Musculoskeletal NCCPA outline Latest Actual Questions and

Musculoskeletal (NCCPA outline) (Latest / ) Actual Questions and Answers 100% Correct

• - most common injury sustained in blunt thoracic trauma.
• may cause localized pain, crepitus, pain with inspiration, dyspnea, and may even cause

pneumothorax or hemothorax.

Answer: Rib fractures

• Fractures of the - rib usually indicate severe trauma because of the necessary

force to produce such an injury.

Answer: first

• The pain associated with rib fractures may lead to

Answer: hypoventilation, atelectasis, retained secretions, and finally pneumonia.

• treatment for the patient with multiple rib fractures.

Answer:

• Rapid mobilization, respiratory support, and pain management are the mainstays of

treatment.

• Continuous body positioning and oscillation therapy prevent hypoventilation and atelectasis

by promoting redistribution of ventilation and perfusion to various lung segments.

• Mechanical ventilation allows for healing of the ribs and prevention of complications in the

patient with respiratory failure. Incentive spirometry is excellent supportive therapy in stable patients.

• Pain control is paramount in facilitating adequate ventilation. Epidural anesthesia with

bupivacaine controls pain without causing sedation and impairing the cough reflex.

• Sternal fractures are most common in

Answer: postmenopausal females, presumably secondary to osteopenia.

• What is Commotio cordis

Answer: sudden cardiac death after blunt, low-impact chest wall trauma in the absence of structural cardiac abnormality. *Ventricular fibrillation* is the most commonly reported induced dysrhythmia in commotio cordis. Young male athletes aged 5-18 are particularly at risk for this catastrophe. It has been described *after blows to the chest from baseballs, softballs, hockey pucks, and other objects.* Death is usually instantaneous, and successful resuscitation is uncommon.

• Marfan's Syndrome

Answer: Note: Pectus Excavatum

• can also have MVP 1 / 3

• A compartment pressure of is an indication for fasiotomy?-

Answer: 30mmHg

normal pressure = 0-8mmHg

• A 46-year-old male is evaluated for a fall from approximately 15 feet, landing on his legs.

There is intense pain and swelling to the lower extremity, with de- creased sensation. What bone is fractured and is most commonly associated with acute compartment syndrome?

Answer: The Tibia

• Compartment syndrome may occur with or without known trauma. What is a non

physically traumatic cause?Answer: patients with hemophilia or rhabdomyolysis can develop compartment syndrome without direct trauma, and crush injury or tibial fracture can result in compartment syndrome to the affected extremity.

• Physical Exam of Compartment Syndrome

Answer: This pain and the aggravation of pain by passive stretching of muscles in the compartment in question are the most sensitive (and often the only) clinical findings before the onset of ischemic dysfunction in the nerves and muscles.

12. Osteoarthritis: degenerative joint disease three distinct features

Answer:

• narrowed joint space
• spur formation
• subarticular reactive sclerosis

• - Patient will be an older individual
• Complaining of hip or knee pain
• X-ray will show subchondral sclerosis, joint-space narrowing, subchondral cysts, and

osteophytes

• Treatment is NSAIDs, joint replacement

- Comments: No constitutional symptoms

Answer: Osteoarthritis/ degenerative joint dis- ease

• How do you manage osteoarthritis?

Answer: Pharmacologic treatments include oral or topical NSAIDs, acetaminophen, intra- articular corticosteroid or hyaluronate injections, or opioids. Surgical intervention is the definitive treatment.

• Which of the following causes secondary osteoporosis in women?

A Corticosteroid use B Estrogen use 2 / 3

C Hyperlipidemia D Hypoparathyroidism

Answer: Corticosteroid use

• Secondary osteoporosis results from chronic conditions that contribute signifi- cantly to

accelerated bone loss. These chronic conditions include endogenous and exogenous thyroxine excess, hyperparathyroidism, malignancies, gastrointestinal diseases, medications, renal failure and connective tissue diseases. Osteoporosis is a common complication of long-term glucocorticoid therapy and is responsive to bisphosphonates.

Estrogen use (B) is actually used as a treatment in osteoporosis as it is the depletion

of this hormone that cause bone density loss in elderly women. Hypoparathyroidism (C) is not a risk factor for osteoporosis, instead hyperparathyroidism is known as a secondary cause of osteoporosis. Hyperlipidemia (D) has no correlation with osteoporosis. However, obesity is a risk factor for osteoarthritis.

• - Patient will be an elderly woman
• With a history of alcohol, steroid use
• Diagnosis is made by DEXA scan with *T-score d -2.5*
• Most commonly caused by a decline in bone mass with aging resulting in increased bone

fragility and increased fracture risk

• Treatment is bisphosphonates (1st line)
• Comments: Most common fracture: vertebral body compression fractures

Answer: -Osteoporosis

• - X-ray will show *periosteal elevation or bony erosions*
• Diagnosis is made by bone scan or MRI

- Most common causing organism:

6 General: S. aureus

6 Sickle cell: Salmonella, S. aureus

• Cat/dog bites

Answer: Pasteurella multocida

• Treatment is long-term ABX

- Comments:

6 Adults: contiguous spread

• Children: hematogenous spread:

Osteomyelitis

18. Osteomyelitis by Direct Contamination: Puncture wound of nail into shoe.-

Answer: In children, acute osteomyelitis commonly occurs with hematogenous spread or

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