ABFM MUSCULOSKELETAL STANDARD EXAMS
ANSWERS AND QUESTIONS SET A+
✔✔Signs of Hip labral tear: - ✔✔clicking sound with activity and pain in anterior groin
with extreme abduction and adduction
✔✔Back pain that awakens children at night differential is: - ✔✔osteomyelitis, diskitis
(can be viral or bacterial), osteoid osteoma, osteoblastoma and spinal cord tumors
✔✔Mallet finger (torn extensor tendon/ dorsal aspect of finger) - ✔✔avulsion of the
terminal tendon (or fracture of distal interphalangeal joint) and is splinted in full
extension for 8 weeks
- need to consult ortho if fracture > 30% of intraarticular surface
✔✔When to start bisphosphonates in those with osteoporosis? - ✔✔when 10 year risk
of hip fracture is > 3% and patient has had osteoporosis related fractures.
- Treat those with less risk factors with approximately 1200 mg of calcium and 800 IU of
Vit D daily
✔✔When to do surgical fixation of great toe fracture: - ✔✔when > 25% involvement of
the joint surface (intra-articular fracture); use toe plate and short leg walking cast x 2-3
weeks if < 25% intra-articular involvement
✔✔child limping with no clear preceeding injury, next step? - ✔✔X Ray of hip
✔✔Acute lumbar pain with radiculopathy does not need imaging unless: - ✔✔cauda
equina syndrome, suspected cancer, infection or fracture; conservatively manage x 6
weeks
✔✔Proximal muscle weakness in elderly female with normal ESR and normal DTRs,
think of: - ✔✔statin-induced myopathy
- Polymyalgia rheumatica with elevated ESR
, - Guillian Barre with hyporeflexia
✔✔Treatment of mildly displaced mid-clavicular fracture: - ✔✔- sling x 2-6 weeks,
passive mobilization as tolerated when pain is decreased, PT starting at 4 weeks
- cumbersome and not recommended: figure of 8 bandage
✔✔child athlete under age 15 who has heel pain x multiple months (no specific injury,
slight tenderness to posterior heel)- Diagnosis? treatment? Contra-indications to which
modality of treatment? - ✔✔What is clinical presentation of calcaneal apophysitis
(Sever's disease)?
- Treatment is activity modification, use of ice packs and moist heat, stretching,
analgesics and orthotic devices
- Contraindication: therapeutic ultrasound onto growing child with active bone growth
plates (children under age 15)
✔✔Jersey finger is the common name for which injury?
Patient will still be able to weakly flex the DIP joint weekly but unable to hold flexion
against resistance, why? - ✔✔ruptured flexor digitorum profundus (rupture due to
sudden force while distal phalanx is in flexion).
- flexor digitorum sublimis is still present
- Treatment: consult ortho for surgical repair
✔✔Treatment for trochanteric bursitis? - ✔✔corticosteroid injection
✔✔Popliteal cyst treatment? - ✔✔ice and NSAIDs and keeping knee in flexion
- if not effective, then intra-articular corticosterids or cyst aspiration
✔✔athletes with stress fractures can return to play when: - ✔✔they have a normal
physical exam and can walk without pain (usually after 6 weeks)
✔✔How long after reduction of shoulder dislocation should patient keep shoulder
immobilized (can't keep immobilized too long because of increased risks of adhesive
capsulitis) - ✔✔- keep shoulder immobilized x 1 week if age > 30
- keep shoulder immobilized x 3 weeks if age < 30
✔✔New criteria for fibromyalgia diagnosis: - ✔✔based on patient's history (no longer
about tender points)
✔✔Femoroacetabular impingement presents with anterolateral hip joint pain that is
worse when pivoting laterally on affected hip or moving from seated to standing
position. Physical examination tests? - ✔✔FADIR and FABER tests are important
ANSWERS AND QUESTIONS SET A+
✔✔Signs of Hip labral tear: - ✔✔clicking sound with activity and pain in anterior groin
with extreme abduction and adduction
✔✔Back pain that awakens children at night differential is: - ✔✔osteomyelitis, diskitis
(can be viral or bacterial), osteoid osteoma, osteoblastoma and spinal cord tumors
✔✔Mallet finger (torn extensor tendon/ dorsal aspect of finger) - ✔✔avulsion of the
terminal tendon (or fracture of distal interphalangeal joint) and is splinted in full
extension for 8 weeks
- need to consult ortho if fracture > 30% of intraarticular surface
✔✔When to start bisphosphonates in those with osteoporosis? - ✔✔when 10 year risk
of hip fracture is > 3% and patient has had osteoporosis related fractures.
- Treat those with less risk factors with approximately 1200 mg of calcium and 800 IU of
Vit D daily
✔✔When to do surgical fixation of great toe fracture: - ✔✔when > 25% involvement of
the joint surface (intra-articular fracture); use toe plate and short leg walking cast x 2-3
weeks if < 25% intra-articular involvement
✔✔child limping with no clear preceeding injury, next step? - ✔✔X Ray of hip
✔✔Acute lumbar pain with radiculopathy does not need imaging unless: - ✔✔cauda
equina syndrome, suspected cancer, infection or fracture; conservatively manage x 6
weeks
✔✔Proximal muscle weakness in elderly female with normal ESR and normal DTRs,
think of: - ✔✔statin-induced myopathy
- Polymyalgia rheumatica with elevated ESR
, - Guillian Barre with hyporeflexia
✔✔Treatment of mildly displaced mid-clavicular fracture: - ✔✔- sling x 2-6 weeks,
passive mobilization as tolerated when pain is decreased, PT starting at 4 weeks
- cumbersome and not recommended: figure of 8 bandage
✔✔child athlete under age 15 who has heel pain x multiple months (no specific injury,
slight tenderness to posterior heel)- Diagnosis? treatment? Contra-indications to which
modality of treatment? - ✔✔What is clinical presentation of calcaneal apophysitis
(Sever's disease)?
- Treatment is activity modification, use of ice packs and moist heat, stretching,
analgesics and orthotic devices
- Contraindication: therapeutic ultrasound onto growing child with active bone growth
plates (children under age 15)
✔✔Jersey finger is the common name for which injury?
Patient will still be able to weakly flex the DIP joint weekly but unable to hold flexion
against resistance, why? - ✔✔ruptured flexor digitorum profundus (rupture due to
sudden force while distal phalanx is in flexion).
- flexor digitorum sublimis is still present
- Treatment: consult ortho for surgical repair
✔✔Treatment for trochanteric bursitis? - ✔✔corticosteroid injection
✔✔Popliteal cyst treatment? - ✔✔ice and NSAIDs and keeping knee in flexion
- if not effective, then intra-articular corticosterids or cyst aspiration
✔✔athletes with stress fractures can return to play when: - ✔✔they have a normal
physical exam and can walk without pain (usually after 6 weeks)
✔✔How long after reduction of shoulder dislocation should patient keep shoulder
immobilized (can't keep immobilized too long because of increased risks of adhesive
capsulitis) - ✔✔- keep shoulder immobilized x 1 week if age > 30
- keep shoulder immobilized x 3 weeks if age < 30
✔✔New criteria for fibromyalgia diagnosis: - ✔✔based on patient's history (no longer
about tender points)
✔✔Femoroacetabular impingement presents with anterolateral hip joint pain that is
worse when pivoting laterally on affected hip or moving from seated to standing
position. Physical examination tests? - ✔✔FADIR and FABER tests are important
