Orthopedics

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Mallet Finger

Which one of the following statements regarding the management of mallet finger is false?

  • Radiography should be used to differentiate between soft-tissue and bony mallet fingers.
  • Patients with delayed (> 4 weeks) presentation to care can initially be managed with splinting.
  • After 6 weeks of continuous splinting, splints can be used only at night.
  • Return to sports is typically initiated at 8 weeks.
Volume 41.1 - Question 35

Cervical Fractures in Older Adults

Which one of the following statements about cervical fractures in older adults is false?

  • The most frequent mechanism is fall from a standing position.
  • They carry a lower mortality rate than hip fractures.
  • One-year mortality for cervical fractures without spinal cord injury is greater than 20%.
  • The most common cervical fracture in older adults involves C2.
Volume 41.1 - Question 2

Chronic Axial Spine Pain

In the treatment of chronic non-cancer axial spine pain, epidural injection of local anaesthetic and steroids provides significant relief.

  • True
  • False
Volume 40.5 - Question 20

Acupuncture for Sciatica

When compared to sham acupuncture, acupuncture resulted in less pain in patients with chronic sciatica from herniated disk.

  • True
  • False
Volume 40.4 - Question 23

What's New in Orthopedic Trauma

Which one of the following statements about orthopedic trauma is true?

  • In displaced proximal humeral fractures, complications were lower in the surgical treatment group compared to conservative treatment.
  • For humeral shaft fractures, bracing demonstrated a significantly lower rate of nonunion than open reduction techniques.
  • Ulnar styloid fractures associated with distal radial fractures are typically treated operatively.
  • For hip fractures in elderly patients, skin traction did not impact the VAS pain score or morphine usage at 2 hours prior to the surgical procedure or 24 hours after the surgical procedure.
Volume 40.2 - Question 19

Pediatric Elbow Radiograph Interpretation

Experienced health care practitioners demonstrate high accuracy in diagnosing pediatric elbow fractures on x-ray.

  • True
  • False
Volume 40.2 - Question 18

Placebo Injections for Back Pain

A single nondeceptive placebo injection for chronic back pain reduces pain intensity more than usual care.

  • True
  • False
Volume 40.1 - Question 24

Knee Joint Injection

Patients should be advised that a steroid flare-up may occur in the first 24 to 48 hours after knee joint injection.

  • True
  • False
Volume 39.6 - Question 27

Treatment of Bone and Joint Infections

For bone and joint infections, switching to oral antibiotics after the first seven days of IV antibiotics is inferior to IV antibiotic treatment for the first six weeks.

  • True
  • False
Volume 35.61 - Question 25

Casting

Children with minimally displaced metaphyseal both-bone forearm fractures should be treated with a below-elbow cast.

  • True
  • False
Volume 37.3 - Question 36

Long Distance Running and Osteoarthritis

Which one of the following statements regarding osteoarthritis and knee/hip pain among long-distance runners is false?

  • A past history of knee injury that prevents running is a strong predictor for arthritis.
  • Older age reduces the odds of having pain.
  • Increasing weekly mileage reduces the odds of having pain.
  • The number of years running increases the risk of arthritis.
Volume 39.3 - Question 2

Rheumatoid Arthritis

Among patients with rheumatoid arthritis in remission taking conventional disease modifying therapy, treatment with half-dose vs stable-dose therapy results in significantly more disease flares.

  • True
  • False
Volume 36.6 - Question 20

Achilles Tendon Rupture

In cases of Achilles tendon rupture, surgical management reduces the risk of rerupture injuries compared to nonsurgical management.

  • True
  • False
Volume 37.6 - Question 29

Lumbar Spinal Stenosis

Which one of the following statements about lumbar spinal stenosis is false?

  • Discomfort from lumbar spinal stenosis is typically exacerbated by standing and walking.
  • Most patients older than 60 years with imaging evidence of lumbar spinal stenosis are asymptomatic.
  • A wide-based gait and positive Romberg sign are associated with a specificity of more than 90%.
  • The spine is generally tender.
Volume 37.6 - Question 28

Treatment of Knee Osteoarthritis

For patients with knee osteoarthritis triamcinolone administered intra–articularly every 3 months, results in greater loss of cartilage volume than saline injections.  

  • True
  • False
Volume 36.5 - Question 19

Lateral Epicondylitis

For lateral epicondilytis, no treatment has been shown to be better than placebo in the intermediate or long term. 

