Orthopaedic Questions

A 58-year-old woman is referred by orthopaedic surgeon to physical medicine and rehabilitation physician for non- medicamental management of postoperative pain following right knee arthroscopic meniscectomy, done 2 days ago. Physical examination reveals painful and swollen right knee with reduced flexion. Patient cannot use non-steroidal anti- inflammatory drug due to stomach ulcer.
Which physical agent is the best to reduce pain?

In the case of angular deformity, the change of growth of the physis plate plays a major role in the process of remodeling. What percentage of remodeling is happening in this area?

12 y the girl is complaining of a back sprain (spine distortion). What's most common for spine rotation?

Which statment best describes the stages of surgical treatment of intraarticular fractures with spongious bone defect?

According to the National Centre of Complementary and Integrative Health (USA) complementary and alternative medicine services are divided in to five categories.
To which category belongs osteopathy?

26 yrs old woman complains of a right hand and wrist pain which lasts about 1 month. The patient claims that she can not lift heavier things, slip the bread with a knife, because during this time, the pain or stiffness of the thumb is particularly intensified. The patient also notes weakened hand power, swelling of the wrist.
Patient denies shoulder pain, hand injuries, numbness of the fingers, and diabetes mellitus. She is currently growing a baby for 6 months.
What is the most likely cause of the described illness?

A 65-year-old woman has a long history of rheumatoid arthritis. Physical examination reveals painful walking, bilateral ankle joint and toe stiffness, light toe deformity. Examination of the upper limbs reveals light deformity, adequate wrist and hand function. Small joints are slightly swollen and painful.
Which deep heating agent is the best to reduce pain and oedema in joint affected by chronic inflammation?

74y. Ona B. diagnosed with left coxarthritis (grade III) was referred to physical medicine and rehabilitation physician towards evaluation of her functioning and rehabilitation.
What would be most appropriate to choose in order to assess her ability to care for herself?

Patient had an MRI performed because of shoulder trauma, diagnosed - acromioclavicular capsule and ligament rupture, distortion (sprain) of coracoclavicular ligament, minimal damage to deltoid and trapezius muscles. What is the type of injury to acromioclavicular joint according to Rockwood classification?

45 y.o. lady arrived to family doctor due to muscle aches.
She is working as hairdresser, recently it become difficult to work, because of tired arms, ant difficulty to work in standing position.
Obj.: severe weakness of proximal muscles of arms and legs.
Lab: WBT normal, ESR - 65 mm/h., serum creatinfosfokinase 4500 U/I.
The most appropriate treatment in this case is:

A 20-year-old basketball player during training received a direct blow to tibia while the knee was flexed. In couple hours swelling occurred. He was diagnosed with posterior cruciate ligament tear.
What was the most likely mechanism of injury?

51 years old secretary complains of pain and numbness of the right hand. Symptoms started five weeks ago and they are the most severe in the index finger during daytime working with computer. Similar symptoms are felt in the thumb and long finger at the end of the day. Finger numbness, tingling followed by pain are extremely irritating at night. She complains of finger stiffness in the morning. Also she noticed reduced grasping strength, swelling of the wrist and elbow. The patient denies shoulder pain, hand trauma, diabetes mellitus. She has been working in the public hospital for six years and mentioned increased workload in recent weeks.
Treatment of the first choice for the described case

Mary, 72 years of age. 5 weeks ago had broken her radius bone in typical location. After immobilization was ceased, she was referred to the physiotherapy office. Therapist investigates her forearm muscle strength (wrist flexion, extension). The patient performs the movement just in the antigravity position (moves through range of motion without gravity).
Which grade according to R. Lovett scale best describes the clinical finding?

What's the main morphological sign of chronic shoulder joint instability?

A 45-year-old woman 10 months ago, after long walk, started to feel pain in the bottom of her left heel. She was diagnosed with plantar fasciitis. X-ray confirmed the presence of a heel spur. She was treated with pharmacological and nonpharmacological (low energy physical agents) interventions, but the efficacy was not sufficient. She still suffers from pain at the beginning of any activity.
Which high energy physical agent would be the best in her case?

6 y boy is diagnosed with Legg-Calve-Perth's disease.
Comparative (AP and Lauenstein) X-rays of hips performed,
lateralisation of femoral head, increased joint space, and femoral head condensation observed on the right side. There are no radiological changes on the left. What stage of the Legg-Calve-Perthes disease is characterized by changes to the right side (according to the Valdenstrom classification)?

