ORTHO PACKRAT QUESTIONS & ANSWERS
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 - Answers - 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. - Answers - B. Continue ordinary
activities as tolerated
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 - Answers - 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 - Answers - 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 - Answers - 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. - Answers - 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) - Answers - 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 - Answers - 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 - Answers - C. Cauda equina syndrome
25 year-old male presents to the ED with left calf pain and cramping, as well as nausea
and vomiting. He admits to "partying with cocaine all night". He describes his urine as a
dark brown color. Serum creatine kinase (CK) is 1325 IU/L (Normal Range 32-267
IU/L). Which of the following is the initial mainstay of therapy
for this condition?
A. IV rehydration
B. Fasciotomy
C. Toradol (Ketorlac)
D. Hydrotherapy - Answers - A. IV rehydration
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. - Answers - 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). - Answers - 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. - Answers - 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. - Answers - 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. - Answers - A. A thumb spica cast and an x-ray in 2
weeks
A 34 year-old female presents with complaints of right forefoot pain. She notes the pain
as a severe burning accentuated by activity. She notes her dress shoes aggravate the
pain and is relieved when she doesn't have them on. Massage of her foot also helps to
lessen the discomfort. No foot deformity is noted on exam. To confirm the diagnosis,
applying digital pressure along the forefoot would commonly create pain in what area?
A. Between the first and second metatarsal
B. Over the first MTP joint
, C. The base of the 2nd MTP joint
D. Between the third and fourth metatarsal - Answers - D. Between the third and fourth
metatarsal
A 25 year-old female presents to the ED with an open fracture of the left fibula
sustained from an auto accident. The patient has no neurological findings. In addition to
stabilization of the patient which of the following should be immediately initiated?
A. Antibiotic therapy
B. Apply a bi-valve cast
C. Reduce the fracture
D. Surgical debridement - Answers - A. Antibiotic therapy
A patient who has chronic Crohn's disease now complains of a nondeforming
asymmetric oligoarthritis of his large joints. The patient also notes that he has been
having a flare of his Crohn's disease. Which of the following is the best treatment to
alleviate both the inflammatory bowel disease and arthritic symptoms?
A. Indomethacin
B. Methotrexate
C. Infliximab (Remicade)
D. Cyclophosamide (Cytoxan) - Answers - C. Infliximab (Remicade)
A 42 year-old male presents with localized dysesthesias on the plantar medial aspect of
the left foot. Symptoms are aggravated with activity and relieved by rest. Patient also
complains of nocturnal symptoms. Four weeks prior the patient sustained an eversion
ankle sprain that is non tender to walk on, but he is left with some residual diffuse
swelling. Which of the following is most likely diagnosis?
A. Plantar fasciitis
B. Tarsal tunnel syndrome
C. Peroneus longus tendonitis
D. Bone spur of the calcaneus - Answers - B. Tarsal tunnel syndrome
Which of the following is the most significant complication of a dislocation of the knee?
A. Ligament damage
B. Inability to bear weight
C. Instability of the joint
D. Arterial injury - Answers - D. Arterial injury
A 60 year-old patient who has a 20 year history of diabetes mellitus arrives at the clinic
with a complaint of mild to moderate ankle pain. There is no history of trauma. You note
on exam that the joint is unstable but not erythematous or warm. On x-ray you would
expect to see
A. osteopenia.
B. loss of articular cartilage.
C. disintegration of the joint with osteophytes.
D. subchondral cysts. - Answers - C. Disintegration of the joint with osteophytes
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 - Answers - 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. - Answers - B. Continue ordinary
activities as tolerated
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 - Answers - 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 - Answers - 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 - Answers - 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. - Answers - 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) - Answers - 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 - Answers - 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 - Answers - C. Cauda equina syndrome
25 year-old male presents to the ED with left calf pain and cramping, as well as nausea
and vomiting. He admits to "partying with cocaine all night". He describes his urine as a
dark brown color. Serum creatine kinase (CK) is 1325 IU/L (Normal Range 32-267
IU/L). Which of the following is the initial mainstay of therapy
for this condition?
A. IV rehydration
B. Fasciotomy
C. Toradol (Ketorlac)
D. Hydrotherapy - Answers - A. IV rehydration
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. - Answers - 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). - Answers - 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. - Answers - 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. - Answers - 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. - Answers - A. A thumb spica cast and an x-ray in 2
weeks
A 34 year-old female presents with complaints of right forefoot pain. She notes the pain
as a severe burning accentuated by activity. She notes her dress shoes aggravate the
pain and is relieved when she doesn't have them on. Massage of her foot also helps to
lessen the discomfort. No foot deformity is noted on exam. To confirm the diagnosis,
applying digital pressure along the forefoot would commonly create pain in what area?
A. Between the first and second metatarsal
B. Over the first MTP joint
, C. The base of the 2nd MTP joint
D. Between the third and fourth metatarsal - Answers - D. Between the third and fourth
metatarsal
A 25 year-old female presents to the ED with an open fracture of the left fibula
sustained from an auto accident. The patient has no neurological findings. In addition to
stabilization of the patient which of the following should be immediately initiated?
A. Antibiotic therapy
B. Apply a bi-valve cast
C. Reduce the fracture
D. Surgical debridement - Answers - A. Antibiotic therapy
A patient who has chronic Crohn's disease now complains of a nondeforming
asymmetric oligoarthritis of his large joints. The patient also notes that he has been
having a flare of his Crohn's disease. Which of the following is the best treatment to
alleviate both the inflammatory bowel disease and arthritic symptoms?
A. Indomethacin
B. Methotrexate
C. Infliximab (Remicade)
D. Cyclophosamide (Cytoxan) - Answers - C. Infliximab (Remicade)
A 42 year-old male presents with localized dysesthesias on the plantar medial aspect of
the left foot. Symptoms are aggravated with activity and relieved by rest. Patient also
complains of nocturnal symptoms. Four weeks prior the patient sustained an eversion
ankle sprain that is non tender to walk on, but he is left with some residual diffuse
swelling. Which of the following is most likely diagnosis?
A. Plantar fasciitis
B. Tarsal tunnel syndrome
C. Peroneus longus tendonitis
D. Bone spur of the calcaneus - Answers - B. Tarsal tunnel syndrome
Which of the following is the most significant complication of a dislocation of the knee?
A. Ligament damage
B. Inability to bear weight
C. Instability of the joint
D. Arterial injury - Answers - D. Arterial injury
A 60 year-old patient who has a 20 year history of diabetes mellitus arrives at the clinic
with a complaint of mild to moderate ankle pain. There is no history of trauma. You note
on exam that the joint is unstable but not erythematous or warm. On x-ray you would
expect to see
A. osteopenia.
B. loss of articular cartilage.
C. disintegration of the joint with osteophytes.
D. subchondral cysts. - Answers - C. Disintegration of the joint with osteophytes
