A 62-year-old white male presents with a chief complaint of right knee pain and swelling. Past medical history is significant for obesity with a body mass index (BMI) of 34 kg/m2, diet-controlled type 2 diabetes mellitus, and hypertension. His medications include hydrochlorothiazide and acetaminophen as needed for pain. Physical examination is remarkable for a moderate-size effusion of the right
History of orthopedics surgical in Indonesia opened up by Prof. Dr. R. Soeharso, FICS., by is it started the is build central of rehabilitation ( Rehabilitation Centrum = RC) for defect patient in Solo, Central Java, by government in the year 1951. The year 1954, Department of Public Health complements RC with The Institute of Orthopedics Surgical Operation, who(which then in the year 1958 conti
A woman presenting with symmetrical joint swelling with associated pain and stiffness is likely to be suffering from arthritis related to gout rheumatoid arthritis osteoarthritis ankylosing spondylitisAnswer
Osteoarthritis is likely to involve inflammation of the synovial membrane and pannus formation degeneration of articular cartilage and changes to the underlying bone pannus formation and degeneration of the articular cartilage degeneration of articular cartilage with no changes to the underlying bone Answer
Which of the following statements best describes osteoporosis? reduction in bone mineralisation increased porosity of bone due to loss of bone mass bone loss through increased activity of osteoblasts increased porosity of bone due to reduced activity of osteoclastsAnswer
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Hospital Angeles Tijuana, Mexico – Bariatric Lap Band, Gastric Bypass, Orthopedics & General Surgery Hospital
Medical tourism corporation team visited Hospital Angeles in Tijuana, Mexico. This hospital is part of the largest private hospital chain in Mexico. Procedures offered to Medical Tourist at this Mexican hospital are: Gallbladder Removal, Inguinal [...]
A 48-year-old white female secretary presents with progressive difficulty typing over the past month. She also notes that her hands begin to feel numb and weak after typing for long periods of time. Upon testing, which of the following deficits would be predicted?A. Difficulty in abducting the fifth fingerB. Difficulty in adducting the thumbC. Difficulty in flexing digits two and three at the metacarpophalangeal jointsD. Loss of sensation over the lateral half of the dorsum of the handE. Loss of sensation over the lateral half of the palmF. Loss of sensation over the medial half of the dorsum of the handG. Loss of sensation over the medial half of the palmAnswer
Which one of the following is a manifestation of pauci-articular juvenile rheumatoid arthritis?A) UveitisB) SplenomegalyC) ThrombocytopeniaD) GlomerulonephritisE) Erythema nodosumANSWERTags: MCQ, Orthopedics, Rheumatic Disease, Arthritis
The most serious complication of a slipped capital femoral epiphysis is:A) osteomyelitis.B) pathologic fracture.C) avascular necrosis.D) chondrolysis.E) gastrocnemius hypertrophy.ANSWERTags: MCQ, Orthopedics, femoral epiphysis
An 18-year-old white female presents to the emergency department with a history consistent with a lateral ankle sprain that occurred 2 hours ago while she was playing softball. She complains of pain over the distal anterior talofibular ligament, but is able to bear weight. There is mild swelling, mild black and blue discoloration, and moderate tenderness to palpation over the insertion of the anterior talofibular ligament, but the malleoli are nontender to palpation.Which one of the following statements is true regarding the management of this case?A) Anteroposterior, lateral, and 30° internal oblique (mortise view) radiographs should be done to rule out fracture.B) Stress radiographs will be needed to rule out a major partial or complete ligamentous tear.C) Early range-of-motion exercises should be initiated to maintain flexibility.D) For best results, functional rehabilitation should begin within the first 24 hours after Injury.E) The patient should use crutches and avoid
A 10-year-old male is brought to your office after sustaining a fall on an outstretched hand. Radiographs show a nondisplaced fracture of the middle third of the clavicle.Appropriate management would include which one of the following?A) Intermittent heat to the area to help control painB) A figure-of-8 splint or sling supportC) Orthopedic consultation for surgical interventionD) Early shoulder abduction exercises to prevent adhesive capsulitisE) Weekly radiographs to assess callus formationANSWERTags: MCQ, Orthopedics, Clavicular Fracture, Clavicle
An 18-year-old male has acute low back pain without paresthesias or other neurologic signs. There is no lower extremity weakness.Which treatment has been shown to be of most benefit initially?A) Complete bed rest for 2 weeks.B) Bed rest plus local injection of steroids.C) A low back strengthening program.D) Resumption of physical activity as tolerated.E) Herbal formulations and/or traction.ANSWERTags: MCQ, Orthopedics, Back Pain