50-year-old man with gout diagnosis for many years and under not regular urate lowering treatment comes because of right knee arthritis. The joint is heavily swollen.
Which investigation would be the quicker way to determine the origin of the arthritis in this case?

Antinuclear antibodies testing by indirect immunofluorescence assay (ANA (IFA) was used in patient with suspected systemic lupus erythematosus. ANA (IFA) test result: ANA positive at 1:40 dilution with homogenous fluorescence pattern.
Which laboratory test is appropriate for confirmation of ANA (IFA) results?

15 y old boy complains of moderate back pain (thoracic part) lasting for a few months. Clinically and radiologically diagnosed with osteochondrosis of the spine- Scheuermann kyphosis. On lateral radiographs of the thoracic spine there are three keel vertebra bodies, Schmorl's nodes, and kyphosis - 40 degrees. What is the best treatment method?

Christopher W. 52 y., truck driver, in orthopaedic traumatology department underwent total knee arthroplasty 6 days ago and was transferred to in-patient rehabilitation department for further treatment and rehabilitation. Rehabilitation team assessed his ability to orientate in & interact with environment, transmit and receive information, take care of oneself, hear, move in the environment, to be sexually active, work and be economically independent, be socially active.
Which biosocial function remained unassessed?

68 y/o female presented to the clinic with postmenopausal osteoporosis.
X-RAY shows no spinal compression fractures
DEXA scan shows - osteoporosis, spinal T score - 2,5.
Supplements were prescribed.
Which supplements would be most appropriate for this patient?

The patient was diagnosed with rheumatoid arthritis. She complained of difficulties to unlock the door of her house from time to time, to do the buttons and to accomplish other household chores independently. Impaired function of her upper extremities was the reason for decreased performance in her activities of daily living.
Occupational therapist planned to assess her upper extremities function, muscle strength, range of motion.
Which function assessment instruments/scales would be best to use for the evaluation?

What are the clinical and radiological symptoms of the osteochondrosis of the thoracic spine - Mb. Scheuermann

65 years old man complains of the severe pain and swelling of the right toe, elevated body temperature up to 38.5° C.
On inspection - swelling, redness of the right toe and right metatarsophalangeal joint. On palpation this area is warm, very painful.
Anamnesis - gout was diagnosed 10 years ago.
Blood test - leucocytes 12 x 10/1 (12000/mm3),uric acid 590 micromol/l, CRP 190 mg/l.
What investigations are the best for confirmation of diagnosis in this case?

A 32-year-old woman who sustained a moderate right-ankle sprain with partial tearing of the ligament approximately 6 weeks ago. Immobilisation for 4 weeks was applied. Physical examination reveals pain, swelling, stiffness, and reduced range of motion of right ankle.
Which rehabilitation method is the best to increase range of motion?

Which statement is not specific to the primary femoral necrosis head (AVN)?

The patient with suspected ankylosing spondylitis is at consultation with rheumatologist.
Which instrumental test could be the most accurate to prove diagnosis?

Which acromion type is most often associated with degenerative damage to shoulder rotator cuff tendons?

Which statement about the Kaunas clinics trauma team in is correct?

Which muscle tendon is most often damaged during fracture of the distal part of radius?

14 y obese boy started limping with his right leg. complaining of right knee pain. No traumatic symptoms.
Doesn't have fever. Appeared to the family doctor. Laboratory blood tests performed without any changes. In the course of clinical examination, the right knee movements are free and painless. Decreased and painful range of motion of right hip joint. markly limited abduction, internal rotation and flexion in the right hip. Muscle hypotrophy of the right leg observed, slight shortening of the right leg. By comparing (AP and Lauenstein) hip radiographs, one-sided changes in the right femoral head physis area are observed, the Klein line is dislocated. What kind of pathology can be suspected?

What type of implant was used to perform humerus fracture osteosynthesis?

71 y woman complains of pain and deformity of the left foot, walking difficulties. During the survey, redness and congestion are observed in the area of the inner part of the first metatarsal, and the thumb is in valgus position. In radiographs, a moderate degree of hallux deformation and IV stage arthritis of first metatarsophalangeal joint is observed.
Which treatment is most effective in this clinical case?

