46 year old male patient presents with a 2 year history of increasing R sided neck pain over the last year he has begun to loose the sensation to his Right thumb. He notes that he is becoming clumsier with this hand.

1. Differential diagnosis in this patient may include which of the followingA. Cervical radiculopathyB. Cervical spondylosisC. Herniated disc. D. TumorE. All of the above

2. A cervical spine Xray has been done within the past week which was read as being “normal” What evaluation might be most reasonable to carry out at this time? A. MRIB. MyelogramC. Cervical X-ray (AP/Lat/oblique)D. Bone scanE. Cardiolyte Scan.

3. If this patient has a C6 radiculopathy we may expect to find an abnormal muscle test involvingA. Biceps (C5)B. Triceps (C7)C. Extensor carpi radialis longusD. Flexor digitorum profundusE. Abductor digiti minimi

4. If this patients X-ray in reality shows marked DJD at the level of C6-C7.Possible etiologies of his spondylitic changes includeA. Age related degeneration B. HVLA thrust technique from last weeks visitC. Referred pain from his heartD. Acute infectionE. Acute “whiplash”

5. Evaluation and treatment of somatic dysfunction would be absolutely contraindicated in this patient in which of the following situationsA. Herniated discB. Bone spurC. Muscle spasmD. Ligament strainE. Patient request to not “treat” their neck with OMT

Available diagnostic imaging modalities, select one for the following questions:A. RadiographsB. Nuclear Medicine bone scans

C. CT scanD. MRI scan

6. Initial work-up of a patient who sustained trauma to the spine.--A. (radiographs)

7. Which is the cheapest examination in imaging of the spine?--A. (radiographs)

8. The best imaging examination to workup a cancer patient for possible bony metastasis is—B. (Nuclear Medicine bone scans)

9. The best imaging examination for persistent of lumbar pain is:--D. (MRI scan)

10. Which imaging modality does not involve radiation?—D. (MRI scan)

11. We can gain important information on the status of spondylolysis by combining what imaging modalities?A. a + cB. b + cC. c + dD. a + d

Questions 12,13,14

Coronal

transverse

SPECT

a b

Above is a study of a patient with back pain:12. What is study (a)?—A. (I’m not sure where these choices are, but it’s a bone scan)

13. What is study (b)?—C. (???)

14. What is the diagnosis for this patient?A. MetastasisB. Spondylolysis, acute

C. Herniated discD. Normal

Question 15

T2 axial Disc level

a

T2 sag. C-spine

15. What is the structure labeled “a” on the MR of C-spine?A. spinal cordB. cerebrospinal fluidC. discD. lamina

16. Ankylosing spondylitis typically presents asA. sudden onset of sharp lower back painB. pain relieved by restC. insidious low back pain relieved by activityD. chronic pain in the elderlyE. pain usually better in the morning

17. Defining features of ankylosing spondylitis include all of the following exceptA. low back painB. restricted lumbar spinal motionC. decreased chest expansionD. radiographic evidence of sacroiliitisE. HLA-B27

18. The most common extra-articular manifestation of ankylosing spondylitis isA. anterior uveitisB. aortic valve diseaseC. back pain

D. pulmonary fibrosisE. fever

19. Reactive arthritis is a reaction toA. rheumatoid arthritisB. over-activityC. sacroiliac joint inflammationD. infection outside the jointE. trauma

20. Enteropathic arthritis is related toA. bowel infectionB. inflammatory bowel diseaseC. urethritisD. irritable bowel syndromeE. colon cancer

21. Which of the following is a disease of endochondral ossification?A. Blount’s disease (growth disorder of the tibia that causes the lower leg to angle

inward, resembling a bowleg)B. Klippel-Feil syndrome (rare; characterized by the congenital fusion of any 2 of

the 7 cervical vertebrae)C. congenital scoliosis (curvature of spine that’s a result of malformations of the

vertebral elements).D. Scheuermann disease (form of juvenile osteochondrosis of the spine; found

mostly in teens, and presents a significantly worse deformity than postural kyphosis (they can’t consciously correct their posture).

E. idiopathic scoliosis (lateral curvature of spine; can occur in kids aged 10-maturity; the abnormal curve occurs for unknown reasons)

22. Choose the correct statement regarding Klippel-Feil Syndrome:A. males and females are affected equallyB. it usually presents in adulthoodC. five types of this syndrome existD. laboratory tests make the final diagnosisE. osteopathic manual medicine is not indicated

23. A thirteen year old girl is brought to the office with a diagnosis of “mild scoliosis” from a school health screening. The information states that on a Scoliometer, the curve in her back was 10 degrees. What further evaluation would be needed?A. nothing at this timeB. standing flexion testC. spinal x-rays aloneD. a neurologic examE. a CT scan of the spine

24. Choose the correct statement regarding diskitis.A. mild cases in children can resolve without antibioticsB. OMM should be used as the first line of therapyC. recurrence of symptoms is very frequentD. plain films of the spine are diagnosticE. it is always completely dehabilitating

25. Which of the following is true regarding infantile idiopathic scoliosis?A. immediate surgery is neededB. bracing is needed in infancyC. it has significant spontaneous resolutionD. it is only seen in children older than six yearsE. only resolves with surgery

26. A 55 year old woman asks her doctor about osteoporosis and hormone replacement therapy. Her last menstral period was 4 years earlier. She had problems with hot flashes in the past but has not had any symptoms in the past year. She has no history of chronic medical problems or medications associated with decreased bone density. In order to help her decide, you order a DEXA of her hip and spine. The t-score at both sites is less than -3.5. Which of the following is the best next step in the care of this patient?A. start HRTB. start bisphosphonateC. evaluate the patient for secondary causes of osteoporosisD. obtain serum or urine markers of bone resorptionE. nuclear bone scan

27. You are asked to see a patient in the hospital for medical management. He was admitted the previous night when he fell at the grocery store and suffered a hip fracture. He is a 60 year old man with no history of smoking, excessive alcohol use, or medications associated with osteoporosis. Which of the following tests would be least useful?A. OsteocalcinB. TestosteroneC. Serum calciumD. Thyroid stimulating hormoneE. DEXA scan of his spine and opposite hip

