PANCE Orthopedics Practice EXAM
LATEST VERSION QUESTIONS AND
VERIFIED CORRECT ANSWERS
A 66-year-old male presents to his primary care physician complaining of increasing
discharge from an ulcer on the plantar aspect of his right great toe. He has a long
history of poorly controlled diabetes with complications including chronic renal failure
and bilateral peripheral neuropathy to the mid-calf. He denies any pain or fevers/chills.
Examination confirms warmth and erythema of the area surrounding the ulcer. A probe
can be passed into the ulcer; however, it is not readily apparent if bone can be
contacted with the probe. Laboratory evaluation is significant for a WBC count of 17k/uL
and an ESR of 116 mm/h. Which of the following would be the most accurate diagnostic
test for this patient's condition?
A) Three-phase bone scan of the foot
B) Ultrasound of the great toe
C) AP and lateral radiographs of the foot
D) MRI of the foot
E) CT scan of the foot - Answer--D) MRI of the foot
This patient is suffering from osteomyelitis secondary to a diabetic foot infection. MRI is
the most accurate diagnostic imaging test for osteomyelitis.
A 31-year-old male presents with sudden onset of pain and swelling in his right ankle.
On physical exam, you appreciate a warm, swollen, and erythematous ankle. The joint
was aspirated, and the synovial fluid shows 55,000 WBCs, 80% polymorphonuclear
,leukocytes, low glucose levels, and no crystals. Cultures are pending at the time. Which
of the following is the most likely diagnosis based on the information above?
A. Osteoarthritis
B. Septic arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Gouty arthritis - Answer--B. Septic arthritis
Septic arthritis is an infection of the joint space due to bacteria. It can occur at any age,
although the incidence is higher in elderly and very young people. Etiologies include
Staphylococcus aureus, Streptococcus spp., N. gonorrhoeae (in young, sexually active
adults). Septic arthritis either happens due to hematogenous spread or direct
inoculation by microorganisms s/t trauma or iatrogenesis (e.g., joint surgery). Clinical
features include joint pain/swelling, warmth, and decreased ROM. The gold standard for
diagnosis is synovial fluid analysis (Although make sure to note WBC count alone is
insufficient to rule in or out septic arthritis). Patients should be given IV antibiotics
(4-6-week course).
What do you think she has and what are you worried about? - Answer--Anterior
Shoulder Dislocation
Axillary Nerve Injury
An 35-year-old man is brought into the emergency room by his wife. She found him
having a seizure on the floor and brought him in as he was complaining about left
shoulder pain and an inability to move his arm. On exam, his left arm is adducted and
internally rotated. On imaging, the humerus shows a "Light Bulb Sign."
What is the diagnosis? - Answer--Posterior shoulder dislocation
Name 3 complications of an anterior shoulder dislocation. - Answer--1. Hill Sachs
Lesion
2. Bankart Lesion
3. Axillary Nerve Injury
A 7-year-old girl who fell from a jungle gym and lands on her outstretched left hand. She
develops immediate-onset left elbow pain and swelling. On exam, her arm is held in 30
degrees of extension and she is unable to move her elbow due to pain. A radiographic
imaging shows an anterior fat pad sign and a disrupted anterior humeral line.
, What is the diagnosis? - Answer--Supracondylar Fracture
An otherwise healthy 30-year-old woman states that she sustained a left forearm injury
as a result of a fall. Initial examination in the emergency room reveals a clean
2-centimeter laceration over the volar forearm, pain and swelling of the affected arm
along with decreased active and passive range of motion. Radial and ulnar pulses are
intact. X-rays show an isolated transverse fracture of the mid-diaphysis of the ulna.
What should you be worried about in this patient? - Answer--Violence because its a
nightstick fracture
A 13 year old boy comes in with pain and edema over the 5th metacarpal. He states his
sister threw a basketball at him and he punched it. X-ray shows a fracture of the 5th
metacarpal with significant angulation.
What is the name of this fracture?
What type of split would you use to immobilize it? - Answer--Boxer's Fracture
Ulnar Gutter
A 15-year old with fall to an outstretched hand now presents with acute onset of wrist
swelling. On imaging, there is a distal radial fracture with the distal segment protruding
upward (dorsal angulation).
What type of fracture is this? - Answer--Colles Fracture
A 15-year old with fall to an outstretched hand now presents with acute onset of wrist
swelling. On imaging, there is a distal radial fracture with the distal segment protruding
downward (volar angulation).
What type of fracture is this? - Answer--Smith's Fracture
A fracture of the distal radius due to a fall on your hand, common in children that can
occur on one side and not completely break through is known as? -
Answer--Torus/Buckle Fracture
A 10-year-old boy who arrives at your ED complaining of severe right elbow and
forearm pain after sustaining a blunt injury to his right arm. On examination, the affected
arm is swollen and tender around his elbow. Radiographs demonstrate a displaced
fracture of the proximal ulnar diaphysis and radial head dislocation.
What is the diagnosis?
LATEST VERSION QUESTIONS AND
VERIFIED CORRECT ANSWERS
A 66-year-old male presents to his primary care physician complaining of increasing
discharge from an ulcer on the plantar aspect of his right great toe. He has a long
history of poorly controlled diabetes with complications including chronic renal failure
and bilateral peripheral neuropathy to the mid-calf. He denies any pain or fevers/chills.
Examination confirms warmth and erythema of the area surrounding the ulcer. A probe
can be passed into the ulcer; however, it is not readily apparent if bone can be
contacted with the probe. Laboratory evaluation is significant for a WBC count of 17k/uL
and an ESR of 116 mm/h. Which of the following would be the most accurate diagnostic
test for this patient's condition?
A) Three-phase bone scan of the foot
B) Ultrasound of the great toe
C) AP and lateral radiographs of the foot
D) MRI of the foot
E) CT scan of the foot - Answer--D) MRI of the foot
This patient is suffering from osteomyelitis secondary to a diabetic foot infection. MRI is
the most accurate diagnostic imaging test for osteomyelitis.
A 31-year-old male presents with sudden onset of pain and swelling in his right ankle.
On physical exam, you appreciate a warm, swollen, and erythematous ankle. The joint
was aspirated, and the synovial fluid shows 55,000 WBCs, 80% polymorphonuclear
,leukocytes, low glucose levels, and no crystals. Cultures are pending at the time. Which
of the following is the most likely diagnosis based on the information above?
A. Osteoarthritis
B. Septic arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Gouty arthritis - Answer--B. Septic arthritis
Septic arthritis is an infection of the joint space due to bacteria. It can occur at any age,
although the incidence is higher in elderly and very young people. Etiologies include
Staphylococcus aureus, Streptococcus spp., N. gonorrhoeae (in young, sexually active
adults). Septic arthritis either happens due to hematogenous spread or direct
inoculation by microorganisms s/t trauma or iatrogenesis (e.g., joint surgery). Clinical
features include joint pain/swelling, warmth, and decreased ROM. The gold standard for
diagnosis is synovial fluid analysis (Although make sure to note WBC count alone is
insufficient to rule in or out septic arthritis). Patients should be given IV antibiotics
(4-6-week course).
What do you think she has and what are you worried about? - Answer--Anterior
Shoulder Dislocation
Axillary Nerve Injury
An 35-year-old man is brought into the emergency room by his wife. She found him
having a seizure on the floor and brought him in as he was complaining about left
shoulder pain and an inability to move his arm. On exam, his left arm is adducted and
internally rotated. On imaging, the humerus shows a "Light Bulb Sign."
What is the diagnosis? - Answer--Posterior shoulder dislocation
Name 3 complications of an anterior shoulder dislocation. - Answer--1. Hill Sachs
Lesion
2. Bankart Lesion
3. Axillary Nerve Injury
A 7-year-old girl who fell from a jungle gym and lands on her outstretched left hand. She
develops immediate-onset left elbow pain and swelling. On exam, her arm is held in 30
degrees of extension and she is unable to move her elbow due to pain. A radiographic
imaging shows an anterior fat pad sign and a disrupted anterior humeral line.
, What is the diagnosis? - Answer--Supracondylar Fracture
An otherwise healthy 30-year-old woman states that she sustained a left forearm injury
as a result of a fall. Initial examination in the emergency room reveals a clean
2-centimeter laceration over the volar forearm, pain and swelling of the affected arm
along with decreased active and passive range of motion. Radial and ulnar pulses are
intact. X-rays show an isolated transverse fracture of the mid-diaphysis of the ulna.
What should you be worried about in this patient? - Answer--Violence because its a
nightstick fracture
A 13 year old boy comes in with pain and edema over the 5th metacarpal. He states his
sister threw a basketball at him and he punched it. X-ray shows a fracture of the 5th
metacarpal with significant angulation.
What is the name of this fracture?
What type of split would you use to immobilize it? - Answer--Boxer's Fracture
Ulnar Gutter
A 15-year old with fall to an outstretched hand now presents with acute onset of wrist
swelling. On imaging, there is a distal radial fracture with the distal segment protruding
upward (dorsal angulation).
What type of fracture is this? - Answer--Colles Fracture
A 15-year old with fall to an outstretched hand now presents with acute onset of wrist
swelling. On imaging, there is a distal radial fracture with the distal segment protruding
downward (volar angulation).
What type of fracture is this? - Answer--Smith's Fracture
A fracture of the distal radius due to a fall on your hand, common in children that can
occur on one side and not completely break through is known as? -
Answer--Torus/Buckle Fracture
A 10-year-old boy who arrives at your ED complaining of severe right elbow and
forearm pain after sustaining a blunt injury to his right arm. On examination, the affected
arm is swollen and tender around his elbow. Radiographs demonstrate a displaced
fracture of the proximal ulnar diaphysis and radial head dislocation.
What is the diagnosis?
