Core Competencies and Standards of Clinical Excellence:
1) You must know how to diagnose developmental dysplasia of
the hip in a newborn.
2) What is the proper management of stress fractures of the
proximal femur?
3) Define atlantoaxial instability and os odontoidium and list
the complications and management of each.
4) How do you diagnose and manage slipped capital femoral
epiphysis, avascular necrosis, and septic arthritis?
5) How do you differentially diagnose and manage meralgia
paresthetica from femoral neuropathy?
6) Since differentiation based on physical examination and
history is impossible, you must know which lab tests are used to
distinguish hip osteoarthritis from hemochromatoic arthropathy and how
the tests are correlatively interpreted.
7) You must know how to diagnose by cauda equina syndrome by
history and physical examination alone (e.g., without CT or MRI
results).
8) You must know how to diagnose and manage vertebral
osteomyelitis and infectious discitis
9) Be able to explain the mechanism by which vitamin D
deficiency causes low back pain; know the indications,
contraindications, dosing, and monitoring involved with vitamin D
supplementation
10) Name five inflammatory disorders that can affect the lumbar
spine and sacroiliac joints. Provide the diagnostic criteria and
management strategy of each.
11) List at least five ways to improve
proprioceptive/sensorimotor function in patients with low-back pain.
12) Differentially diagnose a bladder infection from a kidney
infection; describe appropriate management strategies for both problems.
13) Be able to explain why “fibromyalgia” is an overused
diagnosis and be able to provide a list of treatable conditions that are
often misdiagnosed as fibromyalgia.
14) Name the proper angle for obtaining an
anteroposterior radiograph of the knee to demonstrate osteoarthritis
15) List the characteristics of migraine headaches and the proper
administration of six nutritional treatments.
16) Differentiate a benign headache from one that is potentially
life-threatening.
17) Name the two best and most commonly used tests for assessing
the anterior cruciate ligament. Which test is better and why?
18) McMurray’s test is one of the most commonly used tests for
assessing menisci. How is the test performed, and what is the
sensitivity and specificity of a positive finding?
19) You must know how to identify and manage acute compartment
syndrome.
20) If you think your patient may have a meniscus injury, how do
you decide for or against ordering an MRI?
21) Describe the clinical manifestations of spinal cord
compression.
22) Your patient is a cyclist and presents with knee pain under
the patella on the lateral aspect. What is the most likely diagnosis
and your treatment?
23) Why must you examine the hip of an adolescent patient who
presents with knee pain? Provide the specific anatomic basis.
24) You must know how to distinguish benign sacroiliac and pelvic
pain from that which results from rheumatic diseases such as the
spondyloarthropathies and infections.
25) You must know the wrist/hand manifestations of
hemochromatosis and how to differentiate this potentially
life-threatening condition from benign osteoarthritis. Compare and
contrast the physical examination, laboratory, and treatment
differences.
26) You must know how to differentially diagnose and treat
rheumatoid arthritis, osteoarthritis, and hemochromatosis.
27) You must know how to properly administer high-dose pyridoxine
as a component of the treatment plan for a patient with carpal tunnel
syndrome.
28) You must know how to diagnose and manage fracture of the
scaphoid.
29) You must know how to manage a hand/bone injury that has been
contaminated with human saliva, such as a hand injury resulting from a
fist fight.
30) You must know how to diagnose and manage supracondylar
fractures of the humerus.
31) You must know how to diagnose and manage lateral
epicondylitis.
32) Differentially diagnose and treat rotator cuff tendonitis
from proximal biceps tendonitis.
33) Differentially diagnose overuse bursitis from septic
bursitis.
34) Differentiate thoracic outlet syndrome from fibromyalgia and
the musculoskeletal manifestations of hypothyroidism.
35) You must know how to grade muscle reflexes and muscle
strength.
36) You must know how to rapidly diagnose and effectively manage
the following musculoskeletal emergencies: Neuropsychiatric lupus, Giant
cell arteritis, Temporal arteritis, Acute red eye, including acute
iritis and scleritis, Atlantoaxial subluxation & instability,
Myelopathy, spinal cord compression, Cauda equina syndrome, Septic
arthritis, Osteomyelitis, Acute nontraumatic monoarthritis
37) Following a joint aspiration for acute monoarthritis, which
analyses are used to differentiate septic arthritis from inflammatory
arthritis and gout?
38) Demonstrate competency in the interpretation and correlative
interpretation of the following commonly performed tests: CRP, ESR, CBC,
Chemistry/metabolic panel, Ferritin, Serum 25(OH)-vitamin D, TSH, ANA,
CCP.
39) For example, what is the important difference between
“elevated CRP with a normal ferritin” and “elevated CRP with elevated
ferritin.”
40) Bonus: If the lactulose-mannitol assay is abnormal (elevated
lactulose-to-mannitol ratio) and the comprehensive stool analysis and
comprehensive parasitology results are normal, what are the two most
likely diagnoses, assuming that your patient does not overconsume
alcohol or NSAIDs.
41) If your patient’s serum 25(OH)-vitamin D is low but the serum
calcium level is elevated, what are three possible underlying diseases
and what single blood test is most indicated?
42) Describe how to clinically distinguish fibromyalgia from
polymyalgia rheumatica.
43) How are nondisplaced clavicle fractures managed?
44) Provide one example from each letter of the “p.r.i.c.e. a.
t.u.r.n.” mnemonic acronym for holistic acute care for musculoskeletal
injuries.
45) List the two most common clinical findings associated with
myofascial trigger points and describe appropriate physical/manual and
nutritional treatments.
46) Describe a plan for proproceptive retraining/rehabilitation
for a patient who has no exercise equipment.
47) Describe the effects of stereotypic NSAIDs on chrondrocyte
metabolism and the long-term effects on joint structure.
48) Name four biochemical/physiologic mechanisms by which COX-2
inhibiting drugs predispose to cardiovascular death.
49) Name the only absolute contraindication to the use of willow
bark extract.
50) In a patient with fever and focal back pain exacerbated by
spinal percussion, what is the most likely diagnosis?
51) How do you differentiate chest/back pain resulting from a
“benign” musculoskeletal condition from pain that is a manifestation of
intrathoracic pathology?
52) Briefly and generally describe how to administer the
following relative to the treatment of musculoskeletal pain; you must
know the treatments by their commonly used names and abbreviations: ALA,
EPA, DHA, GLA, D3, Niacinamide, Glucosamine sulfate and Chondroitin
Sulfate, proteolytic enzymes, Zingiber, Cat’s claw, Salix, topical
Capsicum annuum, Boswellia, Devil’s claw, Curcuma longa
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