NMS Q&A Family Medicine

170 NMS Q&A Family Medicineof 5 ft, 5 in. (1.65 m). He holds his left hip in about5 degrees of flexion and is unable to fully extend thehip to 180 degrees. He has no constitutional symptomsor signs. The result of a CBC is unremarkable. Aplain posteroanterior x-ray film of the left hip isunremarkable. Which of the following is the mostlogical next step in obtaining a diagnosis?(A) Order a lateral view x-ray of the left hip(B) Order serum level tests of calcium and alkalinephosphatase(C) Perform left hip joint aspiration(D) Order a magnetic resonance image of the lefthip(E) Consult a surgeon for arthroscopic explorationof the left hip7 While examining a female newborn, you perform aBarlow maneuver (attempting to dislocate the newborn’sfemoral heads interiorly from the acetabulumwith your forefinger, while grasping the thigh withyour thumb placed on the medial proximal thigh).You sense a clear movement interiorly of the femoralhead on the baby’s left hip. Each of the followingstatements is true regarding the condition in thepatient in the vignette except for which one?(A) Female infants are affected more than maleinfants.(B) For optimal outcome the condition must bediagnosed and treated before the child reachesthe age of 6 months.(C) There may be a history of this condition in thebaby’s family.(D) If the baby is not diagnosed before the age ofwalking, the baby’s gait becomes waddling andthe perineum broadened.(E) The presence of intoeing effectively rules outdevelopmental dislocation of the hip.8 A 5-year-old girl has complained for 5 months ofpain in her left wrist and right second and thirdmetacarpophalangeal joints. This week she complainsof photophobia in the left eye. Examination showsthe left pupil to be constricted, compared with theright eye. An antinuclear antibody level is elevated.Which of the following is the most likely and mostprecise diagnosis, given the clinical picture?(A) Rheumatic fever(B) JRA or Still disease(C) Reiter syndrome(D) Pauciarticular JRA(E) Rheumatoid arthritis9 Parents frequently are concerned with “intoeing” ininfants. It may be safe to say that parents bring it to theirdoctors’ attention more than the other way around.Being armed with data regarding this complaint makesit much quicker and easier for physicians to manage thefamilies as well as the patients. Which of the following isnot true in regard to intoeing?(A) Metatarsus adductus may be the cause.(B) Internal tibial torsion may be the cause.(C) Excessive femoral anteversion may be the cause.(D) Developmental hip dislocation may beassociated with it.(E) The majority of cases require surgical correction ifthey have not resolved by the time the childreaches the age of 8 years.10 A father brings to you a 6-year-old boy who fell ontohis outstretched hand while playing at recess in gradeschool. The boy complains of pain and the extremitymanifests swelling in an area just proximal to thewrist. An x-ray done stat in the office building comesback to reveal a buckling of the distal radius, visiblein both anteroposterior and lateral views. Which ofthe following is the best treatment strategy?(A) Open reduction(B) Short-arm cast for 6 weeks(C) Closed reduction followed by casting for 3 weeks(D) Long-arm cast for 3 weeks(E) Observation only