Questions from lecture Flashcards
A 62 y/o male complains of low back pain that radiates from his back down into his buttock and into his right leg. On PE, you note sensory loss on the lateral aspect of the right foot, decreased ability to perform a toe walk on the right side and a decreased Achilles reflex. The straight leg raise test elicits pain at 45% elevation. On the basis of this information, between which pair of vertebrae is the disc herniation most likely to have occurred?
L2-L3 L3-L4 L4-L5 L5-S1 S1-S2
E
A 24-year-old presents with low back pain of 2 days duration. The patient is a manual laborer and reports lifting a heavy box while at work the previous day. Initially, the patient had no complaints, but the following day, stiffness and pain began. The patient denies radiation of the pain, numbness or difficulty with urination. On exam, there is paravertebral muscle spasm and slight decrease in range of motion of the spine. Deep tendon reflexes are equal bilaterally, and no sensory defects are noted. Which of the following is the most appropriate intervention?
a) MRI of lumbar spine
b) Plan x-rays of lumbar spine
c) Return the patient to work with no limitations
d) Refer the patient for trigger point injections
e) Initiate a short period of rest, analgesia, and progressive functional use
E
Which of the following clinical manifestations is most characteristic of polymyalgia rheumatica (PMR)?
a) Subcutaneous inflammatory lesions
b) Abrupt onset of proximal muscle pain + stiffness in shoulder and pelvic girdle
c) Insidious onset of symmetrical joint involvement
d) Widespread musculoskeletal pain and tender points
e) Symmetrical weakness initially in the legs that progresses caudally
B
NOT A: this is erythema nodosum
NOT C: insidious= RA
NOT D: widespread and trigger points=fibromyalgia
NOT E: GB
Which of the following conditions is strongly associated with systemic sclerosis (scleroderma)?
a) Polymyositis
b) Reactive arthritis
c) Dermatomyositis
d) Sjogren’s disease
e) Raynaud’s phenomenon
E
Patients diagnosed with Sjogren syndrome should be counseled to avoid which of the following classes of medications?
A) Penicillins B) Decongestants C) Antihistamines D) Corticosteroids E) Fluoroquinolones
B–bc decongestants will decrease saliva
The diagnosis of SLE is reported by a positive initial antibody screen; however, the test is not specific. Which of the following tests is most specific in the diagnostic eval of SLE?
a) Gliadin antibody
b) Anti-dsDNA
c) Antinuclear antibody (ANA)
d) Anticentromere antibody
e) Antiribosomal P antibody
B
**anti-smith antibodies also specific for SLE
NOT ANA because that is not specific to SLE
Which of the following clinical manifestations is associated with systemic disorders that are HLA-B27 related, including ankylosing spondylitis, reactive arthritis, psoriasis and Bechet syndrome?
a) Uveitis
b) Dysentery
c) Vasculitis
d) Hyperuricemia
e) Thoracic involvement
A
A 40-year-old female has a 2-year history of Raynaud’s phenomenon. She now has heartburn and dysphagia to both solids and liquids. Vital signs are normal. Examination shows thickening of the skin of the fingers with loss of the creases. Which of the following is the most likely diagnosis?
a) Sjogren’s syndrome
b) Achalasia
c) Squamous cell carcinoma of the esophagus
d) Carcinoma of the lung with paraneoplastic syndrome
e) Scleroderma
E
A 52-year-old male has a 4-month history of progressive exertional breathlessness without associated cough or angina pectoris. He now has dysphagia to both solids and liquids. Blood pressure is 140/90 Hg sitting; pulse, 96 / min / regular; and respiratory rate, 28 / min. Examination shows thickening of the skin of the face and hands. Telangiectasia are noted on the face. Chest radiograph shows diffuse pulmonary fibrosis. Which of the following is the most likely diagnosis?
Sarcoidosis Chronic pulmonary embolic disease Asbestosis Scleroderma Silo-Filler’s disease
Scleroderma
A patient with systemic lupus erythematosus has a rash in the malar area and on the extremities. Which of the following is the appropriate counseling to be given to the patient?
Apply coal tar and salicylate gel topically on a weekly basis Avoid direct sunlight Avoid sunscreen preparations Take weekly cornstarch bath Avoid hydrocortisone topical medications
avoid direct sunlight
In a neonate, unequal thigh folds may indicate which of the following?
A. Coxa vara
B. Legg-Calve-Perthes disease
C. Developmental hip dysplasia
D. Slipped capital femoral epiphysis
C
NOT B– thats a painless limp kids 4-10 YO due to avasc necrosis
NOT D= SCFE fx primarily in adolescents obese
An obese 15-year-old male presents with complaint of a limp and right knee pain for two weeks. He denies recent trauma or history of previous injury. Physical examination of the right knee is unremarkable. Examination of the right hip reveals pain with passive range of motion and limited internal rotation and abduction. Flexion of the hip results in external rotation of the thigh. Gait is antalgic with the right hip externally rotated. Which of the following radiographic findings supports the most likely diagnosis?
Displacement of the femoral epiphysis
Irregularity and fragmentation of the joint space
Capsular swelling of the joint
Dislocation of the hip
Displacement of the femoral epiphysis
— bc this PT has a SCFE
A 14-year-old male who is overweight presents with complaints of left knee and anteromedial thigh pain for the past month. He states the pain gets better with rest and denies any known trauma. On examination of the gait, a slight limp is noted. X-ray films of the left knee are normal. The most likely diagnosis is:
Genu valgum
Legg-Calve-Perthes disease
Osgood-Schlatter disease
Slipped capital femoral epiphysis
SCFE
A 12-year-old male has been limping for the past 2 months. Exam reveals a moderately obese young male in no acute distress who complains of pain in his left hip region. There is a limitation of internal rotation of the hip with a 2-cm left limb discrepancy as compared to the right. What is the most appropriate diagnostic test?
