Orthopedics PANCE Flashcards
At what age should you begin ordering DEXA scan’s for male patients? What about female patients?
70 for males, 65 for females
Give the DEXA score for osteopenia and osteoporosis
Osteopenia 1 to 2.4
Osteoporosis 2.5 or greater
What fracture is the number one cause of compartment syndrome
Tibial shaft fracture
A patient’s lab work shows positive Smith anti-body and positive double-stranded DNA anti-bodies. What is the most likely diagnosis
Lupus
Where are Bouchard’s nodes found
Proximal interphalangeus joint (PIP)
What will an x-ray show in acute osteomyelitis
Nothing. It will show bone destruction in chronic osteomyelitis
What is the best imaging to diagnose osteomyelitis
Either a bone scan or an MRI will provide the diagnosis
A 22-year-old male patient presents with what is clearly a septic knee. You noticed lesions on his hands and feet what is the most likely pathogen?
Neisseria gonorrhea
What would you expect the WBC count to be in the joint fluid of an infected knee
Greater than 50,000 at a minimum and probably much higher
A patient presents with a painless mass in her right wrist. What is the most likely diagnosis
Ganglion cyst
What is the age range for osteosarcoma? Where are the most typically found in the body
Osteosarcoma usually occur in 15 to 25-year-old males and are most commonly found around the knee
You think a patient may have an odteiod osteoma due to his complaints of severe night pain. You set him up for an x-ray but in the meantime what medication do you start him on?
If it is truly an osteoid osteoma ibuprofen will resolve this pain
Clicking or locking of the knee indicates what diagnosis
Minuscule tear
A 65-year-old presents complaining of severe pain in his great toe that began when he woke up this morning. It is swollen, red, and very tender. What is the most likely diagnosis
Gout would be the number one but you also need to consider an infection
What uric acid level helps to confirm a diagnosis of gout
Greater than 7.5
What is the medical treatment for gout
Allopurinol and Colochicine
A pathology report comes back with positive birefringment crystals. What is the most likely diagnosis
Pseudogout
A patient with a history of hepatitis B presents complaining of bilateral knee pain, fever and weight loss. What is the most likely diagnosis
Polyarteritis nodosa
You suspect the patient has polyarteritis nodosa. What is the test for a definitive diagnosis and what is the treatment
Biopsy, high-dose steroids
On physical exam, you notice ulnar deviation and swan neck deformities. What is the most likely diagnosis
Rheumatoid arthritis
A positive neers test indicates which diagnosis
Rotator cuff impingement
List three medications that may cause lupus
Procainamide, isoniazid and Quinidine
What test do you do for sjogren syndrome
Schirmer test
A patient with rheumatoid arthritis is heading to the OR for an open reduction and internal fixation of the ankle. In addition to ankle films, what other x-ray should you get
C-spine, anesthesia will want them due to concerns about instability of C1 and C2
Which carpal bone has a higher rate of non-union in occult fracture
Scaphoid
What medication is used for patients with lupus
Systemic steroids
Scleroderma limited version has five main characteristics for which the crest acronym is often use. What are those five things
Calcinosis, Reynards, Esophageal dysmotility, Sclerodactyly, telangiectasia
There is a Sunburst appearance on x-ray. What is the most likely diagnosis
Osteosarcoma
Anatomically where are 80% of clavicle fractures located
Middle third
A pathology report comes back showing negatively birefringment crystals. What is the most likely diagnosis
Gout
What are the four muscles of the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Describe the characteristics of a lytic lesion on x-ray
Spiculated, elevated periosteum, bone destruction
What ligament is most commonly injured in an ankle sprain?
