Deck 14: Musculoskeletal System

Question 1

Your patient is a 40-year-old baseball player who needs his yearly physical examination. He reports a 5-year history of chronic lower back pain due to spinal stenosis. Which of the following findings indicate spinal stenosis?

A) Lumbar x-ray demonstrates vertebral osteophytes
B) Positive straight leg raising sign on physical examination
C) Lumbar magnetic resonance imaging shows decreased intervertebral space
D) A and C

Answer 1

A and C

Question 2

Whenever a patient presents with acute nontraumatic shoulder pain, the clinician should make sure to exclude a:

A) Cardiac or respiratory origin of symptoms
B) Gastrointestinal condition
C) Cervical spine disorder
D) All of the above

Answer 2

All of the above

Question 3

A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness on palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses:

A) Osteoarthritis
B) Rheumatoid arthritis
C) Fibromyalgia
D) Polymyalgia rheumatica

Answer 3

Fibromyalgia

Question 4

A 34-year-old female presents with fever, general malaise, fatigue, arthralgias, and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein, and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems:

A) Fibromyalgia
B) Sarcoidosis
C) Systemic lupus erythematosus
D) Rheumatoid arthritis

Question 5

Which of the following serological diagnostic tests is most specific for rheumatoid arthritis?

A) C-reactive protein (CRP)
B) Rheumatoid factor (RF)
C) Antinuclear antibodies (ANAs)
D) Anti-citrullinated protein autoantibodies (ACPAs)

Question 6

A 56-year-old male presents with complaints of right-sided neck pain with radiation down the right arm into the right index finger and thumb. He reports a recent fall from a scaffold while painting on the job. On physical examination, you note a 0/4 biceps reflex on the right compared to 2/4 on the left and 1/5 grip strength of the right hand compared to 5/5 of the left hand. Which of the following is a test that can be performed to assist in the diagnosis of cervical disk herniation?

A) Spurling's sign
B) Apley's sign
C) Lhermitte's sign
D) A and C

Question 7

Sarcoidosis is an autoimmune disease that presents with nonspecific symptoms of fatigue, fever, and arthralgias. Which of the following signs should raise suspicion of this disorder?

A) Facial rash across nose and cheeks
B) Bilateral hilar lymphadenopathy on chest x-ray
C) Specific tender points on the body
D) Swelling of metacarpophalangeal joints

Question 8

A 75-year-old female patient complains of fatigue, as well as pain and stiffness of the shoulders and neck. There is no history of trauma or exercised-induced pain. Medications include a beta blocker and ACE inhibitor. Medical history includes giant cell arteritis and Raynaud's syndrome. Physical examination is unremarkable. There is no swelling or erythema over the temporal arteries. There is no swelling, erythema, limitation in range of motion, or point tenderness over the shoulder joints. The neck has normal range of motion and no tenderness or swelling. Which of the following disorders should be included in the list of possible diagnoses?

A) Rheumatoid arthritis
B) Polymyalgia rheumatic
C) Drug-induced myalgia
D) Fibromyalgia

Question 9

Your patient is a 55-year-old male who presents with sudden, severely tender, swollen, erythematous elbow. The patient reports that he experienced similar symptoms in the past. You note the right elbow has a swollen, tender, soft, 3 cm round nodule. The clinician should recognize these are signs and symptoms of:

A) Gouty arthritis
B) Rheumatoid arthritis
C) Epicondylitis
D) Reiter's syndrome

Question 10

Which of the following disorders has a strong genetic component and causes loss of spinal mobility and progressive erosion of the sacroiliac joint?

A) Syringomyelia
B) Spinal stenosis
C) Ankylosing spondylitis
D) None of the above

Question 11

A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon?

A) Straight leg raising sign
B) Lumbar herniated disc on x-ray
C) Loss of left-sided patellar reflex
D) Urinary incontinence

Question 12

A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of:

A) Osteoarthritis
B) Rheumatoid arthritis
C) Scleroderma
D) Sarcoidosis

Question 13

A 17-year-old male complains of severe right knee pain. He was playing football when he heard a pop at the moment of being tackled and his knee gave way from under him. On physical examination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate:

A) Knee ligament injury
B) Osgood-Schlatter disease
C) Prepatellar bursitis
D) Chondromalacia patella

Question 14

A 60-year-old female patient complains of pain in the hands that is worse in the morning. On physical examination, the thumb metacarpophalangeal joint is swollen on both hands. There is swelling of the proximal and distal interphalangeal joints bilaterally. These are typical signs of:

A) Osteoarthritis
B) Rheumatoid arthritis
C) Normal aging
D) Gouty arthritis

Question 15

Muscle strength is assessed by:

A) Having the patient move their muscle against the clinician's resistance
B) Examining how the patient performs active range of motion
C) Passively stretching the patient's muscle
D) Performing passive range of motion on the patient's muscle

Question 16

A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis?

