Ortho/Rheum 8

A 37-year-old woman has chronic aching pain in the low back, hips, shoulders, and neck. Trigger points are noted on examination. Fibromyalgia is diagnosed. Which of the following is the preferred initial therapy?

A 76-year-old man has a 10 day history of pain in his left ribs. Examination shows local tenderness without crepitation. Radiography of the ribs shows osteolytic lesions. Hemoglobin is 9 g/dL. Serum calcium is 11.4 mg/dL. Which of the following is the most likely diagnosis?

A 44-year-old woman has a 2 day history of right posterior knee pain that is worsened by prolonged standing. Presence of which of the following on the ipsilateral side differentiates a ruptured Baker’s cyst from thrombophlebitis?

A 12-year-old baseball player jammed his index finger while trying to catch a ball. He now has a disruption of the extensor tendon at the point of insertion on the dorsal aspect of the distal phalanx. This type of injury is referred to as a:

A 67-year-old man has acute knee pain with swelling. Presence of which of the following radiographic signs is most suggestive of pseudogout?

An 85-year-old woman has had 3 episodes of blurred vision, each in her left visual field, and lasting 10 to 15 minutes. Examination shows left temporal artery tenderness. Which of the following is the definitive diagnostic procedure?

A 46-year-old man has a 4 week history of heartburn and dysphagia to both liquids and solids. He now has Raynaud phenomenon in both hands when they are exposed to frozen food packages. Which of the following is the most likely diagnosis?

A 22-year-old man has a 2 month history of low back pain that extends into the buttocks area. Radiography of the spine shows calcification of the anterior and lateral spinal ligaments. Which of the following is the most likely diagnosis?

A 67-year-old woman has a 1 month history of aching and morning stiffness in her hips and shoulders bilaterally. Examination is normal. Hemoglobin is 9.6 g/dL and erythrocyte sedimentation rate is 88 mm/hr. Polymyalgia rheumatica is diagnosed. Which of the following is the preferred initial therapy?

A 52-year-old female experiences pain on the plantar surface of her right foot in the plantar region that is worse when initiating walking. Wearing tight shoes worsens the pain and the pain is relieved by removing shoes. Examination reveals point tenderness, elicited by dorsiflexing the patient’s toes with one hand in order to pull the plantar fascia taut, and then palpating with the thumb or index finger of the other hand along the fascia from the heel to the forefoot. The patient has tried wearing wider shoes with metatarsal cushions, applying ice, stretching and taking NSAIDS but her symptoms persist. What is the best therapeutic option at this point?

A 77-year-old man has nerve deafness. His examination shows an enlarged skull. The serum alkaline phosphatase level is elevated, but serum gamma-glutamyl transpeptidase is normal. Which of the following laboratory values is most suggestive of Paget’s disease of bone?

A 55-year-old man has an acute fracture of the left femur due to an automobile accident. Thirty-six hours later he has acute dyspnea. Examination shows central cyanosis, tachypnea, and mental confusion. Which of the following is the most likely diagnosis?

A 67-year-old woman has a 1 month history of aching and morning stiffness in her hips and shoulders bilaterally. Examination is normal. Hemoglobin is 9.6 g/dL and erythrocyte sedimentation rate is 88 mm/hr. Which of the following is the most likely diagnosis?

A 15-year-old boy who is a pitcher on a baseball team has a 2-day history of painful swelling of the left medial elbow area. Examination shows local tenderness without swelling. Pain is increased during wrist flexion and extension. Which of the following is the most likely diagnosis?

Burning or tingling sensation in the 4th and 5th digits of the hand is most commonly seen in which of the following?

A 13-year-old boy is in your office complaining of painful knees. He complains of increasing pain with activity. On exam you note tenderness and swelling of the tibial tuberosities of each knee. Which of the following is the most likely diagnosis?

Of the following, the most common cause of osteoporosis in women is?

On a radiograph, calcification of the spinal ligaments reveals so-called “bamboo spine”. This is a manifestation of:

An epiphyseal plate fracture that extends transversely above the epiphyseal plate and nearest the joint is classified as a:

An epiphyseal plate fracture that extends transversely below the epiphyseal plate away from the joint is classified as a:

A 32-year-old obese female comes to your office complaining of right heel pain which is worse with the onset of walking, then gets better after a few steps. It is increased by the end of the day. X-rays are normal. On physical examination the patient has plantar medial heel tenderness with palpation and accentuated with dorsiflexion of the ankle and toes. What is the initial treatment for this problem?

Carpal tunnel syndrome is caused by compression of which of the following structures?

A 23-year-old patient presents with complaints of right wrist, hand and forearm pain, occurring over the past two months but now becoming more severe. She wakes up at night with numbness and tingling in her right hand. She has normal sensation to all digits, a positive Tinel’s sign and a negative Phalen’s sign. The most likely diagnosis is:

A 78-year-old man has a 2 week history of pain in his left heel where the back of his hard shoe hits the heel. Examination shows tenderness, slight redness, and mild swelling of the posterior heel. Which of the following is the most likely diagnosis?

A 60-year-old male patient presents with intermittent pain over his right metatarsophalangeal joint. On inspection, you notice a tender, red, swollen joint. He is afebrile. Which of the following medications is most likely to be contributory to this patient’s diagnosis?

A 62-year-old man complains of six months of gradual pain in his right TMJ, occasional stiffness, and some crepitation. He is able to fully open his jaw. X-rays are normal. ESR is normal. What is the most likely diagnosis?

A 30-year-old man has pain and tingling from the right sacroiliac area to the great toe. Physical exam shows weakness of dorsiflexion of the great toe. Injury to which of the following nerve roots is causing the symptoms?

A 48-year-old woman with rheumatoid arthritis has a 1-day history of hot and painful erythematous swelling of the right knee. White blood cell count is 22000/mm3. Which of the following is the most likely diagnosis?

A 35 year-old male presents with joint pains in his hands. Exam reveals symmetric pitting of the nails, sausage fingers and a history of psoriasis.  X-ray demonstrates a cup and saucer appearance. What is the diagnosis?

Alendronate (Fosamax) therapy is initiated in a 56 year old woman for treatment of osteoporosis. Which of the following instructions should be given to the patient?