Musculoskeletal

Question 1

A patient presents with ankle pain associated with climbing stairs. After finding the ankle to be swollen and stiff, you diagnose the patient with osteoarthritis. This condition is probably ______ (unilateral/bilateral), and is probably results because of prior ______.

Answer 1

unilateral, injury

Question 2

A patient presents with ankle pain associated with climbing stairs. After finding the ankle to be swollen and stiff, you diagnose the patient with osteoarthritis. For many patients with this condition, a non-pharmacological, non-surgical treatment results in symptom relief. What is that “treatment”?

Answer 2

weight loss

Question 3

A 34 year-old male presents with posterior ankle pain. He states that the pain onset acutely when he attempted to steal a base in a softball game. The patient describes feeling as if he’d been “shot in the back of the leg”. On exam, you find the posterior ankle swollen and tender. The patient is unable to plantar flex the ankle. Which test is the most sensitive and specific for confirming your suspected diagnosis?

Answer 3

Thompson’s test

Question 4

A patient presents with a high ankle sprain. Which anatomic structure is affected?

Answer 4

Syndesmosis

Question 5

A 40 year-old overweight male presents with heel pain that is worst right after he gets out of bed in the morning. The patient recently started running to lose weight. On exam, there is tenderness over the medial plantar surface of the calcaneus and pain with passive dorsiflexion. What is the most likely diagnosis?

Answer 5

Plantar fasciitis

Question 6

A patient presents with bilateral femur fractures, a posterior hip dislocation, and a scaphoid fracture that resulted from an automobile crash. What is your first priority in managing this patient?

Answer 6

Airway, Breathing, Circulation

Question 7

A patient presents with right knee pain and associated effusion. You perform a joint aspiration and find the fluid’s cellularity to be greater than 100,000. Which common knee pain treatment is absolutely contraindicated in this case?

Answer 7

Steroid injection

Question 8

A patient presents with shoulder pain that radiates down the upper arm unilaterally. The patient states that the pain began after a weekend that he spent painting his living room. Suspecting shoulder impingement syndrome, which two specific tests do you perform?

Answer 8

Hawkins, Neer

Question 9

A patient presents with back pain secondary to a previously diagnosed HNP. Which traditional treatment is probably best limited to 24 hours or less duration?

Answer 9

Bed rest

Question 10

A 28 year-old paramedic presents with lower back pain radiating down the right thigh and calf that began after he lifted a patient out of a wrecked car one week ago. On exam, you find decreased sensation along the L5/S1 dermatomes, and the straight-leg test is positive. What is the most likely diagnosis?

Answer 10

Herniated nucleus pulposis

Question 11

A patient presents with severe back pain and bilateral sciatica. What is the most serious potential complication that you must assess for, and what should you ask about specifically in the history to address it?

Answer 11

Cauda equina syndrome
Do you use cocaine? Wait…no, not that.
Bowel/bladder dysfunction (incontinence, urinary retention)

Question 12

A 20 year-old male presents with lower back pain and stiffness that is worse in the morning and somewhat relieved by activity. On exam, you find decreased ROM in the lumbar spine, as well as anterior uveitis. Radiographs show the appearance of “bamboo spine”. CRP and sed rate are elevated. What is the most likely diagnosis?

Answer 12

Ankylosing Spondylitis

Question 13

A 19 year-old male presents with joint pain and stiffness in the knees and ankles. He also endorses pain with urination and penile discharge. On exam, you note uveitis. WBC and ESR are elevated. What is the most likely diagnosis, and what is its most common etiology?

Answer 13

Reiter Syndrome

Chlamydia Trachomatis

Question 14

A patient presents with swelling and tenderness of the DIP joints. On exam, you find the DIP joints to be red and warm, and note that there is pitting and yellowing of the fingernails as well. X-rays of the hand show a “pencil in cup” deformity. What is the most likely diagnosis?

Answer 14

Psoriatic arthritis

Question 15

A patient presents with swelling and tenderness of the DIP joints. On exam, you find the DIP joints to be red and warm, and note that there is pitting and yellowing of the fingernails as well. X-rays of the hand show a “pencil in cup” deformity. To support a diagnosis of psoriatic arthritis, which serum factor should be negative?

Answer 15

Rheumatoid factor

Question 16

A rheumatology PA is examining a patient with a history of SLE who has developed some chest pain that is relieved by leaning forward. The PA goes to the store and buys a stethoscope, then calls a friend from PA school who reminds her how to use it. The PA notices a pericardial friction rub and orders an EKG that shows diffuse, concave ST-segment elevations. Which potential complication of SLE is most likely?

Answer 16

Pericarditis

Question 17

The vast majority of patients with lupus will have a ______(positive/negative) ANA test. Most people with a positive ANA test ______ (do/don’t) have lupus. In diagnosing lupus, ANA testing is highly ______ (sensitive/specific), but lacks ______ (sensitivity/specificity).

Answer 17

positive, don’t, sensitive, specificity

Question 18

48 hours after undergoing ORIF for a tibial fracture, a 25 year-old male patient develops intense leg pain that is refractory to morphine and hydromorphone. He has significant pain with passive ROM. What is the most likely diagnosis, and what is the treatment of choice?

Answer 18

Compartment syndrome, fasciotomy

Question 19

A patient presents with anterior shoulder pain within the intertuberous groove that is aggravated by resisted supination. What is the most likely diagnosis?

Answer 19

Biceps tendonitis

Question 20

An abnormal Cobb angle is indicative of what disorder?

Answer 20

Scoliosis

Question 21

A patient presents with an inferiorly displaced patella. Which tendon is most likely damaged?

Answer 21

Quadriceps tendon

Question 22

Compared to benign lesions, malignant bone lesions are more likely to be ______ (lytic/blastic), are ______ (more/less) likely to be painful, and have a ______ (higher/lower) likelihood of invading adjacent tissue.

Answer 22

lytic, more, higher

Question 23

A patient presents with a dislocated knee. You reduce the dislocation and then consider an angiogram to assess for vascular damage. Which vessel are you most concerned about, given the injury?

Answer 23

Popliteal artery

Question 24

A patient who is recovering from a generalized tonic-clonic seizure complains of shoulder pain. Which radiographic view will be most useful in assessing this patient’s condition?

Answer 24

Axillary lateral view

Question 25

A patient suffers radial nerve injury in an automobile crash. You have a high index of suspicion for a fracture of which bone, since it’s the most common site of median nerve injury?

Answer 25

Humerus

Question 26

A 65 year-old female presents with a 1-month history of shoulder and hip pain. She also reports a 10-pound unintentional weight loss and low-grade fever during that time. On exam, strength is 5/5 throughout, but ROM is limited in the shoulders. Which laboratory study would be of most value in confirming your clinical suspicion?

Answer 26

ESR

Question 27

A 65 year-old female presents with a 1-month history of shoulder and hip pain. She also reports a 10-pound unintentional weight loss and low-grade fever during that time. On exam, strength is 5/5 throughout, but ROM is limited in the shoulders. You suspect that the pt has polymyalgia rheumatica. What is the most serious potential complication of this disease, and what is the gold standard for its diagnosis?

Answer 27

Temporal arteritis, temporal artery biopsy