MSK

Question 1

A 35-year-old woman presents to her physician with a 6-week history of hand stiffness, swelling, and pain. The stiffness is worst in the morning, taking up to an hour to become better. She has had some pain in her knees over the past 6 months related to inactivity. Her grandmother had “arthritis”. Physical examination shows mild swelling and tenderness over the metacarpophalangeal joints of both hands. Her knees have slight warmth and small effusions bilaterally but no point tenderness. The patient has no rashes or mouth ulcers. Laboratory findings are: WBC count: 8200/mm3, Erythrocyte sedimentation rate: 50 mm/hr, C-reactive protein: 6 mg/L, Antinuclear antibody: negative, Rheumatoid factor: highly positive, Radiographs of the wrist reveal soft tissue swelling, osteopenia and erosions of the MCP joints bilaterally. What is the most likely diagnosis?
A.Psoriatic arthritis (PsA)
B.Rheumatoid arthritis (RA)
C.Systemic lupus erythematosus (SLE)
D.Osteoarthritis (OA)

Answer 1

B.Rheumatoid arthritis (RA)

Question 2

A 63-year-old man complains that he can no longer abduct his right arm since falling on outstretched hands 3 weeks ago, the pain in his right shoulder is typically exacerbated at night that wakes him up. Physical examination reveals tenderness to palpation below the right acromion. The patient also has pain at 60 degrees as he abducts his right arm and is unable to abduct with resistance. He is unable to hold his right arm abducted at 45 degrees. He is unable to laterally rotate his forearm against resistance. What is the most likely diagnosis?
Please justify your answer
A.Adhesive capsulitis
B.Carpal tunnel syndrome
C.Thoracic outlet syndrome
D.Rotator cuff tears

Answer 2

D.Rotator cuff tears

Question 3

A 3-year-old boy is brought to the pediatrician by his parents because he has been falling frequently and struggling to get up from a sitting or lying position, whereas he had previously done so easily. His developmental history is notable for delayed motor skills; he began to walk at 18 months. The boy has a waddling gait and when sitting uses his arms to push himself into the upright position. Physical examination shows marked muscle weakness of the extremities, particularly of the proximal muscle groups, and hypertrophy of his calf muscles. The patient’s maternal uncle, who died at 16 years of age, suffered from similar symptoms when he was younger. What is the most likely diagnosis?
Please justify your answer
A.Juvenile idiopathic arthritis
B.Osteogenesis Imperfecta
C.Duchenne muscular dystrophy
D.Erb-Duchenne palsy

Answer 3

C.Duchenne muscular dystrophy

Question 4

A 40-year-old man presents to the clinic complaining of pain in his left big toe. The pain began suddenly this morning and woke him from sleep. He denies trauma to that area. Pain is triggered by having red meat. Physical examination reveals a warm, erythematous, and extremely tender left metatarsophalangeal joint. Arthrocentesis of the affected toe is performed revealing yellow needle-shaped crystals. Laboratory studies are significant for a serum uric acid level of 9 mg/dL. What is the most likely diagnosis?
Please justify your answer
A.Gouty arthritis
B.Septic arthritis
C.Polyneuropathy
D.Spondyloarthropathy

Answer 4

A.Gouty arthritis