A. AP and lateral radiographs of the left hip
B. AP pelvic films
C. frog leg view of both hips
D. weight-bearing MRI of the left hip
C–frog leg
A 14-year-old male presents with anterior knee pain and swelling that gets worse after soccer games. The patient reports no trauma to the knee. On exam, knee range of motion is normal but the patient is tender to palpation over the tibial tubercle. What is the most likely diagnosis?
A. Chondromalacia patella
B. Medial collateral ligament tear
C. Osgood-Schlatter disease
D. Prepatellar bursitis
C
A 25 y/o man was involved in a MVA and complains of right leg pain. At the time of the accident, he was sitting in the passenger side of the front seat. The force of the collision caused the dashboard to be driven back against the patient’s knees. On the basis of the mechanism of injury, what would you expect to find when you inspect the right leg?
Flexed, abducted and externally rotated
Shortened, abducted and externally rotated
Shortened, abducted and internally rotated
Shortened and externally rotated
Shortened, adducted, and internally rotated
E— bc its a hip dislocation
***hip fx=shortened, abducted and externally rotated
What is a typical radiographic finding that supports a diagnosis of a Lisfranc dislocation-fracture?
An AP view which reveals lateral shift of the second metatarsal off the middle cuneiform
Do boys or girls typically develop slipped capital femoral epiphysis at a younger age?
girls. Girls typically present at a younger age (10-14) versus boys (12-16)
A 59-year-old man presents to your ED with severe left knee pain that started the previous evening and became worse overnight, waking him up early this morning. He denies having anything like this before. He denies any trauma to the knee or onset with activity. He states he drinks a glass of whiskey daily and enjoys red meat. The knee is swollen, red, exquisitely warm, and has a limited range of motion in both passive and active phases. Vital signs are within normal limits.
ESR and CRP are slightly elevated. You decide to tap the knee for synovial fluid, which shows a white count of 40,000 with neutrophil predominance and negatively birefringent crystals in polarizing light microscopy. Gram stain of the fluid is negative and culture is pending. Given these findings, which of the following treatments should be initiated next?
A) Allopurinol B) Joint aspiration and intra-articular triamcinolone C) Oral colchicine D) Oral indomethacin E) Oral prednisone
D
CRYSTAL ARTHROPATHY
Acute Treatment
1. NSAIDS (not ASA)
2. Corticosteroids (if refractory to NSAIDS or NSAIDS contraindicated). Can be injected into joint OR oral
3. Colchicine (if NSAIDS and steroids don’t work)
Prophylaxis
- Avoid purine rich foods
- Allopurinol -> decreased uric acid production
- Uricosuric drugs (Probenecid) -> increased urine excretion of uric acid
- Colchicine (lower doses)
A 37-year-old woman has been taking prednisone for 4 years as therapy for rheumatoid arthritis. Bone density study now shows significant osteopenia. In addition to oral calcium supplementation, which of the following is recommended?
Initiate therapy with a thiazide diuretic Initiate therapy with fluoride Initiate therapy with a bisphosphonate Obtain 24-hour urinary calcium level Initiate high-protein diet
Initiate therapy with a bisphosphonate
A 57-year-old female is to begin alendronate as treatment for osteoporosis. Which of the following instructions should be given to the patient?
Take the medication at bedtime
Do not eat for 60 minutes after taking the medication
Take medication with an aluminum-containing antacid
Stand or sit upright for 30 minutes after taking the medication
Check daily for signs of purpura
Stand or sit upright for 30 minutes after taking the medication
**why? because this drug can cause bad esophagitis
A 13 year-old girl reports two weeks of worsening right knee pain with no history of antecedent injury or recent trauma. She reports frequent episodes of nighttime awakening with knee pain in the past two weeks. Examination of the knee reveals edema and a tender mass over the anterior proximal right tibia. Her knee exam is otherwise within normal limits. Radiographs of the right knee show a lytic mass with a multi-laminated periosteal reaction involving the proximal anterior tibia. What is the most likely diagnosis?
Ewing sarcoma
Osteochondroma
Multiple myeloma
Osteoid osteoma
Ewing sarcoma
-xray findings explain onion skin
A 12 year-old male presents with pain in his left leg that is worse at night. NSAIDs relieve the pain and the patient denies injury. On examination, there is point tenderness over the tibia, and the patient has a slight limp that favors the left leg. Radiographs show a 1 cm radiolucent nidus surrounded by osteosclerosis. Which of the following is the most likely diagnosis?
Osteosarcoma
Legg-Calve-Perthes disease
Osgood-Schlatter disease
Osteoid osteoma
Osteoid Osteoma
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following?
Ehlers-Danlos syndrome
Marfan syndrome
Achondroplasia
Osteogenesis imperfecta
Osteogenesis imperfecta
In what age group are physeal
injuries most common?
12-15 boys
9-12 girls
What is the classic description of ankylosing spondylitis?
insidious onset of bilateral buttock pain (sacroiliitis), thoracolumbar pain (enthesitis), and morning lumbar stiffness that lessens with exercise. Most commonly seen in young men.
