Ortho practice

Question 1

A pt with a Hx of rheumatoid arthritis presents with hip pain and limping with severely limited ROM. Crescent sign is present on XR, and MRI confirms this diagnosis (gold standard). What is this condition?
a) Greater Trochanteric Pain Syndrome
b) Avascular Necrosis (AVN) of the Hip
c) Osteoarthritis
d) Bursitis

Answer 1

b) Avascular Necrosis (AVN) of the Hip

Question 2

A pt whose occupation is cleaning houses has swelling over their anterior knee, but ROM isn’t causing them any pain. What is the best next step?
a) XR
b) Aspiration
c) Steroid injections
d) NSAIDs

Answer 2

d) NSAIDs

(pt has Knee Bursitis; aspiration can also work if refractory or worried abt septic joint)

Question 3

Which test is for MCL tear?
a) Anterior drawer
b) Posterior drawer
c) Varus
d) Valgus
e) Lachman’s

Answer 3

d) Valgus

Question 4

McMurray’s test: if you Internally rotate ankle and extend the knee, you are testing the _________ meniscus
a) lateral
b) medial

Answer 4

a) lateral

Positive with click (heard or felt) or joint line pain

Question 5

A pt with a BMI of 37 presents with non-traumatic pain over the bottom of the foot that is worse after rest and with dorsiflexion of toes. XR shows pes planus (flat floot) and a calcaneal spur. Which is NOT a first line Tx?
a) Orthotic inserts (arch supports)
b) Physical therapy
c) Steroid injections
d) NSAIDs

Answer 5

c) Steroid injections

(pt has Plantar Fasciitis)

Question 6

What tendon is clinically the most important part of the rotator cuff?
a) Supraspinatus
b) Infraspinatus

Answer 6

a) Supraspinatus

Question 7

Which is incorrect about shoulder conditions?
a) Rotator cuff tendinopathy may or may not cause weakness, but will cause pain
b) Rotator Cuff Tendinopathy can be diagnosed with MRI
c) Diabetes is a risk factor for adhesive capsulitis
d) Steroid injections are not an option for both rotator cuff tendinopathy and adhesive capsulitis

Answer 7

d) Steroid injections are not an option for both rotator cuff tendinopathy and adhesive capsulitis

Question 8

Which involves the extensor carpi radialis brevis tendon and causes pain with resisted wrist extension? (hint: steroid injection can help)
a) Lateral epicondylitis
b) Medial epicondylitis

Answer 8

a) Lateral epicondylitis

Question 9

De Quervain’s tenosynovitis is also known as ____________ and can be tested for with Finkelstein’s test
a) Stenosing Tenosynovitis
b) Radial Styloid Tenosynovitis
c) Palmar Fibromatosis
d) Carpal Tunnel Syndrome

Answer 9

b) Radial Styloid Tenosynovitis

(Tx w NSAIDs & Thumb spica brace (splint)
Stenosing Tenosynovitis = “trigger finger”
Palmar Fibromatosis = “Dupuytren’s Contracture”

Question 10

Which can be treated with Xiaflex (collagenase) injection and can cause loss of extension? (important)
a) Stenosing Tenosynovitis
b) Radial Styloid Tenosynovitis
c) Palmar Fibromatosis
d) Carpal Tunnel Syndrome

Answer 10

c) Palmar Fibromatosis

Question 11

Which is present in both carpal tunnel syndrome and radial styloid tenosynovitis?
a) Numbness/tingling in the median nerve distribution
b) Worse at night, waking up to shake their hands
c) Grip weakness
d) Dropping objects
e) Thenar atrophy (late stage)

Answer 11

c) Grip weakness

Question 12

Positive straight leg raise, hyporeflexia, and lower back + LE pain without bladder Sxs would be expected with what?
a) DDD
b) Acute HNP
c) Lumbar Strain
d) Cauda Equina Syndrome

Answer 12

b) Acute HNP

Question 13

Cauda Equina Syndrome requires STAT MRI, then urgent surgical decompression is preferred within 6–8 hours; up to ____ hours is usually acceptable
a) 12
b) 24
c) 48
d) 72

Answer 13

c) 48

Question 14

A child athlete presents with Spondylolysis due to a stress fracture at the pars interarticularis. Where is the most common location for this to occur?
a) C5
b) T5
c) L5
d) L4

