Orthopedic Practice Questions with Answers 2, Exams of Orthopedics

Download Orthopedic Practice Questions with Answers 2 and more Exams Orthopedics in PDF only on Docsity! ONC Orthopedic Practice Questions with answers 2. A 33-year-old man complains of left anterior shoulder pain for 4 weeks. The pain is made worse with overhead activities. On examination, you note maximal pain in the shoulder with palpation between the greater and lesser tubercle. Pain in the shoulder is exacerbated when the arm is held at the side, elbow flexed to 90° and the patient is asked to supinate and flex the forearm against your resistance. On the basis of this presentation, what is the most likely diagnosis? (A) rotator cuff tendonitis (B) myocardial infarction (C) anterior shoulder dislocation (D) rotator cuff tear (E) bicipital tendonitis ✔(E) bicipital tendonitis 4. A 73-year-old woman presents to the emergency department following a fall in her home. She tripped over a throw rug, fell forward, and landed with her arms extended and hands outstretched. She presents complaining of left wrist pain. Radiographs reveal a dorsally angulated and displaced distal radius metaphyseal fracture. What is the most likely diagnosis? (A) Barton fracture (B) Colles fracture (C) Smith fracture (D) boxer fracture ✔(B) Colles fracture 5. Idiopathic osteonecrosis of the femoral head is the most likely diagnosis in which of the following patients? (A) Five-year-old boy who complains of significant hip and knee pain (B) Six-year-old boy who reports a limp and aching in the groin and proximal thigh (C) Seven-year-old obese girl who manifests a painless limp (D) Twelve-year-old girl who complains of progressively worsening hip pain, fever, and chills (E) Eighteen-year-old boy who complains of bilateral hip pain that is worse in the morning and is relieved with activity ✔(B) Six-year-old boy who reports a limp and aching in the groin and proximal thigh 6. A 22-year-old female person was playing basketball when she tripped and landed on the pavement with her hands outstretched. She presents complaining of abrasions on the right thenar eminence and "wrist pain." Physical examination reveals tenderness to palpation between the extensor pollicis longus and the extensor pollicis brevis. Assessment of the median, ulnar, and radial nerves reveals no sensor or motor changes when compared with the left hand. Radial and ulnar pulses are 2+ bilaterally with capillary refill less than 2 seconds on all five fingers of the right hand. Posterior-anterior view radiographs of the wrist and posterior-anterior wrist radiographs with the wrist in ulnar deviation reveal no fractures or dislocations. What is the appropriate management for this patient at this time? (A) immediate orthopedic referral (B) cock-up splint until symptoms resolve (C) physical therapy referral for assessment and treatment (D) thumb spica splint and repeat radiographs in 3 weeks (E) No further treatment is necessary because the radiographs were negative and no vascular or neurological abnormalities were noted on examination. ✔(D) thumb spica splint and repeat radiographs in 3 weeks 7. A 53-year-old patient of Scandinavian descent presents with pain in the ring finger of the right hand. The patient states that he/she has pain when he/she extends his/her finger after making a fist. The finger will not extend on its own, requiring the patient to manually extend the finger, a maneuver that produces both an audible snap and considerable pain. What is the most likely diagnosis? (A) jersey finger (B) trigger finger (C) Dupuytren contracture (D) gamekeeper finger (E) ganglion cyst ✔(B) trigger finger 9. A 27-year-old woman with no significant medical history presents complaining of left elbow pain for 3 days. The patient states that over the last 3 days, her left elbow has become increasingly red, swollen, and painful. The patient is left-hand-dominant. The patient is against the patient's knees. On the basis of this mechanism of injury, what would you expect to find when you inspect the right leg? (A) flexed, abducted, and externally rotated (B) shortened, abducted, and externally rotated (C) shortened, abducted, and internally rotated (D) shortened and externally rotated (E) shortened, adducted, and internally rotated ✔(E) shortened, adducted, and internally rotated 18. A 42-year-old automobile mechanic presents complaining of neck pain that radiates down the lateral aspect of his arm and into his left hand. The patient states that the pain has become progressively more constant over the past 3 weeks. He feels that he is "loosing strength" in his left hand and that parts of his left hand are feeling numb. He states that his symptoms seem to lessen when he places his hand on top of his head. Physical examination reveals vital signs that are within normal limits; no muscle atrophy or spasm are noted in the neck or upper extremities bilaterally. Sensory ability is diminished