Orthopedics

22 Questions | Total Attempts: 86

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Orthopedics

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Questions and Answers
  • 1. 
    • A. 

      Resection of the mass

    • B. 

      Avoidance of activity until resolution of pain

    • C. 

      Biopsy of the mass to rule out neoplasm

    • D. 

      Aspiration of the hematoma to relieve pain

    • E. 

      MRI of the right arm and shoulder

  • 2. 
    During a regularly scheduled health maintenance visit, an 11 year old female is noted to have scoliosis.  Which of the following statement concerning scoliosis is true?
    • A. 

      The primary cause of scoliosis is always related to a spinal abnormality

    • B. 

      Scoliosis is one of the few orthopedic problems without a genetic component to its etiology

    • C. 

      Curves of >/= 12 degrees have much more of a chance of progression than do curves

    • D. 

      The time to peak progression of the curve occurs immediately following the time of peak height velocity

    • E. 

      The pattern and location of the curve are both related to the risk of progression

  • 3. 
    A 14 year old male athlete presents with well-localized chest pain that seems to worsen with exercise.  There is no history of associated radiation of pain, syncope, dizziness, palpitations, wheezing, or exercise intolerance.  He is on no medication, has no allergies, and is otherwise well.  He reports symptoms of an upper respiratory infection several weeks prior to the onset of the pain. Which of the following is the most likely cause of the pain?
    • A. 

      Costochondritis

    • B. 

      Trauma

    • C. 

      Muscle Strain

    • D. 

      Pleurisy

    • E. 

      Rib Fracture

  • 4. 
    A 15 year old boy presents with left thigh and knee pain and a limp of several weeks duration.  On physical exam he is noted to be above the 95th percentile in weight.  Range of motion of hip is limited upon internal rotation.  There is also evidence of limited flexion and abduction.   An X-ray is taken and shown here: Which of the following is the most likely diagnosis for this patient?
    • A. 

      Slipped Capital Femoral Epiphysis

    • B. 

      Collapsed dense capital femoral epiphysis with associated fragmentation

    • C. 

      Lateral and cephalad displacement of the femur

    • D. 

      Evidence of the beginning of a false acetabulum on the left

    • E. 

      Evidence of effusion within the hip joint

  • 5. 
    A 14 year old female presents with back pain.  Although there is no specific history of trauma, she is on the gymnastics team and practices two hours a day.  On exam, she indicates the pain is in the lower lumbar area.  There is also evidence of tight hamstring muscles. Which of the following is the most common complication of her disorder?
    • A. 

      Slippage of the L5 vertebrae relative to the body of the S1 vertebrae

    • B. 

      Loss of the intervertebral disk height with associated disk herination

    • C. 

      Development of a spinal epidural abscess

    • D. 

      Progressive development of lumbar scoliosis

    • E. 

      Acute urinary retention or incontinence resulting from compromise of the sacral nerve roots

  • 6. 
    • A. 

      This condition develops as a result of direct trauma to the area surrounding the tibial tubercle

    • B. 

      Tenderness when applying pressure over the patella is common associated finding on physical exam

    • C. 

      Steroid injection is the treatment of choice because it offers prompt relief of pain and allows for return to sports participation

    • D. 

      X-rays of the involved extremity typically show “beaking” of the tibia associated with collapse of the medial epiphysis

    • E. 

      This condition is most common during or recently after a rapid growth spurt

  • 7. 
    Maxine is a 4 year old girl who presents to the ED with complaint of arm pain.  Her mother notes that her older brother was picking her up and swinging her around, after which she complained of pain and her arm became limp.  On exam, you note that her arm is held close to her body, her elbow is slightly flexed, and the forearm is pronated.  She will not allow you to supinate the arm.  The elbow is not tender to palpation, and no swelling is noted.   Which of the following is the most likely diagnosis?
    • A. 

      Dislocation of the ulna

    • B. 

      Dislocation of the radius

    • C. 

      Fracture of the ulna

    • D. 

      Radial head subluxation

    • E. 

      “Greenstick” fracture of the radius

  • 8. 
    The radiograph below illustrates which of the following?
    • A. 

      Normal lateral ankle radiograph

    • B. 

      Salter Harris III fracture

    • C. 

      Salter Harris II fracture

    • D. 

      Salter Harris IV fracture

    • E. 

      Salter Harris V fracture

  • 9. 
    • A. 

      This is not a question. I just wanted you all to have this graphic to use to interpret the previous question and the program wouldn't allow me to paste the picture in the explanation. Just click this answer to get the question right.

    • B. 

      This is the false answer. DO NOT MARK THIS ANSWER.

  • 10. 
    • A. 

      Osteochondroma

    • B. 

      Ewing sarcoma

    • C. 

      Osteosarcoma

    • D. 

      Osteoid osteoma

    • E. 

