Hip
Acetabular impingement, Labral Tear, Osteoarthritis, Psoas tendinitis, proximal rectus femoris rupture, SCFE/AVN of the hip, Femoral neck fx/stress fx, hip dislocation.
FADIR test is a good test to evaluate what?
A)Femoral Stress fx
B)Avascular Necrosis of the Hip
C)Acetabular Impingement
D)Snapping Hip syndrome
C) Acetabular impingement
The neuromuscular hallmark of polymyalgia rheumatica is?
proximal muscle pain and stiffness particularly involving the shoulder, neck and pelvic girdle
a positive straight leg raise indicates what?
lumbosacral nerve root irritation (can be vertebral or related to extra-pelvic compression eg. piriformis syndrome)
MCC of back pain?
muscle strain!! Most get better within 2-6 weeks. Treat with heat, NSAIDs, muscle relaxers, PT, rest.
What are some risks for AVN of the hip (Perthes Dz)?
Steroids (MCC), Pancreatitis, ETOH, Trauma, Infection, Idiopathic.
AVN of the hip is BILATERAL 80% of the time (what does it look like on xray?)
Lateral femoral cutaneous nerve impingement would bring about which of the following?
A)paraesthesia of the lateral thigh
B)Decreased strength testing
C)Decreased deep tendon reflexes (DTRs)
D)Positive Tinel sign over symptomatic area.
A & D
Which of the following fractures is associated with the greatest risk of avascular necrosis of the femoral head?
A)Intertrochanteric
B)Femoral Neck
C)Subtrochanteric
D)Pelvic Rim
B) Femoral Neck
A 26 year-old male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular symptoms are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints His examination demonstrates an inability to stand on his toes and a positive straight leg raise. Which of the following is most appropriate diagnostic study in this patient?
MRI
CT
DEXA scan
Radionuclide testing
MRI
A herniated disc is (better/worse) with extension while pain from spondylolysis is (better/worse) with extension
Herniated disc is better with extension (flexion can cause more pressure on disc)
Spondylolysis is worse with extension
In which of the following conditions is surgery indicated for the large majority of patients?
Femoral neck stress fracture
Femoral neck fracture
Avascular Necrosis of the hip
Sacroiliitis
Femoral neck fracture.
What is piriformis syndrome? What do XR and MRI often show? How do we treat?
Piriformis syndrome is radicular/sciatic nerve symptoms due to extra-pelvic compression of the sciatic nerve. Usually this is glute pain down posterior leg aggravated by prolonged sitting.
XR, MRI often normal.
Treat with PT, rest, NSAIDs, uncommon to have steroid injections or surgical release.
Which of the following osteoporosis therapies is so poorly absorbed that it must be taken alone and on an empty stomach?
raloxifene (Evista)
alendronate (Fosamax)
calcitonin (Miacalcin)
teriparatide (Forteo)
Alendronate (Fosamax)
cervical disc herniations are more likely to impact ____ while lumbar disc herniations are more likely to impact ____
Options:
Single nerve root
Multiple nerve roots
cervical disc herniations are more likely to impact a single nerve root while lumbar disc herniations are more likely to impact multiple nerve roots.
A 27 year-old male presents with gradually worsening low back pain and stiffness for the past two years. His symptoms are worse upon awakening and gradually improve throughout the day. Lumbosacral flexion is less than 50%. Lumbosacral spine films show erosions in the joint line of both sacroiliac joints. HLA-B27 test is positive. Which of the following is the most appropriate first-line medication for this patient?
Indomethacin (Indocin)
Methotrexate (Rheumatrex)
Prednisone (Medrol dose pack)
Sulfasalazine (Azulfidine)
Indomethacin
A 22 year old patient presents to you with generalized anterior hip pain following an injury during soccer in which she hyper-extended her hip to tackle an opposing player. She has severe pain worse with flexion, and has reproducible clicking with movement of the hip, though x-rays taken a few days earlier are negative for any fracture or dislocation. What physical exam is most specific for evaluation of a labral tear? What diagnostic study would be used to confirm?
labral tears can be positive with FABER tests (also positive with OA or other intra-articular pathology, but considering pt age and mechanism this is most likely).