Answer 14

c) L5

Question 15

Scottie dog sign on oblique view XR indicates what?
a) Spondylolysis
b) Spondylolisthesis
c) Ankylosing Spondylitis
d) Vertebral Compression Fracture

Answer 15

a) Spondylolysis

Question 16

Which is used to measure spondylolisthesis before bracing PRN and PT?
a) U/S
b) XR
c) CT
d) MRI

Answer 16

b) XR

CT: confirm fx
MRI: neuro deficits

Question 17

A pt presents with SI joint pain that’s recently progressed to chronic LBP (lower back pain), restricted ROM, and new-onset IBD. Testing shows positive HLA-B27 and elevated ESR/CRP. XR shows “bamboo spine”. Which of the following are second-line treatments? Select all that apply
a) NSAIDs
b) PT
c) Infliximab
d) Etanercept
e) Adalimumab

Answer 17

c) Infliximab
d) Etanercept
e) Adalimumab

(PT and NSAIDs are first line Txs, TNF inhibitors are second line)

Question 18

Cervical __________ can cause gait abnormalities
a) radiculopathy
b) myelopathy
c) neuropathy

Answer 18

b) myelopathy

Question 19

Idiopathic Scoliosis: When should you get an MRI to r/o tumor or spinal pathology?
a) Convex right thoracic curve
b) Convex left thoracic curve

Answer 19

b) Convex left thoracic curve

Question 20

Risser stages measure what?
a) Severity of scoliosis angle
b) Presence of cervical radiculopathy
c) Indirect measure of skeletal maturity based on bone age scan
d) Indirect measure of skeletal maturity based on iliac crest apophysis ossification/fusion

Answer 20

d) Indirect measure of skeletal maturity based on iliac crest apophysis ossification/fusion

Question 21

Which range of scoliosis curve degrees is usually eligible for bracing?
a) 0-25 degrees
b) 25-50 degrees
c) 50-90 degrees

Answer 21

b) 25-50 degrees

Question 22

If a pt presents with a lower extremity fracture, they can generally expect to need immobilization for _________
4 weeks
6 weeks
8 weeks
12 weeks

Answer 22

8 weeks

Upper extremity = 6 weeks

Question 23

“Communated” describes what about a fracture?
a) Number of fracture fragments
b) Relationship of one fragment to another
c) Direction of fracture line
d) Open to the atmosphere

Answer 23

a) Number of fracture fragments

Question 24

Which type of anterior shoulder dislocation involves a greater tuberosity compression fracture?
a) Hill-Sachs lesion
b) Bankart lesion
c) Both of the above

Answer 24

a) Hill-Sachs lesion

(Bankart lesion = Glenoid fracture)

Question 25

A 5 year old experiences a FOOSH with a hyperextended elbow. Anterior fat pad sign (sail sign) on XR is present. What is the best Tx? a) Closed reduction/ K wire fixation b) ORIF

Answer 25

a) Closed reduction/ K wire fixation (pt has a Supracondylar Humerus Fracture; ORIF if adult)

Question 26

On XR you think a pt has a Radial Head Fracture, but you’re not sure. How would you verify this? a) U/S b) MRI c) CT d) Repeat XR

Answer 26

c) CT

Question 27

Which is a distal radius fracture with dorsal angulation due to FOOSH mechanism with extended wrist? a) Colles Fracture b) Smith Fracture

Answer 27

a) Colles Fracture

Question 28

An ulnar gutter splint with the wrist extended and 4th and 5th MCP flexed is the appropriate Tx for what? a) Colles Fracture b) Smith Fracture c) Boxer’s Fracture d) Scaphoid Fracture

Answer 28

c) Boxer’s Fracture (Scaphoid fracture = Thumb spica splint)

Question 29

“Internally rotated and adducted” describes the more common hip dislocation direction, which is what? a) Anterior b) Posterior

Answer 29

b) Posterior

Question 30

Normal ABI is ____ and above (higher in the ankle)

Answer 30

1.3 Emergent vascular surgeon consult for signs of vascular compromise or ABI below 0.9

Question 31

Fractures of the _______________ usually involve Lisfranc complex injury; CT is usually ordered or pre-op planning a) 2nd metatarsal base b) 2nd metatarsal head c) 4th metatarsal base d) 4th metatarsal head

Answer 31

a) 2nd metatarsal base