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A 45-year-old male presents to the family doctor with 1-month history of right shoulder pain. The pain is located over the lateral aspect of the shoulder and it is exacerbated when he tries to do any overhead activities. He denies a history of trauma but works as a laborer for a construction company. There are no associated symptoms of instability and he has not noticed a fever or weight-loss. Physical examination reveals 4 out of 5 strength with abduction. Radiographs of the shoulder are seen in Figures A and B. MRI images are seen in Figures C-E. What is the next best step in the management of this patient?
Physical therapy and observation
Curettage and bone graft
White cell labeled bone scan
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A 30-year-old male presents with thumb swelling and pain of 6 months duration. He denies a history of trauma or previous problems with the thumb. Radiographs, MRI, and histology slide are shown in Figures A through D. What is the most appropriate treatment for this patient?
Curettage and bone grafting
Radiation and intralesional excision
Which of the following diseases carries greater than 50% risk of developing a malignancy?
Multiple hereditary exostoses
A 56-year-old male with a history of prostate cancer presents to your clinic complaining of bilateral foot pain (right greater than left) that he relates to his chronic bunion and claw toe deformities. He denies new trauma, fevers, or weight loss. He says that he is able to ambulate but has had progressively increased pain in the great and lesser toes of both feet, with progressive difficulty in wearing shoes. During his radiographic evaluation a lesion is found in the right tibia which is shown in Figure A. What is the next most appropriate step in management of the tibial lesion?
Core needle biopsy of the right tibia
Excisional biopsy of the right tibia
MRI of the right tibia
Reassurance and repeat radiographs in 3-6 months
Staging with CT of the chest, abdomen, and pelvis, and referral to an orthopaedic oncologist
A 70-year-old woman falls and presents with pelvic pain. Physical exam shows she is able to walk without difficulty. Radiographs of the pelvis and hip are shown in Figure A, B, and C. A biopsy of the lesion in the proximal femur is shown in Figure D. What is the next best step in management of the femoral lesion?
Resection and internal fixation
Chemotherapy followed by wide resection
A 55-year-old male with a history of diabetes mellitus presents with left leg pain localized to his posterior knee and calf. The pain is worse with prolonged walking and resolves when he rests and remains standing upright. He has a history of chronic low back pain, prior cardiac stenting, and smokes 1 pack of cigarettes daily for the last twenty years. Physical exam is remarkable for 1+ patellar reflexes and an ABI of 0.8. A radiograph of his lumbar spine is shown in Figure A. T2-weighted sagittal and axial MRI images are shown in Figure B and C respectively. A radiograph of his left knee is shown in Figure D. What is the most likely cause his leg pain?
Lumbar Disc Herniation