SPEX Exam Musculoskeletal and Orthopedics

Question 1

A 28-year-old man presents 4 hours after a forearm fracture with severe pain out of proportion to the injury, paresthesias in the hand, and a tense compartment on palpation.
The most appropriate immediate management is:

Accepted Answer

Emergency fasciotomy

Answer

Elevation of the extremity and ice application

Answer

Urgent MRI of the forearm

Answer

IV morphine and reassessment in 2 hours

Question 2

A 55-year-old woman with type 2 diabetes reports a 3-month history of bilateral hand numbness that is worse at night and relieved by shaking the hands. Physical examination reveals decreased sensation over the palmar aspect of the first three fingers. The most likely diagnosis is:

Accepted Answer

Carpal tunnel syndrome

Answer

Cubital tunnel syndrome

Answer

Cervical radiculopathy at C6

Answer

Raynaud phenomenon

Question 3

A 70-year-old woman with no prior fractures has a DEXA T-score of −2.7 at the femoral neck. She has no secondary causes of bone loss and no history of fracture. Which intervention is MOST appropriate?

Accepted Answer

Initiate bisphosphonate therapy plus calcium and vitamin D

Answer

Calcium and vitamin D supplementation alone

Answer

Teriparatide (PTH analogue) as first-line therapy

Answer

Repeat DEXA in 2 years before deciding on treatment

Question 4

A 35-year-old pitcher develops anterior shoulder pain during the throwing motion. On examination, there is a positive 'empty can' test and weakness with resisted external rotation. Which structure is most likely injured?

Accepted Answer

Supraspinatus tendon

Answer

Long head of the biceps tendon

Answer

Subscapularis tendon

Answer

Glenoid labrum (SLAP tear)

Question 5

A patient with acute low back pain radiating down the left leg to the foot has a positive straight-leg raise at 40°. Imaging shows L4–L5 disc herniation. After 6 weeks of conservative management, which finding would be the STRONGEST indication for urgent surgical referral?

Accepted Answer

New onset saddle anesthesia and urinary retention

Answer

Persistent pain VAS 6/10 despite NSAIDs

Answer

Absence of improvement in walking distance

Answer

Positive Lasègue sign bilaterally

Question 6

According to the Ottawa Ankle Rules, plain radiographs of the ankle are indicated when the patient has:

Accepted Answer

Pain in the malleolar zone AND inability to bear weight for four steps both immediately and in the ED

Answer

Significant swelling and bruising around the lateral malleolus regardless of weight-bearing ability

Answer

Tenderness anywhere along the fibula above the lateral malleolus

Answer

Pain onset during sports activity rather than a fall