Ortho – practice Exam with Complete
Solutions
2. 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 - ANSWER-(E) bicipital tendonitis
4. 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 - ANSWER-(B) Colles fracture
5. 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 - ANSWER-(B) Six-year-old boy who reports a limp and aching
in the groin and proximal thigh
,6. 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 - ANSWER-(D) thumb spica splint and
repeat radiographs in 3 weeks
7. 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 - ANSWER-(B) trigger finger
9. 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
trauma. On physical examination, you discover an elbow joint that is markedly
erythematous,
warm to touch, and tender to palpation. Range of motion is decreased secondary to
edema and
pain. Radiograph of the elbow reveals only soft tissue swelling but no fracture or
dislocation.
Joint aspiration is performed and a gram-negative diplococcus is identified on
cytological
exa - ANSWER-(C) Neisseria gonorrhoeae
10. A 53-year-old woman presents with pain in her right wrist. The pain is aggravated by
movement
of the thumb and when she makes a fist. She also notes that when she moves her
thumb, there is
an occasional locking sensation in the radial aspect of her wrist. Physical examination of
the
wrist reveals swelling and tenderness over the distal radius, and full flexion of the thumb
into the
palm, with ulnar deviation of the wrist, produces pain. Radiographic evaluation of the
wrist
shows no bone abnormalities. Which of the following would be the treatment of choice
in this
patient presentation?
(A) immobilization of the wrist with a thumb spica splint
(B) tendon sheath corticosteroid injection
(C) operative treatment to restore functionality
(D) prompt neurological evaluation
(E) proceed to bone scan to evaluate the area of pain - ANSWER-(A) immobilization of
the wrist with a thumb spica splint
11. Which of the following most accurately describes the physical examination findings
suggestive of
a boutonniere deformity?
(A) hyperextension of the proximal interphalangeal joint with fixed flexion of the distal
interphalangeal joint
(B) persistent extension of the proximal interphalangeal joint with hyperflexion of the
distal interphalangeal joint
(C) hyperextension of the distal interphalangeal joint with flexion of the proximal
interphalangeal joint
(D) persistent flexion of the proximal interphalangeal joint with hyperextension of the
distal interphalangeal joint
(E) hyperextension of the distal interphalangeal joint with extension of the proximal
interphalangeal joint - ANSWER-(D) persistent flexion of the proximal interphalangeal
joint with hyperextension of the distal interphalangeal joint
Solutions
2. 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 - ANSWER-(E) bicipital tendonitis
4. 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 - ANSWER-(B) Colles fracture
5. 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 - ANSWER-(B) Six-year-old boy who reports a limp and aching
in the groin and proximal thigh
,6. 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 - ANSWER-(D) thumb spica splint and
repeat radiographs in 3 weeks
7. 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 - ANSWER-(B) trigger finger
9. 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
trauma. On physical examination, you discover an elbow joint that is markedly
erythematous,
warm to touch, and tender to palpation. Range of motion is decreased secondary to
edema and
pain. Radiograph of the elbow reveals only soft tissue swelling but no fracture or
dislocation.
Joint aspiration is performed and a gram-negative diplococcus is identified on
cytological
exa - ANSWER-(C) Neisseria gonorrhoeae
10. A 53-year-old woman presents with pain in her right wrist. The pain is aggravated by
movement
of the thumb and when she makes a fist. She also notes that when she moves her
thumb, there is
an occasional locking sensation in the radial aspect of her wrist. Physical examination of
the
wrist reveals swelling and tenderness over the distal radius, and full flexion of the thumb
into the
palm, with ulnar deviation of the wrist, produces pain. Radiographic evaluation of the
wrist
shows no bone abnormalities. Which of the following would be the treatment of choice
in this
patient presentation?
(A) immobilization of the wrist with a thumb spica splint
(B) tendon sheath corticosteroid injection
(C) operative treatment to restore functionality
(D) prompt neurological evaluation
(E) proceed to bone scan to evaluate the area of pain - ANSWER-(A) immobilization of
the wrist with a thumb spica splint
11. Which of the following most accurately describes the physical examination findings
suggestive of
a boutonniere deformity?
(A) hyperextension of the proximal interphalangeal joint with fixed flexion of the distal
interphalangeal joint
(B) persistent extension of the proximal interphalangeal joint with hyperflexion of the
distal interphalangeal joint
(C) hyperextension of the distal interphalangeal joint with flexion of the proximal
interphalangeal joint
(D) persistent flexion of the proximal interphalangeal joint with hyperextension of the
distal interphalangeal joint
(E) hyperextension of the distal interphalangeal joint with extension of the proximal
interphalangeal joint - ANSWER-(D) persistent flexion of the proximal interphalangeal
joint with hyperextension of the distal interphalangeal joint