in the long finger on the left hand. Triceps muscle strength is 5/5 on the right and 4/5 on the left. Bicep strength is 5/5 bilaterally. Biceps and brachioradialis reflexes are +2 bilaterally, right-sided triceps reflex is 2+, and left- sided triceps reflex is 1+. On the basis of this presentation, what spinal root is most likely involved? (A) C5 (B) C6 (C) C7 (D) C8 (E) T1 ✔(C) C7 20. A 7-year-old boy is brought to the emergency department after sustaining a fall onto his outstretched hand. He complains of pain involving the entire arm and refuses to move his arm, which is held in anatomical position with the elbow flexed at 90°. On physical examination, there is notable tenderness over the elbow with associated swelling and pain on attempted rotation. There is no apparent tenderness to palpation involving the wrist or shoulder. The child refuses to participate with range of motion evaluation. Radiographic evaluation of the elbow shows the presence of a positive posterior fat pad sign. What is the most likely diagnosis with this patient's presentation? (A) nursemaid elbow (B) lateral epicondylitis (C) medial epicondylitis (D) radial head dislocation (E) occult fracture of the radial head ✔(E) occult fracture of the radial head 21. A 35-year-old man presents with complaints of swelling and pain in left knee. The patient states that he sustained a twisting injury in a basketball game 3 days ago. The injury did not take him out of the game; he was able to participate with minimal difficulty. Over the last 2 days, the pain has progressed. He notes a *catching* sensation and pain that is more medially located. On physical examination, the patient is found to have tenderness over the medial joint line and limited range of motion. Forced flexion and circumduction of the joint causes a *painful click*. What is the most likely diagnosis in this patient presentation? (A) anterior cruciate ligament tear (B) medial meniscus tear (C) pes anserine bursitis (D) tibial plateau fracture (E) medial collateral ligament tear ✔(B) medial meniscus tear 22. Which of the following motor, sensory, and reflex finding are most likely to be found in a patient with lumbar radiculopathy of the L4-L5 disc? (A) weakness of the anterior tibialis, numbness of the shin, and an asymmetric knee reflex (B) weakness of the great toe flexor and gastrocsoleus, inability to sustain tiptoe walking, and an asymmetrical ankle reflex (C) weakness of the great toe extensor, numbness on the top of the foot and first web space, no reflex findings (D) perianal numbness, urinary and bowel incontinence (E) ankle clonus ✔(C) weakness of the great toe extensor, numbness on the top of the foot and first web space, no reflex findings 24. A 15-year-old boy was playing football and was hit during a play, causing an abduction injury of his left lower leg. He locates the pain along the medial aspect of the knee, and there is a minimal level of joint effusion. Which of the following tests would assess for stability of the medial collateral ligament? (A) valgus stress test (B) varus stress test (C) apprehension sign (D) Lachman test (E) anterior drawer sign ✔(A) valgus stress test 25. A 12-year-old obese boy presents with pain in the right thigh and medial knee. The pain has been over a 6-week period. The pain is described as aching in nature. Over the last month, the patient has had a limp present. On physical examination, the right knee is found to be unremarkable, but there is a slight limp noted with gait. Radiographs of the right knee are normal. Which of the following is the most appropriate step in the evaluation of this patient? (A) examine and x-ray the right hip (B) x-ray the left knee for comparison (C) obtain a CT scan of the right knee (D) obtain a magnetic resonance image of the right knee (E) reassure the parents and observe the patient for progression ✔(A) examine and x-ray the right hip 29. An 8-year-old boy presents with complaint of a painful right wrist of 2 days' duration. The mother of the child reports that the child jumped off of a swing landing on his outstretched arms. He immediately complained of pain in the right wrist and now has some mild swelling on the radial aspect of the wrist. Radiographic evaluation of the wrist presents an area of impaction on the distal radius, with a slight bend in the opposing cortex. Which of the following best describes this type of pediatric fracture? (A) greenstick fracture (B) torus fracture (C) plastic deformation (D) radial neck fracture (E) Monteggia fracture ✔(B) torus fracture 30. A 39-year-old woman presents with complaints of pain in her left foot of 4 weeks' duration. The patient works as a cashier in a department store, which requires her to be on her feet for long periods. She notes that the pain is most severe on the bottom of her foot and is worse upon arising in the morning and then it subsides with ambulation. The patient has a benign medical history and