Surgery-MSK/Rheumatology

Question 1

Examination for MCL injury

Answer 1

• Valgus stress test

Question 2

Examination for ACL injury

Answer 2

• Anterior drawer test

- Lachman test

Question 3

Examination for Meniscal tear

Answer 3

• Thessaly test

- McMurray test

Question 4

Place knee at 30 degrees flexion, stabilize distal femur with 1 hand & pull proximal tibia anteriorly with the other laxity of tibia- what test is this & evaluate what injury

Answer 4

• Lachman test

- ACL injury

Question 5

Passive knee flexion and extension while holding the knee in internal or external rotation, pain, clicking, or catching indicates __________, what test is it?

Answer 5

• McMurray test

- Meniscal tear

Question 6

Pt stands on 1 leg with knee flexed 20degrees, pt then internally and externally rotates on flexed knee. What test is it? to test what injury?

Answer 6

• Thessaly test

- Meniscal tear

Question 7

Stabilize lateral thigh, apply abduction force to lower leg laxity indicates ______ injury & called

Answer 7

• MCL injury

- Valgus stress test

Question 8

Risk factors for stress fracture (5)

Answer 8

• repetitive activites
• abrupt increase in physical activity
• inadequate calcium and vit D intake
• decreased caloric intake
• Female athlete triad: low caloric intake, hypomenorrhea/amenorrhea, low bone density

Question 9

Clinical presentation of stress fracture (3)

Answer 9

• insidious onset of localized pain
• point tenderness at fracture site
• possible neg x-ray in the first 6 weeks

Question 10

Management of stress fracture

Answer 10

• 1st tx- rest and simple analgesics
• reduce weight bearing for 4-6 weeks
• referral to orthopedic surgeon for fracture at high risk of malunion (eg. anterior tibial cortex, 5th metatarsal)

Question 11

Caused by repeated tension or compression without adequate rest and occur most commonly in athletes or other who suddenly increase their activity & x-ray is usually normal

Answer 11

Tibial stress fractures

Question 12

Pt with uncomplicated MCL tear can be managed?

Answer 12

nonoperatively with rest, ice, compression, elevation (RICE measures) and analgesics

Question 13

The most sensitive test for MCL tear diagnosis is

Answer 13

MRI

Question 14

Cause of meniscal tears in younger pt

Answer 14

rotational force on planted foot

Question 15

Cause of meniscal tears in older pt

Answer 15

degeneration of meniscal cartilage

Question 16

Acute “popping” sensation, catching, locking, reduced ROM, Slow onset joint effusion, joint line tenderness

Answer 16

Meniscal tears

Question 17

Diagnostic for meniscal tears (2)

Answer 17

MRI & Arthroscopy

Question 18

Management for mild meniscal tears in older pt

Answer 18

rest, activity modification

Question 19

Management for meniscal tears with persistent symptoms and impaired activities

Answer 19

Surgery (in younger pt)

Question 20

Pain with abduction, external rotation of shoulder

Answer 20

Rotator cuff impingement or tendinopathy

Question 21

Subacromial tenderness

Answer 21

Rotator cuff impingement or tendinopathy

Question 22

Physcial examination for rotator cuff impingement or tendinopathy

Answer 22

Neer

Hawkins

Question 23

Weakness with external rotation of shoulder in >40 years old

Answer 23

Rotator cuff tear

Question 24

Decreased passive and active range of motion with more stiffness than pain of the shoulder

Answer 24

Adhesive capsulitis (frozen shoulder)

Question 25

Anterior shoulder pain, pain with lifting, carrying or overhead reaching

Answer 25

Biceps tendinopathy/rupture

Question 26

Usually caused by trauma, gradual onset of anterior or deep shoulder pain, decreased active and passive abduction and external rotation

Answer 26

Glenohumeral osteoarthritis

Question 27

DDX for hip pain in middle-aged adult (5)

Answer 27

• Infection
• trauma
• arthritis
• bursitis
• radiculopathy

Question 28

Middle-aged adult with superficial unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh (as when lying on the affected side in bed) suggests

Answer 28

Trochanteric bursitis

Question 29

A synovial sac that alleviates friction at bony prominence and ligamentous attachments

Answer 29

Bursa

Question 30

Anterior knee pain, tenderness, erythema and localized swelling, and common in occupations requiring repetitive kneeling

Answer 30

Prepatellar bursitis “housemaid’s knee”

Question 31

Common bacteria that infect the bursa via penetrating trauma, repetitive friction or extension from local cellulitis in prepatellar bursitis

Answer 31

Staphlococcus aureus

Question 32

Complications of Supracondylar fracture of the humerus (4)

Answer 32

• Brachila artery injury
• Median nerve injury
• cubitus varus deformity
• compartment syndrome/Volkmann ischemic contracture

Question 33

Most common way to cause supracondylar fracture of the humerus

Answer 33

Fall on an outstretched hand (more in pediatric)

Question 34

Ischemia and infarction from compartment syndrome in the arm can lead to

Answer 34

Volkmann contracture

Question 35

Fracture of marrow-containing bone (femur), orthopedic surgery and pancreatitis can lead to

Answer 35

Fat embolism syndrome

Question 36

Clinical triad: Respiratory distress, neurologic dysfunction and petechial rash

Answer 36

Fat embolism syndrome

Question 37

Pt with clavicle fracture should get

Answer 37

Angiogram;

To evaluate neurovascular (brachial plexus and subclavian artery) involvement

Question 38

The most commonly injured muscle due to degeneration of the tendon with age and repeated ischemia induced by impingement between the humerus and the acromion during abduction

Answer 38

Supraspinatus

Question 39

+ drop arm test indicates

Answer 39

Supraspinatus tear - weakness of abduction

Question 40

Test used to confirm supraspinats tear

Answer 40

MRI

Tx- surgery