45 yrs old woman complains of the pain over the distal palm, locking of the thumb during active flexion-extension activity about 6 months. The patient claims that she can not lift heavier things, slip the bread with a knife, because during this time, the pain or stiffness of the thumb is particularly
intensified and things get out of the hand. Patient denies shoulder pain, hand injuries, numbness of the fingers, and diabetes mellitus.
She is right hander and works in a furniture factory.
Obj.: palpable nodule in the line of the flexor digitorum superficialis (FDS), just distal to the metacarpophalangeal (MCP) joint in the palm
What is the best treatment method?

70 years old A.L. underwent hip arthroplasty 2 years ago. Now patient is walking without any technical aid. However, lately, during her long-distance walks, she started to feel herself not safe: experiences insecurity and fear of falling.
Which of the following technical aids would be most appropriate for her to recommend for long-distance walking?

A-30-years old office worker has been having back pain for almost a year, so he visited a family doctor. During the consultation, the doctor finds out that the patient has been suffering from inflammatory back pain.
Which of the following options best describes the inflammatory lumbar pain?

45 years old builder complains of the right shoulder pain, especially when he poises the arm above his head. On objective investigation: painful palpation of the right humeral head, painful active abduction, especially between 60-120 degrees. Right shoulder joint not swollen, no redness or warmth. Blood CRB test 3 mg/l.
Which is the most likely diagnosis in his case?

A 35 years old patient suffers from rheumatoid arthritis. Woman complains of writs pain, reduced range of motion(s) and swelling.
Obj: wrist swelling, reduced ROM of fingers. X-ray shows radiocarpal arthritis, distal radioulnar joints and carpometacarpal joints. Ultrasound scan shows fluid collection of the sheath surrounding the tendon.
Which treatment would you suggest/recommend for patient?

While playing football in the yard, Peter, 22 years of age, had "twisted" his ankle. He felt sharp pain in the ankle, it became swollen. After trauma Peter could not bear any load on it. In the emergency department, X-ray was done and results showed fracture (stable, without dislocation) of his distal fibula. Conservative treatment tactics had been chosen: cast for 8 weeks was applied for immobilisation. Peter inquired when he would become able to play football again?
Which answer would have been most appropriate?

Which statement most accurately describes a knee cartilage transplantation surgery?

45 y.o. arrived to her family doctor for the muscle aches.
She works as a hairdresser. Recently it become hard to work, mainly due to tired hands, and difficulty to work in standing position.
Obj.: there is no distal muscle weakness in the hands, the patient is able to push doctor's hand strongly.
The most appropriate investigation for evaluation of musculoskeletal damage in this case is:

55 years old woman complains on muscle weakness and pain, hand fingers pain, especially when she has ulcers on the fingers ends. In cold weather she experience painful whitening of fingers, after they get blue and red. She lost 8 kg of weight, it is difficult to swallow food.
Physical exam: hardened skin of fingers, scars on the fingers endings, -content subcutaneous nodules in some fingers. Fingers are bit flexed, it is impossible to extend them fully.
What diagnosis is the most likely in this case?

14 y boy is diagnosed with juvenile epiphysiolysis of the femur head. Comparative X-rays (AP and Lauenstein) of hip joints were performed. Changes in the proximal physis of the femur were observed - widening of the growth zone, islets of dissolving porous bone on both sides of growth zone, Klein line is not dislocated. There are no radiological changes on the left. What is the stage of juvenile epiphysiolysis according to the classification of the disease duration?

Which clinical condition is the most dangerous for the patient's health in the early post-traumatic period after intraarticular comminuted fracture of proximal tibia?

The USA Surgeons Association has formulated ATLS (Advanced Trauma Life Support), the ABCDE principles for traumatized patient. Which statement about ABCDE principles is incorrect?

45 year-old woman admitted due to joint pain.
Rheumatoid arthritis was diagnosed several years ago. Patient is taking diclofenac, occasionally - prednisolone. Treatment does not help, joint pain does not decrease, the joint deformations are slightly progressing. She is working as an office administrator, but recently it become hard to work with computer, to perform her favorite leisure activities, such as knitting, stitching.
Obj.: arthritis of wrists and II-V metacarpophalangeal and proximal interphalangeal joints of both hands, and both feet metatarsophalangeals.
Lab tests- light anaemia, ESR 35 mm/h., rheumatoid factor 164 U/ml. Roentgenogram: erosions in all mentioned joints, wrists ankylosis.
->ma nig
The diagnosis, best describing patient's condition, is: