PC Podiatrist Diagnosis & Treatment Methods 2 — Questions and Answers
Question 1: Which imaging modality is MOST useful for evaluating a suspected stress fracture of the second metatarsal that is negative on plain radiographs?
- CT scan
- MRI (Correct answer)
- Bone scintigraphy
- Ultrasound
Correct answer: MRI
MRI is the gold standard for early stress fracture detection, showing bone marrow edema before cortical changes appear on X-ray.
Question 2: A patient presents with a painful, thickened toenail with yellowish discoloration and subungual debris. KOH preparation confirms fungal elements. Which oral antifungal is first-line for onychomycosis?
- Fluconazole
- Terbinafine (Correct answer)
- Itraconazole
- Griseofulvin
Correct answer: Terbinafine
Terbinafine (Lamisil) is the first-line oral antifungal for dermatophyte onychomycosis due to its superior cure rates and shorter treatment duration.
Question 3: During assessment of a diabetic foot ulcer, which finding indicates a wound probe-to-bone test is positive and suggests osteomyelitis?
- Visible bone or tendon in the wound bed
- Palpation of hard, gritty tissue with a sterile blunt probe (Correct answer)
- Purulent drainage from the wound
- Periwound erythema extending 2 cm
Correct answer: Palpation of hard, gritty tissue with a sterile blunt probe
A positive probe-to-bone test occurs when a sterile blunt metal probe inserted into the ulcer contacts hard, gritty bone, indicating osteomyelitis with high specificity.
Question 4: Which nerve block technique anesthetizes all five toes simultaneously by injecting at the level of the ankle?
- Digital block
- Metatarsal block
- Ankle block (Correct answer)
- Posterior tibial nerve block only
Correct answer: Ankle block
An ankle block targets the five terminal nerves at the ankle (sural, saphenous, superficial peroneal, deep peroneal, posterior tibial), anesthetizing the entire foot.
Question 5: A runner presents with heel pain worst with the first step in the morning that improves after walking. The Windlass test is positive. What is the most likely diagnosis?
- Tarsal tunnel syndrome
- Calcaneal stress fracture
- Plantar fasciitis (Correct answer)
- Baxter's nerve entrapment
Correct answer: Plantar fasciitis
Plantar fasciitis classically presents with post-static dyskinesia (worst first steps), and the Windlass test reproduces pain by dorsiflexing the hallux to tension the plantar fascia.
Question 6: Which surgical procedure involves removing the distal portion of the proximal phalanx and is used to correct a rigid hammertoe deformity?
- Weil osteotomy
- Keller arthroplasty
- DuVries arthroplasty (proximal interphalangeal joint resection) (Correct answer)
- Cotton osteotomy
Correct answer: DuVries arthroplasty (proximal interphalangeal joint resection)
DuVries arthroplasty (PIP resection arthroplasty) removes the head of the proximal phalanx to create a flexible joint and correct rigid hammertoe deformity.
Question 7: When measuring the tibial varum (tibiocalcaneal angle) with the subtalar joint in neutral, a normal finding is approximately:
- 0 degrees
- 3 degrees varus (Correct answer)
- 8 degrees varus
- 15 degrees valgus
Correct answer: 3 degrees varus
Normal tibial varum is approximately 3 degrees of varus, meaning the tibia is slightly bowed inward relative to the weightbearing surface.
PC Podiatrist Diagnosis & Treatment Methods 2
Which imaging modality is MOST useful for evaluating a suspected stress fracture of the second metatarsal that is negative on plain radiographs?