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Ortho - practice questions
- A 33-year-old man complains of left anterior shoulder pain for 4 weeks. The pain is made worse with overhead activities. On examination, you note maximal pain in the shoulder with palpation between the greater and lesser tubercle. Pain in the shoulder is exacerbated when the arm is held at the side, elbow flexed to 90° and the patient is asked to supinate and flex the forearm against your resistance. On the basis of this presentation, what is the most likely diagnosis? (A) rotator cuff tendonitis (B) myocardial infarction (C) anterior shoulder dislocation (D) rotator cuff tear (E) bicipital tendonitis ✔✔(E) bicipital tendonitis
- A 73-year-old woman presents to the emergency department following a fall in her home. She tripped over a throw rug, fell forward, and landed with her arms extended and hands outstretched. She presents complaining of left wrist pain. Radiographs reveal a dorsally angulated and displaced distal radius metaphyseal fracture. What is the most likely diagnosis? (A) Barton fracture (B) Colles fracture (C) Smith fracture (D) boxer fracture ✔✔(B) Colles fracture
- Idiopathic osteonecrosis of the femoral head is the most likely diagnosis in which of the following patients? (A) Five-year-old boy who complains of significant hip and knee pain (B) Six-year-old boy who reports a limp and aching in the groin and proximal thigh (C) Seven-year-old obese girl who manifests a painless limp (D) Twelve-year-old girl who complains of progressively worsening hip pain, fever, and chills (E) Eighteen-year-old boy who complains of bilateral hip pain that is worse in the morning and is relieved with activity ✔✔(B) Six-year-old boy who reports a limp and aching in the groin and proximal thigh
- A 22-year-old female person was playing basketball when she tripped and landed on the pavement with her hands outstretched. She presents complaining of abrasions on the right thenar eminence and "wrist pain." Physical examination reveals tenderness to palpation between the extensor pollicis longus and the extensor pollicis brevis. Assessment of the median, ulnar, and radial nerves reveals no sensor or motor changes when compared with the left hand. Radial and ulnar pulses are 2+ bilaterally with capillary refill less than 2 seconds on all five fingers of the right hand. Posterior-anterior view radiographs of the wrist and posterior-anterior wrist radiographs with the wrist in ulnar deviation reveal no fractures or dislocations. What is the appropriate management for this patient at this time? (A) immediate orthopedic referral (B) cock-up splint until symptoms resolve (C) physical therapy referral for assessment an ✔✔(D) thumb spica splint and repeat radiographs in 3 weeks
- A 53-year-old patient of Scandinavian descent presents with pain in the ring finger of the right hand. The patient states that he/she has pain when he/she extends his/her finger after making a fist. The finger will not extend on its own, requiring the patient to manually extend the finger, a maneuver that produces both an audible snap and considerable pain. What is the most likely diagnosis? (A) jersey finger (B) trigger finger (C) Dupuytren contracture (D) gamekeeper finger (E) ganglion cyst ✔✔(B) trigger finger
- A 27-year-old woman with no significant medical history presents complaining of left elbow pain for 3 days. The patient states that over the last 3 days, her left elbow has become increasingly red, swollen, and painful. The patient is left-hand-dominant. The patient is employed as a chiropractor, she is sexually active but denies a history of sexually transmitted infections. The patient is currently having her menses, denies any recent foreign travel, and acknowledges that while she regularly plays tennis, she does not recall any history of elbow