A high incidence of osteonecrosis of the femoral head occurs with: A) femoral neck fractures.B) intertrochanteric fractures.C) subtrochanteric fractures.D) femoral shaft fractures. E) supracondylar femoral fractures. ANSWERTags: MCQ, Orthopedics, Osteonecrosis
An 18-year-old white male comes to your office complaining of pain in the right wrist since falling 2 weeks ago. On examination, he is tender in the anatomic snuffbox. A radiograph reveals a fracture of the proximal one-third of the carpal navicular bone (scaphoid).Which one of the following is the most appropriate management at this time?A) A bone scanB) Physical therapy referralC) A Velcro wrist splintD) A short arm castE) A thumb spica castANSWERTags: MCQ, Orthopedics, Wrist Sprain, Fracture
A 3-year-old white female is brought to your office because she is complaining of pain in her right arm. Her mother tells you the pain began after she pulled her daughter by the arm while the girl was fighting with her brother. You examine the child and diagnose “nursemaid’s elbow”.You recommend which one of the following?A. Manipulation of the forearm to reduce radial head subluxationB. Long arm cast immobilizationC. Use of a sling for arm restD. A cock-up wrist splintE. Referral for family counseling AnswerTags: MCQ, Orthopedics, nursemaid’s elbow
A high school golfer presents with a history of “tingling hands.” Which one of the following would support a diagnosis of carpel tunnel syndrome?A) Absence of symptoms at nightB) Numbness in the fourth and fifth digitsC) Wasting of the thenar compartmentD) Provocation of symptomsE) Positive Phalen’s maneuver ANSWERTags: MCQ, Orthopedics, Carpal Tunnel Syndrome
An 18-year-old male is admitted to the hospital after being found lying on the floor unconscious from a drug overdose. The next morning, he is alert and complains of constant pain in the anterior aspect of his left leg. On examination you note pain with passive stretching, pain with palpation anteriorly, and a slightly decreased dorsalis pedis pulse on the left. There is no edema or erythema. Radiographs of the lower extremity are normal.Which one of the following would you do now?A. Recommend rest, ice, and elevation along with physical therapy.B. Begin empiric intravenous antibiotics.C. Order duplex Doppler ultrasonography of the left leg.D. Order impedance plethysmography of the left leg.E. Obtain immediate surgical consulation. ANSWERTags: MCQ, Orthopedics, Drug Overdose
An 18-year-old white female college marathon runner presents with persistent pain and tenderness over the public symphysis. With exercise, pain is noted in the lower abdomen and medial thighs. There is no fever. A radiograph shows widening of the pubic symphysis.What is the most likely diagnosis? A.Osteomyelitis of the pubisB.Stress fracture of the pubisC.Osteitis pubisD. Inguinal herniaE. CystitisANSWERTags: MCQ, Orthopedics, Pubic Pain
A 22-year-old white male who is a distance runner on his school track team complains of left knee pain. On examination, you note tenderness over the distal lateral femoral condyle.The most likely diagnosis isA) Osgood-Schlatter disease.B) osteochondritis dissecans.C) bipartite patella.D) iliotibial band syndrome.E) patellar tendiniti.ANSWERTags: MCQ, Orthopedics, Knee Pain
Idiopathic osteonecrosis or avascular necrosis of the capital femoral epiphysis (Legg-Calve-Perthes disease):A) usually occurs in tall children.B) affects girls more often than boys.C) frequently occurs during adolescence.D) is usually bilateral.E) is usually associated with a painless limp.ANSWERTags: Legg-Calve-Perthes, Orthopedics, MCQ
A 3-year-old white female is brought to your office because she is complaining of pain in her right arm. Her mother tells you the pain began after she pulled the child by her arm while the child was fighting with her brother. You examine the child and diagnose “nursemaid’s elbow.”You recommend which one of the following:A) Hyperpronation of the forearm to reduce radial head subluxationB) Long arm cast immobilizationC) Use of a sling for arm restD) A cock-up wrist splint ANSWERTags: MCQ, Orthopedics, nursemaid’s elbow
A 13-year-old white female with no prior history of arm pain or dysfunction has sudden severe pain in the upper arm and hears a loud snapping sound in her arm as she serves the ball while playing tennis. The pain is persistent, and swelling develops over the deltoid region. On examination, the upper arm is very tender.Likely diagnostic possibilities include which of the following?A) Unicameral bone cystB) Aneurysmal bone cystC) Osteoid osteomaD) Primary lymphomaE) Osteoscarcoma ANSWERTags: MCQ, Orthopedics, Bone Tumors, Bone cysts
You are seeing a 5-year-old female child with in-toeing due to excessive femoral anteversion. She is otherwise normal and healthy, and her mobility is unimpaired. Her parents are greatly concerned by the cosmetic appearance and possible future disability, and request that she be treated.You recommend which one of the following?A) ObservationB) Medial shoe wedgesC) Torque heelsD) Sleeping in a Dennis Browne splint for 6 monthsE) Derotational osteotomy of the femurANSWERTags: MCQ, Orthopedics, In toeing