no other complaints. Which of the following is the most likely diagnosis of this patient? (A) heel spur (B) Achilles tendonitis c. Fracture through the physeal plate and metaphysis d. Fracture through the physeal plate and diaphysis e. Fracture through the physeal plate only ✔Fracture through the physeal plate and epiphysis All of the following are used in the management of fractures except a. Open reduction internal fixation b. Splinting c. Closed reduction d. RICE e. Traction ✔d. RICE A potentially serious problem that leads to vascular compromise in patients with casts is a. Overdose of viagra b. Nonunion c. Bunion d. Compartment syndrome e. Osteomyelitis ✔d. Compartment syndrome What is the most likely type of fracture that occurred in question number 7 where Tom beat the person with his "night stick"? a. Transverse fracture b. Stress fracture c. Spiral/oblique fracture d. Segmental fracture e. Comminuted fracture ✔a. Transverse fracture Which of the following is NOT true of osteoarthritis? a. Recreational running does not increase incidence b. A key component is inflammation of symmetrical joints c. It is characterized by articular stiffness that lasts less than 15 min d. Obesity is a risk factor for development. e. It is the most common form of joint disease. ✔b. A key component is inflammation of symmetrical joints Which of the following diseases has been demonstrated to reduce life expectancy? a. Rheumatoid arthritis b. Osteoarthritis c. Gout d. Degenerative joint disease e. Chondrocalcinosis ✔a. Rheumatoid arthritis A 50-year-old man who is employed as a fire fighter presents with complaints of right arm pain x 1 mo. The pain is aggravated by sneezing, coughing, and raising the arm up to the shoulder. Exam reveals a decrease in the biceps reflex on the right side. Based on the history and physical findings, what is the likely diagnosis? a. Cervical spondylosis b. Cervical strain c. Thoracic outlet syndrome d. Chondrocalcinosis e. Herniated cervical nucleus pulposus ✔e. Herniated cervical nucleus pulposus 1. What is the appropriate treatment of a patient with herniated cervical nucleus pulposus? a. Referral to surgery b. Bed rest and NSAIDs c. Epidural steroid injection d. Bracing e. Steroid injection into the facet joint ✔b. Bed rest and NSAIDs A 21-year-old patient arrives in the emergency department with a leg injury secondary to an MVA. X-ray examination reveals a fracture of the tibia. You note that there is a large free-floating piece of bone between well-defined fracture lines superior and inferior to it. This would be most correctly described as a _____ fracture. a. Segmental b. Comminuted c. Spiral d. Torus e. Transverse ✔a. Segmental A 50-year-old man presents with acute pain in the upper right arm and shoulder. The patient relates a history of "snapping" over the area for the last 3 wk. On examination, you note that (1) flexion of the elbow elicits pain; (2) there is local tenderness of the biceps and anterior shoulder; and (3) there is an egg -shaped swelling in the biceps on the affected arm. These findings are most consistent with a. Bicipital tendinitis b. Osteochondral fracture c. Biceps rupture d. Impingement syndrome e. Rotator cuff damage ✔c. Biceps rupture The single best test of radial nerve friction is the ability to a. Make an OK sign with the fingers b. Abduct the index finger c. Close and open the fingers against resistance d. Make a "steeple" with the index fingers a. Extend the wrist and fingers against resistance ✔a. Extend the wrist and fingers against resistance An 82-year-old woman presents to the emergency department after a fall in her home. She is not able to walk or bear weight on her right leg. There is marked pain in her right hip. Exam reveals some shortening of the right limb and some external rotation. What is the likely diagnosis? a. Femoral shaft fracture a. Femoral neck fracture b. Intertrochanteric fracture c. Anterior dislocation d. Femoral head fracture ✔a. Femoral neck fracture A 24-year-old patient presents after a skiing injury to the left knee the night before. Choose the correct statement concerning knee injuries. a. History of painful locking points toward cruciate tear b. The medial meniscus is more likely to be torn than the lateral c. Think of posterior cruciate tears if the patient hears a "pop" with the injury d. Tests like the McMurray test accurately identify a torn meniscus over 90% of the time e. The anterior drawer test is most sensitive in diagnosing anterior cruciate tears ✔b. The medial meniscus is more likely to be torn than the lateral The preferred initial treatment for a wrist ganglion is a. Forceful compression with a book b. Injection with steroids c. Aspiration and chemical cauterization d. NSAIDs e. Surgical excision ✔c. Aspiration and chemical cauterization A 30-year-old man presents with left shoulder pain. There is no history of acute injury, but the patient participates in several