28. The main factor influencing peak bone mass is:A. body mass indexB. calcium intake during childhood and adolescenceC. genotypeD. exerciseE. protein-calorie nutritional status

29. Which of the following tests is best suited to determine short-term assessment of response to therapy with a bisphosphonate?A. Baseline DEXA scan with repeat DEXA in 6 monthsB. Osteocalcin levels 3 months after treatment is begunC. C-telopeptide of collagen 2 months after therapy is beginD. Urinary pridinoline at baseline with repeat value in 3 months

30. All of the following medications reduce the risk of fragility fracture by slowing bone resorption (osteoclastic activity) except:A. bisphosphonatesB. hormone replacement therapyC. synthetic estrogen receptor modulatorD. recombinant PTH E. miacalcin

31. Which of the following statements about Pagets disease is correct?A. Treatment with bisphosphonates only improves pain and does not alter the

structure of the bone. B. Osteosarcoma is a benign bone tumor that can complicate the disease.C. Normal calcium, phosphorus and PTH (parathyroid hormone) are the rule in

Paget’s disease.D. Bone scan is not sensitive in Pagets disease since the lesions typically seen are

lytic.E. Pain is often due to the new bone formation being harder and more firmly

structured.

32. Cord compression is the most important complication of Skeletal TB (tuberculosis). However, patients with skeletal TB usually present with:A. FeverB. Weight lossC. CoughD. Progressive painE. Joint erythema and warmth

33. A 52 year old presents with a markedly increased alkaline phosphatase of 850 with normal liver function tests, calcium, phosphorous, parathyroid hormone and creatitine. He has had B/L hip and knee pain since college. XR demonstrates cortical thickening with irregular trabeculae. Old records show an elevated AP for over 5 years. The most likely diagnosis is:A. Skeletal TBB. PagetsC. SarcoidosisD. RicketsE. Osteonecrosis

34. Which of the following statements about osteonecrosis, also known as avascular necrosis is correct?A. Results from compromise of bone vasculature leading to death of the bone

and bone marrow.B. Patients most commonly present with fractureC. Bone scan is the most sensitive radiographic study.D. The goal of treatment is to restore normal blood flow to the arteries leading to the

joint.E. Steroids, sickle cell anemia and trauma are the only known causes

35. All of the following are known complication of Pagets disease EXCEPT:A. Deafness B. Iron deficiency anemia C. OsteosarcomaD. FractureE. Conduction abnormalities of the heart

36. On your hospital rounds, you are seeing a 28 year old is suspected of having osteomyelitis of his tibia. Your attending physician notes that certain medical conditions are more closely associated with osteomyelitis caused by certain organisms. If this patient had sickle cell disease, which organism is most associated with osteomyelitis?

A. aspergillusB. M furfurC. P multocidaD. Salmonella spE. S aureus

37. A 17 year old has chronic osteomyelitis of his second toe. On his x-ray you see whitened open areas surrounding little pockets of normal bone. Which of the following BEST describes this finding?A. osteolysisB. periosteal thickeningC. rarefactionD. sequestrumE. soft tissue swelling

38. You are seeing a 21 year old college student who complains of joint swelling. First it was in her knee and then her elbow and now she presents to you with a red warm right wrist and a rash on her hands. While you are awaiting cultures to return, which of the following is the BEST course of action?A. CBC and ESRB. IM ceftriaxoneC. Joint aspirationD. Oral penicillinE. No treatment until cultures return

39. During your rounds with an attending, you see a previously well 38 year old male with a high fever and a red swollen knee joint. Which of the following MOST LIKELY determines the underlying etiology?A. Empiric antibioticsB. Joint aspirationC. Physical examinationD. RadiographsE. Referral to orthopedics

40. During your rounds with an attending, you see a previously well 38 year old male with a high fever and a red swollen knee joint. Which of the following MOST SUGGESTS a septic arthritis as the underlying cause?A. FeverB. Synovial WBC 25000C. Synovial WBC 50000D. Synovial WBC 100,000 E. WBC count of 12000

41. Spondylolysis is:A. A stress fracture of the pars interarticularisB. Tuberculosis of the spine.C. Malignancy of the spine.D. A post operative complication of lumbar discectomy.

42. When evaluating a young athlete with low back pain it is important to obtain oblique views of the lumbar spine in order to adequately visualize the:A. Vertebral bodyB. Transverse processC. Spinous processD. Pars Interarticularis

43. Atypical Scheuerman’s Disease is characterized by:A. Pain, vertebral body endplate changes and Schmorl’s nodesB. Pain and pars interarticularis fractureC. Pain and peripheral neuropathyD. Pain, hemi-vetebrae and scoliosis

44. Bonnet’s Test is a nerve root tension sign that helps to differentiate:A. Pott’s disease from meralgia parestheticaB. Herniated lumbar disc from piriformis syndromeC. Lumbago from multiple myelomaD. Degenerative disc disease from facet syndrome

45. Ligaments and fascia help to stabilize the spine and set motion limits. One of the primary functions of the thoracolumbar fascia is to:A. Serve as a force transfer link between the legs and the trunk

B. Protect the kidneysC. Facilitate hamstring contractionD. Facilitate adductor contraction

46. Thoracic kyphosis is most commonly associated with what condition?A. OsteoporosisB. Rib FractureC. Poor conditioningD. Vertebral fractureE. Pectus carinatum

47. A 46 yo male presents with back pain. Exam demonstrates poor flexion of the lumbar spine. X-rays show a spine which looks like “bamboo”. What is the most likely diagnosis?

A. OsteoarthritisB. Ankylosing spondylitisC. Rheumatoid arthritisD. KyphoscoliosisE. Lupus arthritis

48. A 68-year-old white woman, whose mother and maternal aunt had late-life hip fractures, asks you about osteoporosis prevention. She is healthy and walks 4 or 5 days each week. Her only medications are calcium and vitamin D supplements. At a health fair, she had an ultrasonography of the heel, with a T score of –1.5. She is reluctant to take additional drugs. Which of the following is most appropriate for this patient?

A. Reassurance and continuation of the current regimenB. Quantitative computed tomography (QCT) of the spineC. Dual-energy x-ray absorptiometry (DEXA scan) of the spine and hipD. AlendronateE. Plain lumbar and hip films.