Confirm with MRI arthrogram.
A 57 year-old male presents with acute bilateral lower extremity weakness and urinary incontinence that began after he fell earlier today. His examination is significant for bilateral lower extremity sensory deficits and weakness along with decreased rectal sphincter tone. Which of the following is the most appropriate intervention?
Epidural steroid injection
Analgesics (opioid/NSAIDs)
Physical Therapy focusing on strengthening modalities
Surgery
Surgery (CES)
A 52-year-old male presents with a severely painful, swollen right great toe. He denies recent trauma but reports several similar episodes of toe pain and swelling over the past two to three years. He has a history of alcohol abuse and hypertension, for which he "takes medication" of an unknown type. Examination reveals bright erythema and edema associated with the right first MTP joint. Which of the patient's antihypertensive medications is most likely contributing to this condition?
Lisinopril
Diltiazem
Metoprolol
Hydrochlorothiazide
HCTZ
A 65 year-old female presents to the office with a six-month history of back pain. The patient states that she is shrinking and thinks she is about an inch shorter than she was a year ago. Serum parathyroid hormone, calcium, phosphorus, and alkaline phosphatase are all normal. Which of the following would you most likely see on the x-ray of her spine?
Radiolucent lesions
Demineralization
Chondrocalcinosis
Subperiosteal resorption
Demineralization
What are the red flag symptoms in a patient with back pain? Hint: TUNAFISH
Trauma
Unexplained weight loss
Neurologic symptoms (eg. weakness)
Age >50
Fever
IVDU history
Steroid Use
Hx of Cancer
An obese 15 year-old male presents with complaint of a limp and right knee pain for two weeks. He denies recent trauma or history of previous injury. Physical examination of the right knee is unremarkable. Examination of the right hip reveals pain with passive range of motion and limited internal rotation and abduction. Flexion of the hip results in external rotation of the thigh. Gait is antalgic with the right hip externally rotated. Which of the following radiographic findings supports the most likely diagnosis?
Displacement of the femoral epiphysis
Irregularity and fragmentation of the joint space
Capsular swelling of the joint
Dislocation of the hip
Displacement of the femoral epiphysis (SCFE)
A 11 year old boy presents to you with a 2 month history of anterior hip pain, and he walks in with a noticeable limp. He is tender globally and has pain with internal rotation, flexion, abduction and external rotation. You are concerned for AVN of the femoral head, and decide to get Xrays, which are normal. What do you do?
Observe, bring back patient for repeat xrays 1-3 months later. AVN can often take time to be seen radiographically.
What factors indicate an MRI is appropriate for evaluation of a patient with scoliosis?
Neuromuscular concerns
Surgical Planning
Backwards Curve (Left Thoracic Curve)
Patient is >12 years old at diagnosis
Neuromuscular concerns, surgical planning, backwards curve
Differentiate the following:
Spondylolysis
Spondylolisthesis
Ankylosing Spondylitis
Spondylosis
Spinal Stenosis
Spondylolysis = fx of pars interarticularis
Spondylolisthesis = spondylolysis + shift of vertebral body (most commonly anteriorly)
Ankylosing Spondylitis = autoimmune spondylitis involving bridging osteophytes->fusion of vertebrae. HLA-B27 positive. bamboo sign. tx with indomethacin, PT, steroid inj.
Spondylosis = state of degenerative changes, pain +/- radicular symptoms depending on severity. Most people asymptomatic.
Spinal stenosis Narrowing of spinal cord or nerve roots due to any cause. pain worse with extension
Match the following:
-Jefferson Fx
-Hangman Fx
-Chance Fx
-Burst Fx
-Compression Fx
-Anterior vertebral body fracture commonly due to osteoporosis
-Bilateral C2 pars interarticularis fx
-Burst fracture of C1 (Atlas)
-Axial loading forces
-Flexion distraction forces
-Jefferson Fx = Burst fracture of C1 (Atlas)
-Hangman Fx = Bilateral C2 pars interarticularis fx
-Chance Fx = Flexion distraction forces
-Burst Fx = Axial loading forces
-Compression Fx = Anterior vertebral body fracture commonly due to osteoporosis