Whilst hospitalized after a hip replacement, a patient with acute intermittent porphyria has a seizure thought to be due to alcohol withdrawal. Patient requires large amounts of analgesia. Six days post-operatively, she suffers a porphyric attack. Which of the following drugs is most likely responsible?

A 20 year old man falls onto his outstretched left hand. On examination, there is pain on deep palpation at the base of the thumb.
Which one of the following bones is most likely fractured?

A 25 year old man comes to the emergency department because of pain, swelling and erythema over the metacarpophalangeal joint of the right long finger. Three days ago he struck an opponent in the mouth during an altercation. On physical examination there is an abrasion over the dorsal surface of the joint, pain on passive motion of the finger, and tenderness along the volar aspect of the finger and metacarpal. His temperature is 38.5°C (101.3°F). X-ray films are normal. Which of the following is the most appropriate management?

A 26 year old male comes to your office complaining of pain in the right wrist since falling 2 weeks ago. On examination he is tender in the anatomic snuffbox. A fracture of the proximal one-third of the scaphoid is visualized on the radiograph. Which one of the following is the most appropriate management at this time?

A 12 year old boy is brought to your office after sustaining a fall on an outstretched hand. Radiographs show a nondisplaced fracture of the middle third of the clavicle. Appropriate management would include which one of the following?

A.72 year old white female is scheduled to undergo a total knee replacement for symptomatic osteoarthritis. She is otherwise healthy, with no history of vascular disease. Which one of the following is most appropriate for prophylaxis against deep vein thrombosis?

A 14 year old boy fractures his leg during a football match. After a few days in a cast he develops pain on passive extension. What is the most likely cause?

A 26 year old man has a week´s history of knee pain. He says he jogs 3 miles a day and that the pain in his knee worsens during his run. His gait appears to be normal on physical examination. Examination of the right knee reveals tenderness and fullness over the medial collateral ligament. On physical examination there is most likely to be

A 19 year old motorcyclist presents in the emergency department following an accident. Radiographic investigation reveals a compound tibia and fibula fracture of the right leg and on examination the right leg has no pulses. Your immediate treatment should be

A 26 year old player severely fractures his ankle during a game of football and subsequently requires ORIF treatment. Indications for ORIF treatment of an ankle fracture include all of the following, except

Which one of the following is consistent with spinal stenosis but not herniated vertebral disk?

Which one of the following is the most serious complication of a slipped capital femoral epiphysis is

Two hours after application of the plaster cast for supracondylar fracture, a patient comes back to emergency room with a complaint of severe pain in the hand. On examination it is revealed that fingers are swollen and cyanosed. Which one of the following is the best management?

A 22 year man who is a competitive runner has pain when walking. The pain has increased recently and is noted in his 2nd and 3rd metatarsal bone of his forefoot. What is the most likely diagnosis?

A 23 year hockey player gets hit on his face with a puck traveling at high speed. He presents with facial pain, diplopia and malocclusion of his teeth. Which of the following fractures is most likely to have occurred?

A woman aged 38 presents with pain on the lateral aspect of her elbow. Her pain is reproduced by extending the wrist against resistance with the elbow extended. The most likely diagnosis is?

A woman aged 52, who wears high-heeled, pointed shoes, complains of pain in the forefoot after prolonged standing or walking. Occasionally, she also experiences numbness, tingling and burning sensation in the area. A very tender spot in the third interspace, between the third and fourth toes is present. There is no redness or signs of inflammation. What is your likely diagnosis?

An older, overweight man complains of disabling, sharp heel pain every time his foot strikes the ground. The pain is worse in the mornings. A bony spur is found matching the location of his pain, and exquisite tenderness is present to direct palpation right over that heel spur. Furthermore, when the ankle is dorsiflexed, the entire inner border of the fascia is tender to palpation. Which of the following is the most likely diagnosis?