A 32-year-old woman presents with left inguinal and groin pain of 1 week duration that is worse with weightbearing and ambulation. Physical examination reveals full range of motion of the left hip. She walks with a limp. She had previously been treated with mechlorethamine, vincristine, procarbazine, and prednisone therapy for Hodgkin's disease. An anteroposterior film of the pelvis demonstrates no osseous abnormality. Which of the following tests would be most useful in making the diagnosis? A. Serum rheumatoid factor B. Erythrocyte sedimentation rate C. Magnetic resonance imaging (MRI) of the left hip D. Arthrogram of the left hip E. Blood alcohol level AnswerTags: MCQ, Orthopedics, Hip Pain
All of the following are characteristic patterns of joint involvement in rheumatoid arthritis, except A. Polyarticular involvement B. Oligoarticular involvement C. Symmetrical involvement D. Involvement of the proximal interphalangeal (PIP), metacarpophalangeal (MCP) wrist, and metatarsophalangeal (MTP) joints E. Frequent cervical spine involvement AnswerTags: MCQ, Orthopedics, Rheumatoid Arthritis
A 46-year-old man on hemodialysis for 12 years complains of insidious onset of painful nocturnal dysesthesias involving the thumb and three fingers, relieved by shaking the hand. Physical examination of the hand reveals thenar wasting and numbness over the fingers. Each of the following statements is true, exceptA. Deposits of β2-microglobulin AH (amyloidosis associated with hemodialysis) amyloid compressing the median nerve could produce these findings.B. An entrapment neuropathy could explain these findings. C. Paresthesias involving the radial side of the thumb, second, third, and fourth fingers suggest compression of the medial nerve.D. Carpal tunnel syndrome could explain these findings. E. Deposits of amyloid of the primary type AL (amyloidosis associated with light chains) would be typical. AnswerTags: MCQ, Orthopedics, Nerve Entrapment
All of the following conditions involve the distal interphalangeal (DIP) joint, except A. Multicentric reticulohistiocytosis B. Erosive osteoarthritis C. Psoriasis with nail changes D. Juvenile chronic arthritis E. Rheumatoid arthritis AnswerTags: MCQ, Orthopedics, Phalangeal joint
A 42-year-old woman with seropositive rheumatoid arthritis has become disabled by pain and tightness behind the right knee. Physical examination reveals cystic swelling over the popliteal fossa and semimembranous tendon. Which of the following is the most appropriate next step?A. Arthrogram of the right knee B. Synovial biopsy of the right knee C. Ultrasound study of the right knee popliteal fossa D. Venogram of right lower extremity E. None of the above AnswerTags: MCQ, Orthopedics, Swelling, Knee
54-year-old woman complains of severe right shoulder pain localized mainly to the midhumerus but also diffusely around the anterolateral shoulder. The onset was sudden and not precipitated by trauma. Physical examination reveals limited abduction with point tenderness over the subacromial bursa and the greater tuberosity of the humerus. A radiograph reveals a linear calcific density in the supraspinatus tendon. All of the following statements are true, exceptA. Treatment consists of cortisone injection into the subacromial bursa, NSAIDs, and physical therapy. B. The calcific density is most likely calcium urate. C. The diagnosis could not be made by an arthrocentesis. D. Local tendon injury may be the major cause.AnswerTags: MCQ, Orthopedics, Shoulder Pain
In a patient with an ankle fracture where there was a spiral fracture of the lateral malleolus, what is the treatment of choice? a) compression screws b) tension banding wiring c) buttress plating d) no treatment requiredAnswerTags: MCQ, Orthopedics, Ankle Fracture
A 32 year old female presents with acute onset of neck pain of musculo-skeletal origin. At this age it has been shown that A. Only a few patients are pain free after one month.B. the majority of patients will have recurrence of pain within 2 years.C. soft cervical collars are of proven benefit in reducing the duration of symptoms.D. non steroidal anti inflammatory drugs have been shown to be of benefit in reducing the duration of symptoms.E. manipulative techniques (e.g. Cyriax) have been shown to be of no additional benefit.AnswerTags: MCQ, Orthopedics, Pain
A 73 year old woman has become progressively kyphotic over the last 3 years. Her past history includes Ca Colon & hysterectomy at age 26 for fibroids. She now presents with acute back pain & localised mid-thoracic tenderness. CXR & lateral spine X-rays are shown (interpreted as osteopaenia with wedge compression # in mid-thoracic vertebrae with no lytic or sclerotic lesions seen). The most likely diagnosis is:Multiple myeloma Bone metastases Osteoarthritis Osteoporosis HyperparathyroidismAnswerTags: MCQ, Orthopedics, Kyphosis
