Ortho PACKRAT Questions with
complete solutions graded A+
In the young child, unequal thigh folds may indicate
A. coxa Vara.
B. nondisplaced hip fracture.
C. developmental hip dysplasia.
D. slipped capital femoral epiphysis - correct answer ✔✔B. Developmental hip dysplasia
A 36-year-old PA educator has a history of recurrent low back pain. When lifting a stack of books
yesterday, he experienced sudden, severe pain in the lumbar area. He denies radicular pain His
lower extremity examination is unremarkable, and his back examination is normal, except for
paraspinal muscle tenderness and increased pain with flexion at the waist. Which of the
following management options should be instituted at this time?
A. Refer the patient to orthopedic surgery.
B. Continue ordinary activities as tolerated.
C. Confine the patient to bed with traction.
D. Recommend sleeping on a softer mattress. - correct answer ✔✔B. Continue ordinary
activities as tolerated
A 24-year-old female presents with complaints of pain over the r~t metatarsal region. She began
an intensive jogging program 2~weeks earlier An initial x-ray of the foot fails to reveal a fracture.
Which of the following is the most appropriate next step?
A. Order a bone scan.
B. Refer the patient to physical therapy.
C. Order a serum alkaline phosphatase.
D. Repeat the plain film x-ray in 1 week. - correct answer ✔✔A. Order a bone scan
,A 22-year-old female presents with a 2-day history of a swollen, warm, red left knee. Synovial
fluid WBC count is 65,000 cells/pL and the Gram stain is negative. The best initial treatment is
A. IV nafcillin sodium (Unipen
B. oral ciprofloxacin (Cipro).
C. oral doxycycline (Vibramycin
D. IV ceftriaxone (Rocephin). - correct answer ✔✔D. IV ceftriaxone (Rocephin)
A patient is 12 hours post-closed reduction of a tibial fracture and is in a long leg cast. Despite
an injection of meperidine (Demerol), the patient complains of unrelieved pain and cannot
move his toes. The most appropriate next step is to
A. immediately split the cast medially and laterally.
B. elevate the leg on an extra pillow.
C. observe over the next 6 hours.
D. remove the cast completely. - correct answer ✔✔A. Immediately split the cast medially and
laterally
A patient presents with pain localized to the proximal humerus and anterior portion of the
shoulder joint that is aggravated by resistive supination of the forearm. The most likely
diagnosis is
A. bicipital tendonitis.
B. axillary nerve injury.
C. rupture of pectoralis major.
D. distal fracture of the clavicle. - correct answer ✔✔A. Bicipital tendonitis
A 32-year-old male presents to the clinic after a fall on his outstretched hand. He has tenderness
on the radial aspect of his wrist over the anatomic snuffbox, but the rest of his examination is
normal. An x-ray is negative for fracture. At this time, the most appropriate treatment is
A. a thumb spica cast and an x-ray in 2 weeks.
,B. warm soaks and NSAID5 for pain relief.
C. a wrist splint during the day at work.
D. an ACE wrap for comfort. - correct answer ✔✔A. A thumb spica cast and an x-ray in 2 weeks
Which of the following injuries should be anticipated in a football quarterback who is sacked
and falls directly on the lateral aspect of his shoulder?
A. rotator cuff tear
B. anterior dislocation
C. posterior dislocation
D. acromioclavicular separation - correct answer ✔✔D. Acromioclavicular separation
A practitioner is following a 10-year-old girl with scoliosis to monitor the potential progression
of the curvature. At what minimal degree of curve angulation should treatment begin?
A. 10
B. 20
C. 30
D. 40 - correct answer ✔✔B. 20
Which of the following tests would be included in the physical exam to evaluate a high ankle
sprain with instability?
A. Anterior drawer
B. Lachman
C. Vibratory sense
D. Thompson - correct answer ✔✔A. Anterior drawer
A 35 year-old male placed in a thumb spica cast for a scaphoid fracture presents complaining of
forearm and hand pain that is not relieved with pain medication and elevation. Which of the
following is the earliest physical exam sign for his current condition?
, A. Slow capillary refill
B. Loss of two-point discrimination
C. Absent peripheral pulses
D. Pain with passive stretch. - correct answer ✔✔B. Loss of two-point discrimination
Which of the following is the most sensitive screening test for systemic lupus erythematosus?
A. Anti-Ribonuclear protein (U1-RNP)
B. Antinuclear antibody (ANA)
C. Anti-double-stranded DNA (anti-ds-DNA)
D. Anti-Smith anti-body (anti-Sm) - correct answer ✔✔B. Antinuclear antibody (ANA)
Chronic oral steroid use can predispose a patient to which of the following?
A. Charcot's joint
B. Osteoarthritis
C. DeQuervains syndrome
D. Avascular necrosis of the femoral head - correct answer ✔✔D. Avascular necrosis of the
femoral head
A 35 year-old female who was a back seat passenger in a vehicle which was involved in a head-
on collision is brought to the ED. She is able to tell you that she is having difficulty moving both
of her legs and is experiencing bilateral leg pain as well. She is embarrassed because she has
"wet myself." Physical examination reveals markedly diminished sensory and motor function of
both legs and decreased rectal sphincter tone. Which of the following is the most likely
diagnosis?