A football player of age 25 years sustains a finger injury during practice. According to him his finger got caught in another team member´s jersey. His right ring finger is tender on the volar surface, and is swollen around the distal interphalangeal joint. He is unable to flex at the distal interphalangeal joint. No bone abnormality is found on radiograph. You would now

The incidence of osteonecrosis of femoral head is high in

A 72 year old white female with osteoporosis comes for a follow-up a few days after an emergency department visit for an acute T12 vertebral compression fracture. The emergency department physician prescribed oxycodone (OxyContin) and NSAIDs, but considerable discomfort is still present. In addition to increasing the dosage of oxycodone, which one of the following intervention would you suggest to decrease the pain?

The most serious complication of supracondylar fracture of the humerus is?

A 26 year old man suffers a severe car accident. Following accident the man was found to have an unstable knee joint. On examination under anesthesia, it is possible to pull the tibia forward excessively on the femur. The structure most likely injured in this patient is which one of the following?

What is the most serious complication of a displaced supracondylar fracture of the humerus?

Which one of the following is false regarding knee injuries?

An 81 year old male falls while walking down stairs. He is brought to the emergency department with a 3 part intertrochanteric hip fracture. You choose to perform which of the following procedure?

A 17 year old girl fell while roller-blading on her outstretched right hand. She is brought to the emergency department. X-rays confirmed the diagnosis of a closed Colles fracture. Which of the following is the proper reduction technique for this fracture?

Out of following, which is true regarding mandibular fractures?

False statement with regard to falls in the elderly is

A 33 year old female marathon runner complains of persistent pain and tenderness over the pubic symphysis. With exercise, pain is noted in the lower abdomen and medial thighs. Pain is not associated with fever. Widening of pubic symphysis is seen on a radiograph. Which of the following is most likely diagnosis?

A 90 year old man has a history of painless ulcer on the dorsum of the proximal interphalangeal joint of the second toe for 6 months. Examination shows a hallus valgus and a rigid hammer toe of the second digit. Mild to moderate atrophic skin changes are present on his foot and the dorsal and posterior tibial pulses are absent. Which of the following is appropriate treatment?

An elderly woman with osteoporosis falls on her outstretched hand. She presents with a deformed and painful wrist that looks like a dinner fork. Radiograph show a dorsally displaced, dorsally angulated fracture of the distal radius. Associated fracture of the ulnar styloid is also present. A neurologic examination is normal. The most appropriate management is which of the following?

All of the following are indications for repair of an orbital blow-out fractures, except

A 42 year old athlete complains of gradually worsening pain on the lateral aspect of his foot. He runs on asphalt, and has increased his mileage from 2 miles/day to 5 miles/day over the last 2 weeks. Palpation causes pain over the lateral 5th metatarsal. The pain is also developed when he jumps on the affected leg. When asking about his shoes he tells you that he brought them several years ago. The most likely diagnosis is

A 20 year old girl presents to the emergency department with a history persistent with a lateral ankle sprain that occurred 2 hours ago while she was playing softball. She has pain over the distal anterior talofibular ligament, but is able to bear weight. Mild swelling is present; mild black and blue discoloration and moderate tenderness to palpitation over the insertion of the anterior talofibular ligament, but the malleoli are nontender to palpitation. Which is true regarding the management of this case?

The highest risk for postoperative deep venous thrombosis is present in which one of the following procedures?

A boy of age 21 year presents to you after a fall on an outstretched hand while skateboarding. He has pain at the anatomic snuffbox with no abrasion. No finding is revealed on radiographs. The most appropriate management is

An 18 year old female athlete has a history of constant groin pain for 1 week. There is limited hip motion on flexion and internal rotation of the right hip. Radiographs of the hip and pelvis are normal. The most likely diagnosis is

A 69-year-old woman has recently been operated on for a left hip replacement. All of the following are appropriate prophylaxis for deep-vein thrombosis EXCEPT

A 17-year-old male injures his foot by stepping on a nail that penetrates the sole of his tennis shoe and pierces the arch of his foot. He is given a tetanus shot and erythromycin. He presents again a week later with more pain, and radiography reveals a lytic lesion of the second metatarsal consistent with osteomyelitis. The likeliest responsible organism is

A girl aged 17 year is brought to emergency room by her parents for severe right foot pain. The patient states that the pain started 1 day prior to presentation. She cannot recall any recent trauma, and denies any past medical or surgical problem. She is active and walks at least 1 hour daily in the nearby forest. She goes to high school and is doing very well. She gets along well with her parents except that they insist she should eat more as her weight has dropped from 130 to 105 pounds over the past year. The most likely diagnosis is

Which one of the following is the most common bacterial cause of osteomyelitis?