      Fibrous dysplasia

  • 11. 
    A 6 year old boy presents to the ED with a swollen, tender, right elbow.  He feel from a height of 5 feet off of the monkey bars.  He denies hitting his head.  He is complaining of moderate pain in his right elbow and denies other complaints.   His examination is normal except for his right upper extremity.  There is a large amount of right elbow swelling.  It is tender to palpation.  Range of motion testing of the elbow cannot be done due to significant pain.  A radiograph reveals a displaced supracondylar fracture of the distal humerus   Which of the following statements is most correct?
    • A. 

      These are uncommon childhood fracture of the elbow with a low risk of complication. The patient can be splinted, pain control provided, and follow up arranged with the orthopedist.

    • B. 

      This is a common childhood fracture of the elbow. A pertinent piece of the physical examination, the neurovascular status of the arm, was not provided, but it is unlikely that this would be a problem with this type of fracture.

    • C. 

      This is a common childhood fracture of the elbow with a low risk of complication. The patient can be splinted, pain control provided, and follow up arranged with the orthopedist.

    • D. 

      This is a common childhood fracture of the elbow. A pertinent piece of the physical examination the neurovascular status of the arm, was not provided. The neurovascular status of the arm must be monitored closely. This type of fracture has a high risk for complication such as brachial artery, median, or radial nerve damage, or a compartment syndrome.

  • 12. 
    A 2 year old female presents to the office with a chief complaint of right arm injury.  She was crossing the street with her mother when she attempted to run out of the crosswalk.  Her mother grabbed her by the arm to stop her and, since then, she has refused to use her right arm.  The mother thinks that she has injured her wrist.   Physical examination:  Toddler who appears apprehensive.  She is holding her right arm by her side, flexed at the elbow.  There does not appear to be any swelling to her elbow, forearm, or wrist.  She screams and cries when moving her wrist during the examination.  Neurovascular examination is normal.  Full range of motion of her elbow and wrist is not done due to her discomfort and your concern for a fracture.   A radiograph of the right wrist and forearm is obtained and is normal.  On reassessment after returning from medical imaging, the mother reports that her daughter is now using her arm normally, and the pain seems to have resolved.  You can now examine the arm without difficulty and find no abnormalities.   Which of the following statements is the most correct?
    • A. 

      There is a contusion to her right forearm that is now not causing her any pain. Treatment recommendations include acetaminophen for pain and return for increased symptoms.

    • B. 

      There is an occult fracture of the distal right radius. Treatment recommendations include splinting of the wrist, ice, elevation, acetaminophen, and follow up with orthopedics.

    • C. 

      The patient had a subluxation of the radial head. It was reduced in medical imaging when her forearm was supinated for her x-ray study. Treatment recommendations include observation and avoidance of traction on her arm.

    • D. 

      The patient has a sprain of her wrist. Treatment recommendations include sling, ice, acetaminophen, and follow up in 3 days.

    • E. 

      There is an occult fracture of one of the carpal bones. Treatment recommendations include splinting of the wrist, ice, elevation, acetaminophen, and follow up with orthopedics.

  • 13. 
    A 9 year old landed on his right leg after jumping off a 5 foot porch.  He presents with significant pain and swelling to the right lower leg.  He denies other injuries.  On exam, his right lower leg and ankle is swollen and tender to palpation.  He has decreased range of motion secondary to pain.  His sensation and distal pulses are normal.  An XR of his lower leg is obtained as shown. The radiograph below illustrates which of the following?
    • A. 

      Salter Harris I

    • B. 

      Salter Harris II

    • C. 

      Salter Harris III

    • D. 

      Salter Harris IV

    • E. 

      Salter Harris V

  • 14. 
    • A. 

      Again -- this is not a question. I just wanted you all to have this graphic to use to interpret the previous question and the program wouldn't allow me to paste the picture in the explanation. Just click this answer to get the question right.

    • B. 

      This is the false answer. DO NOT MARK THIS ANSWER.

  • 15. 
    Fractures are common among active children and often take on different characteristics from those seen adults.   Which of the following statements are true concerning fractures in the pediatric age group?
    • A. 

      When a bone is angulated beyond the limits of physiologic and structural (plastic) deformation, a buckle (or torus) fracture often occurs

    • B. 

      A Salter III fracture occurs through a portion of the physis and extends into a portion of the metaphysic

    • C. 

      An injury to the physis may result in an angular deformity, shortening of the bone, or both.

    • D. 

      The presence of anterior rib fracture in a child

    • E. 

      A Salter IV fracture represents a crush injury to the physis, which may be difficult to detect on initial radiographic evaluation

  • 16. 
    A 3 year old male with a 2 week history of abdominal and lower back pain suddenly refuses to walk.  On exam, he is irritable and has localized pain to palpation over the midline at the lower lumbar area, decreased muscle strength, and deep tendon reflexes in the lower extremities.  Plan XR illustrate narrowing of the intervertebral space at L4-L5.   Which of the following is most likely to be present upon further investigation and lab evaluation in a MAJORITY of patients with this disorder?
    • A. 

      Elevated WBC

    • B. 

      Elevated ESR

    • C. 

