Final module: bone and joint disorders

1. A 46-year-old woman presents to your clinic with multiple complaints. She describes fatigue and
general malaise over 2-3 months. Her appetite has decreased. She thinks she has unintentionally
lost approximately 5.5 kg. lately, she notes pain and stiffness in her fingers on both hands that is
worse in the morning and with repetitive movement. She has a grandmother and a sister who
have rheumatoid arthritis, and she is very concerned that she now has it as well. Which of her
complaints represents the most common manifestation of established rheumatoid arthritis?
a. Positive family history with two relatives with RA
b. Pain in symmetric joints that is worsened with movement
c. Fatigue and anorexia for more than 2 months with concomitant joint pain
d. Weight loss of more than 4.5 kg during period of active disease
e. Morning joint stiffness lasting for more than 1 hour
2. Greater tuberosity of hummer’s fracture in most cases can be treated:
a. Shoulder endoprotesis
b. With intramedullary rods
c. Intramedullary screw
d. Plates and screws
3. For the non-pharmacologic pain management in cancer patients which of the following cannot
be applied on the site of tumor?
a. Biofeedback
b. Iontophoresis
c. Ultrasound
d. Cryotherapy
4. What is Pfn?
a. Intramedullary rod
b. Femoral plate and screws
c. AO intramedullary screw
d. Proximal femoral nail
5. A 27-year-old woman is admitted to the intensive care unit after delivery of a full-term infant 3
days prior. The patient was found to have right hemiparesis and a blue left hand. Physical
examination is also notable for livedo reticularis. Her laboratories were notable for a white
blood cell count of 10.2 /ml, hematocrit 35%, and platelet count of 13,000/ml. her BUN is 36
mg/dl and her creatinine is 2.3 mg/dl. Although this pregnancy was uneventful, the three prior
pregnancies resulted in early losses. A peripheral smear shows no evidence of schistocytes.
Which of the following laboratory studies will be confirm the underlying etiology of her
presentation?
a. Doppler examination of her left arm arterial tree
b. Anticardiolipin antibody panel
c. Echocardiography
d. Antinuclear antibody
e. MRI of her brain
6. Assessment of patient’s functional mobility is important to:
a. Predict risks linked to immobility, need for assistive devices
b. All of the above
 c. Determine independence, determine safety
d. Identify environmental hindering factors
7. Anticipatory postural control tests are:
a. The Stork Stand test
b. The Romberg and sharpened Romberg test
c. The Five-times-sit-to-stand test (5 x STS)
d. The functional Reach test and the Star Excursion Balance test (SEBT)
8. Which ages Galeazzi fractures are more common:
a. Middle aged
b. Old people
c. Children
d. Youngsters
9. Spina bifida can cause:
a. All above is correct
b. Hydrocephalus
c. Orthopedic problems
d. Bowel and bladder problems
10. A special braces to wear:
a. Casting
b. Pillow of Freyka
c. Splints
11. Meniscus complete tear can often cause:
a. Swelling
b. Bruising
c. Blockage of knee joint
d. Deformity of knee
12. Proximal femoral fracture is:
a. Femur diaphysis fracture
b. Epicondyle fractures
c. Sub capital fracture
d. Patellar fracture
13. Congenital torticollis is:
a. Shortening of clavicle bone
b. Congenital deformity of scapula
c. Shortening of deltoid muscle
d. Shortening of sternocleidomastoids muscle
14. Static balance tests are:
a. The Five-times-sit-to-stand test (5 x STS)
b. The Romberg and sharpened Romberg test
c. The Star Excursion Balance Test (SEBT)
d. The Functional Reach Test
15. Choose an incorrect answer: heat therapy:
a. May be delivered through the use of SWD
b. Is useful during acute inflammation
 c. May be delivered through the use of light, sound and electromagnetic energies
d. All answers are correct
16. What is Frejka pillow?
a. Knee fixator
b. Its for treatment of hip dysplasia
c. Splint for arm
d. Cast for spine
17. Risk factors of scoliosis are:
a. All above
b. Puberty
c. Bone tumors
d. Infections
18. The most common method to treat tibia shaft fractures is:
a. Intramedullary nailing
b. Pfn
c. Dhs
d. Spica cast
19. Congenital hip dysplasia can be treated before 1 year of age with:
a. With bandaging
b. With special pins
c. Surgery
d. With Pavlik harnesses
20. Which of the following is the most common extraarticular manifestation of ankylosing
spondylitis?
a. Inflammatory bowel disease
b. Third-degree heart block
c. Aortic insufficiency
d. Pulmonary fibrosis
e. Anterior uveitis
21. Congenital clubfoot symptoms are:
a. Varus deformity
b. Valgus deformity
c. Pathologic movement
d. Recurvation
22. A 35-year-old female presents to her primary care doctor complaining of diffuse body and joint
pain. When asked to describe which of her joints are most affected, she answers “all of them”.