A 25-year-old white male presents with asymmetric arthritis of the left knee. X-ray reveals joint disease in the sacroiliac joints. Blood cultures for gonococci are negative. A diagnosis of Reiter´s syndrome is made. Which one of the following is LEAST likely to be associated with this condition?

Osteoarthritis of the shoulders is most commonly found in

A Colles´ fracture involves the

A 41-year-old male who is status post-nephrectomy for renal clear cell carcinoma presents with a metastatic lesion to his tibia that requires surgical stabilization. Staging work-up does not reveal any other metastatic foci. Prior to surgery which one of the following interventions is most appropriate?

The most important principle in the management of an acute compartment syndrome of the tibia is

Which one of the following is NOT true of osteomyelitis?

A 25 year old patient is brought after an automobile accident in which he suffered a posterior knee dislocation. The dislocation has been reduced and post-reduction X-rays show a good reduction and no fractures. The patient has a normal pulse and normal neurovascular exam. He is otherwise stable and no other injuries are present. Which of the following diagnostic studies should be ordered urgently?

What is the initial management of a neurologically intact patient, seen in the emergency room with a fracture of the cervical spine?

A 16 year old boy has persistent pain in the right distal femur. The pain is not relieved by aspirin or other nonsteroidal inflammatory drugs. Radiologic studies demonstrate a mass that expands the distal femur and infiltrates the surrounding soft tissue. A biopsy is taken which shows a tumor composed of anaplastic cells and osteoid matrix. The limb must be amputated. The most appropriate diagnosis is

A 62 year old woman undergoes bilateral hip replacement with removal of the proximal portions of both femurs for severe osteoarthritis. A bone sample is taken from the distal end of one of the removed specimens shows the changes of osteoarthritis and also the changes illustrated in the image. The changes present in the image are most suggestive of?

A 52 year old female is brought to the emergency department after slipping and falling in her bathroom. She denies any weight loss but admits to weakness and constipation. Radiographs reveal a femoral neck fracture and also multiple sharply demarcated lytic bone lesions throughout her bones, including the skull. Biopsy of one of the lesions is performed and shown below. Based on the history and biopsy finding, further evaluation would most likely show

A 44 year old man presents because of chronic fatigue. According to him he has stopped exercising, and feels tired after mild activity. A complete blood count reveals a hematocrit of 31, a white count of 1,950, and a platelet count of 90.000. The radiographic finding that would most likely lead to the correct diagnosis is?

A 21 year old man develops a swollen and painful upper arm after a fall on basketball court. Over the next several weeks, the involved area becomes more circumscribed and firm and then later evolves to a painless, hard, well-demarcated mass. X-ray of the arm at this point would most likely show which of the following?

A golfer accidentally hits the ground very hard, making a divot. His hand begins to hurt immediately, and he is taken to an emergency department. On physical examination marked tenderness of the palm near the little finger is found. Flexion of the little finger against resistance elicits pain at the same site. Which of the following is the most likely diagnosis?

A 72 year old man puts some 8-ounce cans of vegetables on a shelf in his kitchen and develops the acute onset of severe right upper arm pain. He visits the local emergency room and a radiograph of his humerus shows a non displaced fracture. The most likely etiology for this lesion is:

Which of the following is the recommendation for patients that have undergone total hip replacement who plan to undergo dental procedures?

A 66 year old woman slipped and fell on the ice. She was brought to the emergency department and X-rays were taken. She has no past medical history except osteoporosis. The fracture that her physician would most likely find is

Surgical emergency secondary to the increased risk of infection with delayed surgery occurs in which of the following?

