PANRE Orthopedics 5 — Questions and Answers
Question 1: A 30-year-old male presents with a 'dinner fork' deformity of the wrist after a fall on an outstretched hand. X-ray confirms a Colles fracture. What is the hallmark of this fracture?
- Volar angulation of the distal radius
- Dorsal angulation of the distal radius with radial shortening (Correct answer)
- Ulnar styloid avulsion only
- Intra-articular fracture of the radiocarpal joint
Correct answer: Dorsal angulation of the distal radius with radial shortening
Colles fracture is a distal radius fracture with dorsal angulation and radial shortening, classically causing the 'dinner fork' deformity.
Question 2: Which special test is used to evaluate for rotator cuff impingement?
- Speed test
- Neer impingement sign (Correct answer)
- O'Brien active compression test
- Sulcus sign
Correct answer: Neer impingement sign
The Neer impingement sign is performed by passively forward-flexing the arm with the forearm pronated; pain indicates subacromial impingement.
Question 3: A 65-year-old male with a known history of gout is found to have chalky white deposits over his Achilles tendon and ear helices. What are these deposits called?
- Heberden nodes
- Bouchard nodes
- Tophi (Correct answer)
- Rheumatoid nodules
Correct answer: Tophi
Tophi are deposits of monosodium urate crystals that form in chronic tophaceous gout, commonly at pressure points and cooler areas like the ear helix.
Question 4: A 5-year-old boy presents with a limp and hip pain. X-ray shows flattening and increased density of the femoral head. What is the diagnosis?
- Slipped capital femoral epiphysis
- Legg-Calvé-Perthes disease (Correct answer)
- Developmental dysplasia of the hip
- Septic arthritis
Correct answer: Legg-Calvé-Perthes disease
Legg-Calvé-Perthes disease is avascular necrosis of the femoral head in children aged 4–10, appearing as a flattened, sclerotic femoral head on X-ray.
Question 5: A patient sustains a proximal humerus fracture. Which nerve is at greatest risk of injury?
- Radial nerve
- Musculocutaneous nerve
- Axillary nerve (Correct answer)
- Median nerve
Correct answer: Axillary nerve
The axillary nerve passes inferior to the glenohumeral joint and around the surgical neck of the humerus, making it vulnerable in proximal humerus fractures.
Question 6: Which of the following is the most appropriate diagnostic test for suspected osteomyelitis when X-rays are negative?
- CT scan of the affected area
- MRI of the affected area (Correct answer)
- Bone scintigraphy only
- Ultrasound of the affected area
Correct answer: MRI of the affected area
MRI is the most sensitive and specific imaging modality for diagnosing osteomyelitis, capable of detecting early infection before changes are visible on plain radiographs.
Question 7: A PA who evaluates a construction worker with acute low back pain finds no neurological deficits and no red flags. What is the most appropriate initial management?
- Immediate MRI of the lumbar spine
- Bed rest for 2 weeks
- NSAIDs, activity modification, and follow-up in 4–6 weeks (Correct answer)
- Refer immediately to orthopedic surgery
Correct answer: NSAIDs, activity modification, and follow-up in 4–6 weeks
Acute low back pain without red flags or neurologic deficits is managed conservatively with NSAIDs, staying active as tolerated, and reassessment at 4–6 weeks.
PANRE Orthopedics 5
A 30-year-old male presents with a 'dinner fork' deformity of the wrist after a fall on an outstretched hand.
X-ray confirms a Colles fracture.
What is the hallmark of this fracture?