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CT Orthopedics Exam Questions And Answers
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CT Orthopedics Exam CT Orthopedics Exam CT Orthopedics Exam
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CT Orthopedics ExamA 23 y/o woman presents to the ED with a 10/10 painful right arm. She also reports numbness and
tingling of her right hand and fingers. She burned her arm on the stove 1 week ago and was prescribed a
silver-containing cream. PE is remarkable for swelling and tenderness of the right forearm. She also has
decreased sensation in her right hand and weakness of the right thenar muscles. Tissue pressure in the
arm is 55 mmHg (normal <8 mmHg). What is the best initial management? - ANS surgery (diagnosis is
compartment syndrome)
A 34 y/o man was the driver in a single car MVA. Preliminary radiographic studies show a comminuted
fracture of the right tibia. The patient is describing a substantially increasing amount of pain felt in the
injured extremity. He describes the pain as being a 10/10; it seems as if it is becoming worse every
minute. He describes it as a deep achy burning pain. You quickly examine the right leg; you note pallor, a
tense wood-like feeling of the extremity, diminished sensation, and muscle weakness. What is the
diagnosis and management? - ANS Diagnosis: compartment syndrome
Confirm diagnosis by measuring pressure
Treatment: surgery (fasciotomy)
A 57 y/o male presents with acute bilateral lower extremity weakness and urinary incontinence that
began after he fell earlier today. His exam is significant for bilateral lower extremity sensory deficits and
weakness along with decreased rectal sphincter tone. What is the most appropriate intervention? - ANS
order MRI, consult neurosurgery
An obese 15 y/o male presents with a complaint of a limp and right knee pain for two weeks. He denies
recent trauma or history of previous injury. PE of the right knee is unremarkable. Exam of the right hip
reveals pain with passive ROM 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. What is the next best
test, diagnosis, and first line treatment? - ANS next best test: x-ray
diagnosis: SCFE
first line treatment: surgery
A 49 y/o man presents with pain in his left lower extremity. During questioning, the patient states that
while doing construction work 3 months ago, he jumped from an elevated height of 6 feet. Ever since
this episode, he has noted increased issues with left sided hip and knee pain. He describes the pain as
, radiating into the left groin and front middle thigh area. The pain is relieved with sitting and aggravated
by walking and climbing up stairs. The patient denies any paresthesias, numbness, bowel or bladder
dysfunction, fever, night sweats, or chills. Pertinent medical history includes a 20 year extensive history
of alcohol (which is a risk factor for this condition; other risk factors are long term steroid use and sickle
cell disease which aren't present in this patient). A radiograph interpretation shows the presence of a
crescent sign and marked irregularity of the left femoral head with sclerosis. Dx and tx? - ANS Diagnosis:
avascular necrosis
Treatment: give crutches - avoid weight bearing, surgery is 1st line (not emergent; but needs total hip
replacement)
A 52 y/o overweight woman has had pain in her right hand for the past month. She is employed as a
pastry chef and has trouble making a fist. On exam, she is tender over the radial styloid. You have her
flex her thumb into her palm and move the wrist into ulnar deviation. This movement recreates her
pain. What is the diagnosis and initial management? What would be second line and third line
management? - ANS - diagnosis: De Quervain's tenosynovitis
- management: 1st line is NSAIDs, rest and thumb spica splint. 2nd line is steroid injections into first
dorsal. 3rd line is surgical release of first dorsal compartment (only done for severe symptoms and not
even considered until after 6 months of failed nonoperative management).
A 73 y/o man presents with the inability to actively raise his left non-dominant arm to retrieve plates
from the kitchen cabinet. He further describes the inability to retrieve any objects with his left hand/arm
because of limited ROM. He is worried because he is the only driver in the household and does not want
to lose his driving privileges. He has a longstanding history of shoulder impingement syndrome. On
exam, he is found to have a positive drop arm test. What is the diagnosis? Best management? When
would you do surgery? - ANS - diagnosis: rotator cuff tear (over time, chronic shoulder impingement
syndrome can cause a torn rotator cuff)
- initial management: physical therapy
- Surgery would be appropriate if it were a complete rupture tear (but it's partial in this case), if it were
trauma-related, young athlete
Management of torn rotator cuff would be an arthroscopic or mini-open rotator cuff repair for which
patients? - ANS - acute full-thickness tears
- younger patients
- but otherwise and in most cases, physical therapy, activity modifications, NSAIDs are the treatment
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