  • True
  • False
Volume 36.4 - Question 18

Identification of Child Abuse

Children aged less than three years presenting with rib fractures require specific evaluation for child abuse. 

  • True
  • False
Volume 36.4 - Question 4

Pediatric Fractures & Ultrasound

Ultrasound has an excellent diagnostic accuracy for non-elbow upper extremity fractures in children:

  • True
  • False
Volume 37.1 - Question 17

PoCUS for Shoulder Dislocation

Which one of the following statements about the utility of Point of Care Ultrasonography (PoCUS) for the diagnosis of shoulder dislocation is false? 

  • The sensitivity of PoCUS for shoulder dislocation nears 100%.   
  • PoCUS can identify both posterior and anterior dislocations.   
  • The sensitivity for detecting dislocation associated fractures nears 100%.   
  • For trained practitioners, the median total time required for diagnosis is < 30 seconds.  
Volume 36.2 - Question 21

Distal Radius Fracture

In patients aged 60 years and older with unstable distal radius fractures, there are no clinically meaningful patient-reported outcome differences 24 months after injury between patients choosing surgical treatment and those opting for closed reduction and casting.

  • True
  • False
Volume 37.4 - Question 18

Viscose Supplementation for Knee Osteoarthritis

Intra-articular hyaluronic acid for knee osteoarthritis results in a small, non-clinically important reduction in pain intensity. 

  • True
  • False
Volume 38.1 - Question 20

Thumb Carpal Metacarpal Arthritis

Which one of the following statements about thumb carpometacarpal joint arthritis is false? 

  • It is associated with female sex. 
  • The “traction shift” test is highly specific. 
  • Corticosteroid injection improves function with activity. 
  • Trapeziectomy with ligament reconstruction and tendon interposition is a common surgical treatment. 
Volume 38.1 - Question 19

Non Acute ACL Tear Treatment

For patients with non-acute anterior cruciate ligament injury and persistent symptoms of instability, rehabilitation management is as effective as surgical reconstruction.    

  • True
  • False
Volume 38.1 - Question 18

De Quervain Tenosynovitis

Which one of the following statements about de Quervain tenosynovitis is false?

  • It is associated with increased smartphone use in younger populations.
  • Splinting for immobilization should include the wrist and thumb.
  • Combined treatment with corticosteroid injection and immobilization does not improve outcome compared to either alone.
  • The Finkelstein test is highly specific.
Volume 38.2 - Question 18

Degenerative Meniscal Tears

Over a period of five years, for self-reported knee function, exercise-based physical therapy is non-inferior to arthroscopic partial meniscectomy for degenerative meniscal tears.

  • True
  • False
Volume 38.2 - Question 17

Physical Activity for Chronic Pain

In patients with osteoarthritis and/or chronic low back pain, wearable activity trackers increase physical activity in addition to counseling and education.

  • True
  • False
Volume 37.5 - Question 33

Metformin Use and Associated Risk

Metformin use in type 2 diabetes is associated with a lower risk of total knee replacement.

  • True
  • False
Volume 38.4 - Question 18

Osteoporosis Screening

Which one of the following statements about using the Canadian clinical Fracture Risk Assessment Tool (FRAX) to prevent fragility fractures in females aged 65 years or older is false?

  • It reduces BMD testing.
  • It decreases clinician time compared to using BMD testing.
  • Repeat screening should be done at least every 5 years in stable patients.
  • Screening 250 females after age 65 at least once would be expected to prevent 1 hip fracture.
Volume 39.2 - Question 1

Distal Forearm Fractures

In children and adolescents with a distal forearm injury without clinically visible deformity, the use of ultrasonography as the initial diagnostic imaging method is inferior to radiography with regard to the outcome of physical function of the arm at 4 weeks.  

  • True
  • False
Volume 39.1 - Question 12

Physical Activity After Total Knee Arthroplasty

A high physical activity level after total knee arthroplasty does not increase the risk of revision surgery during the first twelve years.

  • True
  • False
Volume 38.6 - Question 26

Intra-articular Lidocaine for Shoulder Reduction

Intra-articular lidocaine may be a safe and effective alternative to intravenous sedation for facilitating reduction of anterior shoulder dislocations in the emergency department.

  • True
  • False
Volume 38.5 - Question 29

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