A) Joint infection
B) Chondromalacia patella
C) Prepatellar bursitis
D) All of the above

Question 17

Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally, and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect?

A) Beta blocker
B) ACE inhibitor
C) Statin medication
D) Metformin

Question 18

To assess muscle tone, the clinician should:

A) Palpate the patient's muscle as the muscle is passively stretched
B) Examine how the patient performs active range of motion
C) Palpate the muscles, comparing side to side
D) A and C

Question 19

Which of the following infectious diseases is often the cause of a reactive arthritis?

A) Gonococcus infection
B) Beta-hemolytic streptococcus infection
C) Chlamydia infection
D) Norovirus infection

Question 20

Which of the following microorganisms causes Lyme disease?

A) Clostridia
B) Shigella
C) Borrelia
D) Epstein-Barr virus

Question 21

Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician's resistance. These are typical signs of:

A) Carpal tunnel syndrome
B) Osteoarthritis of the wrist
C) Epicondylitis
D) Cervical osteoarthritis

Question 22

A 3-year-old male toddler complains of sudden arm pain. The mother indicated that pain occurred suddenly while his 9-year-old sister was helping him get dressed. The child presents with the arm flexed while protecting his elbow. On physical examination, there is tenderness along the radius with no swelling or evidence of trauma. This is a typical history of:

A) Nursemaid's elbow
B) Epicondylitis
C) Smith fracture
D) Nursery pseudo-fracture

Question 23

A 46-year-old administrative assistant complains of pain in the wrist that radiates into the palm and into the fingers. The clinician can test the patient for carpal tunnel syndrome by eliciting which of the following signs?

A) Phalen's sign
B) Apley's sign
C) Finkelstein sign
D) Lhermitte's sign

Question 24

A 34-year-old baseball pitcher complains of pain in the left shoulder, particularly with raising the left arm when attempting to pitch. Which of the following is a test used to diagnose rotator cuff injury?

A) Apley's test
B) Trousseau test
C) Hawkin's test
D) A and C

Question 25

A 33-year-old male marathon runner presents with knee pain. Which of the following tests is positive if the meniscus of the knee is torn?

A) McMurray's test
B) Straight leg raising sign
C) Anterior drawer sign
D) Lachman test

Question 26

Which of the following describes the pathology of De Quervain's tenosynovitis?

A) Irritation of a tendon located on the radial side of the wrist, near the thumb
B) Impingement of the median nerve, causing pain in the palm and fingers
C) Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist
D) Ulnar nerve compression at the olecranon process

Question 27

Which of the following is a sign of glenohumeral instability?

A) Positive Lachman test
B) Negative Spurling's sign
C) Positive apprehension test
D) Negative Lhermitte's sign

Question 28

A 23-year-old female presents with ankle pain due to a fall while walking on ice 1 hour ago. You watch her limp as she walks into the emergency room. On physical examination, the ankle is erythematous, swollen, and tender to touch. The patient cannot stand on the affected ankle. Range of motion is severely limited on inversion of the ankle. On palpation, there is no pain with pressure on the medial or lateral malleolus. Should this patient be sent for ankle x-rays according to the Ottawa ankle rules?

A) No, the ankle shows no tenderness over the medial or lateral malleolus
B) Yes, the patient is unable to bear weight on the ankle
C) Yes, ankle range of motion is limited
D) No, range of motion of the ankle is not limited in all planes

Question 29

A 36-year-old female patient complains of foot pain when she wears high heels. There is no history of trauma or arthritis. On physical examination, there is tenderness at the space between the third and fourth metatarsal bones. Foot x-ray shows no evidence of stress fracture. This history is typical of:

A) Plantar fasciitis
B) Morton's neuroma
C) Achilles tendonitis
D) None of the above

Question 30

What is the most common cause of hip pain in older adults?

A) Osteoporosis
B) Osteoarthritis
C) Trauma due to fall
D) Trochanteric bursitis

Question 31

A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an x-ray of the feet be ordered?

A) Yes, there is tenderness over the fifth metatarsal
B) No, there is not tenderness over the navicular bone
C) Yes, the patient cannot bear weight on the foot
D) A and C