49. A 75-year-old white man has back pain after gardening and is found to have a T10 vertebral compression fracture. The patient has no other symptoms and has always been in good health except for mild hypertension that is treated with a diuretic. He is very active and does weight-bearing exercise for 1-2 hours each day. He does not smoke cigarettes and drinks alcohol only occasionally. Which of the following is the most likely cause of the fracture?A. OsteoporosisB. Testosterone deficiencyC. Longstanding corticosteroid useD. Chronic malabsorptionE. Metastatic carcinoma

50. A 73 year old woman comes to your office with recent onset of low back pain that seems worse with activity. She is able to sit with no pain and sleeps pain free. The pain has, on occasion, seemed to radiate into both lower extremities. On

examination, there are no tender areas in the back. Neurologic and vascular exams are normal. The most likely diagnosis is:A. Polymyalgia RheumaticaB. Vertebral compression fractureC. Spinal StenosisD. Herniated diskE. Sever osteoporosis.

1. Which of the following is NOT considered in the differential diagnosis of acute monoarticular joint pain?A. InfectionB. GoutC. TumorD. OsteoporosisE. Hemarthrosis

2. What according to textbooks is considered to be the most common cause of acute non-traumatic monoarthritis?A. StaphB. StrepC. GonococcusD. GoutE. Mycobacterium

3. A 57 yo male presents to the ER with a red, painful and swollen right knee. synovial fluid analysis reveals 4cc of opaque, yellow fluid with a WBC count of 120,000 with 75% polys. Gram stain and culture are pendidng at this time. What is the appropriate treatment?A. Cefazolin 1gm IV q 8hoursB. Ciprofloxacin 400mg IV q 12 hrsC. Ceftriaxone 1gm IV q 12 hrsD. Vancomycin 1 gm IV q 12 hrsE. Ibuprofen 800 mg q 4 hours prn

4. Choose the correct statement regarding the pathophysiology of the joint pain in JRA:A. extra synovial fluid and distention of the jointB. a positive rheumatoid factorC. a positive ANAD. bacteria in the jointE. redness over the joint

5. Joint destruction in JRA is due to which of the following factors?A. the presence of cytokines and proteasesB. bacterial in the synovial fluidC. decreased synovial fluidD. increased lymphocytes

E. hyperplasia of the synovium

6. Choose the correct statement regarding polyarticular JRA:A. only small joints are involvedB. is always associated with high feverC. cervical spine pain may be presentD. only involves large jointsE. has a rash as a component

7. Which type of JRA can be associated with nodule formation?A. systemic onset JRAB. pauciarticular JRAC. rheumatoid factor negative JRAD. polyarticular JRAE. psoriatic arthritis

8. Osteopenia is commonly associated with which of the subtypes of JRA?A. systemic onset JRAB. polyarticular JRAC. pauciarticular JRAD. osteopenia is not associated with JRAE. psoriatic arthritis

9. Which of the following is associated with short stature?A. Poland syndrome (one-sided congenital malformations ; underdevelopment or

absence of pectoralis muscles on one side of body as well as webbing of the fingers on the ipsilateral hand).

B. Jeune syndrome (asphyxiating thoracic dysplasia; classic manifestations in infancy include dwarfism with short ribs, short limbs, and radiographic changes in ribs and pelvis)

C. pectus excavatumD. pectus carinatumE. all are associated with short stature

10. Asphyxiating thoracic dystrophy is a synonym for which of the following?A. pectus carinatumB. pectus excavatumC. Jeune syndromeD. Poland syndromeE. nipple hypoplasia

11. A six year old child presents to the office with his parents, with a chief complaint of fatigue, and a chest wall deformity. The evaluation in the office reveals an abnormal heart sound, a click. Which of the following would you consider as a diagnosis?A. Jeune syndromeB. Poland syndrome

C. pectus carinatumD. pectus excavatumE. asphyxiating thoracic syndrome

12. A twenty two year old woman comes to the office with a complaint of “asymmetrical breast development”. She has no other complaints, or symptoms. Which diagnosis would you consider with this information?A. Poland syndromeB. Jeune syndromeC. pectus carinatumD. pectus excavatumE. Marfan syndrome

13. Which of the following is the result of a vascular event early in gestation?A. Jeune syndromeB. Poland syndromeC. pectus carinatumD. pectus excavatumE. Marfan syndrome

14. Which of the following findings would be associated with a diagnosis of developmental dysplasia of the hip?A. unequal thigh creasesB. increased adduction on the affected sideC. decreased abduction on the opposite sideD. no findings except a hip clickE. pain on hip movement

15. The Scottish Rite Brace is associated with which of the following?A. slipped capital femoral epiphysisB. idiopathic scoliosisC. transient synovitisD. developmental dysplasia of the hipE. Legg-Calve-Perthes disease

16. The evaluation modality of choice for transient synovitis is which of the following?A. ultrasound aloneB. AP and lateral frog leg x-raysC. bone scan aloneD. magnetic resonance imaging aloneE. physical examination alone

17. Choose the correct statement regarding transient synovitis of the hip:A. always requires antibiotic therapyB. does not need any therapyC. may require needle aspiration

D. requires an Atlanta braceE. requires surgery

18. Avascular necrosis of the femoral head can occur in which of the following disorders?A. slipped capital femoral epiphysisB. congenital scoliosisC. transient synovitisD. Scheuermann disease E. developmental dysplasia of the hip

19. Choose the correct statement regarding sickle cell anemia:A. only the hip joint is affectedB. males are more affected than femalesC. only children are affected until age six yearsD. this condition rarely needs antibioticsE. the most common painful joint sites are the humerus, tibia and femur

20. Which of the following is true regarding osteosarcoma?A. it is rare in very young childrenB. the incidence in African-Americans is lowerC. females are affected more commonlyD. is less common in adolescenceE. is more common in the spine

21. Which is the true statement regarding the onset of osteosarcoma?A. it has a sudden onsetB. it always presents with high feverC. does not present as a mass lesionD. symptoms may be present for weeksE. only occurs in the femur

22. Choose the correct statement regarding modalities for evaluating osteosarcoma:A. plain films are diagnosticB. a combination of modalities is neededC. only MRI is necessaryD. imaging is not necessaryE. a bone scan is always diagnostic

