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Penn Med Self Study Questions

Arthritis


Osteoporosis and metabolic bone disease

  • Heaney wrote, "Although bone mass is certainly the most extensively studied of the fragility factors, low bone mass is not the whole of the osteoporosis story and may not even be its most important component (despite frequent assertions to the contrary). If one could magically normalize bone mass in everyone, would one eliminate osteoporotic fractures? The best answer that can be given today is ‘no.’ There would be fewer such fractures, but there would still be many, especially hip fractures." (Heaney RP Bone Mass, Bone Loss, and Osteoporosis Prophylaxis. Annals Internal Medicine 15 February 1998 128: 313-314). Explain what Heaney meant. That is, What else besides intrinsic bone problems could cause hip fracture?
  • Mr. Smith, a 72 year old with hip pain, had x-rays ordered by his PCP that showed lytic lesions concerning for bone cancer. The radiology report, however, read the films as “Paget’s Disease” to which Mr. Smith exclaimed with delight, “It’s not cancer! That’s great news! What is Pagets disease of the bone? And why might that diagnosis not be "great news"?

Trauma

  • What is compartment syndrome and how is it prevented, diagnosed, and treated? What are the consequences of not treating a compartment syndrome and over-treating a suspected compartment syndrome?
  • What is osteonecrosis? (also known as “avascular necrosis” or “AVN”) How does hip dislocation lead to avascular necrosis? How does avascular necrosis lead to end stage arthritis?

Sports Injuries

  • What is a stress fracture? How is a stress fracture treated in a normal person? What are the consequences of a stress fracture which is not treated? Why might a young woman with an eating disorder be at particular risk for stress fracture?
  • What is rotator cuff tendinitis? What are the consequences of labeling it (perhaps incorrectly) as an “---itis"? What are the consequences of labeling rotator cuff tendinitis as “impingement syndrome”?

Spine

  • Back pain is a common, self-limited condition in many people. Discitis, cancer and cauda equine syndrome are causes of back pain which are not innocent and self-limiting. First, by way of background, define "cauda equina syndrome", discitis and the common cancers are found in the spine. Next, name some questions a physician might ask to help detect the diagnoses?
  • A so-called herniated disc may compress a nerve root and cause radicular complaints/findings. What are the classic motor and sensory findings of L4 L5 and S1 compression? Why, given that an MRI can localize the disc herniation, if present, should/must a student know the motor and sensory findings of each nerve root level? Suggest a medical rationale for not obtaining an MRI in a patient with low back pain and no neurological features. Forget about the cost of the MRI itself: why might a physician considering only the best medical interests of his or her patient choose to omit an MRI?

Carpal Tunnel Syndrome


Infection

  • What is osteomyelitis? What are its causes? Although bone is part of the vascular system (and therefore fractures can cause hemorrhage and metastatic cells can lodge in the skeleton) why might IV antibiotics have trouble reaching areas of infected bone?

Pediatric Hip conditions


Disorders of the foot and ankle

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