- You have been following a 52-year-old man with a complaint of back pain over the past 7 weeks. During the first 5 weeks of his condition, Abraham's back pain was steadily declining and his neurological findings on physical examination were decreasing. Over the past 2 weeks, Abraham has complained of worsening pain that is currently unrelenting, especially at night. On physical examination, Abraham demonstrates findings on both the straight leg raise and crossed straight leg raise tests. His muscle weakness has likewise accelerated over the past 2 weeks, and he is no longer able to heel walk using his left ankle. What is the most appropriate management strategy at this time? (A) conservative therapy including application of ice and physical therapy referral for muscle stretching and strengthening (B) plain radiographs of the spine (C) computed tomography (CT) of the spine (D) MRI of the spine ✔✔(D) MRI of the spine
- A 10-year-old boy is brought to the emergency department after falling during the recess at school. The patient states that he was running with a football when two of his classmates tackled him. He complains of pain in his right wrist. Radiographs reveal a fracture to the right radius. The fracture line runs diagonally from the epiphysis through the metaphyseal bone. By definition, how would you classify this patient's fracture? (A) Salter-Harris type I (B) Salter-Harris type II (C) Salter-Harris type III (D) Salter-Harris type IV (E) Salter-Harris type V ✔✔(B) Salter-Harris type II
- A 25-year-old man was involved in a motor vehicle accident (MVA) and complains of right leg pain. The car was traveling approximately 50 miles per hour when the driver lost control of the vehicle, causing it to leave the road and run head-on into a tree. 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 violently back against the patient's knees. On the basis of this mechanism of injury, what would you expect to find when you inspect the right leg? (A) flexed, abducted, and externally rotated (B) shortened, abducted, and externally rotated (C) shortened, abducted, and internally rotated (D) shortened and externally rotated (E) shortened, adducted, and internally rotated ✔✔(E) shortened, adducted, and internally rotated
- A 42-year-old automobile mechanic presents complaining of neck pain that radiates down the lateral aspect of his arm and into his left hand. The patient states that the pain has become progressively more constant over the past 3 weeks. He feels that he is "loosing strength" in his left hand and that parts of his left hand are feeling numb. He states that his symptoms seem to lessen when he places his hand on top of his head. Physical examination reveals vital signs that are within normal limits; no muscle atrophy or spasm are noted in the neck or upper extremities bilaterally. Sensory ability is diminished in the long finger on the left hand. Triceps muscle strength is 5/5 on the right and 4/5 on the left. Bicep strength is 5/5 bilaterally. Biceps and brachioradialis reflexes are +2 bilaterally, right-sided triceps reflex is 2+, and left-sided triceps reflex is 1+. On the basis of this presentation, what spinal r ✔✔(C) C
- A 7-year-old boy is brought to the emergency department after sustaining a fall onto his outstretched hand. He complains of pain involving the entire arm and refuses to move his arm, which is held in anatomical position with the elbow flexed at 90°. On physical examination, there is notable tenderness over the elbow with associated swelling and pain on attempted rotation. There is no apparent tenderness to palpation involving the wrist or shoulder. The child refuses to participate with range of motion evaluation. Radiographic evaluation of the elbow shows the presence of a positive posterior fat pad sign. What is the most likely diagnosis with this patient's presentation? (A) nursemaid elbow (B) lateral epicondylitis (C) medial epicondylitis (D) radial head dislocation (E) occult fracture of the radial head ✔✔(E) occult fracture of the radial head
- A 35-year-old man presents with complaints of swelling and pain in left knee. The patient states that he sustained a twisting injury in a basketball game 3 days ago. The injury did not take him out of the game; he was able to participate with minimal difficulty. Over the last 2 days, the pain has progressed. He notes a catching sensation and pain that is more medially located. On physical examination, the patient is found to have tenderness over the medial joint line and limited range of motion. Forced flexion and circumduction of the joint causes a painful click. What is the most likely diagnosis in this patient presentation?
