ICM Final MSK Practice Questions
Your previous patient has tried your recommended non-pharmacologic measures and NSAIDs at max daily dosing with limited relief. They are interested in trying something else for their symptoms. Which of the following is the next best treatment recommendation for your patient? A) Infliximab (Remicade) B) Cyclobenzaprine (Flexeril) C) Acetaminophen (Tylenol) D) Prednisone (Deltasone) E) Diclofenac (Voltaren)
A) Infliximab (Remicade)
A 60-year-old female with a history of joint pain presents with an acutely swollen and painful right knee. Synovial fluid analysis reveals a WBC count of 1200/microL. What is the most likely characterization of her synovial fluid based on the WBC count? A) Noninflammatory B) Inflammatory C) Infectious D) Arthritic E) Putrid
A) Noninflammatory
A 50-year-old presents to the Emergency Department with severe back pain that began suddenly when lifting a heavy box at work. They report bilateral leg weakness, urinary incontinence, and loss of sensation in the perianal region and inner thighs. Which of the following neurological deficits is most indicative of your suspected diagnosis? A) Saddle anesthesia B) Lhermitte's sign C) Diminished sensation in lower extremities D) Hyperreflexia of lower extremities E) Unilateral radicular leg pain
A) Saddle anesthesia
Which of the following is an injury that affects the ligamentous tissue? A) Sprain B) Strain C) Spasm D) Herniation E) Fracture
A) Sprain
A 57-year-old female patient presents to the post-operative clinic for a follow-up after undergoing total knee replacement surgery 5 days ago. She reports moderate pain around the surgical site but denies any signs of infection or excessive swelling. The patient has a history of mild chronic kidney disease and is concerned about the potential adverse effects of pain medication. Which of the following medications, based on its mechanism of action and routes of administration, is most appropriate to manage this patient's post-operative pain while considering her medical history? A) Topical diclofenac B) Oral naproxen C) Oral celecoxib D) IV ibuprofen E) Oral prednisone
A) Topical diclofenac
Your ICM professor has been having issues!!! It started about 4 months ago...she started to develop an aching discomfort in her left wrist that keeps getting worse. It is especially bothersome because it is waking her up at night and she has tingling into her thumb and index finger. She denies any injury. What is the MOST likely diagnosis? A. Carpal tunnel syndrome B. Cubital tunnel syndrome C. De Quervain's tenosynovitis D. Cervical radiculopathy E. Bursitis
A. Carpal tunnel syndrome
A 50-year-old male with a history of Sjögren's syndrome complains of generalized fatigue and arthralgia. He is currently using artificial tears for dry eyes and pilocarpine for dry mouth. Which of the following additional treatments is most likely to improve his systemic symptoms? (potentially multiple answers) A. Glucocorticoids B. Nonsteroidal anti-inflammatory drugs (NSAIDs) C. Hydroxychloroquine D. Cyclophosphamide E. Rituximab
A. Glucocorticoids C. Hydroxychloroquine D. Cyclophosphamide
A 15-year-old male presents with progressively worsening pain in his right thigh for the past few weeks. He denies any history of trauma. Physical examination reveals a tender mass in the proximal right thigh. X-ray shows a "sunburst" pattern and Codman's triangle. What is the most likely diagnosis? A. Osteosarcoma B. Ewing's sarcoma C. Chondrosarcoma D. Osteoblastoma E. Chondroblastoma
A. Osteosarcoma
You are evaluating a 62-year-old patient in the ER for acute left knee pain. She has a history of degenerative joint disease and has been contemplating a total knee replacement with her orthopedic surgeon. About 5 days ago her specialist drained a recurring effusion in the office which initially gave her relief. She now describes abrupt increase of swelling, redness and pain in her knee which is very painful to move. What is the MOST likely diagnosis? A. Septic arthritis B. Gouty arthritis C. Pseudogout arthritis D. Rheumatoid arthritis E. Psoriatic arthritis
A. Septic arthritis
A 21-year-old female presents for evaluation of a left knee injury. A collegiate soccer player, she injured this joint during a practice last evening. She notes that it happened quickly, but from what she recalls, when she planted her foot to stop the rest of her upper body momentum kept going forward. She complaints of severe pain, swelling, impaired movement and difficulty with weight-bearing. What is the MOST likely anatomical injury that she has sustained? A.ACL sprain/tear B.PCL sprain/tear C.MCL sprain/tear D.LCL sprain/tear E.Meniscal injury
A.ACL sprain/tear
A 45-year-old patient presents with a painless lump on the dorsum of their wrist that has gradually increased in size over the past few months. On examination, the lump is non-tender, mobile, and transilluminates. What is the most likely diagnosis? A. Ganglion cyst B. Lipoma C. Synovial sarcoma D. Giant cell tumor E. Osteochondroma
Answer: A. Ganglion cyst
A 55-year-old male presents with severe lower back pain that radiates down his left leg. He describes numbness and tingling in the same leg. Physical examination reveals decreased sensation and weakness in the left foot dorsiflexion and great toe extension. Straight leg raise test is positive. What is the most likely diagnosis? A. Lumbar disc herniation B. Sacroiliitis C. Lumbar spinal stenosis D. Sciatica E. Piriformis syndrome
Answer: A. Lumbar disc herniation
A 45-year-old female presents with chronic hip pain exacerbated by weight-bearing activities. She describes a dull ache in the groin area and difficulty with internal rotation of the hip. Physical examination reveals decreased range of motion and tenderness to palpation. Which of the following is the most likely diagnosis? A. Osteoarthritis B. Rheumatoid arthritis C. Septic arthritis D. Avascular necrosis E. Osteoporosis