There is no associated stiffness, redness, or swelling of the joints. No Raynaud’s phenomenon
has been appreciated. Occasionally she notes numbness in the fingers and toes. The patient
complains of chronic pain and poor sleep quality that she feels is due to her pain. She previously
was seen in the clinic for chronic headaches that were felt to be tension related. She has tried
taking over-the-counter ibuprofen twice daily without relief of pain. She has no other medical
problems. On physical examination, the patient appears comfortable. Her joints exhibit full
range of motion without evidence of inflammatory arthritis. She does have pain with palpation
at bilateral suboccipital muscle insertions, at C5, at the lateral epicondyle, in the upper outer
 quadrant of the buttock, at the medial fat pad of the knee proximal to the joint line, and
unilaterally on the second right rib. The erythrocyte sedimentation rate is 12 seconds.
Antinuclear antibodies are positive at a titer of 1:40 in a speckled pattern. The patient is HLA-
B27 positive. Rheumatoid factor is negative. Radiograms of the cervical spine, hips and elbows
are normal. What is the most likely diagnosis?
a. Fibromyalgia
b. Ankylosing spondylitis
c. Systemic lupus erythematosus
d. Disseminated gonococcal infection
e. Rheumatoid arthritis
23. Electrotherapy is not useful for:
a. Increasing of temperature in the soft tissue
b. Reeducation and retraining: functional electrical stimulation
c. Pain management
d. Strengthening: neuromuscular electrical stimulation
24. Which of the following is not a contextual factor?
a. Age
b. Personality
c. Lost function
d. Home environment
25. Which of the following statements regarding rheumatoid arthritis is true?
a. Females are affected three times more often than are males, and this difference is
maintained throughout life
b. The earliest lesion in rheumatoid arthritis is an increase in the number of synovial lining
cells with microvascular injury
c. Titers of rheumatoid factors are not predictive of the severity of rheumatoid arthritis or its
extraarticular manifestations
d. There is an association with the class II major histocompatibility complex allele HLA-B27
e. Africans and African Americans most commonly have the class II major histocompatibility
complex allele HLA-DR4
26. All of the following are characteristic extraarticular manifestations of rheumatoid arthritis
except:
a. Anemia
b. Cutaneous vasculitis
c. Secondary Sjogren syndrome
d. Pericarditis
e. Thrombocytopenia
27. Clavicle fractures may occur:
a. While labor
b. All of these
c. Direct hit on shoulder
d. From fall on stretched arm
28. A 23-year-old woman is evaluated by her primary care physician because she is concerned that
she may have systemic lupus erythematosus after hearing a public health announcement on the
 radio. She has no significant past medical history, and her only medication is occasional
ibuprofen. She is not sexually active and works in a grocery store. She reports that she has had
intermittent oral ulcers and right knee pain. Physical examination shows no evidence of
alopecia, skin rash, or joint swelling/inflammation. Her blood work shows that she has a positive
antinuclear antibody (ANA) at a titer of 1:40, but no other abnormalities. Which of the following
statements is true?
a. If a urinalysis shows proteinuria, she will meet the criteria for systemic lupus erythematosus
b. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus;
this patient has two
c. The demonstration of a positive ANA alone is adequate to diagnose systemic lupus
erythematosus
d. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus;
this patient has three
e. She meets the criteria for systemic lupus erythematosus because she has three criteria for
