ORTHOPEDICS EXAMINERS QUESTIONS AND ANSWERS (SET TO SCORE A+)

ORTHOPEDICS EXAMINERS QUESTIONS AND ANSWERS (SET TO SCORE A+) Impaired synthesis of previtamin D Explanation: Elderly adults are at increased risk of Vitamin D deficiency related to several factors. In addition to those mentioned, lack of sun exposure decreases synthesis of Vitamin D. As renal status declines in older patients, hydroxylation diminishes which diminishes available Vitamin D. Patient with dark skin are also at increased risk of Vitamin D deficiencies. -Answer- Besides inadequate intake of Vitamin D in elder adults, what other factor contributes to deficiencies? Impaired synthesis of previtamin D Decreased physical activity Diminished hepatic function Decreased body mass Swelling and pain to touch of the anterior knee Explanation: Prepatellar bursitis is often precipitated by an increase in activity involving the knee, such as was given in history by this patient. If it was infectious in origin, erythema would be present, but based on this patient's history and absence of risk factors, that is less likely. Prepatellar bursitis is characterized by swelling and inflammatory changes anterior to the patella, no symptoms posteriorly. The patient probably will limp due to pain. Tenderness to touch of the tibial tubercle is characteristic of Osgood Schlatter disease, but, is common in an under 19 years age group. -Answer- A 60 year-old patient who is otherwise healthy, presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding? Limping and erythema about the anterior knee Swelling and pain to touch of the anterior knee Posterior knee pain, anterior knee edema, and redness Tenderness to touch of the tibial tubercle Antinuclear antibody (ANA) Explanation: The criteria for diagnosis of lupus have been established by the American College of Rheumatology. It includes 11 criteria: malar rash, discoid rash, sun-related rash, painless oral ulcerations, joint pain or swelling involving two or more joints, inflammation involving the heart or lungs, renal disorder, a non-specified neurological disorder (seizures or psychosis), CBC abnormalities such as anemia, leukopenia, or thrombocytopenia, immunologic disorders (another positive autoimmune test such as an anti-phospholipid antibody test), or positive ANA. Having 4 or more of these criteria either at one time or over time can constitute a diagnosis of SLE. An elevated sedimentation rate is a very non-specific measure of inflammation. -Answer- Which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus (SLE)? Antinuclear antibody (ANA) Rheumatoid factor Elevated liver function studies Erythrocyte sedimentation rate (ESR) Fever Explanation: This presentation is classic for gout except that gout is not associated with fever. This presentation coupled with fever should prompt the examiner to suspect septic arthritis. If this is the presentation, this patient should have a joint tap (or refer to an orthopedic surgeon). Synovial fluid will be aspirated and sent to the laboratory for evaluation. The fluid will contain white cells and bacteria if infection is present. -Answer- A 55 year-old male patient describes severe pain at the base of his left first toe. He is limping and says he can't remember hurting his toe. Which symptom below suggests something other than gout? Pain Elevated sedimentation rate Erythema Fever Morning stiffness, positive rheumatoid antigen and antinuclear antibody Explanation: Rheumatoid arthritis is a difficult diagnosis to make because there are many factors to evaluate and none are consistently positive in all patients. Clinical clues that should cause the examiner to suspect rheumatoid arthritis are symmetrical peripheral polyarthritis, morning stiffness lasting greater than one hour, the presence of rheumatoid nodules, bone erosions on x-ray, positive sedimentation rate as an early phase reactant, positive rheumatoid antigen, and positive antinuclear antibody. None of these characteristics are positive in all patients and other autoimmune rheumatic diseases can be part of the differential. -Answer- Which symptoms are most commonly found in a patient with rheumatoid arthritis? Morning stiffness, positive rheumatoid antigen and antinuclear antibody Fever, symmetrical joint involvement, normal sedimentation rate Asymmetrical joint involvement, male gender, pain Nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody Acute lymphocytic leukemia (ALL) Explanation: Bone pain is common in children, especially adolescents. However, a six year-old with complaints of mid-bone pain should be evaluated for ALL. Osgood-Schlatter produces pain in the knees. Growing pain usually occurs at nighttime. There is no information from history to suggest psychogenic pain, but ALL must always be considered since it is the most common malignancy in children. The child should be assessed for lymphadenopathy since this accompanies bone pain in ALL at least 50% of the time. -Answer- A 6 year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from "playing outside too much". When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? Osgood-Schlatter disease Growing pains Acute lymphocytic leukemia (ALL) Psychogenic pain Roast beef with gravy, rice Explanation: Patients who have gout exacerbations should avoid foods high in purines. A low purine diet can significantly reduce risk of gout. Uric acid is a byproduct of purine metabolism. Purines can be found in high concentrations in beef, pork, bacon, lamb, seafood, beer, bread, gravy, and most alcoholic beverages. Foods considered low in purines are fruits and fruit juices, green veggies, nuts, dairy products, chocolate. -Answer- A patient who frequently has episodes of gout should avoid which groups of food? Beans, rice, and tea Scrambled eggs, milk, and toast Roast beef with gravy, rice Fish and steamed vegetables 18 months. Explanation: Common developmental tasks for an 18 month old include: walking backwards, throwing a ball, saying 15-20 words, pointing to multiple body parts, pointing and naming objects in a book, and stacking 3-4 blocks. -Answer- The age at which a child can first walk backwards is: 12 months. 15 months. 18 months. 24 months. risk for falls. Explanation: The "get up and go" test is used to evaluate musculoskeletal function. The patient is asked to rise from a seated position in an armchair, walk across the room, turn around, and return to the chair. This test evaluates the patient's gait, balance, leg strength, and vestibular function. It should be assessed in patients who report a fall or who present after a fall but who appear without injury. -Answer- The "get up and go" test in an elderly patient is used to evaluate: risk for falls. lower extremity strength. mental acuity. driving safety.