A 59-year- old woman has been told by her orthopedist that the preferred treatment for her debilitating pain in both knees is knee replacement surgery. She agrees to have the surgery in one month when she will have time for rehabilitation. In the interim, the physician prescribes a medication for pain relief and to reduce inflammation. The woman is otherwise healthy, takes no medication, and has no known drug allergies. The physician decides on a nonsteroidal anti- inflammatory drug that has a high affinity for cyclooxygenase-2 (COX-2) and no affinity for COX-1. Compared to other NSAIDs, this drug is less likely to cause:

A 59-year- old woman has been told by her orthopedist that the preferred treatment for her debilitating pain in both knees is knee replacement surgery. She agrees to have the surgery in one month when she will have time for rehabilitation. In the interim, the physician prescribes a medication for pain relief and to reduce inflammation. The woman is otherwise healthy, takes no medication, and has no known drug allergies. The physician decides on a nonsteroidal anti- inflammatory drug that has a high affinity for cyclooxygenase-2 (COX-2) and no affinity for COX-1. Compared to other NSAIDs, this drug is less likely to cause:

A. Allergy
B. Blood clots
C. Elevated blood pressure
D. Gastric ulcer
E. Peripheral vasoconstriction


Answer: D

A 69-year-old male presents to your office complaining of pain in his neck that extends bilaterally over his shoulders. He also complains of an aching sensation in both of his arms and loss of fine motor control of his hands. This has been progressing over the past six months. He worked in construction and had multiple small neck injuries during college wrestling and football. His overall health is quite good. On X-rays studies of his cervical spine you would expect to find?

A 69-year-old male presents to your office complaining of pain in his neck that extends bilaterally over his shoulders. He also complains of an aching sensation in both of his arms and loss of fine motor control of his hands. This has been progressing over the past six months. He worked in construction and had multiple small neck injuries during college wrestling and football. His overall health is quite good. On X-rays studies of his cervical spine you would expect to find?

A. Normal findings
B. Nothing abnormal except for the loss of the cervical lordotic curve
C. Narrowing of multiple disc spaces, with osteophytes and loss of cervical lordosis
D. An anterior wedge deformity is present at C5
E. A large lytic lesion in the body of C4


Answer: C

In the most classical presentation of a herniated L4-L5 lateral disk herniation, the most common reflex change present is:

In the most classical presentation of a herniated L4-L5 lateral disk herniation, the most common reflex change present is:

A. No reflex change at all
B. Loss of cremasteric reflex
C. Loss of knee jerk reflex
D. Loss of ankle jerk reflex
E. Loss of plantar response (Babinski)


Answer: A

A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:

A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:

A. Admitting him to the hospital immediately
B. Arranging for outpatient physical therapy
C. Giving him a prescription for acetaminophen
D. Recommending him for an outpatient lumbar spine MRI
E. Recommending for him bed rest and a return visit in a week


Answer: A

A 25-year-old female medical student comes to your office asking for an MRI of her neck to confirm her suspicion that she has a herniated cervical disc. On exam, her triceps reflex is absent, and she has weakness of elbow extension and numbness on her long finger. You both expect the MRI to reveal a disc herniation at:

A 25-year-old female medical student comes to your office asking for an MRI of her neck to confirm her suspicion that she has a herniated cervical disc. On exam, her triceps reflex is absent, and she has weakness of elbow extension and numbness on her long finger. You both expect the MRI to reveal a disc herniation at:

A. C3
B. C4
C. C5
D. C6
E. C7


Answer: E

A 57-year-old physician presents to his doctor complaining of neck pain that radiates down the lateral aspect of his right arm. He also complains of numbness in his right thumb with weakness on resisted thumb extension. You suspect a herniated disc compression which nerve root?

A 57-year-old physician presents to his doctor complaining of neck pain that radiates down the lateral aspect of his right arm. He also complains of numbness in his right thumb with weakness on resisted thumb extension. You suspect a herniated disc compression which nerve root?

A. C3
B. C4
C. C5
D. C6
E. C7



Answer: D

A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:

A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:

A. Admitting him to the hospital immediately
B. Arranging for outpatient physical therapy
C. Giving him a prescription for acetaminophen
D. Recommending him for an outpatient lumbar spine MRI
E. Recommending for him bed rest and a return visit in a week


Answer: A