Answer: A. Osteoarthritis
A 65-year-old male presents to the emergency department with sudden onset severe chest pain radiating to his back. He describes it as tearing in nature. On examination, his blood pressure is significantly different in both arms. Which of the following imaging modalities is the most appropriate for initial evaluation of suspected aortic dissection? A) Plain film chest X-ray B) CT angiography C) MRI of the chest D) Echocardiogram E) Ultrasound of the chest
Answer: B) CT angiography
A 55-year-old woman with a history of heavy smoking presents with worsening shortness of breath, chronic cough, and unintentional weight loss. On physical examination, decreased breath sounds are noted on the right side of the chest. Which imaging study is most appropriate for the initial evaluation of suspected lung cancer? A) Chest X-ray B) Chest CT scan C) PET scan D) MRI of the chest E) Lung ultrasound
Answer: B) Chest CT scan
A 60-year-old male presents with chronic pain and stiffness in multiple joints, particularly in the mornings. He also has nail changes consistent with pitting and onycholysis. Additionally, he reports a family history of similar symptoms. Which of the following is the most likely diagnosis? A) Rheumatoid arthritis B) Psoriatic arthritis C) Fibromyalgia D) Osteoarthritis E) Ankylosing spondylitis
Answer: B) Psoriatic arthritis
A 55-year-old male presents with chronic, progressive pain and stiffness in his hands and wrists. He states that the pain is worse in the mornings and improves with activity. On examination, there are deformities noted in his hands with ulnar deviation of the fingers and swan neck deformities. Laboratory investigations show elevated rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
Answer: B) Rheumatoid arthritis
A 75-year-old male presents with recurrent episodes of joint pain and swelling in his hands and knees. He describes the pain as being worse in the morning and improving throughout the day. On examination, there are nodules present over his distal interphalangeal joints. Laboratory investigations reveal elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
Answer: B) Rheumatoid arthritis
A 55-year-old male presents with a sudden onset of severe, tearing chest pain that radiates to the back. On examination, blood pressure is different in both arms, and there is a discrepancy in pulse volume. What is the most likely diagnosis? A. Myocardial infarction B. Aortic dissection C. Pulmonary embolism D. Pericarditis E. Esophageal rupture
Answer: B. Aortic dissection
A 9-year-old male presents with left hip pain and a limp of 2 months' duration. He denies any recent history of trauma. On examination, there is limited internal rotation of the left hip and pain with passive range of motion. Radiographs demonstrate posterior displacement of the femoral head relative to the femoral neck. Which of the following is the most appropriate next step in management? A. Immediate surgical stabilization B. Closed reduction under anesthesia C. Initiation of non-weight-bearing activity D. Physical therapy referral E. Serial observation with repeat radiographs in 4-6 weeks
Answer: B. Closed reduction under anesthesia
A 50-year-old male with a history of hypertension presents to the emergency department with excruciating pain and swelling in his left forearm following a fall. He is unable to extend his fingers or flex his wrist. Pulse and sensation distal to the injury are intact. What condition should be suspected? A. Radial nerve injury B. Compartment syndrome C. Ulnar artery thrombosis D. Ruptured biceps tendon E. Rhabdomyolysis
Answer: B. Compartment syndrome
A 14-year-old male complains of constant pain in his right leg for several weeks. There's no history of recent trauma. Physical examination reveals localized swelling and warmth in the right leg. X-ray demonstrates "onion-skin" appearance. What is the most likely diagnosis? A. Osteosarcoma B. Ewing's sarcoma C. Chondrosarcoma D. Osteoblastoma E. Chondroblastoma
Answer: B. Ewing's sarcoma
A 25-year-old male complains of increasing pain in his left distal femur. Imaging reveals a lytic lesion with a "soap-bubble" appearance and cortical thinning. Biopsy shows a mixture of osteoclast-like giant cells and mononuclear stromal cells. Which of the following is the MOST likely diagnosis? A. Chondroblastoma B. Giant cell tumor of bone C. Osteosarcoma D. Aneurysmal bone cyst E. Osteochondroma
Answer: B. Giant cell tumor of bone
A 24-year-old female athlete presents with a history of a hyperextension injury to her left knee during a gymnastics routine. On examination, there is tenderness over the posterior aspect of the knee, a positive posterior drawer test, and an audible "pop" during the injury. What ligament is likely involved? A. ACL B. PCL C. MCL D. LCL E. Meniscus
Answer: B. PCL sprain/tear
A 28-year-old rugby player presents to the clinic with a history of a recent injury during a match. He describes a popping sensation followed by severe pain in his shoulder, which has since become swollen and immobile. On examination, there is a flattened deltoid contour and an obvious deformity in the shoulder region. Which of the following injuries is most likely? A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
Answer: B. Shoulder dislocation
A 35-year-old construction worker presents to the clinic after falling off a ladder at a job site. He complains of severe pain and deformity in his shoulder area. On examination, there is a prominent bump on the superior aspect of the shoulder, and the patient holds his arm slightly abducted and internally rotated. Which of the following injuries is most likely? A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
