MSK/rheum Exam Questions With Complete Solutions
abatacept Correct Answer biologic. inhibits T-cell activation.
avoid in pts w/ acute or chronic infections. obtain PPD prior to
initiating. increases exacerbations of COPD
achilles tendon rupture Correct Answer MOI: mechanical
overload from eccentric contraction of gastrocsoleus complex.
75% occur as sports-related injury. common 30-50y. *increased
risk w/ fluoroquinolone use*
sx: sudden heel pain after push-off movement, pop, sudden
sharp calf pain
-*thompson test*
tx: splint initially in mild plantar flexion w/ subsequent splinting
employing gradual dorsiflexion towards neutral. surgical repair
allows for early ROM
ACL injury Correct Answer *MC knee ligament injury* (+/-
associated w/ meniscal tears). 70% sports related
MOI: non contact pivoting injury (deceleration, hyperextension,
internal rotation)
sx: pop and swelling --> hemarthrosis, +/- knee buckling,
inability to bear weight, does not actively extend knee. MC in
women
,PE: ACL laxity --> *lachmans test* most sensitive, pivot shift
test. *anterior drawer* test least reliable bc spasms may stabilize
knee
-segond fracture: avulsion of the lateral tibial condyle w/ varus
stress to the knee. if present, ligamental injuries are most likely
present. pathognomic for ACL tear
tx: controversial (depends on activity level of pt). therapy vs
surgical.
*unhappy (odonoghues triad)*: injury to ACL + MCL + medial
meniscus
acromioclavicular joint dislocation "shoulder separation"
Correct Answer MOI: direct blow to adducted shoulder
sx: pain w/ lifting arm, unable to lift arm @ shoulder, +/-
deformity @ AC joint
dx: radiography w/o or w/ weights to reveal mild separations
tx: brief sling immobilization, ice, analgesia, ortho f/u, type III
may need surgery
acromioclavicular joint dislocation "shoulder separation" class I-
V Correct Answer -class I: normal CXR (ligament sprain)
-class II: slight widening (AC ligament rupture, coracoclavicular
ligament sprained)
-class III: significant widening -- rupture of AC and CC
ligaments
,-class IV: AC and CC rupture + displacement of clavicle
into/through trapezius
-class V: class IV + disruption of clavicular attachments
adalimumab (humira) Correct Answer biologic TNF inhibitor
(TNF-alpha). recombinant IgG1 Ab w/ additive effect when
taken w/ methotrexate. often used when tx w/ other DMARDs
not as effective
adhesive capsulitis (frozen shoulder) Correct Answer
pathophys: shoulder stiffness due to inflammation (especially w/
DM, hypothyroidism), Mc 40-60s
sx: shoulder pain/stiffness 18-24mo. *decreased ROM w/
external rotation*, stiff-pain cycle. pain usually worse at night.
gradual return of ROM. *resistance on PROM* on affected side
tx: rehab ROM therapy mainstay, antiinflammatories,
intraarticular steroid injection, heat
anakira Correct Answer biologic recombinant *interleukin-1
receptor antagonist*. increased activity when given w/
methotrexate. often used when tx w/ other DMARDs not as
effective
ankle dislocations Correct Answer MOI: major trauma
(MVA), high velocity injury, posterior MC, +/- peroneal nerve
injury
sx: pain, edema, deformity, inability to bear weight
, tx: closed reduction + posterior splint, +/- ORIF
ankle sprains Correct Answer 85% involve collateral
ligaments (anterior talofibular MC, calcaneofibular). anterior
talofibular is main stabilizer during inversion. deltoid ligament
injury seen w/ eversion injuries
sx: pop--> swelling, pain, inability to bear weight
tx: RICE, NSAIDs --> increase ROM and conditioning, crutches
for 1st 2-3 days. grade I and II incomplete tears, grade III
complete tears
ottawa ankle rules
-pain along lateral malleolus or medial malleolus --> ankle films
-navicular (mid foot) pain or 5th metatarsal pain --> foot films
inability to walk >4 steps at time of injury and in ER
ankylosing spondylitits dx Correct Answer elevated ESR, (+)
HLA-B27 inflammatory arthropathy. neg ANA and rheumatoid
factor
*bamboo spine* on x-ray = *squaring (bridging) of vertebral
bodies*, loss of curvature
ankylosing spondylitits pathophys Correct Answer chronic
inflammatory arthropathy of axial skeleton and sacroiliac joints
w/ progressive stiffness
abatacept Correct Answer biologic. inhibits T-cell activation.
avoid in pts w/ acute or chronic infections. obtain PPD prior to
initiating. increases exacerbations of COPD
achilles tendon rupture Correct Answer MOI: mechanical
overload from eccentric contraction of gastrocsoleus complex.
