Musculoskeletal (MSK) Medicine 10 Single Best Answer (SBA)
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1. A 65-year-old woman presents with pain and swelling in the mid-upper arm following a fall. Examination reveals tenderness over the midshaft of the humerus and wrist drop. What is the most likely associated nerve injury?
Answer: Radial nerve
Midshaft humerus fractures are classically associated with radial nerve injury, which presents with wrist drop.
2. A 7-year-old boy falls on his outstretched hand and complains of elbow pain. X-ray shows a posterior fat pad sign. What is the most likely diagnosis?
Answer: Supracondylar fracture
In children, a posterior fat pad sign on elbow X-ray commonly indicates a supracondylar fracture.
3. A 3-year-old girl refuses to use her right arm after being swung by her parents. Her arm is held slightly flexed and pronated. What is the most appropriate immediate management?
Answer: Reduction by supination and flexion
Radial head subluxation (“nursemaid’s elbow”) is usually reduced with a quick maneuver of supination and elbow flexion.
4. Which of the following best describes the mechanism of a nightstick fracture of the ulna?
Answer: Direct blow to the ulna, typically while defending oneself
A “nightstick” fracture is an isolated fracture of the ulna from a direct blow to the forearm.
5. A 60-year-old woman falls on an outstretched hand and presents with a “dinner fork” deformity. X-ray shows a distal radius fracture with dorsal angulation. What is the most appropriate initial management?
Answer: Closed reduction and splinting
A Colles’ fracture involves dorsal angulation. Initial management often involves closed reduction under anesthesia and splinting/casting.
6. A 25-year-old man presents with wrist pain after a fall. There is tenderness in the anatomical snuffbox. X-ray appears normal. What is the most appropriate next step?
Answer: Immobilisation in a thumb spica splint
Because scaphoid fractures are prone to avascular necrosis, suspected fractures must be immobilised in a thumb spica even if initial X-rays are normal.
7. What is the most common complication of an untreated Boxer’s fracture?
Answer: Rotational deformity of the 5th finger
Boxer’s fractures involve the neck of the 5th metacarpal. If improperly treated, malunion can cause the 5th finger to rotate and overlap adjacent fingers.
8. A 30-year-old man presents with pain and swelling at the base of his thumb after a fall. X-ray reveals a fracture dislocation at the base of the first metacarpal. What is the most appropriate management?
Answer: Open reduction and internal fixation (ORIF)
A Bennett fracture is an intra-articular fracture dislocation at the base of the first metacarpal. ORIF is typically necessary for stable fixation.
9. A 30-year-old man presents with ankle pain after twisting it during a football match. According to the Ottawa Ankle Rules, which of the following findings would indicate the need for an X-ray?
Answer: Inability to bear weight immediately and in the emergency department
Ottawa Ankle Rules indicate an X-ray if the patient cannot bear weight both right after the injury and in the emergency department, or if there is bone tenderness in specific areas.
10. A 40-year-old man falls on his outstretched hand and complains of elbow pain. According to the Ottawa Elbow Rule, which clinical feature warrants an X-ray?
Answer: Inability to fully extend the elbow
If a patient cannot fully extend the elbow after trauma, the Ottawa Elbow Rule recommends obtaining an X-ray to rule out fracture.
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