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Self-Assessment Questions

Internal Medicine

Hip Pain: Review Questions

Bernard M. Karnath, MD, and Tracy U. Nguyen-Oghalai, MD

Dr. Karnath is an associate professor of medicine, Division of General Medicine, and Dr. Nguyen-Oghalai is an assistant professor of medicine, Division of Rheumatology, University of Texas Medical Branch, Galveston, TX.



Choose the single best answer for each question.



Figure 1



Figure 2

1. A 30-year-old man presents with sudden-onset posterior hip pain and low back pain that began while he was moving heavy furniture. Which of the following maneuvers is most helpful in eliciting the most likely diagnosis?

  1. Internal and external rotation of the hip
  2. Ober’s test
  3. Patrick’s maneuver
  4. Straight leg raising test
Click here to compare your answer.


2. A 70-year-old woman presents with a 5-day history of worsening right hip pain. The pain has progressed to the point that she can no longer walk. The patient denies any history of recent trauma. Patrick’s maneuver is markedly positive. A plain radiograph of the hip shows no abnormalities, and magnetic resonance imaging (MRI) is ordered (Figure 1). What is this patient’s most likely diagnosis?

  1. Avascular necrosis (AVN)
  2. Hip fracture
  3. Osteoarthritis
  4. Trochanteric bursitis
Click here to compare your answer.


3. A 70-year-old woman presents with acute right hip pain that started after a fall this morning. She is unable to walk because of severe pain. The patient has a history of osteoporosis for which she takes alendronate 70 mg weekly. Patrick’s maneuver is markedly positive. A plain radiograph is obtained (Figure 2). What is this patient’s most likely diagnosis?

  1. AVN
  2. Hip fracture
  3. Osteoarthritis
  4. Trochanteric bursitis
Click here to compare your answer.




Figure 3A



Figure 3B

  4. A 70-year-old man presents with progressive right hip pain for the past 2 months. He is diagnosed with osteoarthritis of the hip based on radiographic findings (Figure 3), and hip replacement surgery is recommended. A preoperative chest radiograph reveals a 3-cm right lung mass (Figure 4). Further history reveals that the patient is a nonsmoker. A biopsy of the hip reveals malignancy. What is this patient’s most likely diagnosis?
  1. Adenocarcinoma
  2. Large cell carcinoma
  3. Small cell carcinoma
  4. Squamous cell carcinoma
Click here to compare your answer.




Figure 4



Figure 5

5. A 60-year-old woman presents with a 6-month history of bilateral hip pain. Pain is more severe in the right hip than in the left hip. Patrick’s maneuver is markedly positive on the right side. On range of motion testing, the patient also complains of pain, and crepitus is noted in the right hip. A plain radiograph is ordered (Figure 5). What is this patient’s most likely diagnosis?

  1. AVN
  2. Hip fracture
  3. Osteoarthritis
  4. Trochanteric bursitis
Click here to compare your answer.


6. A 25-year-old distance runner presents with lateral hip pain with every step. The patient is unable to jog. Ober’s test is positive. What is this patient’s most likely diagnosis?

  1. Iliotibial band syndrome
  2. Meralgia paresthetica
  3. Sciatica
  4. Trochanteric bursitis
Click here to compare your answer.


7. A 40-year-old obese man presents with numbness and tingling over the anterolateral right thigh. He reports a 20-lb weight gain over the past year. When asked about his clothing, he states that he has not purchased any new clothing. What is this patient’s most likely diagnosis?

  1. Iliotibial band syndrome
  2. Meralgia paresthetica
  3. Sciatica
  4. Trochanteric bursitis
Click here to compare your answer.


 

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