Surgical urgency secondary to the increased risk of fat embolus with delayed surgery occurs in

With delayed surgery high rate of neurovascular injury occurs in

Which one of the following is the best and safest current medical management of osteoarthritis?

A 34 year old man sustained a work related injury to his left hand. He subsequently develops pain, swelling, loss of skin in the affected part. Radiography reveals osteoporosis of the hand. Which of the following is the most likely diagnosis?

A 66 year old woman presents to the emergency room with a pathologic fracture of the shaft of her humerus. Radiographic studies demonstrate multiple lytic and blastic bone lesions. Biopsy of one of these lesions shows adenocarcinoma. The most likely source of the primary tumor is which one of the following?

A 70 year old male develops the insidious onset of pain in his pelvis. A random serum alkaline phosphatase level is found to be elevated. Correct diagnosis can be provided by which of the following?

A 6 year old girl is brought to the emergency room with a displaced distal radius fracture. Radial pulse is weak and the hand is cyanotic. Median nerve sensation is diminished. What should be the initial treatment?

A 77 year old man has chronic osteoarthritis of the left knee. The orthopedic surgeon recommends total knee replacement. What treatment should be started after surgery to prevent the most common complication?

A 19 year old boy with a history of sickle cell disease falls and impacts a sharp stick deep into his upper arm, just above the elbow. He pulls the stick out and does not seek medical attention at that time. His arm heals but his leg starts to become sore over the next two months. He feels relatively ill and has fever. An X-ray film of his symptomatic leg is shown below. The most likely diagnosis is

A 34 year old man sustains a compound femoral fracture after falling from ladder. He is recovering well after surgery until the third post operative day, when he develops acute shortness of breath. The best treatment for him is

A 64 year old female decides to begin a rigorous exercise program, which includes long walks. She walks four miles on city streets on the first day. Next morning she awakens with sharp pain in the lateral aspect of the sole of her foot. The most likely cause of this discomfort is

A 21 year old boy fractures his femoral head and several ribs and requires open reduction and internal fixation of his hip fracture and strapping of his chest wall. One week later he develops acute onset of palpitations. His ECG upon arrival to hospital is most likely to show

A 24 year old male fractures his femur in a skiing accident and is casted for six weeks. He is able to walk with little pain after removal of the cast. His radiograph is likely to show which one of the following?

Management of an open fracture should consist of which one of the following in addition to fracture reduction, fixation, and/or immobilization?

A 33 year old woman underwent open arthrotomy to repair a torn anterior cruciate ligament in her right knee. She develops a painful nodule in the incision after a few months. Which of the following is represented by this nodule?

A 73 year old female vacuums her floors. She notices severe mid thoracic pain the next morning that radiates around to her anterior chest. The chest X-ray is likely to show which one of the following as the cause of her pain?

Which one of the following is NOT a surgical emergency?

An 81 year old woman with severe osteoarthritis undergoes a left total knee replacement and subsequent physical therapy at home. Four weeks later she presents with fever and left leg pain. The most common complication postoperatively after total knee arthroplasty is

A 70 year old male has vertigo, tinnitus, and musculoskeletal pain. His ALP level was elevated to 1,000 mg/dl. Examination showed severe enlargement of the base of the skull and deformities of the long bones and clavicle. Which one of the following is NOT a feature of this disease?

Which one of the following statement is FALSE regarding falls in the elderly?

A 60 year old female slips on the ice and sustains a left femur fracture. What is the most likely etiology of this?

A 63 year old man noticed that he cannot wear his hats properly because they no longer fit. Examination is remarkable for abnormal vertebral studies of L1-L4 with increased density in L2 and L3. Which of the following would be most likely to account for these changes?

A 75 year old diabetic woman undergoes a left total knee replacement for severe osteoarthritis. She takes daily NPH insulin and has good control over blood glucose. She also takes oxycodone for pain relief. She is planning on getting involved in a physical therapy rehabilitation program at the local hospital. On review of her medications, which one is most acutely indicated at this time?