(B) x-ray the left knee for comparison (C) obtain a CT scan of the right knee (D) obtain a magnetic resonance image of the right knee (E) reassure the parents and observe the patient for progression ✔✔(A) examine and x-ray the right hip
- An 8-year-old boy presents with complaint of a painful right wrist of 2 days' duration. The mother of the child reports that the child jumped off of a swing landing on his outstretched arms. He immediately complained of pain in the right wrist and now has some mild swelling on the radial aspect of the wrist. Radiographic evaluation of the wrist presents an area of impaction on the distal radius, with a slight bend in the opposing cortex. Which of the following best describes this type of pediatric fracture? (A) greenstick fracture (B) torus fracture (C) plastic deformation (D) radial neck fracture (E) Monteggia fracture ✔✔(B) torus fracture
- A 39-year-old woman presents with complaints of pain in her left foot of 4 weeks' duration. The patient works as a cashier in a department store, which requires her to be on her feet for long periods. She notes that the pain is most severe on the bottom of her foot and is worse upon arising in the morning and then it subsides with ambulation. The patient has a benign medical history and no other complaints. Which of the following is the most likely diagnosis of this patient? (A) heel spur (B) Achilles tendonitis (C) tarsal tunnel syndrome (D) plantar fascitis (E) posterior tibial nerve entrapment ✔✔(D) plantar fascitis
- A 17-year-old boy presents with complaints of pain located in his fifth digit. He was involved in an altercation and states that his hand was injured from punching someone. On physical examination of the patient's hand, there is tenderness, swelling, and pain with extension. The patient is diagnosed with a "boxer fracture." What radiographic finding would be present to
diagnose this patient? (A) spiral fracture of the third metacarpal (B) fracture of the fourth metacarpal (C) fracture of the fifth metacarpal (D) comminuted fracture of the distal phalanx of the fifth digit (E) comminuted fracture of the distal phalanx of the fourth digit ✔✔(C) fracture of the fifth metacarpal
- Which of the following best defines the deformity that causes a "mallet finger"? (A) rupture or avulsion of the insertion of the extensor tendon at the base of the distal phalanx (B) rupture or avulsion of the insertion of the flexor tendon at the base of the distal phalanx (C) fracture of the distal phalanx (D) dislocation of the distal interphalangeal joint (E) fracture of the proximal phalanx ✔✔(A) rupture or avulsion of the insertion of the extensor tendon at the base of the distal phalanx
- A 10-year-old boy presents to the emergency department status post a fall from his bicycle. The patient complains of pain located in his right knee with an associated 2 cm × 2 cm abrasion just inferior to the patella. There is no swelling noted of the knee. The child is not cooperative with examination of the extremity. Radiographs are taken of the right knee, and there is no finding of fracture or joint changes. Incidentally, a lesion is noted at the distal femur, described as a pedunculated bone mass capped in cartilage. With this finding, what is the most likely diagnosis? (A) osteoid osteoma (B) chondroblastoma (C) osteosarcoma (D) osteochondroma (E) Ewing sarcoma ✔✔(D) osteochondroma
- A 39-year-old woman presents with complaints of left anterior knee pain of 4 weeks' duration. She has noted difficulty with going up and down the staircase. The patient also notes increased pain in the knee upon arising after being seated for a period. The pain may then improve with walking. The patient denies joint crepitus or locking sensation. On physical examination, there is no swelling or obvious joint distortion. The pain is reproduced with placing the knee in slight flexion and gentle pressure placed on the patella as the patient
e. Fracture through the physeal plate only ✔✔Fracture through the physeal plate and epiphysis 27.All of the following are used in the management of fractures except a. Open reduction internal fixation b. Splinting c. Closed reduction d. RICE e. Traction ✔✔d. RICE 28.A potentially serious problem that leads to vascular compromise in patients with casts is a. Overdose of viagra b. Nonunion c. Bunion d. Compartment syndrome e. Osteomyelitis ✔✔d. Compartment syndrome 29.What is the most likely type of fracture that occurred in question number 7 where Tom beat the person with his "night stick"? a. Transverse fracture b. Stress fracture c. Spiral/oblique fracture d. Segmental fracture e. Comminuted fracture ✔✔a. Transverse fracture 30.Which of the following is NOT true of osteoarthritis? a. Recreational running does not increase incidence b. A key component is inflammation of symmetrical joints c. It is characterized by articular stiffness that lasts less than 15 min d. Obesity is a risk factor for development. e. It is the most common form of joint disease. ✔✔b. A key component is inflammation of symmetrical joints
