styloid process of the radius

Question 20

DeQuervain’s tenosynovitis: S/Sx

Answer 20

Tenderness over the radial aspect of the wrist that may radiate up to the tip of the thumb
May be erythema
Crepitus is rarely noted
No numbness or tingling

Question 21

DeQuervain’s tenosynovitis: mechanism

Answer 21

repetitive hand motions

Question 22

Ruptured Achilles’ tendon: tests

Answer 22

Thompson test: firmly squeezing the gastrocnemius muscle does not elicit plantar flexion

Question 23

Lisfranc joint injury

Answer 23

Injury to the tarsometatarsal joints, which represent the bony articulations between the midfoot and the forefoot

Question 24

Lisfranc joint injury: mechanism

Answer 24

direct (trauma)
indirect (axial load on a plantar-flexed foot)

Question 25

Lisfranc joint injury: treatment

Answer 25

anatomic reduction and immobilization with or without surgery

Critical to treat properly as even mild injuries can produce chronic disability

Question 26

Marfan syndrome features

Answer 26

Triad:
- long, thin extremities frequently associated with other skeletal changes
- reduced vision d/t dislocation of the lenses (ectopia lentis)
- aortic aneurysm that typically begins at the base of the aorta

Other abnormalities:
-severe chest deformities
-scoliosis
-kyphosis
-pes planus (flat feet)
-spontaneous pneumothorax
-inguinal, incisional hernias

Question 27

Ehlers-Danlos syndrome type IV (vascular type) features

Answer 27

aortic aneurysms and rupture
joint hypermobility
mitral valve prolapse
spontaneous pneumothorax

Question 28

homocystinuria features and diagnosis

Answer 28

tall stature
pectus deformities
scoliosis
pes Plans (flat feet)
progressive lense dislocation

detected by a positive urinary-nitroprusside test result or elevated by urinary homocysteine through amino acid chromatography

Question 29

stress fracture presentation and imaging

Answer 29

gradual onset of symptoms resulting in inability to bear weight on the foot
lack of crepitus and erythema
bony tenderness

Xray
if not detected, MRI (best imaging modality to detect a stress fracture)

Question 30

“bucket handle” meniscal tear

Answer 30

surgical emergency – should be addressed within a few days

lack of full extension (locked knee)
pain over the medial joint line
effusion

Question 31

FRAX score

Answer 31

Determines a patient’s fracture risk and if treatment is indicated
Calculated based on age, gender, BMI, and risk factors (prior fragility fractures, parental history of hip fracture, tobacco use, long-term oral glucocorticoid use, RA, causes of secondary OA, EtOH)

Question 32

osteomyelitis: imaging required to diagnose

Answer 32

MRI

Xrays may occasionally show gas formation associated w/osteomyelitis but they are not a reliable method to confirm diagnosis as they lack sensitivity for osteomyelitis

Question 33

spastic gait

Answer 33

aka hemiplegic gait
Walking with one stiff leg, which either drags or swings around in a semicircular motion (circumduction).

Seen w/cerebral palsy, MS, or hemiplegia

Question 34

DEXA score: +1 to -1

Answer 34

normal bone density

Question 35

DEXA score: -1 to -2.5

Answer 35

osteopenia

Question 36

DEXA score: -2.5 or lower

Answer 36

osteoporosis

Question 37

recommended calcium intake for osteoporosis

Answer 37

1200mg daily (diet + supplement)

Question 38

recommended vitamin D intake for osteoporosis

Answer 38

800 IU daily