ORTHO PRACTICE QUESTIONS, (Answered). 2022 update, Graded A+

ORTHO PRACTICE QUESTIONS, (Answered). 2022 update, Graded A+ A 24-year-old male presents with left anterior shoulder pain one hour after falling directly onto his left arm. On physical examination, the patient's lef ...

ORTHO PRACTICE QUESTIONS, (Answered). 2022 update, Graded A+ A 24-year-old male presents with left anterior shoulder pain one hour after falling directly onto his left arm. On physical examination, the patient's left shoulder is held in abduction and external rotation. There is a squared-off appearance to the left deltoid area. The patient has minimal range-of motion in all planes of the left shoulder. What is the most likely diagnosis? - ✔✔anterior shoulder dislocation A 62-year-old industrial painter presents complaining of worsening left shoulder pain for 6 weeks without history of trauma. The pain is located anterolaterally and exacerbated by overhead activity. The patient also reports having difficulty sleeping on that side due to pain and weakness of the right arm that causes him to use it less for overhead activities. On physical examination, you elevate the patient's left arm to 90 degrees, abduct to 30 degrees, and internally rotate. You note weakness and drooping of the arm with this maneuver that is worsened when you apply downward pressure. On the basis of this presentation, what is the most likely diagnosis? - ✔✔left supraspinatus tendon tear What does the radial nerve innervate? - ✔✔wrist extension A patient with a shoulder dislocation has decreased sensation in the "regimental badge" or superolateral aspect of the upper arm. What nerve is most likely affected? - ✔✔axillary nerve Which physical examination maneuver is most sensitive for anterior glenohumeral capsular laxity? - ✔✔apprehension test Which of the common tendon insertions is not part of the rotator cuff of the shoulder? - ✔✔Teres Major Which rotator cuff tendons are located anteriorly relative to the scapula? - ✔✔subscapularis Which rotator cuff tendons are located posteriorly relative to the scapula? - ✔✔infraspinatus, supraspinatus, teres minor Which of the following is most commonly involved in rotator cuff injuries? - ✔✔supraspinatus tendon What maneuver does the following best describe: place one hand on the posterior scapula and use the other hand to flex the shoulder passively with the elbow in extension and the arm internally rotated? - ✔✔neer impingement sign The cross arm test evaluates symptomatic acromioclavicular arthritis or injury. Please describe this test. - ✔✔flex the patient's shoulder to 90 degrees with the elbow in full extension. then horizontally adduct the arm across the body 10 degrees With the patient upright, flex the patient's shoulder to 90° with the elbow in full extension. Pronate the arm so the patient thumb is pointing down. Then have the patient attempt to keep their arm in this position while the examiner applies a gentle downward force to the arm. Pain at the acromioclavicular joint is consistent with pathology within that joint. Pain "inside" the shoulder may indicate labral tears. - ✔✔obrien test A 26-year-old amateur tennis player complains of lateral elbow pain and decreased strength in her backhanded swing. This is most likely due to chronic changes of what structure? - ✔✔extensor carpi radialis A patient has lateral elbow pain that increases with forearm supination and dorsiflexion of the wrist against resistance on physical examination. What is the most likely etiology of the pain? - ✔✔lateral epicondylitis or tennis elbow If a patient has a large swelling over the tip of the elbow that is soft, mobile, mildly tender, and transilluminates on physical, what is the most likely etiology of the swelling? - ✔✔olecranon bursitis What is the best anatomical location for palpation of the radial head? - ✔✔antecubital fossa, lateral to the elbow joint What are the three elbow articulations? - ✔✔unohumeral, radiocapitellar, and radioulnar What are the three major extensor muscles of the forearm? - ✔✔extensor carpiradialis brevis, extensor digitorus communis, extensor carpi ulnaris What anatomic structure lies between the lateral and medial epicondyle of the distal humerus? - ✔✔coronoid fossa When aspirating an olecranon bursa, in which direction should the needle be introduced? - ✔✔the needle should be directed toward the tip of the olecrenon A patient with radial tunnel syndrome may experience weakness. Where does this weakness typically occur? - ✔✔it affects the thumb and finger extensors and the extensor carpi ulnaris Name the eight carpal bones of the wrist, beginning with the proximal row, fol lowed by the distal row, from the lateral (radial) to medial (ulnar). - ✔✔scaphoid, lunate, triquetrum, pisiform = proximal row trapezium, trapezoid, capitate, hamate = distal row mneumonic: So Long To Pinky, Here Comes The Thumb The distal surfaces of the distal row of carpal bones articulate with what structures? - ✔✔metacarpals Each of the digits has three phalanges. Name the digit that does not. - ✔✔thumb What nerve is responsible for sensation of the thumb, index, middle, and radial side of the ring finger? - ✔✔median nerve Name the three phalanges found in most digits, from proximal to distal, including the articulations between each. Please write the complete joint name AND include its accepted medical abbreviation. - ✔✔Proximal phalanx—proximal interphalangeal (PIP) joint—middle phalanx—Distal interphalangeal (DIP) joint—distal phalanx A patient complains of numbness and tingling of the thumb, index, and middle fingers of the right hand. This occurs during the day when she is working for extended periods of time typing reports on her computer. The symptoms also wake her up at night. After shaking her hand and wrist for several minutes the symptoms decrease and she is able to fall back to sleep. Which physical examination techniques would be the most suggestive of carpal tunnel syndrome? - ✔✔Tinel's, Phalen's, and Durkan's compression test Please describe the examination methods for each of the maneuvers listed for the previous patient. - ✔✔Tinel's Test—with the patient's wrist extended (dorsiflexed), gently percuss or "tap" the median nerve just proximal to the palmar crease. This will reproduce or exacerbate the patient's symptoms. Phalen's Test—instruct the patient to flex (volar flex) both wrists while keeping the dorsal surface of the hands together. This will reproduce or exacerbate the patient's symptoms. Durkan's Compression Test—apply pressure to the interthenar portion of the median nerve. If paresthesias occur within 30 seconds of applied pressure it is considered positive. Since the ulna does not reach the wrist, how are forces received by the hand transmitted from the radius to the ulna? - ✔✔interosseous membrane The ability of the radius to pivot about the ulna, allows for what motion? - ✔✔supination and pronation What additional characteristics are unique to the thumb? - ✔✔opposability: pinch and grip strength saddle MCP joint has its own pulse due to the princeps pollicis artery What nerve is responsible for sensation of the pinky side of the ring finger and pinky? - ✔✔ulnar nerve Which nerve is responsible for extension (dorsiflexion) of the wrist? - ✔✔radial nerve When the above nerve is injured, what characteristic clinical sign is seen and why? - ✔✔wrist drop unopposed tonus of the flexor muscles and gravity A series of inconsistent findings during examination of a patient with complaints of back pain, that include superficial tenderness, nonanatomical tenderness, axial loading, and acetabular rotation pain. what physical exam maneuver does this describe? - ✔✔Waddell sign "Flick" the fingernail of the middle finger and look for thumb and index finger flexion. what physical exam maneuver does this describe - ✔✔Hoffman reflex The patient laterally bends and rotates their neck toward the affected side, and then the examiner applies gentle axial loading to the top of the head in order to illicit cervical disk herniation. what physical exam maneuver does this describe - ✔✔spurling test While supine, the patient bends their hip and knee and then slowly extends the knee until pain is felt. what physical exam maneuver does this describe? - ✔✔kernig sign