Answer: B. Shoulder dislocation
A 30-year-old female presents with recurrent joint pain, particularly in the wrists and knees, associated with morning stiffness lasting over an hour. She also reports eye redness and blurry vision. On examination, there is tenderness and swelling in multiple joints, along with bilateral conjunctivitis. What is the most likely diagnosis? A. Rheumatoid arthritis B. Systemic lupus erythematosus C. Ankylosing spondylitis D. Sjögren's syndrome E. Reactive arthritis
Answer: B. Systemic lupus erythematosus
A 32-year-old female presents with widespread musculoskeletal pain, fatigue, and sleep disturbances for the past several months. She reports experiencing tenderness at specific tender points upon palpation. She has a history of depression and anxiety. Which of the following is the most likely diagnosis? A) Rheumatoid arthritis B) Psoriatic arthritis C) Fibromyalgia D) Systemic lupus erythematosus E) Ankylosing spondylitis
Answer: C) Fibromyalgia
A 60-year-old female presents with sudden onset severe pain and swelling in her right knee. She denies any recent trauma or injury. On examination, her knee is warm to touch, and aspiration of synovial fluid reveals positively birefringent, needle-shaped crystals under polarized light microscopy. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
Answer: C) Gout
A 55-year-old man with a history of diabetes presents with a swollen and painful left knee. He denies any recent trauma but reports feeling unwell with fever and chills. Physical examination shows erythema and warmth over the knee joint. Synovial fluid analysis reveals a WBC count of 80,000/microL with 90% neutrophils. What is the most likely diagnosis? A) Crystal-induced arthritis B) Osteoarthritis C) Septic/infectious arthritis D) Rheumatoid arthritis E) Ankylosing spondylitis
Answer: C) Septic/infectious arthritis
A 50-year-old man presents to the emergency department after falling onto his outstretched hand. He complains of pain and swelling over the top of his shoulder, exacerbated by overhead movements. On examination, there is tenderness and a step-off deformity at the acromioclavicular joint. Which of the following injuries is most likely? A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
Answer: C. AC sprain
A 45-year-old male presents with a gradual onset of pain and swelling behind his knee. He denies any recent trauma. On physical examination, there is a palpable, fluctuant mass with fullness noted in the popliteal fossa. He has pain with knee flexion and extension. Which of the following is the most likely diagnosis? A. Quadriceps tendonitis B. Popliteal artery aneurysm C. Baker's cyst D. Meniscal tear E. Osgood-Schlatter disease
Answer: C. Baker's cyst
A 40-year-old female presents with pain and swelling in her right hip joint. She reports increasing discomfort over the past few months. Physical examination reveals limited range of motion in the hip. X-ray shows a lobulated mass with calcifications. What is the most likely diagnosis? A. Osteosarcoma B. Ewing's sarcoma C. Chondrosarcoma D. Osteoblastoma E. Chondroblastoma
Answer: C. Chondrosarcoma
A 28-year-old male presents to the emergency department with severe pain and swelling in his right lower leg following a motorcycle accident. On examination, the leg is tense, swollen, and tender to touch. Distal pulses are intact. What is the most likely diagnosis? A. Deep vein thrombosis B. Delayed union of the fracture C. Compartment syndrome D. Rhabdomyolysis E. Ligamentous injury to the knee
Answer: C. Compartment syndrome
A 6-year-old child presents with a gradual onset of left hip and thigh pain. The pain worsens with activity and improves with rest. On physical examination, there is limited range of motion in the left hip, with pain elicited on internal rotation. Radiographs reveal flattening and sclerosis of the femoral head with joint space narrowing. What is the most likely diagnosis? A. Osteomyelitis B. Slipped capital femoral epiphysis C. Legg-Calve-Perthes disease D. Juvenile idiopathic arthritis E. Hip dysplasia
Answer: C. Legg-Calve-Perthes disease
A 35-year-old male presents to the clinic after a football match with complaints of medial knee pain and swelling. He describes a twisting injury while pivoting during a tackle. On examination, there is tenderness over the medial joint line, a positive valgus stress test, and mild effusion. What is the most probable diagnosis? A. ACL sprain/tear B. PCL sprain/tear C. MCL sprain/tear D. LCL sprain/tear E. Meniscal injury
Answer: C. MCL sprain/tear
A 55-year-old female presents with pain and swelling over her elbow. She recalls a recent episode where she had to lean on her elbows for an extended period during gardening. On examination, there is tenderness over the olecranon bursa with associated swelling. Which of the following is the most likely diagnosis? A. Tennis elbow B. Radial tunnel syndrome C. Olecranon bursitis D. Elbow osteoarthritis E. Ulnar collateral ligament sprain
Answer: C. Olecranon bursitis
A 30-year-old female presents with a sudden, severe headache that she describes as "the worst headache of her life." She reports feeling nauseous and has vomited twice since the headache started. On examination, she has nuchal rigidity and photophobia. What is the most appropriate next step in management? A. Administer analgesics and antiemetics B. Perform a lumbar puncture C. Order a head CT without contrast D. Start intravenous antibiotics E. Refer to a neurologist for further evaluation
Answer: C. Order a head CT without contrast
A 12-year-old obese male presents with left hip pain that has been worsening over the past few weeks. On examination, there is limited internal rotation of the left hip and external rotation is painful. Which of the following conditions is most likely responsible for these findings? A. Osteochondroma B. Osteosarcoma C. Slipped capital femoral epiphysis D. Osteomyelitis E. Osgood-Schlatter disease
Answer: C. Slipped capital femoral epiphysis
A 40-year-old female presents with persistent joint pain and swelling in her hands and feet. On examination, you note asymmetric involvement of the small joints of the hands and feet. She has a history of recurrent joint effusions and tophi. Which of the following is the most likely diagnosis? A) Rheumatoid arthritis B) Psoriatic arthritis C) Fibromyalgia D) Gout E) Osteoarthritis
Answer: D) Gout
A 65-year-old male presents with sudden onset severe pain and swelling in his left knee. He has a history of osteoarthritis in both knees. Imaging studies show chondrocalcinosis in the affected joint. Synovial fluid analysis reveals weakly positively birefringent, rhomboid-shaped crystals under polarized light microscopy. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
Answer: D) Pseudogout
A 70-year-old female presents with acute onset severe pain, warmth, and swelling in her right ankle joint. She denies any recent trauma or injury. On examination, the affected joint is extremely tender to touch. Aspiration of synovial fluid reveals weakly positively birefringent, rhomboid-shaped crystals under polarized light microscopy. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
Answer: D) Pseudogout
A 28-year-old female presents with a butterfly-shaped rash over her cheeks, fatigue, joint pain, and swelling. She also complains of hair loss and mouth ulcers. Laboratory investigations reveal positive antinuclear antibodies (ANA) and anti-double-stranded DNA antibodies. What is the most likely diagnosis? A) Rheumatoid arthritis B) Psoriatic arthritis C) Fibromyalgia D) Systemic lupus erythematosus E) Mixed connective tissue disease
Answer: D) Systemic lupus erythematosus
A 25-year-old female presents with complaints of progressive lateral curvature of the spine, along with uneven shoulder heights and a prominent rib hump. Which of the following physical examination findings is most suggestive of the suspected diagnosis? A) Saddle anesthesia B) Lhermitte's sign C) Diminished sensation in lower extremities D) Uneven shoulder heights E) Unilateral radicular leg pain
Answer: D) Uneven shoulder heights
A 22-year-old college football player presents to the athletic trainer with complaints of pain and swelling over the top of his shoulder after a direct blow during a game. On examination, there is tenderness over the acromioclavicular joint, and there is pain with cross-body adduction. Which of the following injuries is most likely? A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
Answer: D. AC separation
A 45-year-old office worker presents with complaints of numbness and tingling in the thumb, index, and middle fingers, often waking her up at night. On examination, you note positive Tinel's sign over the wrist. What is the most likely diagnosis? A. Cubital tunnel syndrome B. Radial tunnel syndrome C. Ulnar tunnel syndrome D. Carpal tunnel syndrome E. Lateral epicondylitis
Answer: D. Carpal tunnel syndrome
A 25-year-old marathon runner presents with severe pain and swelling in his calf muscles after a recent competition. He reports having pushed himself exceptionally hard during the race. Physical examination reveals tender, swollen calf muscles, and he is unable to bear weight on that leg. Which of the following conditions should be suspected? A. Muscle strain B. Achilles tendon rupture C. Deep vein thrombosis D. Compartment syndrome E. Osteomyelitis
Answer: D. Compartment syndrome
A 32-year-old male presents with a history of a fall while playing basketball. He experienced a direct blow to the lateral aspect of his right knee. On examination, there is tenderness over the lateral joint line, a positive valgus stress test, and swelling. Which ligament is most likely damaged in this scenario? A. ACL B. PCL C. MCL D. LCL E. Meniscus
Answer: D. LCL sprain/tear
A 17-year-old male presents with persistent pain and swelling in his right knee. He denies any significant trauma. Physical examination reveals a palpable mass around the knee joint. X-ray demonstrates a well-defined, osteolytic lesion with thinning of cortical bone. What is the most likely diagnosis? A. Osteosarcoma B. Ewing's sarcoma C. Chondrosarcoma D. Osteoblastoma E. Chondroblastoma
Answer: D. Osteoblastoma
A 50-year-old male presents with Raynaud's phenomenon, dysphagia, and tightening of the skin on his fingers and face. He also complains of heartburn and difficulty swallowing solid foods. Which of the following autoimmune conditions is most commonly associated with these findings? A) Rheumatoid arthritis B) Psoriatic arthritis C) Fibromyalgia D) Sjögren's syndrome E) CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia)
Answer: E) CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia)
A 68-year-old male presents with acute onset of breathlessness and pleuritic chest pain. He has a history of deep vein thrombosis (DVT) two years ago for which he was on warfarin therapy, but he has been non-compliant with his medications. On examination, he is tachypneic, tachycardic, and has decreased breath sounds on the right side. What is the most appropriate initial diagnostic test? A. Pulmonary angiography B. Echocardiography C. D-dimer assay D. Ventilation-perfusion (V/Q) scan E. Chest X-ray
Answer: E. Chest X-ray
A 40-year-old cyclist presents to the emergency department after falling off his bike onto his outstretched arm. He complains of sharp pain over the collarbone and difficulty lifting his arm. On examination, there is localized tenderness and swelling over the clavicle, with palpable crepitus. Which of the following injuries is most likely? A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
Answer: E. Clavicle fracture
A 35-year-old tennis player complains of pain on the lateral aspect of the elbow, exacerbated by gripping activities and wrist extension. There is tenderness over the lateral epicondyle and pain with resisted wrist extension. What is the most likely diagnosis? A. Medial epicondylitis B. Carpal tunnel syndrome C. Radial tunnel syndrome D. Cubital tunnel syndrome E. Lateral epicondylitis
Answer: E. Lateral epicondylitis
A 40-year-old cyclist presents with pain and tenderness over the lateral aspect of the elbow. He describes a recent fall from his bike onto an outstretched hand. On examination, there is tenderness over the lateral epicondyle and pain with resisted wrist extension. What is the most likely diagnosis? A. Medial epicondylitis B. Cubital tunnel syndrome C. Radial head injury D. Carpal tunnel syndrome E. Lateral epicondylitis
Answer: E. Lateral epicondylitis
A 50-year-old golfer presents with pain localized to the medial aspect of the elbow. The pain is aggravated by gripping activities and wrist flexion. On examination, there is tenderness over the medial epicondyle and pain with resisted wrist flexion. What is the most likely diagnosis? A. Lateral epicondylitis B. Cubital tunnel syndrome C. Radial tunnel syndrome D. Carpal tunnel syndrome E. Medial epicondylitis
Answer: E. Medial epicondylitis
A 30-year-old male presents with a history of sudden onset pain and swelling in his right knee after a twisting injury during a tennis match. He reports feeling a "pop" at the time of injury. On examination, there is joint line tenderness, a positive McMurray test, and limited range of motion. What is the most likely diagnosis? A. ACL sprain/tear B. PCL sprain/tear C. MCL sprain/tear D. LCL sprain/tear E. Meniscal injury
Answer: E. Meniscal injury
A 62-year-old male with a history of diabetes presents with a sudden onset of unilateral foot pain and redness. On examination, the foot is swollen and warm to touch. Lab results show an elevated white blood cell count. What is the most likely diagnosis? A. Diabetic neuropathy B. Cellulitis C. Gout D. Deep vein thrombosis E. Osteomyelitis
Answer: E. Osteomyelitis
A 42-year-old female is brought to the emergency department by EMS after being found unconscious at home. She has a history of alcohol abuse. On examination, her urine appears dark, and laboratory tests reveal elevated creatine kinase levels. What condition should be of immediate concern? A. Acute pancreatitis B. Drug overdose C. Ruptured ovarian cyst D. Acute liver failure E. Rhabdomyolysis
Answer: E. Rhabdomyolysis
An 8-year-old presents for their yearly well child visit. The child's parent notes that the child has complained of intermittent back pain, occasionally interfering with their normal activities. On exam, a curvature of the spine is noted. What Cobb angle is considered the threshold to intervene with bracing in this growing child? A) > 10 degrees B) > 30 degrees C) > 45 degrees D) > 15 degrees E) > 55 degrees
B) > 30 degrees
A 32-year-old male has been diagnosed with a chronic inflammatory condition that primarily affects his spine and sacroiliac joints. He complains of back pain and stiffness, which improves with exercise but not with rest. He has been managed with NSAIDs with partial relief. The patient is interested in exploring treatments that could modify the course of his disease. Which category of medication would be most appropriate to consider as part of his long-term management plan to potentially halt disease progression? A) Beta-blockers B) Disease-Modifying Antirheumatic Drugs (DMARDs) C) Calcium channel blockers D) Proton pump inhibitors E) Statins
B) Disease-Modifying Antirheumatic Drugs (DMARDs)
In patients with suspected psoriatic arthritis, which of the following laboratory findings is most commonly associated with the disease? A) Elevated rheumatoid factor B) Negative rheumatoid factor C) Low erythrocyte sedimentation rate (ESR) D) High serum uric acid E) Positive antinuclear antibody (ANA)
B) Negative rheumatoid factor
A 45-year-old woman presents with a persistent dry mouth, difficulty swallowing dry foods, and bilateral parotid gland enlargement. She also reports experiencing dry eyes and joint pain. Which of the following is the most appropriate diagnostic test to confirm the suspected diagnosis? (2 possible answers) A. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies B. Anti-nuclear antibodies (ANA) and anti-Ro/SSA and anti-La/SSB antibodies C. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) D. Oral glucose tolerance test E. Schirmer's test and salivary gland biopsy
B. Anti-nuclear antibodies (ANA) and anti-Ro/SSA and anti-La/SSB antibodies and E Schirmer's test and salivary gland biopsy is more invasive but can be done
A 50-year-old obese male presents with sudden onset dyspnea and pleuritic chest pain. On examination, he is tachypneic and hypoxic. Arterial blood gas analysis shows a decreased partial pressure of oxygen (PaO2) and increased partial pressure of carbon dioxide (PaCO2). Which of the following is the most likely diagnosis? A. Pneumothorax B. Pulmonary embolism C. Acute respiratory distress syndrome (ARDS) D. Chronic obstructive pulmonary disease (COPD) exacerbation E. Asthma exacerbation
B. Pulmonary embolism
You are assessing a 72-year-old female for assessment of an injury to her right upper extremity. She states that she tripped and landed on her right outstretched hand. She is complaining of pain, swelling and impaired range of motion. Given the diagnosis of scaphoid fracture what is the best means to immobilize this injury? A. ACE wrap B. Thumb spica splint C. Volar splint D. Ulnar gutter splint E. Sling and swathe
B. Thumb spica splint
A 45-year-old woman presents with widespread pain, fatigue, and difficulty concentrating. She reports experiencing these symptoms for at least three months. On physical examination, there are multiple tender points upon palpation. Laboratory investigations reveal no abnormalities. Which of the following is the most appropriate initial pharmacological intervention? A. Prescribe high-dose corticosteroids for immediate symptom relief B. Administer opioid analgesics to manage pain C. Initiate treatment with pregabalin or duloxetine D. Refer the patient to a pain management clinic for procedural interventions E. Suggest intensive physical therapy with a focus on resistance training
Correct Answer: C. Initiate treatment with pregabalin or duloxetine
What does a Complete Blood Count (CBC) test measure? A) Blood sugar levels B) Cholesterol levels C) Different components of blood D) Liver function E) Kidney function
C) Different components of blood
A 27-year-old cisgender male presents to your primary care office with a chief complaint of back pain and stiffness x 2 months. It is worse in the morning and seems to improve as he gets up and moving throughout the day. He also reports fatigue and sensitivity to light. Based on your suspected diagnosis, which of the following laboratory tests is most helpful to support your diagnosis of this condition? A) RF B) ANA C) HLA-B27 D) ESR E) CRP
C) HLA-B27
What are Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) tests primarily used to measure? A) Blood glucose levels B) Kidney function C) Inflammatory activity in the body D) Oxygen carrying capacity of blood E) Nutritional status
C) Inflammatory activity in the body
Which of the following does a Basic Metabolic Panel (BMP) primarily assess? A) Heart function B) Lung function C) Kidney function D) Brain function E) Immune system function
C) Kidney function
What additional information does a Comprehensive Metabolic Panel (CMP) provide compared to a Basic Metabolic Panel (BMP)? A) Blood cell counts B) Hormone levels C) Liver function tests D) Nutritional status E) Thyroid function tests
C) Liver function tests
A 45-year-old male presents with a 6-month history of morning stiffness lasting more than 30 minutes, worsening with rest and improving with activity. He also reports a history of psoriasis. On examination, you note asymmetric swelling of his distal interphalangeal joints and dactylitis of the left third toe. Which of the following is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Psoriatic arthritis D) Gout E) Lyme disease
C) Psoriatic arthritis
A 45-year-old male is evaluated for a swollen, red, and hot left knee. Synovial fluid analysis shows a WBC count of 55,000/microL with 80% neutrophils. What does this finding most likely suggest? A) Noninflammatory process B) Inflammatory arthritis C) Septic/infectious arthritis D) Hemarthrosis E) Traumatic effusion
C) Septic/infectious arthritis
A 50-year-old woman with a diagnosis of fibromyalgia presents with persistent widespread pain, fatigue, and sleep disturbance. She has tried over-the-counter pain medications with little relief. Considering the current management guidelines for fibromyalgia, which of the following is the most appropriate initial treatment plan for this patient? A. High-dose corticosteroids B. Opioid analgesics C. Pregabalin or duloxetine D. Immediate referral for surgical evaluation E. Intensive aerobic exercise program only
C. Pregabalin or duloxetine
A 35-year-old auto-mechanic presents to your clinic for repeat evaluation of his right lower leg. Three days ago, a jack gave way and the front end of a vehicle fell, crushing his right leg. He was evaluated and diagnosed with a non-displaced fracture of his mid-shaft tibia. Given the intact fibula it was determined that he did NOT need operative repair. He is to follow-up with orthopedics tomorrow BUT is re-presenting with marked increased pain at the site of injury despite not bearing weight and keeping leg elevated in his ER applied splint. What is the MOST CONCERNING possible diagnosis? A.Patient intolerance of pain B.Delayed displacement of mid-shaft tibial fracture C.Compartment syndrome D.Rhabdomyolysis E.Secondary effusion of left knee
C.Compartment syndrome
A 67-year-old patient presents for evaluation of right knee pain. She states that she is very used to some chronic discomfort as she has osteoarthritis in that joint which makes her knee stiff in the morning and when she first stands up. She did extra walking, including some hills, on vacation with her family last week. She denies any trauma. The pain is located just inferior to her medial joint line, which is slightly swollen and tender to touch. What is the most likely diagnosis? A.Acute MCL sprain B.Medial meniscal tear C.Pes anserine bursitis D.Pathologic tibial fracture E.Baker's cyst
C.Pes anserine bursitis
An 8-year-old patient presents to the ER for assessment of a right wrist injury. He was attempting to ice skate but fell onto a right outstretched hand. On exam is swelling and tenderness, and the x-ray reveals this image. What is the BEST description of the radiograph? A.Salter I fracture of distal radius B.Salter II fracture of distal radius C.Salter III fracture of distal radius D.Salter IV fracture of distal radius E.Salter V fracture of distal radius
C.Salter III fracture of distal radius
A 55-year-old woman presents with a two-year history of worsening digital cyanosis, episodic finger pallor followed by erythema upon cold exposure, and difficulty swallowing solid foods. She also reports thickening of the skin on her fingers. Physical examination reveals calcinosis cutis on her fingers, telangiectasias on her face, and mild sclerodactyly. ANA and anti-centromere antibodies (ACAs) are positive. Which of the following is the most likely diagnosis? A. Systemic lupus erythematosus (SLE) B. Rheumatoid arthritis (RA) C. Scleroderma (diffuse-Systemic sclerosis) D. Dermatomyositis E. CREST syndrome
E. CREST syndrome
A 38-year-old male complains of persistent fatigue, cognitive difficulties, and widespread body pain that has been present for over six months. He mentions that his symptoms significantly impair his daily activities. On examination, there are no signs of joint inflammation or muscle weakness. Which of the following criteria is LEAST required to establish a diagnosis according to the 2010 ACR guidelines for Fibromyalgia? A. Presence of symptoms for at least three months B. A Widespread Pain Index (WPI) score above 7 C. A Symptom Severity (SS) scale score above 5 D. Evidence of another underlying condition that explains the symptoms E. Positive findings on tender point examination
E. Positive findings on tender point examination
You are evaluating a 13-year-old female for ongoing left knee pain x months. She denies injury but describes mild discomfort and minimal swelling. The x-ray demonstrates this finding. Which of the following is the MOST likely diagnosis? A. Osteosarcoma B. Ewing's sarcoma C. Chondrosarcoma D. Osteoblastoma E. Chondroblastoma
E.Chondroblasto ma
A 35-year-old male presents with complaints of widespread musculoskeletal pain, fatigue, and sleep disturbances for the past six months. Physical examination reveals multiple tender points upon palpation. Laboratory investigations, including complete blood count and inflammatory markers, are within normal limits. Which of the following is the most appropriate next step in management? A. Initiation of high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) B. Prescription of opioid analgesics for pain relief C. Start a trial of amitriptyline for pain modulation and improved sleep D. Immediate referral for orthopedic consultation E. Advise the patient to increase physical activity with a focus on low-impact exercises
Correct Answer: C. Start a trial of amitriptyline for pain modulation and improved sleep
A 35-year-old woman presents with a swollen and painful right knee. She recently had a urinary tract infection and developed conjunctivitis. On examination, there is tenderness and warmth over the knee joint. Synovial fluid analysis reveals a WBC count of 30,000/microL with 70% neutrophils. What is the most likely diagnosis? A) Reactive arthritis B) Rheumatoid arthritis C) Septic/infectious arthritis D) Osteoarthritis E) Gouty arthritis
Answer: A) Reactive arthritis
A 40-year-old man presents with asymmetric oligoarthritis involving his knees and ankles. He recently had diarrhea and urethritis. On examination, there is tenderness and swelling over the affected joints. Synovial fluid analysis reveals a WBC count of 20,000/microL with 60% neutrophils. What is the most likely diagnosis? A) Reactive arthritis B) Psoriatic arthritis C) Septic/infectious arthritis D) Osteoarthritis E) Gouty arthritis
Answer: A) Reactive arthritis
A 28-year-old male presents to the emergency department after a skiing accident. He reports a sudden twisting motion in his right knee followed by a popping sound. On examination, there is tenderness along the joint line, a positive anterior drawer test, and a feeling of instability. Which of the following structures is most likely injured? A. ACL sprain/tear B. PCL sprain/tear C. MCL sprain/tear D. LCL sprain/tear E. Meniscal injury
Answer: A. ACL sprain/tear
A 13-year-old male presents to the emergency department with acute-onset left hip pain and an inability to bear weight on the affected limb. He denies any history of trauma or previous hip pain. On physical examination, there is limited range of motion of the left hip, especially in abduction and internal rotation. Which of the following radiographic findings is most consistent with the suspected diagnosis? A. Crescent sign B. Periosteal reaction C. Codman triangle D. Joint space narrowing E. Slipped capital femoral epiphysis
Answer: A. Crescent sign
A 30-year-old construction worker complains of severe pain and weakness in his arms and legs after being trapped under a collapsed structure for several hours. Upon examination, he is found to have swollen and tender muscles, particularly in his arms and thighs. Laboratory tests show elevated levels of serum myoglobin and creatine kinase. What is the most likely diagnosis? A. Crush syndrome B. Peripheral neuropathy C. Sickle cell crisis D. Compartment syndrome E. Osteomyelitis
Answer: A. Crush syndrome
A 45-year-old male presents with sudden-onset severe pain and swelling in his right calf. He denies any recent trauma but reports prolonged immobility due to a long flight last week. On examination, his right calf is tender, warm, and erythematous. Homan's sign is positive. What is the most appropriate initial diagnostic test? A. Duplex ultrasonography B. MRI of the lower leg C. D-dimer assay D. Arterial Doppler ultrasound E. Contrast venography
Answer: A. Duplex ultrasonography
Which of the following underlying causes of back pain is likely to cause midline, focal tenderness? A) Infection B) Fracture C) Direct trauma D) Cancer E) All of the above
E) All of the above
A physician is evaluating a patient with suspected inflammatory disease. To assist in diagnosis, the physician orders both an Erythrocyte Sedimentation Rate (ESR) and a C- Reactive Protein (CRP) test. What is a key difference between these two tests? A) ESR measures kidney function, while CRP measures liver function. B) ESR is specific to cardiac inflammation, while CRP is specific to joint inflammation. C) ESR directly measures the concentration of inflammation-related proteins, while CRP is an indirect measure of inflammation. D) ESR is influenced more by factors like anemia and pregnancy, while CRP is a more specific indicator of acute inflammation. E) CRP is typically used for chronic conditions, while ESR is used for acute inflammatory conditions.