31.Which of the following diseases has been demonstrated to reduce life expectancy? a. Rheumatoid arthritis b. Osteoarthritis c. Gout d. Degenerative joint disease e. Chondrocalcinosis ✔✔a. Rheumatoid arthritis 32.A 50-year-old man who is employed as a fire fighter presents with complaints of right arm pain x 1 mo. The pain is aggravated by sneezing, coughing, and raising the arm up to the shoulder. Exam reveals a decrease in the biceps reflex on the right side. Based on the history and physical findings, what is the likely diagnosis? a. Cervical spondylosis b. Cervical strain c. Thoracic outlet syndrome d. Chondrocalcinosis e. Herniated cervical nucleus pulposus ✔✔e. Herniated cervical nucleus pulposus
- What is the appropriate treatment of a patient with herniated cervical nucleus pulposus? a. Referral to surgery b. Bed rest and NSAIDs c. Epidural steroid injection d. Bracing e. Steroid injection into the facet joint ✔✔b. Bed rest and NSAIDs 34.A 21-year-old patient arrives in the emergency department with a leg injury secondary to an MVA. X-ray examination reveals a fracture of the tibia. You note that there is a large free-floating piece of bone between well-defined fracture lines superior and inferior to it. This would be most correctly described as a _____ fracture. a. Segmental b. Comminuted c. Spiral d. Torus
39.A 24-year-old patient presents after a skiing injury to the left knee the night before. Choose the correct statement concerning knee injuries. a. History of painful locking points toward cruciate tear b. The medial meniscus is more likely to be torn than the lateral c. Think of posterior cruciate tears if the patient hears a "pop" with the injury d. Tests like the McMurray test accurately identify a torn meniscus over 90% of the time e. The anterior drawer test is most sensitive in diagnosing anterior cruciate tears ✔✔b. The medial meniscus is more likely to be torn than the lateral 40.The preferred initial treatment for a wrist ganglion is a. Forceful compression with a book b. Injection with steroids c. Aspiration and chemical cauterization d. NSAIDs e. Surgical excision ✔✔c. Aspiration and chemical cauterization 41.A 30-year-old man presents with left shoulder pain. There is no history of acute injury, but the patient participates in several sports. Examination reveals tenderness approximately 2 cm below the tip of the acromion. There is also pain in the left shoulder as the patient supinates against resistance. What is the most likely diagnosis? a. Rotator cuff tear b. Adhesive capsulitis c. Rotator cuff tendinitis d. First-degree sprain of AC joint e. Bicipital tendinitis ✔✔e. Bicipital tendinitis 42.A patient with adhesive capsulitis a. Complains of decreased ROM of the shoulder b. Is likely to be elderly c. Often is unable to raise the arms above the head d. Demonstrates a decrease in passive ROM
e. All of the above ✔✔e. All of the above 43.Which statement is true concerning spinal tumors? a. Spinal tumors are common bone tumors b. Pain made worse with activity suggests a tumor c. Multiple myeloma is the most common malignant primary bone tumor d. Although common, tumors in the vertebral body are usually benign e. Most spinal tumors in people under 21 years of age are malignant ✔✔c. Multiple myeloma is the most common malignant primary bone tumor 44.Which of the following is the most common cause of low back pain in children and adolescents? a. Scoliosis b. Herniated lumbar disc c. Spondylolysis d. Spondyloesthesis e. Spinal stenosis ✔✔c. Spondylolysis 45.Painless, hard nodules located at the PIP joints on the hand of a 58-year-old laborer are probably associated with a. Rheumatoid arthritis b. Reiter syndrome c. Osteoarthritis d. Tophaceous gout e. Ankylosing spondylitis ✔✔c. Osteoarthritis 46.A 32-year-old female patient with a positive Tinel test should also demonstrate a. Numbness of the 4th and 5th digits b. Decreased ulnar nerve conduction velocities c. A positive Finkelstein test d. Thenar atrophy e. Weakness of wrist ✔✔d. Thenar atrophy