A 63 year old man presents to the emergency department with a swollen and extremely painful ankle. He had twisted his ankle while running to catch a bus and had fallen on his inverted foot. Examination shows swelling and angulation of the ankle. Anteroposterior (AP), lateral, and mortise X-ray films show displaced fractures of both malleoli. Which one would be the preferred form of treatment?

In the middle of a tennis game a 42 year old male falls to the ground clutching his ankle. He limps off the court with pain and swelling in the back of the lower leg. He presents the next day because of persistent pain, swelling, and limping. He can put weight on that foot with no exacerbation of the pain, but the motion of taking a step is painful. The likely finding on examination would be

A car is involved in an accident. The driver, who is wearing his seat belt, explains that he saw his drunk, unrestrained front seat passenger hit the windshield with his face, and the dashboard with his knees. Passenger´s exam shows multiple facial lacerations and shortened and adducted right lower extremity. Other joint examination is normal. He is neurologically intact and head CT is normal. A potential orthopedic emergency is not obvious but is suspected. Therefore, a radiologic image of which area should likely be ordered?

A 33 year old man is struck by a car going approximately 30mph. In the ED he is awake and talking and in no respiratory distress, but pulse is 110/min and BP is 136/68 mm Hg. Exam shows tenderness of the calf with significant edema and a thready right dorsalis pedis and posterior tibial pulse compared to the left lower extremity. X-rays confirm a tibial fracture. Next step in workup is

A 58 year old type 1 diabetic presents with left foot pain. He reports chronic pain on his left foot for about 6 months. He has poor dietary compliance takes his insulin as prescribed, but does not check his sugar regularly. His BP pressure is 164/88 mm Hg, heart rate is 95/min, and he is afebrile. He has 1+ palpable dorsalis pedis and posterior tibial pulses. On the distal aspect of the dorsum of his left foot, he has a clean 2 x 2 cm area of erythema that is tender but not fluctuant. He has bilateral loss of fine sensations. The most important intervention in his management is

A boy aged 8 years falls on his right hand with the arm extended, and he breaks his elbow by hyper-extension. X-ray shows a supracondylar fracture of the humerus. The fracture is reduced and immobilized. The mother asks if her son is going to be okay and what is “the worst that can happen.” Which complication is of greatest concern with this type of injury?

A 2-year-old boy after he fell in the bathtub has been limping and refusing to bear weight on his right leg. X ray shows a displaced transverse fracture of the femoral shaft without soft tissue changes. The child´s leg is immobilized and stabilized. CBC and coagulation studies are normal.

Which of the following is the most appropriate initial step in management?

A 44 year old woman, who wears high-heeled, pointed shoes, has pain in the forefoot after prolonged standing or walking. She sometimes experiences numbness, a burning sensation, and tingling in the area. Exam shows a very tender spot in the third interspaced, between the third and fourth toes. There is no limitation of motion or signs of inflammation. The most likely diagnosis is

A 30 year old footballer is referred for chronic knee pain. He has played football for over 10 years and cannot recall a time when his left knee did not hurt. The pain is significantly worse after extreme exertion. On exam, he has tenderness to palpation of the medial joint line and a trace effusion, but no limited range of motion or motor deficits. X-ray shows minimally narrowed joint space. MRI reveals a small tear in the medial meniscus but integrally of the all of the knee ligaments. The next appropriate step in the management is

A 28 year old man presents with persistent right leg pain. He has “achy” pain at the hip radiating down his femur to the knee. It is worse on exertion but is also present at rest. It is usually relieved with NSAIDs. Medical history is significant for Crohn´s disease. His last flare-up was successfully managed with 2 weeks of prednisone orally. Examination is significant for limited range of the right hip, specifically with external rotation. X-ray shows a dulling of the femoral head. The next step in the diagnosis is

A 63 year old hypertensive is brought after a fall. He also has dyslipidemia, and migraines. X-ray confirms a femoral fracture that is corrected by open reduction and internal fixation are performed. For several post-op days he has limited range of motion, resulting in the need for bed rest and heavy narcotic use. What one is the appropriate for prevention of a DVT in him?