the disease
29. From the listed below which activities are not ADL?
a. Feeding
b. Financial management
c. Bowel and bladder management
d. Eating
30. Patellar fractures often cause:
a. All above
b. Bruising
c. Inability to walk
d. Inability to straighten knee
31. During proliferation stage we need increase processes of:
a. Hemostasis/clot formation, Cell-mediated phagocytosis
b. Epithelialization, collagen production, closure/contraction, revascularization
c. All answers are incorrect
d. Vasoconstriction
32. Functional tests for balance assessment are:
a. Timed up and go test (TUG) and Berg balance scale
b. The Romberg and sharpened Romberg test
c. Pushes and pull test
d. The functional reach test and the star excursion balance test (SEBT)
33. A 42-year-old male presents with complaints of a rash and joint pain. He first noticed the rash 6
months ago. It is primarily on the hands, the extensor surfaces of the elbows, and the knees, low
back, and scalp. Although he complains of the appearance of these lesions, they do not itch or
hurt. He has not been previously evaluated for them and has recently noticed changes in the nail
beds. For the last 2 weeks, the patient has had increasingly severe pain in the distal joints of the
hands and feet. His hands are so painful that he is having trouble writing and holding utensils.
He denies fevers, weight loss, fatigue, cough, shortness of breath, or changes in bowel or
bladder habits. Which of the following is the most likely diagnosis?
a. Osteoarthritis
 b. Arthritis associated with inflammatory bowel disease
c. Gout
d. Rheumatoid arthritis
e. Psoriatic arthritis
34. The most common complication of knee joint trauma is:
a. Leg discrepancy
b. Osteomyelitis
c. Posttraumatic arthritis
d. All above
35. Injury of anterior cruciate ligament can cause
a. Tenderness around the knee joint
b. All above
c. Anterior drawer symptom
d. Reduced range of motion
36. Which from the following is not characteristic for a chronic pain?
a. Pain lasting more than 1 month beyond the course of an acute illness or injury
b. Pain is not related to cancer and lasts more than 3 months
c. Pain recurring at intervals of months or years
d. Patient who has chronic pain does not know how to cope with it and seeks for help
37. Which of the following definitions best fits the term enthesitis?
a. Alteration of joint alignment so that articulating surfaces incompletely approximate each
other
b. Inflammation at the site of tendinous or ligamentous insertion into bone
c. Inflammation of a saclike cavity near a joint that decreases friction
d. A palpable vibratory or crackling sensation elicited with joint motion
e. Inflammation of the periarticular membrane lining the joint capsule
38. Which of the following is the most common clinical presentation of acute rheumatic fever
(ARF)?
a. Erythema marginatum
b. Chorea
c. Polyarthritis
d. Subcutaneous nodules
e. Carditis
39. Which of the following is the most frequent site of joint involvement in established rheumatoid
arthritis (RA)?
a. Wrist
b. Distal interphalangeal joint
c. Knee
d. Spine
e. Hip
40. Distal humeral intraarticular fractures have the most common complication:
a. Stiffness in elbow (cubitus varus)
b. Inability to lift an arm
c. Ligament tear
 d. Compartment syndrome
41. In patients with established rheumatoid arthritis, all of the following pulmonary radiographic
findings may be explained by their rheumatologic condition except:
a. Lobar infiltrate
b. Bilateral interstitial infiltrates
c. Unilateral pleural effusion
d. Solitary pulmonary nodule
e. Bronchiectasis
42. Choose an incorrect answer: therapeutic application of cold will result in:
a. Decrease bleeding and acute inflammation following injury or tissue disruption
b. Will result in increased blood flow and tissue metabolism
c. Will result in reduced blood flow and tissue metabolism
d. It is a first-aid measure after trauma and as an adjunctive tool in the rehabilitation of
musculoskeletal and neuromuscular dysfunctions
43. From the listed below which activities are not ADL?
a. Communication device use
b. Transfers from bed to chair
c. Bowel and bladder management
d. Eating
44. Which of the following is the earliest plain radiographic finding of rheumatoid arthritis?
a. Soft-tissue swelling
b. Juxtaarticular osteopenia
c. Symmetric joint space loss
d. No abnormality
e. Subchondral erosions
45. Benefits of heat therapy are not:
a. Increasing of blood flow and metabolism
b. Increasing of muscle and soft tissue elasticity
c. Pain reduction
d. Decreasing of neural transmission
46. Primary goals of cold therapy is:
a. All answers are correct
b. Minimize inflammation promote the most expedient and effective healing process because
of increasing blood flow
c. Minimize inflammation promote the most expedient and effective healing process
because of decreasing of blood flow
d. Minimize inflammation promote the most expedient and effective healing process because
of decreasing muscle contractility
47. A 24-year-old woman is newly diagnosed with systemic lupus erythematosus. Which of the
following organ system complications is she most likely to have over the course of her lifetime?