b. flexor tenosynovitis c. de Quervain's disease d. carpal tunnel syndrome cubital tunnel syndrome ✔✔c. de Quervain's disease 5 1. A 34-year-old male presents with complaints of increasing swelling and pain in his left knee since a basketball game yesterday. He states that during the game he twisted his knee and had some discomfort, but was able to keep playing. This morning he awoke with increased swelling and pain as well as difficulty bending the knee. He states that the knee appears to "lock up" on him. On physical examination, there is moderate swelling of the left knee with tenderness to palpation along the medial joint line with limited range of motion, especially in extension. Pain and swelling prohibit any further examination at this time. The most likely diagnosis is a. medial meniscus tear b. patellar tendon rupture c. fracture of the tibial plateau d. medial collateral ligament tear e. anterior cruciate ligament tear ✔✔a. medial meniscus tear 52.Of the following, the most accurate technique for evaluation of a possible injury to the anterior cruciate ligament is the a. Lachman test b. McMurray test c. valgus-varus stress d. anterior drawer sign e. posterior drawer sign ✔✔a. Lachman test 53.A 12-year-old obese male presents with complaints of pain in the right knee. He describes it as an aching pain located in his knee that has affected his walking for the past month. He states the pain gets better with rest. On physical examination you note a slight limp to his gait, but examination of the right knee is unremarkable. X-rays of the right knee are normal. Of the following, the most appropriate next step is to a. order a skeletal survey b. examine and x-ray the right hip c. obtain a CT scan of the patella d. order blood work for juvenile arthritis
e. reassure the parents that nothing serious is present ✔✔b. examine and x-ray the right hip 54.Of the following, the most appropriate next step in management of a reduced traumatic knee dislocation is a. ice and rest for several days b. crutches with weight bearing to tolerance c. immediate vascular referral and evaluation d. immobilization with a splint until pain is relieved e. active physical therapy program for range of motion exercises ✔✔c. immediate vascular referral and evaluation 55.A 24-year-old manual laborer presents complaining of low back pain secondary to lifting a heavy box at work yesterday. Initially he had no complaints, but the following day he was stiff and sore. His supervisor sent him in today for further evaluation. He denies any radiation of the pain, numbness, or difficulty with urination. He denies any previous history of back complaints. On physical examination, you note mild paravertebral muscle spasm and slight decrease in range of motion in all spinal movements. Deep tendon reflexes are equal bilaterally and there are no sensory deficits noted. Of the following, the next most appropriate intervention is to a. order an MRI of the lumbar spine b. order plain x-rays of the lumbosacral spine c. return the patient to work without any limitations d. refer the patient for transcutaneous electrical nerve stimulation (TENS) e. initiate a short period of rest, analgesia, and progress ✔✔e. initiate a short period of rest, analgesia, and progressive functional program 56.A new military recruit in the second week of boot camp is seen in the infirmary with complaints of "shin splints." On physical examination, there is tenderness to palpation over the anterior portion of the tibia. X-rays of the lower legs are negative for fracture. If the pain is unrelieved by conservative management, the next most appropriate diagnostic evaluation is to order a. an MRI b. a CT scan c. a bone scan d. an ultrasound e. repeat plain x-rays in 1 week ✔✔c. a bone scan 57.Which of the following is most consistently seen in Osgood-Schlatter disease?
a. Supraspinatus b. Infraspinatus c. Teres minor d. Suprascapularis e. Subscapularis ✔✔d. Suprascapularis 62.What is the most common bone fractured? a. Sternum b. Clavicle c. Radius d. Scaphoid e. Tibia ✔✔b. Clavicle 63.Thumb extension (hitchhiking) is tests which of the following nerves? a. Radial b. Ulnar c. Median d. Brachial e. Both A and B ✔✔a. Radial 64.The most classic finding in de Quervain tenosynovitis is a positive ________ test? a. Phalen's b. Finkelstein's c. Tinel's d. Yergason's e. Apprehension ✔✔b. Finkelstein's 65.What knee ligament or ligaments prevents valgus angulation of the knee? a. ACL b. PCL
c. MCL d. LCL e. Two of these ✔✔c. MCL 66.The most common injury to the knee requiring surgery would be a. ACL tear b. Meniscal tear c. Fracture of patella d. PCL tear e. Patellar tendonitis ✔✔b. Meniscal tear 67.The unhappy triad consists of which of the following? a. ACL tear b. MCL tear c. Medial meniscal tear d. A and C e. All of the above ✔✔e. All of the above 68.This type of injury occurs due to varus force on the knee and is uncommon a. MCL sprain b. LCL sprain c. ACL sprain d. PCL sprain e. Patella sprain ✔✔b. LCL sprain 69.A positive McMurray sign may be associated with which of the following injuries? a. ACL tear b. Meniscal tear c. PCL tear d. Patella tendonitis