A 66 year old woman falls on her hand while getting off the chair. She presents with a deformed and painful wrist. Neurologic examination is normal. X-ray shows a dorsally displaced, dorsally angulated fracture of the distal radius and the ulna styloid. Which one is the most appropriate management?

A 28 year old man has pain and swelling in his right arm over the past 2 months that is worse when he raises his arm. Past history is unremarkable. He took up heavy weight lifting 1 year ago, and he uses several supplements for weight gain and muscle building. Exam shows a well built vitally stable male. Some pitting edema is noted in his right arm. He is instructed to raise his arm above his head. After 1 minute, the swelling increases markedly in his right arm. The most likely the source of his symptoms is

A 71 year old male is brought to the ED after a fall. He has coronary artery disease, chronic kidney disease, and osteoarthritis. On exam he has severe right hip tenderness, worse on abduction and external rotation, with significant soft tissue edema and ecchymosed, but no open wounds. The next step in his management is

According to the mother of 12 year old boy for the last 12 to 18 months he comes home and refused to exert himself in anyway because his knees hurt from physical education class at school. No motor or sensory deficits are noted in the lower limbs. Range of motion at all joints is normal; however, upon flexion of the knee joints he complains of pain in his proximal shin, and the knee joints are tender to palpation. Appropriate management is

A 13 year old boy injures his right shoulder and arm after a fall. In the ED he is noted to have extensive abrasions and ecchymoses over the lateral aspect of his right upper arm and shoulder, exquisite tenderness, and range of motion limited by pain. He does not complain of any distal parenthesis. Radial pulse is noted to be 2+. Radiographs reveal a distal humerus fracture. The orthopedic team reduces the fracture and casts the arm. While waiting for a repeat X-ray, he complains of numbness in his thumb, and he is found to be unable to extend his wrist. His radial pulse is still 2+. The next step in the management is

A 59 year old policeman has intense, disabling, sharp heel pain every time his foot strikes the ground. It is worse in the mornings, preventing him from putting any weight on the heel. His BMI is 30 kg/m2. He shows exquisite tenderness to direct palpation over the anteromedial aspect of the heel. The pain is exacerbated when the toes are dorsiflexed. X-ray looks normal. The most likely diagnosis is

An 11 year old boy is brought by his mother because he is not much physically active. He does not enjoy sports and is minimally active at physical education class in school. He admits that he is not active because the other children make fun of how he runs. On exam he is slim and noted to have bulkier gastrocnemius and soleus muscles on the left lower extremity and slightly limited abduction at the right hip. His gait evaluation reveals a persistently externally rotated femur. The most likely diagnosis is

A 36 year old man falls on his hand and presents with wrist pain. He was not able to break the fall, and that the heel of his hand took the brunt of his full weight as it hit the pavement. On exam he is distinctly tender to palpation over the anatomic snuff box. Anteroposterior and lateral X-rays are negative. The most likely diagnosis and most appropriate next step in management include

A 54 year old woman falls and hurts her right shoulder. She presents to the ED with her arm held close to her body, but the forearm rotated outward as if she were going to shake hands. She is in pain and will not move the arm from that position. Her shoulder looks “square” in comparison with the rounded unhurt opposite side, and there is numbness in a small area of her shoulder over the deltoid muscle. The most likely diagnosis is

A 26 year old football player is brought to the ED after being rigorously tackled from behind during a game and is in severe left knee pain. On examination the left knee looks swollen and the leg can be pulled inferiorly with the knee flexed at 90 degrees. A similar finding can be elicited with the knee flexed at 20 other. Which one is the most appropriate management for this patient´s condition?

A 33 year old female notices pain in her right shoulder following a seizure and she cannot move it. She presents to a clinic, where she has a limited examination and negative AP X-rays of her shoulder. She is diagnosed as having a sprain and given pain medication. Next day, she still has the same pain and is unable to move her arm. She comes holding her arm close to the body, with her hand resting on her anterior chest wall. The likely diagnosis is