sports. Examination reveals tenderness approximately 2 cm below the tip of the acromion. There is also pain in the left d. carpal tunnel syndrome cubital tunnel syndrome ✔c. de Quervain's disease 1. A 34-year-old male presents with complaints of increasing swelling and pain in his left knee since a basketball game yesterday. He states that during the game he twisted his knee and had some discomfort, but was able to keep playing. This morning he awoke with increased swelling and pain as well as difficulty bending the knee. He states that the knee appears to "lock up" on him. On physical examination, there is moderate swelling of the left knee with tenderness to palpation along the medial joint line with limited range of motion, especially in extension. Pain and swelling prohibit any further examination at this time. The most likely diagnosis is a. medial meniscus tear b. patellar tendon rupture c. fracture of the tibial plateau d. medial collateral ligament tear e. anterior cruciate ligament tear ✔a. medial meniscus tear Of the following, the most accurate technique for evaluation of a possible injury to the anterior cruciate ligament is the a. Lachman test b. McMurray test c. valgus-varus stress d. anterior drawer sign e. posterior drawer sign ✔a. Lachman test A 12-year-old obese male presents with complaints of pain in the right knee. He describes it as an aching pain located in his knee that has affected his walking for the past month. He states the pain gets better with rest. On physical examination you note a slight limp to his gait, but examination of the right knee is unremarkable. X- rays of the right knee are normal. Of the following, the most appropriate next step is to a. order a skeletal survey b. examine and x-ray the right hip c. obtain a CT scan of the patella d. order blood work for juvenile arthritis e. reassure the parents that nothing serious is present ✔b. examine and x-ray the right hip Of the following, the most appropriate next step in management of a reduced traumatic knee dislocation is a. ice and rest for several days b. crutches with weight bearing to tolerance c. immediate vascular referral and evaluation d. immobilization with a splint until pain is relieved e. active physical therapy program for range of motion exercises ✔c. immediate vascular referral and evaluation A 24-year-old manual laborer presents complaining of low back pain secondary to lifting a heavy box at work yesterday. Initially he had no complaints, but the following day he was stiff and sore. His supervisor sent him in today for further evaluation. He denies any radiation of the pain, numbness, or difficulty with urination. He denies any previous history of back complaints. On physical examination, you note mild paravertebral muscle spasm and slight decrease in range of motion in all spinal movements. Deep tendon reflexes are equal bilaterally and there are no sensory deficits noted. Of the following, the next most appropriate intervention is to a. order an MRI of the lumbar spine b. order plain x-rays of the lumbosacral spine c. return the patient to work without any limitations d. refer the patient for transcutaneous electrical nerve stimulation (TENS) e. initiate a short period of rest, analgesia, and progressive functional program ✔e. initiate a short period of rest, analgesia, and progressive functional program A new military recruit in the second week of boot camp is seen in the infirmary with complaints of "shin splints." On physical examination, there is tenderness to palpation over the anterior portion of the tibia. X-rays of the lower legs are negative for fracture. If the pain is unrelieved by conservative management, the next most appropriate diagnostic evaluation is to order a. an MRI b. a CT scan c. a bone scan d. an ultrasound e. repeat plain x-rays in 1 week ✔c. a bone scan Which of the following is most consistently seen in Osgood-Schlatter disease? a. greater incidence in females b. age of onset> 18 years of age c. positive McMurray sign d. exacerbated by kneeling and jumping e. positive rheumatoid factor ✔d. exacerbated by kneeling and jumping Which of the following is NOT a characteristic of carpal tunnel syndrome? a. positive Tinel's sign b. may occur in pregnancy c. atrophy of the hypothenar eminence d. symptoms increase while sleeping e. positive carpal compression ✔c. atrophy of the hypothenar eminence A 3-year-old boy complains of elbow pain after wrestling with his brother. The father states his son cried initially and is currently reluctant to use his right elbow. On exam, tenderness of the radial head increased with supination is noted. His neurovascular status is normal. Radiographs show subluxation of the radial head. The standard treatment of choice is: a. open reduction: percutaneous pinning b. sugar-tone splint c. closed reduction d. observation ✔c. closed reduction A l0-year-old boy presents to the Emergency Department after twisting his ankle while