Pre-test/DVS Flashcards
An 11 y/o boy presents to his pediatrician b/c his mother is concerned that he has been limping for the past 3 days. He states that he is limping b/c of a dull, aching pain in the R groin and thigh that extends down to his R knee. He has no hx of preceding trauma. On exam, there is a shift of the torso over the affected hip with standing. Which of the following explains this physical exam finding?
a. Weakness in hip abduction
b. Weakness in hip flexion
c. Weakness in hip extension
d. Weakness in knee extension
a. Weakness in hip abduction
SCFE = orthopedic emergency
When they sit with the legs dangling, the sole of the foot on the affected side points toward the other foot. On exam, there is limited hip motion, and as the hip is flexed, the thigh goes into external rotation and cannot be rotated internally.
X-rays = diagnostic, and surgical tx pins the femoral head back in place
Anterior dislocation of humeral head from glenoid fossa –> most likely injury?
Axillary n.
16 y/o boy arrives for his 1 month follow-up after straining his back and fracturing his tibia during a snowboarding accident. Using crutches –> saturday night palsy –> what nerve?
Radial nerve injury
(fractures to humeral midshaft and those that use improperly fitted crutches)
A 2 week old female born at 39 weeks gestation to a 36 y/o G2P1 female via normal spontaneous vaginal delivery comes to her pediatrician for her 2-week well-baby exam. The birth was unremarkable, and the baby went home with her mother after 2 days. She received prenatal care starting at 10 weeks gestation and had a normal, healthy pregnancy with no issues.
On physical exam, as the hip is gently adducted and posterior pressure is applied, there is a palpable clunk. Which of the following is the next step in mgmt?
a. Reexamine at 1-month exam
b. CT scan of the hips
c. X-ray of the hips
d. Reassurance
e. U/S of the hips
e. U/S of the hips
during first 6 months, x-ray is not helpful as bones have not yet ossified
A 45 y/o woman presents with pain in her R hand for 2 days. FOOSH injury and pain in anatomic snuffbox. No motor or sensory deficits. What is the most appropriate step in mgmt?
a. Radiograph of hand and, if normal, recommend supportive care with f/u
b. Radiograph of hand and, if normal, recommend thumb spica cast with f/u
c. Thumb spica cast w/o radiograph
d. CT scan of hand
b. Radiograph of hand and, if normal, recommend thumb spica cast with f/u
Scaphoid fracture… hard to capture on xray right away so first immobilize with cast and then re-image 7-10 days later
Anterior dislocation of shoulder = most common form of shoulder dislocation.
Posterior dislocations are rare and occur most often in what type of pts?
Generalized seizures or electrocution
A 32 y/o housekeeper comes to the physician for hip pain localized to the lateral aspect of the hip. The hip pain is interrupting her sleep. She denies any muscle weakness or numbness and tingling. The pain is not worse with physical activity. On exam, there is tenderness to palpation of the lateral aspect of her hip while in the lateral decubitus position. Which of the following is the most likely etiology of the hip pain?
a. Hip osteoarthritis
b. Meralgia paresthetica
c. Trochanteric bursitis
d. Osteonecrosis
e. Hip fracture
c. Trochanteric bursitis
most common cause of unilateral hip pain = inflammation of trachanteric bursa
caused by friction of the gluteus medius tendon and TFL over the outer femur as a result of gait impairment, trauma, or infection… untreated, the bursal wall thickens, fibroses, and gradually loses its ability to lubricate the outer hip
meralgia paresthetica = compression of the lateral femoral cutaneous nerve
A 17 y/o male comes to ER for third time over last month due to pain in his R thigh above his knee that is particularly bothersome at night. He was previously dx with growing pains. Now he has developed swelling above his R knee and states his pain is worse.
On exam, there is a soft tissue mass that is tender to palpation. The skin overlying the mass is erythematous. An X-ray is obtained and shows a “sunburst” pattern in the distal femur. What is the most likely dx?
a. Ewing’s sarcoma
b. Osteosarcoma
c. Osteomyelitis
d. Osteochondroma
e. Osteoid osteoma
b. Osteosarcoma
Primary malignant tumors of bone
- Localized pain present for a while and worse at night
- Predilection for metaphysis of long bones (distal femur, proximal tibia, proximal humerus)
- X-ray –> periosteal bone formation, “sunburst pattern” (lifting of cortex)
Osteoid osteoma = benign painful growth of diaphysis… worse at night but better with aspirin
- on x-ray, central radiolucency surrounded by sclerotic rim
a 28 y/o pregnant woman suffering from preeclampsia is being monitored in the hospital the night before her elective induction when she experiences a generalized seizure.
after successful delivery of a healthy baby boy the next morning, her doctor notices that she is unable to move her R arm. An upper extremity AP radiograph is taken but does not reveal any abnormalities. What is the most appropriate next step in mgmt?
a. Repeat radiographic studies of the upper extremity
b. MRI of the UE
c. CT scan of the UE
d. OR
e. reassurance
a. Repeat radiographic studies of the upper extremity
Pregnant pts with preelampsia or eclampsia that present with an inability to move the arm following a seizure are most likely suffering from a posterior shoulder dislocation (rare)
If radiographs are equivocal, CT scan can be ordered next
A 63 y/o man comes to the ER due to a 2 day hx of R knee pain and swelling. The pain is severe enough to interfere with walking. The pt does not recall any significant trauma to the knee. The pt is an industrial concrete finisher and frequently works extended hours on the job. Temp 99, BP 115/75, pulse 92.
On exam, there is mild swelling anterior to the patella, along with faint erythema and sharp tenderness. Passive ROM is normal.
Which of the following is the most likely cause of this patient’s acute symptoms?
a. Crystal-induced arthropathy
b. Fracture of the patella
c. Infectious arthritis
d. Patellar tendinitis
e. Patellofemoral pain syndrome
f. Prepatellar bursitis
f. Prepatellar bursitis
Commonly due to Staph aureus, which can infect the bursa via penetrating trauma/repetitive friction or extension from local cellulitis.
Dx confirmed via aspiration of bursal fluid for cell count and Gram stain
- Patellar tendinitis: typically seen with inferior patella and patellar tendon –> athletes who jump
- Patellofemoral pain syndrome: chronic anterior knee pain and most common in women –> presents with peripatellar pain worsened by activity or prolonged sitting
A 24 y/o woman comes to the urgent care center due to increasing pain in her R leg. She initially felt a dull, aching pain at the anterior aspect of the lower leg 2 weeks ago. The pt is an avid dancer and often practices 4-5 hours a day; the pain has worsened and is now interfering with her dance sessions. BMI is 16. Exam shows point tenderness over anterior aspect of the R shin. There are no skin abnormalities. X-ray of lower leg revels no abnormalities. Which of the following is the most likely dx?
a. Compartment sydnrome
b. Shin splints
c. Stress fracture
c. Stress fracture
Risk factors: repetitive activities, female athlete triad (low caloric intake, amenorrhea, low bone density)
POINT tenderness at fracture site…. vs DIFFUSE tenderness for shin splints