Anterior talofibular ligament (ATFL)
What is the most common cause of C-spine fracture’s
Motor vehicle accidents
What is the medical term for hunchback
Kyphosis
What is another term for podagra
Gout
A patient presents to the ER with saddle anesthesia and loss of bowel and bladder function. What is the most likely diagnosis
Cauda equina
A patient with HIV presents with severe groin pain. What is the most likely diagnosis
Avascular necrosis of the formoral head. Antiretroviral medications patient at increased risk of AVN
A 95-year-old female presents to the ER after a fall in her home. Her left leg is shortened in externally rotated what is the most likely diagnosis
Hip fracture
You recommend bisphosphonate for a patient with osteoporosis. What instruction do you give her for immediately after taking the medication
Remain upright for 30 minutes
What is the most common cause of a hip dislocation? Is it usually anterior or posterior
MVA, posterior
Which of the four rotator cuff muscles is most commonly injured
Supraspinatus
What is the medical term for tennis elbow
Lateral epicondylitis
What is a first-line treatment for rheumatoid arthritis
Methotrexate
The patient presents to the ER after taking a baseball bat to the knee. He is unable to actively extend his knee. What is the most likely diagnosis
Patella fracture
Are most shoulder dislocations anterior posterior
Anterior
What is the most useful physical exam test for diagnosing an ACL tear
Lachmans followed by anterior drawer
What is the most common knee injury
Medial meniscus injury
Where are herbeidens nodes found
Distal interphalangeal joint (DIP)
The patient presents with knee pain following a soccer game two days ago. He has joint line tenderness medially and feels a locking in the knee from time to time. What two physical exam test should you do
Most likely a medial meniscus injury. McMurray and apply test would be appropriate
A patient presents with conjunctivitis, urethritis, arthritis and oral lesions. What is the most likely diagnosis? What other lab might you expect to be positive
Reactive arthritis, HLA B-27
A 46-year-old male comes into the ER limping a little on the right side. He states that it felt as though he was kicked in the back of the leg during a soccer game, but clearly no one was behind him what is the most likely diagnosis
Achilles tendon rupture
Anti-Joe one antibodies should make you think of what diagnosis
Polymyositis
A positive crossover test indicates what diagnosis
Acromioclavicular joint injury (AC joint)
A positive Hawkins test indicates what diagnosis
Rotator cuff impingement
A positive Finkelstein’s test indicates what diagnosis
Dequiverians tenosynovitis
A positive Phalen’s and tinels sign indicates what diagnosis
Carpal tunnel
Vasculitis with a hepatitis B history should make you think of what diagnosis
Polyarteritis nodosa
What is the most common fracture in children
Clavicle
A fat pad sign on a lateral x-ray of the elbow has what significance
It is blood in the joint indicating a fracture even if the fracture line cannot be seen
A patient presents with progressive neck and proximal muscle weakness. On physical exam, you see a reddish purple maculopapular rash. Her lab work shows an anti-jo 1 antibody. What is the most likely diagnosis
Polymyositis
Which way does a collies fracture angulate: dorsal or volar. What about a smith fracture
Collies is dorsal, Smith is volar
Tenderness over the anatomical snuffbox is indicative of what fracture
Scaphoid
What is the most common fracture in a patient with osteoporosis
A compression fracture of a vertebral body followed by hip fractures
A 15-year-old boy presents complaining of night pain in the pelvis. Since you have no idea what to do you order an x-ray. The report comes back with the description of a mass with in “onionskin appearance” what is the most likely diagnosis
Ewing sarcoma
What is the name for the fourth and fifth metacarpal fracture that often result from throwing a punch
Boxers fracture
A new mother presents with pain over the radio rest. She has a positive Finkelstein’s test. What is the most likely diagnosis
Dequiverians tenosynovitis
A positive McMurray indicate what diagnosis
Meniscus tear
What is the first line treatment for carpal tunnel
Night splint
A bamboo spine indicates what diagnosis
Ankylosing spondylitis
A positive straight leg test indicates what diagnosis
Herniated disc
An African-American female presents with Malor rash and a positive double-stranded DNA antibody. What is the most likely diagnosis
Lupus
Carpal tunnel effect what nerve and what parts of the hand?
Median nerve. Thumb, pointer, ring fingers. The bar atrophy is a sign of advanced disease
A patient has a silver fork deformity on x-ray. What is the most likely diagnosis
Collies fracture
A positive apply indicates what diagnosis
Meniscus tear