23. Which of the following organisms should be suspected in osteomyelitis in a person affected with sickle cell anemia?A. staphylococcus aureusB. Neisseria gonorrheaC. salmonellaD. group B streptococcusE. no specific organism

24. A 13 year old soccer player kicks hard at a bouncing ball moving toward him. He immediately experiences pain and a “popping” sensation in his anterior hip near the anterior superior iliac spine. On examination he is tender directly over the ASIS and x-ray reveals an avulsion injury there. Which muscle is most likely to be involved in this injury?A. adductor magnusB. iliopsoasC. piriformisD. rectus femorisE. sartorius

25. A 22 year old former collegiate soccer player from Mississippi moves to graduate school here in the new river valley. She presents with a 4 week history of anterior hip and thigh pain. The onset was gradual, shortly after moving here and starting to train for a marathon with her boyfriend. When questioned about distance, she states she’s been increasing only about 1 mile a week, except for about a month ago when she increased from 2 to 6 miles four times per week and began running hills. At first her pain was only after running, but now her pain is constant, even at night. Which diagnostic test will show the EARLIEST evidence of injury in her case?A. arthrogramB. bone scanC. CT scan D. electromyelogramE. MRI

26. A 39 year old mail carrier is driving when traffic suddenly stops in front of her. She slams on the brakes but hits the car in front of her forcefully. She has immediate pain in her right hip posteriorly. You diagnose a posterior hip dislocation. Of the following, which is the MOST DEBILITATING complication associated with hip dislocation?

A. avascular necrosisB. femoral neck fractureC. instabilityD. labral tearE. osteoarthritis

27. A positive fulcrum test suggests?

A. anterior hip capsule laxity B. posterior instability of the knee C. posterior hip labral tear D. sacral-iliac dysfunction E. stress injury of the femur

28. A 79 year old grandmother presents with several weeks of right lateral thigh pain. It is deep, achy and “just hurts all the time.” It is especially bad when she hits it on something or when she rolls over on it at night. Then, it wakes her up and is

sometimes bad enough to make her cry. It is better with ice and ibuprofen. Which of the following is essential to diagnose her condition?A. decreased knee reflexB. MRI of lumbar spineC. MRI of right hip D. Palpation distal to right trochanterE. X-ray of right hip

29. A 22 year old has pain in his back and pain that radiates into the region of his inguinal ligament and across the base of his penis and into his inner thigh. As you assemble your differential diagnosis, which nerve root, does this distribution represent?A. T11B. T12C. L1D. L2E. L3

30. A 42 year old complains of pain in the lateral thigh and hip. She has been training for a 10K and complains of a “snapping” in her left hip. It started a few weeks ago, at first it was just annoying, but now it hurts and it feels “like my hip is coming out of joint” – She shows you. It gets worse when she runs or if she walks briskly. Which of the following is the most common cause of “snapping hip”?A. acetabular labral tearB. dislocation of hipC. illiopsoas friction over greater trochanterD. iliotibial band frictionE. loose body in hip

31. A soccer player tries to field a ball with his inner thigh. His hip is in flexion and external rotation when the ball hits his thigh just above the medial aspect of the knee. He feels a pop and immediate pain in his groin and cannot continue playing. On palpation you detect pain and a defect just lateral and inferior to pubic symphysis . There is no change with coughing or sneezing. Which diagnosis of the following should be highest on the differential diagnosis list for this scenario?

A. Acetabular labral tearB. Adductor longus avulsion/tearC. Adductor magus avulsion/tearD. Inguinal herniaE. Ostiitis pubis

32. Which of the following is LEAST LIKELY to be a cause of posterior hip pain?A. Gluteus medius strainB. Gracilis tearC. Posterior acetabular labral tearD. Piriformis syndrome E. Sacroiliac dysfunction

33. A 78 year old complains of a 6 month history of progressively worsening left hip pain which is associated with a deep pain, and particularly worse at night and wakes him from sleep. He has a 50 pack year history of smoking and his review of systems is significant only for a 20 pound non-intentional weight loss over the past few weeks and difficulty starting and stopping his urine stream. Of the following, which exam or diagnostic test is MOST LIKELY to point to his diagnosis?A. Auscultation of lungsB. Exam of hipC. Lumbar spine examinationD. Rectal examinationE. X-ray of hip

In the lecture, the following imaging modalities were discussed: A. RadiographsB. MR imagingC. CTD. Scintigraphy[nuclear medicine bone scan]

Please identify the following images:34. --D. (Scintigraphy)

35.—A. (Radiographs)

36.—B. (MRI)

37. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?A. Lupus tends to be symmetric but RA is notB. Synovial Hypertrophy is common to both RA and LupusC. Prednisone is the initial therapy of choice for both Lupus and RAD. Erosions are common in both RA and LupusE. Myalgias are common in both Lupus and RA

38. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?A. Morning stiffness is common with Lupus but not with RAB. Myositis is common with RA but rare with LupusC. Osteoporosis is rare in both Lupus and RAD. Avascular necrosis is seen in up to 50% of Lupus patients and is uncommon

in RA patientsE. Deforming arthritis in uncommon in RA and common in Lupus

39. Which of the following concerning Lupus and Rheumatoid Arthritis (RA) is correct?A. The swan-neck deformity is seen commonly (>50%) in both Lupus and RA and is

reducible in bothB. Ulnar deviation is seen more commonly in Lupus than RAC. Subcutaneous nodules are seen commonly in Lupus and rarely in RAD. Synovial fluid is always exudative in Lupus and transudative in RAE. In Lupus, the PIP joint is involved more commonly than the wrist or the

knee

40. A 32 year old female patient presents with a 2 month history of morning stiffness lasting 3-4 hrs, pain and swelling of both knees, her MCP and PIP joints. She also has a positive ANA and RF as well as an x-ray of her hands showing mild erosions of the PIP joints bilaterally. What course of therapy would be most beneficial for this patient? A. Watchful waiting with prn acetaminophenB. Watchful waiting with prn NSAIDSC. Methotrexate 7.5mg po weeklyD. Physical therapy with prn Ibuprophen 400mg QID prnE. Prednisone 40mg po BID

