Etiology/RF
A 72-year-old woman presents after tripping on a rug at home. She has immediate groin pain and cannot bear weight. She has a history of smoking, low BMI, and chronic corticosteroid use for COPD. What major underlying disease most likely predisposed her to this injury?
What is osteoporosis?
A 26-year-old basketball player presents after a twisting knee injury. He reports locking, clicking, and pain along the joint line several days later, but minimal swelling initially. Which structure is most likely injured?
What is the meniscus?
A 68-year-old woman with suspected hip fracture has a shortened, externally rotated leg after a fall. Initial AP pelvis and lateral hip X-rays are negative, but she still cannot bear weight. What is the gold standard investigation?
What is hip MRI?
A 67-year-old patient reports chronic low back pain that worsens with prolonged standing and improves with sitting. MRI demonstrates narrowing of the spinal canal. What process is occurring?
What is lumbar spinal stenosis from degenerative changes?
A 64-year-old patient with mild knee osteoarthritis asks for the single most effective non-pharmacologic intervention to improve pain and function long term. What should you recommend?
What are PT/OT, weight loss, exercise?
A 19-year-old soccer player hears a ”pop” followed by rapid knee swelling within 2 hours after playing a soccer game. What is the non contact mechanism most likely predisposed her to this injury?
What is sudden deceleration with pivot/twisting causing ACL injury?
A 5-year-old child refuses to walk after a recent viral illness. He is afebrile and holds the hip in slight flexion and external rotation. Labs are normal. What diagnosis is most likely?
What is transient synovitis?
A 61-year-old man with chronic knee pain has worsening pain with activity, crepitus, and brief morning stiffness. Which radiographic findings would most support the diagnosis?
What are joint space narrowing, osteophytes, subchondral sclerosis, and subchondral cysts?
A patient with osteoarthritis asks why the joint becomes painful over time despite “wear and tear” sounding mechanical. What primary tissue degeneration initiates the disease process?
What is degeneration of articular cartilage?
A 75-year-old woman is diagnosed with GCA after developing headaches and transient vision loss. What treatment must be started immediately, even before biopsy confirmation?
What are high-dose IV corticosteroids?
A 58 year old office worker develops gradually worsening shoulder pain. He has diabetes and a history of repetitive overhead painting work. What chronic condition is most strongly associated with his presentation?
What is rotator cuff tendinopathy/tear?
A 42-year-old woman presents with fatigue, symmetric pain and swelling in the MCP and PIP joints, morning stiffness lasting over an hour, and difficulty opening jars. What inflammatory arthritis is most likely?
What is rheumatoid arthritis?
A 72-year-old woman with temporal headaches and jaw claudication has elevated inflammatory markers. Which laboratory tests are classically elevated in this condition?
What are ESR and CRP?
A 14-year-old boy presents after falling on an outstretched hand. Imaging shows a Salter Harris IV fracture. Why are these fractures clinically important?
What is risk of growth disturbance due to physeal injury?
A 62 year old male with diagnosed systemic scleroderma complains of raynaud’s phenomenon. What treatment would you offer for this patient?
Nifedipine - CCB
A 67-year-old woman presents with jaw claudication, scalp tenderness, and new headaches. She suddenly develops transient monocular vision loss while brushing her hair. What vascular pathology underlies this condition?
What is granulomatous inflammation of medium & large sized arteries?
A 28-year-old woman presents with joint pain, oral ulcers, photosensitive rash, and intermittent pleuritic chest pain. Urinalysis shows proteinuria. What systemic condition best explains this constellation of symptoms?
What is SLE?
A 12-year-old boy presents with persistent nighttime leg pain, fever, and weight loss. Plain films show a destructive bone lesion. Which investigation is required to confirm the diagnosis?
What is bone biopsy?
A 38-year-old woman with progressive proximal muscle weakness and inflammatory polyarthritis is found to have autoimmune connective tissue disease. What immunologic mechanism underlies diseases like SLE?
What is autoantibody-mediated immune system dysfunction causing chronic inflammation? Type III hypersensitivity.
A child presents with a displaced supracondylar humerus fracture after falling from monkey bars. The hand is pale and pulses are weak. What is the immediate management priority?A child presents with a displaced supracondylar humerus fracture after falling from monkey bars. The hand is pale and pulses are weak. What is the immediate management priority?
What is urgent orthopedic evaLatino and reduction due to neurovascular compromise?
A 34-year-old woman complains of cold-induced finger color changes, dysphagia, and tightening skin over her hands. She has reflux symptoms and digital ulcers. What autoimmune process best explains her disease?
What is excessive collagen deposition and vascular dysfunction in systemic sclerosis?
A 74-year-old man presents with acute severe pain, redness, warmth, and swelling of a single knee joint. He is febrile and unable to bear weight. What diagnosis must always be ruled out first?
What is septic arthritis?
A 46-year-old man presents with acute monoarthritis of the knee. Arthrocentesis reveals negatively birefringent needle-shaped crystals. What diagnosis is confirmed?
What is gout?
A 45-year-old construction worker develops acute low back pain radiating down the posterior leg after lifting heavy drywall. Straight leg raise reproduces symptoms below the knee. What pathophysiologic process is most likely?
What is lumbar nerve root compression from disc herniation?
A 55-year-old woman with severe rheumatoid arthritis continues to have active synovitis despite NSAIDs and steroids. What class of medication is required to slow disease progression and prevent joint destruction? What is the MOA of a specific medication in this class?
DMARD’s
Methotrexate - alters purine metabolism leading increase adenosine levels. These decrease activation of neutrophils/immune cells And cytokines leading to anti-inflammatory effect.