75% occur as sports-related injury. common 30-50y. *increased
risk w/ fluoroquinolone use*
sx: sudden heel pain after push-off movement, pop, sudden
sharp calf pain
-*thompson test*
tx: splint initially in mild plantar flexion w/ subsequent splinting
employing gradual dorsiflexion towards neutral. surgical repair
allows for early ROM
ACL injury Correct Answer *MC knee ligament injury* (+/-
associated w/ meniscal tears). 70% sports related
MOI: non contact pivoting injury (deceleration, hyperextension,
internal rotation)
sx: pop and swelling --> hemarthrosis, +/- knee buckling,
inability to bear weight, does not actively extend knee. MC in
women
,PE: ACL laxity --> *lachmans test* most sensitive, pivot shift
test. *anterior drawer* test least reliable bc spasms may stabilize
knee
-segond fracture: avulsion of the lateral tibial condyle w/ varus
stress to the knee. if present, ligamental injuries are most likely
present. pathognomic for ACL tear
tx: controversial (depends on activity level of pt). therapy vs
surgical.
*unhappy (odonoghues triad)*: injury to ACL + MCL + medial
meniscus
acromioclavicular joint dislocation "shoulder separation"
Correct Answer MOI: direct blow to adducted shoulder
sx: pain w/ lifting arm, unable to lift arm @ shoulder, +/-
deformity @ AC joint
dx: radiography w/o or w/ weights to reveal mild separations
tx: brief sling immobilization, ice, analgesia, ortho f/u, type III
may need surgery
acromioclavicular joint dislocation "shoulder separation" class I-
V Correct Answer -class I: normal CXR (ligament sprain)
-class II: slight widening (AC ligament rupture, coracoclavicular
ligament sprained)
-class III: significant widening -- rupture of AC and CC
ligaments
,-class IV: AC and CC rupture + displacement of clavicle
into/through trapezius
-class V: class IV + disruption of clavicular attachments
adalimumab (humira) Correct Answer biologic TNF inhibitor
(TNF-alpha). recombinant IgG1 Ab w/ additive effect when
taken w/ methotrexate. often used when tx w/ other DMARDs
not as effective
adhesive capsulitis (frozen shoulder) Correct Answer
pathophys: shoulder stiffness due to inflammation (especially w/
DM, hypothyroidism), Mc 40-60s
sx: shoulder pain/stiffness 18-24mo. *decreased ROM w/
external rotation*, stiff-pain cycle. pain usually worse at night.
gradual return of ROM. *resistance on PROM* on affected side
tx: rehab ROM therapy mainstay, antiinflammatories,
intraarticular steroid injection, heat
anakira Correct Answer biologic recombinant *interleukin-1
receptor antagonist*. increased activity when given w/
methotrexate. often used when tx w/ other DMARDs not as
effective
ankle dislocations Correct Answer MOI: major trauma
(MVA), high velocity injury, posterior MC, +/- peroneal nerve
injury
sx: pain, edema, deformity, inability to bear weight
, tx: closed reduction + posterior splint, +/- ORIF
ankle sprains Correct Answer 85% involve collateral
ligaments (anterior talofibular MC, calcaneofibular). anterior
talofibular is main stabilizer during inversion. deltoid ligament
injury seen w/ eversion injuries
sx: pop--> swelling, pain, inability to bear weight
tx: RICE, NSAIDs --> increase ROM and conditioning, crutches
for 1st 2-3 days. grade I and II incomplete tears, grade III
complete tears
ottawa ankle rules
-pain along lateral malleolus or medial malleolus --> ankle films
-navicular (mid foot) pain or 5th metatarsal pain --> foot films
inability to walk >4 steps at time of injury and in ER
ankylosing spondylitits dx Correct Answer elevated ESR, (+)
HLA-B27 inflammatory arthropathy. neg ANA and rheumatoid
factor
*bamboo spine* on x-ray = *squaring (bridging) of vertebral
bodies*, loss of curvature
ankylosing spondylitits pathophys Correct Answer chronic
inflammatory arthropathy of axial skeleton and sacroiliac joints
w/ progressive stiffness