41. A 28 you woman presents with a malar rash of 6wks duration as well as a 3 month history of pain involving her right PIP and MCP joints as well as her left knee. She admits to occasional morning stiffness lasting only minutes and has no signs of deforming arthritis on physical exam. X-rays of her hands reveal no erosions. Blood work reveals a positive ANA, a negative RF and serology positive for Anti-double-stranded DNA and anti-Smith antibodies. You begin hydroxychloroquine which is particularly helpful for her skin manifestations as well as arthralgias. You see her in follow-up three weeks later and she is still complaining of arthralgias. What would you begin next? A. An NSAID such as Ibuprofen or NaproxenB. AzithromycinC. Chelation TherapyD. ImmunoglobulinE. Thalidomide

42. Regarding knee imaging studies the diagnostic imaging study that best demonstrates

ligamentous injuries is:A. Plain filmsB. CT ScanC. Bone ScanD. MRI Scan

43. You aspirate an acutely swollen knee that has been injured traumatically and note a bloody effusion. Your top differential diagnostic choice would be:A. ACL TearB. Medial meniscus tear

C. Gouty arthritisD. Patellar tendon rupture

44. The type of knee brace that would be most commonly prescribed for an ACL deficient knee would be: prophylactic brace, the functional brace and the rehabilitative brace.A. A prophylactic braceB. A functional braceC. A rehabilitative braceD. A valgus unloading brace

45. The most common mechanism of injury for acute anterior cruciate ligament tear is: A. Non-contact with coupled flexion, valgus load and torsional knee rotation.B. Contact with hyperextension and varus load with torsional knee rotationC. Direct contact on the anterior tibia with posterior translation of the tibia on the

femurD. Contact with valgus load coupled with hyperflexion

46. A Segond fracture noted on plane films of the knee is pathoneumonic for:A. Torn posterior cruciate ligamentB. Torn anterior cruciate ligamentC. Torn medial collateral ligamentD. Torn lateral collateral ligament

47. A 56 year old man presents with a 3 month history of weakness. He is no longer able to walk up steps and get tools from his upper shelf. He denies fever, weight loss. A CK is markedly elevated at 15,000. He is on no medications and his physical exam shows proximal muscle weakness. You suspect an inflammatory myopathy. What is the definitive test to diagnose polymyositis?A. EMGB. Elevated CKC. BiopsyD. MRIE. PET scan

48. During the physical exam of the above patient, you notice psoriaform plaques on the extensor surface of his elbows and the dorsal surface of his phalanges. EMG excludes a neuropathic cause and suggests myopathy. The most likely diagnosis is:A. PolymyositisB. DermatomyositisC. Inclusion body myositisD. FibromyalgiaE. Psoriatic arthritis

49. Which of the following is the most appropriate initial treatment of the above patient?A. Methotrexate

B. AzathioprineC. CyclosporineD. Intravenous immune globulinE. Prednisone

50. A 26 year old woman presents with undiagnosed muscle pain for over 3 years. She complains of generalized muscle pain and weakness, unrefreshed sleep, chronic tension headaches and fatigue. Physical exam is normal. TSH, CK, CMP, CBC, ANA are normal. She has pain with palpation over her B/L medial epicondyles of the elbows, medial knee, greater trochanters, and sacroiliac joints. She has no pain on palpation of the anterior thigh. The most likely diagnosis is:A. PolymyositisB. DermatomyositisC. Inclusion body myositisD. FibromyalgiaE. Amyopathic dermatomyositis

1. Which of the following is a common cause of genu varus?A. a chromosomal defectB. Blount disease (growth disorder of the tibia (shin bone) that causes the lower leg

to angle inward, resembling a bowleg)C. excessive vitamin D intakeD. amniotic bandsE. Down syndrome

2. In tibial bowing, which of the following associated problems is the biggest concern?A. having an odd gaitB. cosmetic appearanceC. intoeingD. leg length differenceE. knee pain

3. Which of the following causes knee pain in adolescents?A. metatarsus adductusB. tibial torsionC. genu valgumD. hip dysplasiaE. Blount disease

4. Proximal femoral focal deficiency has a proven cause in which of the following?A. thalidomide exposureB. fluoride exposureC. acetaminophen exposureD. alcohol exposureE. aspirin exposure

5. The Van Ness procedure (surgical rotation) is associated with which of the following?A. Blount diseaseB. proximal femoral focal deficiencyC. tibial torsionD. genu valgumE. scoliosis

6. A 21-year-old soccer player “rolled her ankle” at the game. She presented to the emergency room complaining of lateral ankle pain. X-rays reveal an avulsion fracture off the medial maleolus. Which of the following is the best management of this injury? A. avoid running for 4 weeksB. casting non-weight bearing on crutches for 6 weeksC. casting with partial weight bearing on crutches for 6 weeksD. stirrup ankle sprain brace and weight bearing as toleratedE. surgical fixation of the fracture

(An avulsion fracture is an injury to the bone in a place where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone)

7. A 48 year old complains of anterior and lateral leg pain. She states the pain started with a “pop” that occurred while chasing her Great Dane who had broken its leash. She has very weak dorsiflexion of the foot, and her foot tends to invert when she dorsiflexes. Which diagnosis is MOST LIKELY?A. avulsion of the medial maleolusB. high ankle sprainC. rupture of posterior tibialis D. rupture of tibialis anterior E. tibial plateau fracture

8. A 23 year old female presents with posterior heel pain after a fall waterskiing. Of the following, which mechanism of injury is MOST COMMONLYassociated with this mechanism of injury?A. EversionB. Forceful dorsiflexionC. Forceful plantarflexionD. InversionE. Landing after a jump

9. Which of the following treatments has been demonstrated to facilitate tendon healing in patients with achilles tendinosis?A. eccentric exerciseB. electric stimulation C. ibuprofen D. massage

E. steroid injection

10. Which of the following best describes Mulder’s sign? A. contralateral tightness of the iliopsoas & rectus with ipsilateral hip flexionB. lancinating pain improved with restoration of transverse archC. neurologic symptoms with the hip in flexion and ADDuction D. pain on thigh compression in femoral stress fractureE. radicular pain reproduced on straight leg raise