A. Herniated disc at L5-S1 and L4-L5
B. An anterior cord lesion
C. Cauda equina syndrome
D. An L2 lesion - correct answer ✔✔C. Cauda equina syndrome
complete solutions graded A+
In the young child, unequal thigh folds may indicate
A. coxa Vara.
B. nondisplaced hip fracture.
C. developmental hip dysplasia.
D. slipped capital femoral epiphysis - correct answer ✔✔B. Developmental hip dysplasia
A 36-year-old PA educator has a history of recurrent low back pain. When lifting a stack of books
yesterday, he experienced sudden, severe pain in the lumbar area. He denies radicular pain His
lower extremity examination is unremarkable, and his back examination is normal, except for
paraspinal muscle tenderness and increased pain with flexion at the waist. Which of the
following management options should be instituted at this time?
A. Refer the patient to orthopedic surgery.
B. Continue ordinary activities as tolerated.
C. Confine the patient to bed with traction.
D. Recommend sleeping on a softer mattress. - correct answer ✔✔B. Continue ordinary
activities as tolerated
A 24-year-old female presents with complaints of pain over the r~t metatarsal region. She began
an intensive jogging program 2~weeks earlier An initial x-ray of the foot fails to reveal a fracture.
Which of the following is the most appropriate next step?
A. Order a bone scan.
B. Refer the patient to physical therapy.
C. Order a serum alkaline phosphatase.
D. Repeat the plain film x-ray in 1 week. - correct answer ✔✔A. Order a bone scan
,A 22-year-old female presents with a 2-day history of a swollen, warm, red left knee. Synovial
fluid WBC count is 65,000 cells/pL and the Gram stain is negative. The best initial treatment is
A. IV nafcillin sodium (Unipen
B. oral ciprofloxacin (Cipro).
C. oral doxycycline (Vibramycin
D. IV ceftriaxone (Rocephin). - correct answer ✔✔D. IV ceftriaxone (Rocephin)
A patient is 12 hours post-closed reduction of a tibial fracture and is in a long leg cast. Despite
an injection of meperidine (Demerol), the patient complains of unrelieved pain and cannot
move his toes. The most appropriate next step is to
A. immediately split the cast medially and laterally.
B. elevate the leg on an extra pillow.
C. observe over the next 6 hours.
D. remove the cast completely. - correct answer ✔✔A. Immediately split the cast medially and
laterally
A patient presents with pain localized to the proximal humerus and anterior portion of the
shoulder joint that is aggravated by resistive supination of the forearm. The most likely
diagnosis is
A. bicipital tendonitis.
B. axillary nerve injury.
C. rupture of pectoralis major.
D. distal fracture of the clavicle. - correct answer ✔✔A. Bicipital tendonitis
A 32-year-old male presents to the clinic after a fall on his outstretched hand. He has tenderness
on the radial aspect of his wrist over the anatomic snuffbox, but the rest of his examination is
normal. An x-ray is negative for fracture. At this time, the most appropriate treatment is
A. a thumb spica cast and an x-ray in 2 weeks.
,B. warm soaks and NSAID5 for pain relief.
C. a wrist splint during the day at work.
D. an ACE wrap for comfort. - correct answer ✔✔A. A thumb spica cast and an x-ray in 2 weeks
Which of the following injuries should be anticipated in a football quarterback who is sacked
and falls directly on the lateral aspect of his shoulder?
A. rotator cuff tear
B. anterior dislocation
C. posterior dislocation
D. acromioclavicular separation - correct answer ✔✔D. Acromioclavicular separation
A practitioner is following a 10-year-old girl with scoliosis to monitor the potential progression
of the curvature. At what minimal degree of curve angulation should treatment begin?
A. 10
B. 20
C. 30
D. 40 - correct answer ✔✔B. 20
Which of the following tests would be included in the physical exam to evaluate a high ankle
sprain with instability?
A. Anterior drawer
B. Lachman
C. Vibratory sense
D. Thompson - correct answer ✔✔A. Anterior drawer
A 35 year-old male placed in a thumb spica cast for a scaphoid fracture presents complaining of
forearm and hand pain that is not relieved with pain medication and elevation. Which of the
following is the earliest physical exam sign for his current condition?
, A. Slow capillary refill
B. Loss of two-point discrimination
C. Absent peripheral pulses
D. Pain with passive stretch. - correct answer ✔✔B. Loss of two-point discrimination
Which of the following is the most sensitive screening test for systemic lupus erythematosus?
A. Anti-Ribonuclear protein (U1-RNP)
B. Antinuclear antibody (ANA)
C. Anti-double-stranded DNA (anti-ds-DNA)
D. Anti-Smith anti-body (anti-Sm) - correct answer ✔✔B. Antinuclear antibody (ANA)
Chronic oral steroid use can predispose a patient to which of the following?
A. Charcot's joint
B. Osteoarthritis
C. DeQuervains syndrome
D. Avascular necrosis of the femoral head - correct answer ✔✔D. Avascular necrosis of the
femoral head
A 35 year-old female who was a back seat passenger in a vehicle which was involved in a head-
on collision is brought to the ED. She is able to tell you that she is having difficulty moving both
of her legs and is experiencing bilateral leg pain as well. She is embarrassed because she has
"wet myself." Physical examination reveals markedly diminished sensory and motor function of
both legs and decreased rectal sphincter tone. Which of the following is the most likely
diagnosis?
A. Herniated disc at L5-S1 and L4-L5
B. An anterior cord lesion
C. Cauda equina syndrome
D. An L2 lesion - correct answer ✔✔C. Cauda equina syndrome
