Orthopedics

Question 1

OA characteristics

Answer 1

Pain exacerbated by activity, relieved with rest
AM stiffness improves within 1 h
crepitus

Question 2

OA diagnosis

Answer 2

joint space narrowing and/or osteophyte on XR

Question 3

OA treatment non pharm

Answer 3

exercise
weight loss

Question 4

OA pharm tx

Answer 4

use only if symptoms
NSAIDs

Question 5

RA characteristics

Answer 5

auto immune
symmetric, periph polyarthritis

Question 6

criteria for RA dx

Answer 6

1. 3 involved joints
2. serologic abnormality (RF or anti CPP)
3. elevated ESR or CRP
4. Symptoms present >6 weeks

Question 7

fibromyalgia

Answer 7

Chronic widespread musculoskeletal pain >3 months;
accompanied by fatigue, sleep disturbances, and multiple somatic
complaints (HA, bowel irritability, cognitive disturbances)

Question 8

fibromyalgia has

Answer 8

no abnormalities on PE (outside of pain)
no evidence of tissue inflammation

Question 9

Fibromyalgia tx

Answer 9

Sleep hygiene
* Treat comorbids: mood, sleep disorders
* Exercise: aerobic conditioning, stretching, strengthening
* Med for pain: amitriptyline, duloxetine, pregabalin, others

Question 10

Supraspinatus Test (Empty Can Test)

Answer 10

1. Shoulder abducted 90 degrees
2. Shoulder is internally rotated and angled forward 30
   degrees, thumb pointing to floor, then resist
   (+) sign is pain/weakness

Question 11

If pain is orthopedic in etiology, it should be

Answer 11

reproducible!

Question 12

lateral epicondylitis aka

Answer 12

tennis elbow

Question 13

lateral epicondylitis

Answer 13

overuse is common cause
rest, but keep joints moving
nsaids
ice/heat
steroid
pt

Question 14

scaphoid fracture identified with

Answer 14

snuffbox tenderness

Question 15

snuffbox tenderness

Answer 15

• Common complaint of a fracture is deep, dull pain in wrist, worse with gripping
  or squeezing

Question 16

low back pain symptoms that suggest systemic dx

Answer 16

CA hx
>50
unexplained wt loss
pain lasting longer than 4 weeks
nighttime pain

Question 17

Sciatica

Answer 17

• Nerve root irritation manifests as sciatica (radiculopathyfocus on L5-S1)
• Sharp or burning pain radiating down leg to foot or ankle
• May occur as numbness or tingling
• Sciatica due to herniation is worse with coughing, sneezing,
  Valsalva

Question 18

Straight Leg Raise

Answer 18

• Examiner raises patient’s extended leg with the ankle
  dorsiflexed
• Positive if sciatica is reproduced between 10 and 60 degrees
  in the affected leg
• May confirm radiculopathy

Question 19

• General rule: Avoid lumbar X-rays unless

Answer 19

trauma, suspected systemic disease, or pain >4 weeks

Question 20

Lateral hip pain, aggravated by direct pressure suggests

Answer 20

trochanteric bursitis

Question 21

hip pain with use, better with rest

Answer 21

structural joint problem, OA

Question 22

Anterior hip/groin pain suggests

Answer 22

Hip joint: OA,

Question 23

posterior hip pain suggests

Answer 23

SI joint, LBP

Question 24

grades of sprain

Answer 24

 I: minimally torn ligament, stable joint (stretch)
 II: incomplete tear, painful wt bearing (partial rupture)
 III: completely torn ligament; severe pain, swelling, tenderness (complete
rupture)

Question 25

management for sprain

Answer 25

RICE
early mobility
analgesics

Question 26

last resort to treat gout flare

Answer 26

colchicine

Question 27

you do not use allopurinol during

Answer 27

flare

Question 28

positive MTP test associated with

Answer 28

morton’s neuroma

Question 29

nodes of DIP joints secondary to arthritis

Answer 29

heberden nodes

Question 30

positive finkelstein’s test

Answer 30

dequervain’s tenosynovitis
dorsal thumb pain is classic symptom

Question 31

positive tinels, allen, phallen sign

Answer 31

carpal tunnel syndrome

Question 32

common cause of posterior knee pain

Answer 32

baker’s cyst

Question 33

stress fracture

Answer 33

overuse injury of bone
heals in 6 weeks

Question 34

nodes on PIP joints secondary to arthritis

Answer 34

bouchards nodes