11. You and your friends are playing football at the tailgate party. She lands awkwardly on her foot, bringing her full weight down axially on her toes. She has immediate pain over the dorsal aspect of her 1st metatarsal proximally and inability to bear weight on that side. You follow her to the emergency room and routine foot x-rays reveal no fracture. The diagnosis that most closely fits this scenario is?A. First metatarsal-phalangeal joint sprainB. First metatarsal stress fractureC. First metatarsal shaft fractureD. Lisfranc joint injury (fracture and dislocation of the joints in the midfoot, where

a cluster of small bones forms an arch on top of the foot between the ankle and the toes)

E. Navicular fracture

12. A 45 year old complains of posterior heel pain for the past 2 weeks. The pain started at the gym after doing particularly heavy “squat” lifting. His pain is worse with raising up on his toes and worse when you palpate his heel cord and passively dorsiflex his leg. Which of the following is NOT a cause of posterior heel pain?A. achilles tendinosisB. Haglund’s deformity (bony enlargement on back of heel)C. plantar fasciitisD. retrocalcaneal bursitis (inflammation of the bursa at the back of heel)E. shepherd’s fracture (a fracture of the external tubercle (post. process) of the talus)

13. Which of the following is true of bunions?A. Associated with wide, flat shoesB. Due to high transverse arch C. Sesamoiditis contributes to joint changesD. Usually requires surgery for uncontrolled symptoms E. Varus deviation of the first metatarsal phalangeal joint

14. Osteophyte formation on the dorsal aspect of the first metatarsal-phalangeal joint that limits motion results inA. bunionB. hallux rigidusC. hallux valgusD. hallux varusE. turf toe

15. In the treatment of metatarsal stress fractures, the most important consideration for healing is?A. control of ankle motionB. control of painC. control of hindfoot extensionD. control of metatarsal phalangeal joint motionE. restoration of the longitudinal arch

16. In nursemaid elbow, which of the following clinical findings is common?A. redness and warmth are usually presentB. the child will not move the arm at allC. circulation may be abnormalD. the child cannot feel the armE. a fracture is always present

17. Which of the following best describes the clinical findings in Little League Elbow?A. microtrauma is a likely causeB. the wrist is always involvedC. redness of the area is commonD. decreased range of motions is commonE. findings are the same in all ages

18. Choose the correct statement regarding Little League Elbow:A. decreased range of motion in the affected arm is commonB. surgery is always required for this disorderC. most cases only need conservative treatmentD. there is no prevention for this disorderE. medication is curative

19. Choose the correct statement regarding brachial plexus injuries:A. these injuries are always very severe and devastatingB. surgery is required for all brachial plexus injuriesC. there is no treatment for brachial plexus injuriesD. these injuries can be prevented by monitoring fetal sizeE. these disorders are inherited

20. Which of the following statements is correct regarding distal radial fractures?A. these injuries are always the result of abuseB. there is only one type of distal radius fractureC. these fractures are more common in elderly personsD. these injuries are more common in CaucasiansE. casting is the treatment of choice

21. You are evaluating a 15 month old child in the ED for a suspicion of child abuse. The grandmother states that the child has “osteogenesis imperfecta type 2”, and gives no

further history. Since there are multiple fractures on the x-rays you obtain, how would you make the diagnosis?A. perform a bone biopsyB. send collagen synthesis analysis and chromosome markerC. look at the eyes for blue scleraD. send for a chromosome analysis and a CBCE. obtain a CT scan of the entire child

22. Enchondromas and hemangiomas can coexist in which of the following disorders?A. Maffucci syndromeB. metachondromatosisC. Ollier diseaseD. Hurler syndromeE. osteogenesis imperfecta

23. Choose the correct statement regarding the mucopolysaccharidoses:A. all MPS syndromes are fatal in child hoodB. all MPS syndromes have the same enzymatic deficiencyC. all MPS syndromes can be detected prenatallyD. all MPS syndromes are transmitted by sex-linked recessiveE. all MPS syndromes have a normal life span

24. Choose the correct statement regarding Hunter syndrome:A. is also called Sanfilippo syndromeB. is fatal in infancyC. is the same as Hurler syndromeD. has a severe and mild formE. all forms have mental retardation

25. Which is true of Sanfilippo syndrome?A. death occurs by age 10B. the most common problems are orthopedicC. it is inherited by the sex linked recessive transmissionD. it is the same as Morquio syndrome E. it is the most common type of MPS

26. Which of the following dermatomes are found in the hand and wrist?A. T2, T1, and C7B. T1, T2, and C8 C. C6, C7 and C8D. C4, C5, and C6E. C1, C2, and C3

27. Which of the following is true?A. Ganglion cyst are firm nodules that do not transilluminateB. Ganglion cyst are an early sign of malignancy involving the tendon sheath

C. One should suspect a ganglion cyst after presentation of an acute fractureD. All ganglion cysts need to be removed surgically for permanent resolutionE. Ganglion cyst commonly result from a tear in ligaments overlying the lining

of tendons or joints

28. A patient presents complaining of pain in their R little finger at the DIP joint. They mention it is stuck in a flexed position and they cannot straighten it despite trying. The remember banging the tip of the finger while reaching for a door handle three days ago. You suspect which of the following?A. Trigger FingerB. Mallet FingerC. Thumb UCL SprainD. Anterior Interosseous SyndromeE. Guyon’s Canal Syndrome

29. A 30 y/o construction worker doing a lot of jack hammering complains of L wrist

pain with numbness in a nonspecific distribution. He has a negative Tinel’s sign and his grip strength is 5/5. You strongly suspect which of the following?A. Kienbock’s disease (breakdown of the lunate bone)B. Ulnar nerve entrapmentC. Scapholunate InstabilityD. Ganglion cystE. Cubital Tunnel Syndrome