a. Cutaneous
b. Hematologic
c. Musculoskeletal
d. Renal
 e. Cardiopulmonary
48. When spine fractures can be treated conservatively:
a. Unstable fractures
b. Fracture with dislocation
c. Stable fractures
d. None of these
49. Wrist fractures can be healed in:
a. 6 months
b. 8 weeks
c. 4 months
d. 3 weeks
50. Physiological events of the inflammatory stage are:
a. Vasoconstriction, vasodilation, hemostasis/clot formation
b. Collagen production, closure/contraction, revascularization
c. Epithelialization, collagen production, closure/contraction
d. Vasoconstriction, vasodilation, closure/contraction, revascularization
51. A 57-year-old woman with depression and chronic migraine headaches reports several years of
dry mouth and dry eyes. Her primary complaint is that she can no longer eat her favorite
crackers, though she does report photosensitivity and eye burning on further questioning. She
has no other associated symptoms. Examination shows dry, erythematous, sticky oral mucosa.
All of the following are likely to be positive in the patient except:
a. La/SS-B antibody
b. Ro/SS-A antibody
c. Schirmer’s test
d. Scl-70 antibody
e. Sialometry
52. Which of the following autoantibodies is most likely to be present in a patient with systemic
lupus erythematosus?
a. Anti-Ro
b. Anti-RNP
c. Antiphospholipid
d. Anti-dsDNA
e. Antiribosomal P
53. Therapeutic application of cold:
a. Is useful before physical exercises
b. All answers are correct
c. Is useful before stretches
d. Is useful after exercises
54. A 32-year-old woman with a long-standing diagnosis of systemic lupus erythematosus is
evaluated by her rheumatologist as routine follow-up. A new cardiac murmur is heard and an
echocardiogram is ordered. She is feeling well, and has no fevers, weight loss, or preexisting
cardiac disease. A vegetation on the mitral valve is demonstrated. Which of the following
statements is true?
a. The patient has been surreptitiously using injection drugs
 b. Pericarditis is frequently present concomitantly
c. Glucocorticoid therapy has been proven to lead to improvement in this condition
d. The lesion has low risk of embolization
e. Blood cultures are unlikely to be positive
55. Performance-orientated mobility assessment (POMA), timed up and go test (TUG), Berg balance
scale, four square step test (4SST) are:
a. Dynamic balance tests
b. Reactive postural balance tests
c. Functional tests for balance assessment
d. Static balance tests
56. For the non-pharmacologic pain management in cancer patients which of the following cannot
be applied on the site of tumor?
a. Biofeedback
b. Iontophoresis
c. Cryotherapy
d. Massage
57. All of the following agents have been shown to have disease-modifying antirheumatic drug
(DMARD) efficacy in patients with rheumatoid arthritis except
a. Leflunomide
b. Naproxen
c. Rituximab
d. Methotrexate
e. Infliximab
58. Benefits of heat therapy are not:
a. Pain reduction
b. Increasing of muscle and soft tissue elasticity
c. Decreasing of energy expenditure
d. Increasing of blood flow and metabolism
59. Opened fractures can often have complications:
a. All above
b. Infection
c. Bone tumor
d. Volkmann’s contracture
60. Which of the following is not used for patients rehabilitation with oncologic pathologies?
a. Massage therapy
b. ROM exercises
c. Meticulous skin care
d. Soft-tissue mobilization
61. Which of the following is the most common extraglandular manifestation of primary Sjogren’s
syndrome?
a. Raynaud’s phenomenon
b. Peripheral neuropathy
c. Vasculitis
d. Arthralgias/arthritis
 e. Lymphoma
62. Therapeutic application of cold:
a. Is useful during chronic inflammation
b. Is useful during acute inflammation
c. Will result in increased blood flow and tissue metabolism
d. Is useful for increasing muscle contractility
63. Distal femoral fracture healing time is:
a. 3-6 months
b. 1 month
c. 8 months
d. 2 months
64. A patient with primary Sjogren’s syndrome that was diagnosed 6 years ago and treated with tear
replacement for symptomatic relief notes continued parotid swelling for the last 3 months. She
has also noted enlarging posterior cervical lymph nodes. Evaluation shows leukopenia and low
C4 complement levels. What is the most likely diagnosis?
a. HIV infection
b. Lymphoma
c. Chronic pancreatitis
d. Amyloidosis
e. Secondary Sjogren’s syndrome
65.