      Elevated temperature throughout the course of the acute illness

    • D. 

      Positive blood cultures for Staphylococcus aureus

    • E. 

      Elevated levels of ionized calcium and creatinine phosphokinase

  • 17. 
    A 15 year old male presents to the ED in the early morning hours because of severe “leg pain.”  His parents report that he has experience increasingly severe and frequent night pain in his left leg over the previous several weeks.  His pain does not respond to acetaminophen or change in position.  There is no history of trauma.  On physical exam, he is in obvious pain and limps when asked to walk.  He points to his proximal left femur when asked to localize the pain.  Palpation of the area and examination of the range of motion do not appear to relieve or intensify the pain.  A radiograph of his femur reveals a 0.75cm diameter oval metaphyseal lucency that appears to be surrounded by sclerotic bone.   Which of the following is the most appropriate next step in the evaluation and treatment of this patient?
    • A. 

      Biopsy of the lesion to evaluate for Ewing sarcoma or other neoplasm

    • B. 

      MRI examination of the femur to further delineate the etiology of the lesion

    • C. 

      Obtain serum alkaline phosphate levels to evaluate the degree of bony destruction

    • D. 

      Plan XR examination of the entire right and left lower extremities to detect additional lesions which have not yet become symptomatic

    • E. 

      Reassurance of the benign nature of the lesion, along with a recommendation to treat the pain with salicylates and careful follow up

  • 18. 
    A 14 year old boy presents seeking advice after noticing a “hard bum” on his arm.  He is an avid skateboarder and “falls all the time” but denies any specific incident when he fell directly onto his arm.  He is otherwise well and without associated complaints.  On physical exam, a 3x3 cm bony, nontender, irregular mass is present along the lateral side of the proximal humerus.  A radiograph of the humerus shows a stalk-like projection arising form the surface of the bone.   Which of the following is the most appropriate next step in the treatment of this patient?
    • A. 

      Reassurance that no treatment is necessary unless the lesion becomes painful or limits range of motion

    • B. 

      MRI of the humerus

    • C. 

      Excisional biopsy of the lesion

    • D. 

      Plain radiographs of the contralateral humerus and both lower extremities

    • E. 

      Bone Scan

  • 19. 
    The parents of a 3 year old girl present with concerns that their daughter’s “bowlegs” are getting worse.  They also express concern that she is beginning to complain of bilateral knee pain.  They have had similar concerns in the past but were told that her bowleg deformity was due to “intrauterine positioning” and would “get better on its own.”  On physical exam, she has marked evidence of bilateral genu varum associated with tibial torsion.  Radiographs show evidence of bilateral severe angulation of the proximal medial metaphysic of the tibia.   Which of the following statements is correct with regard to the etiology and associated clinical findings of this disorder?
    • A. 

      Caucasians have a higher incidence as compared to African-Americans

    • B. 

      Radiographic findings result from accelerated growth of the lateral tibial growth plate

    • C. 

      The incidence is higher among patients with an elevated body mass index (BMI)

    • D. 

      It is unusual (

    • E. 

      Surgical repair is considered the treatment of choice in all age groups

  • 20. 
    As a part of an evaluation for low back pain in a 15 year old female, an oblique lumbosacral XR shows a defect in the pars interarticularis associated with forward slippage of the L5 vertebral body on S1   Of the following findings on physical exam, which is the most likely to be present in this patient?
    • A. 

      Relief of pain with hyperextension of the lumbar spine

    • B. 

      Radiation of pain to the upper medial thigh and groin with repetitive flexion and extension of the lumbar spine

    • C. 

      Abnormal gait associated with hamstring muscle tightness

    • D. 

      A sacral dimple associated with a tuft of hair

    • E. 

      A high riding an hypoplastic scapula

  • 21. 
    The parents of a 5 year old boy express concern that their son has been limping and complaining of pain in his right anterior thig and knee for the previous several days.  He has other wise been well with the exception of a mild upper respiratory tract infection about a week ago.  He has not been febrile.  There is no history of trauma, but his parents do add that he is very active child.  He is afebrile on exam and appears well but becomes agitated during the examination of his right hip.  He has limited range of motion, especially during extension of the leg and adduction of the hip.  Laboratory results include a normal CBC and ESR of 6mm/hr.   Of the following radiographic finding, which is the most likely to be identified upon further evaluation of this patient?
    • A. 

      Widening of the joint space of the hip

    • B. 

      Partially collapsed capital femoral epiphysis associated with fragmentation

    • C. 

      Posterior slippage of the capital femoral epiphysis

    • D. 

      Lateral and cephalad displacement of the femur

    • E. 

      Stress fracture of the femoral neck

  • 22. 
    • A. 

      Low levels of free thyroxin (T4) associated with elevated levels of thyroid stimulating hormone (TSH)

    • B. 

      Low ionized calcium

    • C. 

      Elevated creatinine phosphokinase (CPK)

    • D. 

      Evidence of Vitamin D Deficiency

    • E. 

      Elevated levels of serum creatinine