30. 23 y/o R handed male presents c/o R wrist pain that has been present for several years. It will come and goes. He locates the pain to the middle of his wrist. He reports he was a cheerleader in college so he often had sore wrists and thought it was from overuse. X-rays are suspicious for Kienbock’s disease. Which of the following is true?A. If Kienbock’s disease is left untreated, it can lead to complete collapse of the

lunateB. Stage 1, Kienbock’s disease never requires surgeryC. Kienbock’s disease is often a result of a traumatic hyperextension injury to the

wrist with the thumb abductedD. A positive Watson Shift Test can indicate presence of avascular necrosis of the

lunateE. Kienbock’s disease is avascular necrosis of the scaphoid after fracturing the

scaphoid bone

31. Avascular necrosis is most likely to occur in what type of hip fracture:A. Non-displaced fractureB. displaced intertrochanteric fractureC. displaced femoral neck fractureD. displaced subtrochanteric fracture

32. The most common treatment for a femoral shaft fracture is:

A. castB. plate and screwsC. intramedullary rodD. amputation

33. When a fracture breeches the articular surface of a joint, a patient is at greatest risk for:A. pain when weather changesB. stiffness/loss of motionC. post traumatic arthrosisD. all of the above

34. Articular discontinuity of __________mm is considered a pre-arthritic state in medial tibial plateau fractures.A. 1mmB. 2mmC. 3mmD. 4mm

35. With a severe fracture to the lower leg or ankle, the most important initial concern is:A. location of fractureB. severity of fractureC. severity of soft tissue injuryD. severity of pain

36. When rehabilitating a significantly injured knee, which type of rehabilitation should first be incorporated?A. Isometric B. EccentricC. IsolyticD. ConcentricE. Econcentric

37. A 20 year VT women’s basketball player comes into the sports medicine clinic complaining of anterior knee pain worse with jumping. You diagnose her with patellofemoral syndrome. Which radiological view is necessary to assess PF alignment?A. LateralB. APC. ObliqueD. Merchant E. Tunnel

38. Which muscle is crucial in patellar stabilization and rehabilitation for patellofemoral syndrome?

A. Rectus femorisB. Vastus intermediusC. Vastus lateralisD. Vastus medialis obliquus E. Shawnus maximus

39. A 19 year old VT football player has suffered from a recurring popliteal cyst and medial knee pain throughout the 2005 season. You are very anxious about traveling to a BCS bowl game next year and want to uncover the reason for the chronicity of his swelling ASAP. Which is the most likely culprit here?A. Medial meniscus pathology B. Anterior cruciate ligament tearC. Posterior cruciate ligament tearD. Quadricep strainE. Apophysitis of the tibial tuberosity

40. A tunnel view on plain xray is an important view in considering which of the following disorders?A. Patellofemoral SyndromeB. Osteochondritis dissecans C. Osgood Schlatter’s diseaseD. Baker’s cystE. Sinding Larsen Johansson’s disease

41. Supracondylar Humerus Fractures in childrenA. Are a difficult fracture to treat because the area is hard to get toB. Are a frequent cause for medical liability claimsC. Are the most common childhood fracture of allD. Are usually flexion type injuriesE. Cause damage to one of the neighboring nerves in 70% of cases

42. If you see an otherwise normal elbow x-ray of a skeletally immature individual with a “posterior fat pad sign,” thenA. The fracture is a supracondylar humerus fractureB. There is a 75% chance of an occult fracture being presentC. This injury is likely to cause a growth disturbanceD. This patient will likely need a surgical repairE. You will never see an anterior fat pad sign at the same time

43. There are _____ growth centers around a normal elbow which appear and fuse at different stages of development.A. 1B. 2C. 3D. 4 or lessE. 5 or more

44. All of the following statements concerning complications following a pediatric supracondylar humerus fracture are correct except:A. Iatrogenic injury to the ulnar nerve can occur during surgery while placing the

pins.B. Malunion is most often due to growth disturbance rather than malreduction

as was once thought.C. Most nerve injuries that do occur resolve spontaneously in 3-6 months.D. Neurologic injury occurs in 10-20% of displaced, extension type supracondylar

humerus fractures in children.E. The anterior interosseus nerve is the one commonly injured.

45. A “Monteggia Fracture” isA. A simple problem to treat, which seldom requires surgeryB. Dislocation of the proximal ulna with fracture of the radial headC. Dislocation of the radial head with fracture of the proximal ulnaD. The most common adult elbow fractureE. The most common pediatric elbow fracture

46. 40 y/o male patient presents w/ medial elbow pain. Relates he is a weekend tennis player. States that he has been playing for years without problems. Only new change is a new racquet. What is his most likely diagnosis based on his history?

????????????????A. Lateral epicondylitisB. Tennis elbowC. Golfer’s elbowD. Olecranon bursitisE. Wrist somatic dysfunction

47. 20 y/o patient presents with pain and numbness in the first 3 fingers of his left hand. Also has noticed weakness in the hand. Upon exam, you notice weakness at the DIP joint of his thumb and index finger. What is the most likely nerve that is being impinged upon to give him the pain and numbness described?

????????????????A. Radial nerveB. Ulnar nerveC. Median nerveD. Vagus nerveE. Phrenic nerve

CCC Exam 1 – Block 8

CCC 1-5 (ALL IMAGE QUESTIONS)-- but they were about Mohs micrographic surgery, tumor advancement by direct extension into surrounding tissue, lesions that are considered precursors to squamous cell carcinomas, growths that are known to spontaneously involute, and a lesion whose histology reveals atypical cells involving epidermal appendages.

6. This acquired hypertrichotic patch (Image) a. arises from abnormal nevomelanocytesb. needs to be biopsied as its malignant potnential is highc. is know as a café au lait patchd. is an acquired large congential hairy nevuse. is a developed hamartomatous anomaly

7. Atypcial nevi (image)a.are not typically present at birthb. are most often found on the lower extremities of menc. decline in frequency around the age of 40d. are most often smaller than common benign nevie. occurring in one family member, puts all first degree relatives at risk for melanoma

8. Breslow deptha. is an anatomic measure of tumor invasionb. is the most important histological determinant of prognosis in patients with melanomac. is measure from the dermoepidermal junction to the deepest part of the tumord. is prognostically less important than histologically proven angiolymphatic invasione. is reported in cm.