D) ESR is influenced more by factors like anemia and pregnancy, while CRP is a more specific indicator of acute inflammation.
A 55-year-old male with a history of hypertension presents with pain and swelling in his left knee. He denies any recent injury but mentions the swelling has increased over the past two weeks. Aspiration of the knee joint is performed, yielding synovial fluid that is opaque and less viscous than normal. What does the gross appearance of the synovial fluid most likely suggest? A) Normal synovial fluid B) Traumatic injury to the knee C) Non-inflammatory joint disorder D) Inflammatory joint disorder E) Degenerative joint disorder
D) Inflammatory joint disorder
A 67-year-old cisgender female presents to your clinic complaining of worsening back pain. Physical exam shows a convex curvature of her cervical and thoracic spine. She has always prided herself on having great posture, so she's not sure why this has developed. She denies any other joint pain or deformities, but she does mention a family history of osteoporosis. Sagittal plane x-ray confirms a Cobb angle > 45°. What is the most likely diagnosis? A) Postural lordosis B) Scheuermann's kyphosis C) Neuromuscular scoliosis D) Osteoporotic kyphosis E) Idiopathic scoliosis
D) Osteoporotic kyphosis
A patient diagnosed with psoriatic arthritis has failed to respond to NSAIDs and physical therapy. Which of the following is the next best step in management? A) Start a TNF inhibitor B) Increase the dose of NSAIDs C) Initiate glucocorticoid injection D) Prescribe a conventional non-biologic DMARD, such as methotrexate E) Recommend surgery
D) Prescribe a conventional non-biologic DMARD, such as methotrexate
A 70-year-old male presents with a painful, swollen right wrist. He has a past medical history of hypertension and chronic knee pain. Synovial fluid analysis from the wrist reveals the presence of rectangular, weakly positively birefringent crystals under a polarized microscope that appear rhomboid-shapred. What is the most likely diagnosis? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Pseudogout E) Septic arthritis
D) Pseudogout
Which of the following is NOT a potential complication of the previous patient's condition? A) Increased risk of falls B) Neurologic symptoms secondary to nerve compression C) Dysphagia and acid reflux D) Urinary retention E) Decreased pulmonary function
D) Urinary retention
A 10-year-old male presents to the ED with his dad for evaluation of an injury to his left shoulder. He was playing in an indoor soccer game when he tripped into a side wall directly into the shoulder. He describes a moderate aching pain on the top of the shoulder with seems to be swollen and is tender to touch. He has pain with attempting to actively extend and abduct this joint. He is right-hand dominant. A. Proximal humeral fracture B. Shoulder dislocation C. AC sprain D. AC separation E. Clavicle fracture
D. AC separation
A 45-year-old female presents with a 4-month history of widespread musculoskeletal pain, fatigue, and sleep disturbances. She reports her pain is diffused and not localized to any specific joint. Laboratory tests including complete blood count, thyroid function, and rheumatoid factor are within normal limits. Which of the following is the most appropriate next step in the diagnosis of this patient? A. Order an MRI of the affected joints B. Initiate a trial of nonsteroidal anti-inflammatory drugs (NSAIDs) C. Refer to a rheumatologist for further evaluation D. Apply the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia E. Perform a tender point examination
D. Apply the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia
A patient presents to your clinic for evaluation of pain that she describes as on the outside of her right elbow. She does not recall any specific injury or trauma occurring before this pain, which has been progressively worsening over the past few weeks. What is the most likely diagnosis? A. Carpal tunnel syndrome B. Cubital tunnel syndrome C. Radial head injury D. Lateral epicondylitis E. Medial epicondylitis
D. Lateral epicondylitis
You are evaluating an 8-year-old patient in your office for left hip and leg pain. His guardian notes that the child has had a progressive limp for just over 3 months which did not initially seem to cause any discomfort. There was no known preceding trauma and he does not participate in recreational sports. The school nurse has called home twice in the past week as he is now complaining of pain during gym class. Which of the following is the MOST probable diagnosis? A. Labral tear B. Septic arthritis C. Hip-flexor tendonitis D. Legg-Calve-Perthes disease E. Slipped capital femoral epiphysis
D. Legg-Calve-Perthes disease
You are evaluating 42-year-old patient who jumped onto a metal nail on the dock near her friend's boat. Initial complaint was of a small puncture wound to the undersurface of her heel but now (4 days post injury) she is in your clinic for severe pain, impaired weight-bearing and has a fever of 101.2 degrees. As you suspect possible osteomyelitis what is the BEST imaging to visualize this diagnosis? A.None needed/clinical diagnosis B.Plain film x-ray of calcaneus C.Ultrasound plantar calcaneus D.Enhanced CT calcaneus E.MRI calcaneus
D.Enhanced CT calcaneus E.MRI calcaneus
An 83-year-old female presents to the ER for severe low back pain. She notes that this came on abruptly when she leaned over to pick up a few papers from her car trunk. On x-rays you make note of this image. (?) What is the most probable underlying problem that led to this pathology? A.Osteoarthritis B.Osteogenesis C.Osteopenia D.Osteoporosis E.Osteomyelitis
D.Osteoporosis
Based on the examples you were given throughout your asynchronous lecture, which of the followings is a DMARD and not an immunosuppressant? A) Cyclosporin B) Tacrolimus C) Azathioprine D) Mychophenolate mofetil E) Adalimumab
E) Adalimumab