playing baseball. Radiographs of the ankle show a fracture of the growth plate and portion of the epiphysis. The most likely diagnosis is: a. Salter type I b. Salter type II c. Salter type III d. Salter type IV e. Salter type V ✔c. Salter type III Which of the following is not one of the muscles that make up the rotator cuff? a. Supraspinatus b. Infraspinatus c. Teres minor d. Suprascapularis e. Subscapularis ✔d. Suprascapularis What is the most common bone fractured? a. Sternum b. Clavicle c. Radius d. Scaphoid e. Tibia ✔b. Clavicle Thumb extension (hitchhiking) is tests which of the following nerves? a. Radial b. Ulnar c. Median d. Brachial e. Both A and B e. All except B are true ✔e. All except B are true A 25 year-old female presents to the ED with an open fracture of the left fibula sustained from an auto accident. The patient has no neurological findings. In addition to stabilization of the patient which of the following should be immediately initiated? a) Antibiotic therapy b) Apply a bi-valve cast c) Reduce the fracture d) Surgical debridement ✔a) Antibiotic therapy A 42 year-old male sustained a closed left tibial fracture in a fall two days ago. He was treated with a cast for immobilization. Acutely, he developed severe pain in his left leg. Examination reveals the anterolateral aspect of the leg to be exquisitely tender to palpation. The patient has extreme pain with plantar flexion. What is the most likely diagnosis? a) Compartment syndrome b) Deep venous thrombosis c) Osteomyelitis d) Complex regional pain syndrome ✔a) Compartment syndrome Which of the following is the most significant complication of a dislocation of the knee? a) Ligament damage b) Inability to bear weight c) Instability of the joint d) Vascular and/or Nerve injury ✔d) Vascular and/or Nerve injury Pain is localized to the proximal humerus and anterior portion of the shoulder joint and is aggravated by resistive supination of the forearm. These symptoms are most consistent with a diagnosis of: a) Bicipital tendinitis b) Axillary nerve injury c) Rupture of pectoralis major d) Distal fracture of the clavicle e) Sternoclavicular sprain ✔a) Bicipital tendinitis A 43-year-old data entry clerk presents with a one-month history of pain and tingling in the right thumb, index finger, and middle finger. Tinel's sign and Phalen's maneuver are positive. The most appropriate intervention at this time is: a) Medrol dose pack. b) Splint in neutral position. c) Observation. d) Surgery. e) Long arm cast ✔b) Splint in neutral position. * A 41 year-old female complains of 3 weeks of gradually worsening pain at the base of the thumb and radial aspect of the wrist. She and her husband have been renovating their home for the past 2 months and it has become increasingly difficult for her to hold a hammer. She denies numbness, tingling or any history of previous trauma to the wrist. On examination, there is tenderness over the radial styloid and pain reproduced with ulnar deviation of a fist clenched over the abducted thumb. Which of the following is the most likely diagnosis? a) Carpal tunnel syndrome b) De Quervain's tenosynovitis c) Ganglion cyst d) Volar flexor tenosynovitis e) Guyon's canal syndrome ✔b) De Quervain's tenosynovitis Which of the following physical examination findings is consistent with a sciatic nerve compression? a. weakness and numbness beside severe pain b. decreased or absent Achilles' reflex c. decreased sensation In the groin region d. a &b e. a,b&c ✔d. a &b A patient was involved in a motor vehicle crash. He is brought to the emergency department where ambulance personnel relate that initially he was confused, but now appears alert. He denies any complaints of chest pain, dyspnea, or dysphagia. Physical examination reveals an alert and oriented patient with stable vital signs and PERRLA. Palpation of the neck reveals no apparent tenderness, and the patient is able to move all extremities. Which of the following diagnoses must still be ruled out in the differential? a. Cervical Sprain/Strain injury b. Whiplash injury c. Cervical spine injury d. Subclavian artery injury ✔c. Cervical spine injury A 74 year-old male presents with one month history of right shoulder pain without any known precipitant. His pain involves an area from the right paraspinous musculature to the right deltoid with occasional radiation down the arm. Pain is worse with movement of the shoulder and is not relieved by acetaminophen. He reports numbness of the right index finger and thumb. Physical examination of the shoulder is limited by pain. There is decreased grip strength and absent pinprick sensation in the index finger and thumb. Relexes are normal. What is the most appropriate initial study to obtain? A. EMG with nerve conduction B. MRI of the right shoulder C. Radiographs of the neck D. Radiographs of the right shoulder e. MRI of the neck ✔C. Radiographs of the neck Cauda Equina Syndrome is a serious condition requiring