9. Malignant melanomaa. is responsible for 25% of skin cancer deaths in the USb. is more common in Hispanic person than in whitesc. is the most common cancer in women aged 25-29d. incidence is unchanged by chronic exposure to UVA radiation from tanning bedse. should most commonly be diagnosed by performing a shave biopsy

10. This pigmented tumor (image)a. accounts for 70% of all malignant melanomasb. most often arises from a precursor lesion called lentigo malignac. is a traumatic blood-filled lesion known as talon noird. is the most frequent melanoma type in African Americans and Asianse. histologically reveals a radial growth phase only

11. A patient presents with a lesion on her ankle. The lesion started as from a poorly fitting shoe that rubbed her heel. The lesion is now noted to be erythematous with crusting and exudates and additional lesions forming adjacent to the lesion. There are no vesicles and no erythema noted in the lower foot below the lesion or on the leg. The diagnosis is most likely:

a. Bullous Impetigob. Non-bullous Impetigo (Correct)

c. Ecthyma (Also Correct)d. Cellulitise. Scalded Skin Syndrome

12. An infant presents with a fluent rash to the trunk and extremities. The skin is peeling in large sheets and the child is very irritable and crying. The child has a low grade fever. The child developed an upper respiratory infection noted with yellow green nasal discharge. This spread rapidly and the child developed a fine rash over the remainer of the body. This was followed by vesicular eruptions.

a. Bullous Impetigob. Non-bullous Impetigo c. Ecthyma d. Cellulitise. Scalded Skin Syndrome

13. The organism that is most likely to cause the illness in question 12?a. Staph Aureusb. Step Pyogenesc. Psuedomonasd. Vibrio Vulnificuse. MRSA

14. An elderly patient in the skilled nursing unit of a nursing home has recently been discharged from the hospital where she had a stroke. The pt. is on IV assisted feeding and has recently had a urinary catheter removed. Today the patient presents with vesicular lesions on the trunk and thighs. The lesions are hemorrhagic, dark in color, and mildly inflamed. There is regional lymphadenopathy and fever of 101 is present. The most likely diagnosis is:

a. Bullous Impetigob. Ecthymac. Ecthyma Gangrenosumd. Cellulitise. Scalded Skin Syndrome

15. The most likely organism to cause this illness in question 14 is: a. Staph Aureusb. Strep Pyogenesc. Psuedomonasd. Vibio Vulnificuse. MRSA

22. – 26. Match the organism from the followinga. Necrotizing Fasciitis from Steptococcal infectionb. Vibrio Vulnificusc. S. Aureus

d. Ecthyma from Strep Pyogenes (Ecthyma is a skin infection similar to impetigo. It is often called "deep impetigo" because it occurs deep inside the skin).

e. PseudomonasTo the infections described in 22 through 26 below.

22. Bacterial infection with green purulent discharge that may be seen with a nail puncture to the bottom of the foot through old tennis shoes. E

23. Infection seen from dirty seawater after a flood or hurricane, causing severe blistering lesions and ulcerations. - B

24. infection seen on the buttocks of a child with deep ulceration, fever, and lymphadenopathy. - D

25. Common secondary infection that occurs in patients with the chronic tinea pedis.- C

26. Servere infection that may follow surgery spreads rapidly and causes tissue death – A

27. Choose the correct statement regarding nodules:a. groups pf nodules are known as plaquesb. nodules cantain clear fluidc. pityriasis rosea is an example of a noduled. nodules are palpable subcutaneous lesionse. nodules are the same as bullae

28. – 32. Match the following lesions with their examples:

28. papules – B (Lichen striatus)29. vesicles – A (Varicella)30. nodules – C (Hemangioma)31. bullae – E (Blistering dactylitis)32. plaques – D (Psoriasis)

a. varicellab. lichen striatusc. hemangiomad. psoriasise. blistering dactylitis

Questions Remembered from CCC Heme Nov 2006

******Use at your own Risk*****Excuse errors, faulty memories and confusion

1. T/F Deaths due to CML are less than 1/1000/yr (true)

2. Cells under microscope for MMF = teardrops

3. Cells under microscope for CML = basophils

4. Cells under microscope for CLL = lymphocytes granular

5. Burkitts lymphoma cause = EBV

6. Stage of NHL; cervical + medistinal masses = Stage II

7. Which test result would show worse prognosis for NHL = LDH; increased

Matching:

8. B12 deficiency = atrophic glossitis 9. Folate deficiency = normal Methylmalonic and homocysteine elevated (this is correct but on the test we think it gave an option of elevated MMA and normal homocysteine so be sure to read what it says) 10. Cytotoxic aplastic anemia = benzene 11. Idiosyncratic aplastic anemia = chemo

12. T/F ALL presents significantly different in Adults than children = True

13. Which one is a B symptom = episodic fever

14. Which one causes neural degeneration = Copper

15. Which is true about Pernicious Anemia = Was named so b/c it was fatal before treatment became available

16. All have low hct, wbc, with reticulocytosis except = aplastic anemia

17. Serum Ferritin Test distinguishes between = iron deficiency anemia vs anemia of chronic disease

18. Which is not associated with ? = gluten insensitivity

19. Medi…man with low MCV > the options were assume thallassemia b/c he is from the Med, Transfuse and GI colonoscopy or give iron

supplements ( Many of us chose give iron supplements b/c he appeared iron deficient)

20. Age range for NHL = > 60

21. Motrin for ankle with identical twin brother > options were take off motrin, schedule Transfusion, take off all meds (many of us chose take off all meds)

22. 2 classifications of MDS = WHO and FAB true

23. These are all seen in the 9 subtypes/categories of MDS except > the options were Pelger Huet Anomaly, punctuate basophilia, maybe gums (the answer was all three we think) 24. Treatment for ANLL would be Induction, consolidation but if the question was

Treatment for ALL then you would need Induction, consolidation and CNS prophalaxis.

25. APL which one is true = present with DIC or the question may have been what is themost common cause of DIC > options obstetric complications, liver disease, ??? (many of us chose obstetric complications????)

26. MDS Staging by total body mass disease = False

27. Leukostasis?

28. ALL presents with wide range chromosomal abnormalities and ploidy = true

29. MDS presents w/???

30. Which method is not used to detect …> answer was go to Philadelphia

31. Markers for ??? options > were T cell CD4, B23 - who knows?????

32. Tyrosine Kinase > blocks phosphorylation

33. Which is not indicative of P Vera = Increased RBC test