PANRE Orthopedics 4 — Questions and Answers
Question 1: A 60-year-old male presents with progressive low back pain radiating to both legs with walking, relieved by sitting or bending forward. What is the most likely diagnosis?
- Lumbar disc herniation
- Spinal stenosis (Correct answer)
- Piriformis syndrome
- Sacroiliac joint dysfunction
Correct answer: Spinal stenosis
Lumbar spinal stenosis causes neurogenic claudication — bilateral leg pain worsened by extension (standing/walking) and relieved by flexion (sitting/leaning forward).
Question 2: Which of the following fractures requires urgent surgical intervention due to risk of compartment syndrome?
- Clavicle fracture
- Distal radius fracture
- Tibial shaft fracture (Correct answer)
- Fifth metatarsal fracture
Correct answer: Tibial shaft fracture
Tibial shaft fractures have the highest risk of compartment syndrome due to the tight compartments in the leg and the energy required to fracture this bone.
Question 3: A 45-year-old female presents with morning stiffness lasting more than 1 hour, symmetric joint swelling, and a positive rheumatoid factor. Which joint pattern is most characteristic of rheumatoid arthritis?
- DIP joints of the hands
- First MTP joint
- PIP and MCP joints of the hands (Correct answer)
- Lumbar facet joints
Correct answer: PIP and MCP joints of the hands
Rheumatoid arthritis characteristically involves the PIP and MCP joints symmetrically, sparing the DIP joints (which are more typical of osteoarthritis or psoriatic arthritis).
Question 4: A 17-year-old male complains of hip pain and a limp. X-ray shows the femoral head appearing to 'slip' posterior and inferior off the femoral neck. What is the diagnosis?
- Legg-Calvé-Perthes disease
- Developmental dysplasia of the hip
- Slipped capital femoral epiphysis (Correct answer)
- Transient synovitis
Correct answer: Slipped capital femoral epiphysis
Slipped capital femoral epiphysis (SCFE) typically presents in obese adolescent males with hip or knee pain and a limp, requiring urgent surgical pinning.
Question 5: Which of the following is the most appropriate initial treatment for a non-displaced clavicle fracture?
- Open reduction and internal fixation
- Sling immobilization for 4–6 weeks (Correct answer)
- Figure-of-eight brace for 8 weeks
- Closed reduction and casting
Correct answer: Sling immobilization for 4–6 weeks
Non-displaced clavicle fractures are managed non-operatively with a simple sling for 4–6 weeks; figure-of-eight braces offer no advantage and are less comfortable.
Question 6: A 55-year-old male with a history of prostate cancer presents with severe low back pain. Plain radiograph shows mixed lytic and blastic lesions of the lumbar vertebrae. What is the most likely etiology?
- Multiple myeloma
- Metastatic prostate cancer (Correct answer)
- Paget disease
- Primary osteosarcoma
Correct answer: Metastatic prostate cancer
Prostate cancer metastases classically produce mixed lytic and blastic lesions (predominantly blastic) in the axial skeleton.
Question 7: A patient presents 24 hours after an ankle sprain with significant swelling and inability to bear weight. The Ottawa Ankle Rules indicate X-ray is needed when there is tenderness at which location?
- Anterior talofibular ligament
- Posterior edge of the distal 6 cm of the fibula or tibia (Correct answer)
- Anterior ankle joint line
- Peroneal tendons
Correct answer: Posterior edge of the distal 6 cm of the fibula or tibia
Ottawa Ankle Rules require X-ray if there is tenderness over the posterior edge of the distal 6 cm of the fibula or tibia, or at the navicular or base of the fifth metatarsal.
PANRE Orthopedics 4
A 60-year-old male presents with progressive low back pain radiating to both legs with walking, relieved by sitting or bending forward.
What is the most likely diagnosis?