emergency treatment.The symptoms include all of the following except: a. Motor and sensory loss b. Saddle anesthesia c. Loss of pulses and edema d. Sciatica e. Bowel or bladder dysfunction ✔c. Loss of pulses and edema The most common cause of spondylolisthesis is: a. Physical stress b. Spondylolisis c. Weight lifting d. Congenital e. General wear and tear ✔b. Spondylolisis In regards to shoulder dislocation, which of the following statements is TRUE? a. Posterior dislocations are more common than anterior dislocations b. Anterior dislocations usually result from seizure activity c. It usually requires surgical reduction. d. Careful sensory exam in the median nerve distribution should be assessed e. X-rays should include anteroposterior, lateral, and axillary (scapular Y) views ✔e. X-rays should include anteroposterior, lateral, and axillary (scapular Y) views Which of the following statements is/are TRUE with regard to scaphoid fractures? a. Initial X-rays may be negative despite fracture b. Treatment includes a thumb spica splint or cast for four to six weeks c. Diagnosis and treatment is based on history and clinical findings (that is, pain in anatomical snuff box) d. Complications include development of Avascular necrosis secondary to blood supply interruption e. All of the above are true. ✔b. Repetitive overuse The segment of the population at the highest risk for hip fracture is a. Elderly white women b. Elderly white men c. Elderly Hispanic women d. Elderly black women e. Elderly black men ✔a. Elderly white women Which of the following is the optimal study to confirm the diagnosis of a stress fracture of the hip in a 20year-old runner? a. Anterior-posterior radiographs of the pelvis b. Scintigraphy c. Magnetic resonance imaging (MRI) d. Tomograms e. Computed tomography ✔c. Magnetic resonance imaging (MRI) Which of the following patients is most likely to develop Osgood-Schlatter disease? a. A 14-year-old swimmer b. An obese 12-year-old male c. A nine-year-old female in karate d. A 15-year-old soccer player e. A 21-year-old basketball player ✔d. A 15-year-old soccer player The most accepted treatment of Osgood-Schlatter disease is: a. Surgical excision of embedded ossicles b. Local steroid injection c. Plaster cast for three to six weeks d. Knee immobilizer with 30 degrees of flexion for two to four weeks e. Modified activity and nonsteroidal anti-inflammatory drugs (NSAIDs) ✔e. Modified activity and nonsteroidal anti-inflammatory drugs (NSAIDs) 4. A mother of a 4-year-old is concerned about a bump on the child's wrist. Examination reveals a 1-cm solitary, soft, mobile, nontender lesion on the dorsal wrist. It transilluminates symmetrically. What is the recommended management? A. aspiration B. observation C. immobilization D. cortisone injection ✔B. observation asymptomatic ganglions are untreated 32. A 27-year-old male presents to the urgent care facility following a jamming injury to his second right digit while playing volleyball. He is unable to extend the fi nger at the DIP. Radiographs are negative. What is the name of this injury? A. boutonnière deformity B. gamekeeper thumb C. mallet fi nger D. trigger fi nger ✔C. mallet fi nger 35. A 55-year-old with mild osteoarthritis presents with swelling of the right knee. He describes intermittent pain and a feeling of locking or giving way over the past week. Physical exam reveals tenderness at the knee joint line. Which of the following maneuvers is most widely used and useful in diagnosing the suspected disorder? A. Lachman test B. McMurray test C. Finkelstein test D. straight leg raise test ✔B. McMurray test 42. A 14-year-old boy sustains an inversion injury of the left ankle while playing basketball. Swelling and pain were immediate. Examination on the fi eld reveals mild swelling and tenderness with full range of motion and a mild limp with weight bearing. What is the recommended treatment? A. early aggressive range of motion B. heat alternating with ice for the fi rst 24 to 48 hours C. ice with progressive exercise against resistance as tolerated D. return to full use as soon as weight bearing is tolerated ✔C. The best initial treatment is ice with progressive exercise against resistance as tolerated. Radiographs are warranted if there is localized tenderness over the malleoli, tenderness beyond ligament attachments, or excessive or unrelenting swelling or inability to bear weight. 67. A 28-year-old who is training for a marathon complains of progressively worsening pain in the left foot. Initially, it was relieved with rest but now is persistent. Examination reveals pain on palpation of the fifth metatarsal. Which of the following is the best test to confirm the suspected diagnosis? A. plain radiography B. bone scan C. CT scan D. MRI ✔B. Bone scan is the most sensitive and defi nitive test for stress fracture. It will show uptake in the area of the stress fracture before anything appears on plain radiography.