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MSK – PACKRAT EXAM WITH 100%
CORRECT ANSWERS 2024
- Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?
- Correct Answer-Supraspinatus
- A 22 year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following knee maneuvers does this represent? - Correct Answer-Lachman test
- A 12-year-old female presents for a routine sports physical. The physical exam reveals asymmetry of the posterior chest wall on forward bending. This is the most striking and consistent abnormality of which of the following? - Correct Answer-Scoliosis
- Physical exam findings in a 4-year-old child that include blue sclerae and recurrent fractures indicates which of the following? - Correct Answer-Osteogenesis imperfecta
- A 65 year-old female presents to the office with a six-month history of back pain. The patient states that she is shrinking and thinks she is about an inch shorter than she was a year ago. Serum parathyroid hormone, calcium, phosphorus, and alkaline phosphatase are all normal. Which of the following would you most likely see on the x-ray of her spine? - Correct Answer-Demineralization
- In a trauma patient who has a suspected cervical spine injury, the x-ray view that will identify the majority of significant injuries is: - Correct Answer-Lateral
- A 38-year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done? - Correct Answer-Compartment pressure
- A 32-year-old male presents with an acute onset of pain and swelling to his left ankle. On physical exam the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis? - Correct Answer- Septic arthritis
- A 32-year-old male presents with migratory arthralgias and profound malaise and fatigue. He states that one week ago he returned from a hunting trip in Pennsylvania. He is also complaining of a lesion on his left thigh that he noticed about 3 days ago. Physical exam reveals a large annular lesion with a bright red outer border and partial central clearing. Which of the following is the most likely diagnosis? - Correct Answer- Lyme disease
- A 22-year-old male presents with pain along the medial tibia. The pain initially began towards the end of soccer practice but now it is present earlier on. Physical exam reveals pain to palpation over the posterior tibialis muscle body. What is the most likely diagnosis? - Correct Answer-Shin splint
- A patient who demonstrates pain on the radial aspect of the wrist with abrupt ulnar movements while the thumb is
flexed into the closed palm most likely has: - Correct Answer- Tenosynovitis
- The most important preventive medicine recommendation for patients with osteoarthritis is which of the following? - Correct Answer-Start an exercise program
- Bone mass measurement should be considered in all women by what age? - Correct Answer-60 - 65
- A 32-year-old medical transcriptionist presents with burning and tingling in her right wrist and hand for the past month. On physical exam, Phalen's test is positive; however, there is no atrophy of the thenar eminence. Which of the following is the initial step in management of this patient? - Correct Answer-Wrist splint for 2-6 weeks
- Which of the following is the correct treatment for a Grade II ankle sprain resulting from an inversion injury? - Correct Answer-Rest, ice, compression, elevation (RICE)
- A 4-year-old boy presents to the ED after sustaining a crush injury to his distal third phalanx. Physical exam reveals
an associated nail bed injury. Which of the following is the appropriate management? - Correct Answer-Immobilize, antibiotics, orthopedics referral
- Which of the following clinical characteristics is associated with bicipital tendonitis? - Correct Answer-Aggravated by resisted supination of the forearm
- Which of the following risk factors is the most predictive for the development of osteoarthritis? - Correct Answer-Age
- The most accurate way to determine the exact degree of spinal curvature in a child with scoliosis is by which of the following? - Correct Answer-Calculation of the Cobb angle
- A 53-year-old female massage therapist presents with new onset of sudden swelling involving the right elbow. She denies previous episodes similar to this. On physical examination, the patient is afebrile. There is a 4 cm fluid-filled mass that is tender to palpation overlying the tip of the elbow with no evidence of erythema or warmth. Which of the following is the most appropriate intervention? - Correct Answer-Rest and NSAIDs
- A 30-year-old male sustains a blow to his right lateral leg during a soccer game. He complains of pain with weight bearing. Examination reveals tenderness along the lateral aspect of the right lower leg, but no point tenderness over the tibia. There is full active range of motion at the ankle, knee, and hip joints. There is no swelling or tenderness of the ankle or knee joints. Which of the following is the most likely diagnosis? - Correct Answer-Fractured fibula
- During the stages of fracture healing which of the following is responsible for producing collagen? - Correct Answer-Fibroblasts
- Which of the following medications inhibits prostaglandin synthesis in a patient with rheumatoid arthritis? - Correct Answer-Aspirin
- Which of the following mechanisms of action is most commonly associated with meniscal tears? - Correct Answer- Axial loading and rotation
- A 14-year-old patient, who fell on his outstretched hand, complains of pain along his entire arm. There is point tenderness and swelling over the midshaft of the radius. There
is significant pain with limited flexion of the elbow joint. An X- ray will most likely show which of the following fractures? - Correct Answer-Galeazzi's
- Which of the following medications used to treat rheumatoid arthritis is contraindicated in patients with chronic hepatitis? - Correct Answer-Methotrexate
- Which of the following X-ray views will show the presence of a "Scotty dog" deformity seen with spondylolysis? - Correct Answer-Oblique
- An X-ray taken on a patient complaining of wrist pain after being hit by a baseball reveals a non-displaced mid-shaft ulnar fracture. Which of the following splints is most appropriate for treatment? - Correct Answer-Sugar tong
- A 12-year-old male presents with pain in his left leg that is worse at night. Aspirin relieves the pain and the patient denies injury. On examination, there is point tenderness over the tibia, and the patient has a slight limp that favors the left leg. Radiographs show a 1 cm radiolucent nidus surrounded by osteosclerosis. Which of the following is the most likely diagnosis? - Correct Answer-Osteoid osteoma
- Which of the following interventions is initially indicated for helping to relieve the symptoms of plantar fasciitis? - Correct Answer-Arch supports
- When injecting a corticosteroid into a joint to help relieve pain, which of the following would most commonly be mixed in the syringe? - Correct Answer-Lidocaine
- A 35 year-old female presents with a long standing complaint of dry, scratchy eyes and dry mouth. She also reports dyspareunia. Labs demonstrate a positive anti-nuclear antibody and Anti-La antibodies. The patient has a prolonged Schirmer test. Which of the following classes of medicines should be avoided in treating this condition? - Correct Answer- Anticholinergics
- In the neonate, unequal thigh folds may indicate which of the following? - Correct Answer-Developmental hip dysplasia
- Which of the following is the underlying pathogen for the development of Lyme disease? - Correct Answer-Borrelia burgdorferi
- Which of the following is an extra-articular manifestation of rheumatoid arthritis? - Correct Answer-Vasculitis
- Which of the following groups is most likely to present with Duchenne's muscular dystrophy? - Correct Answer- Toddler-aged males
- Spina bifida occulta is usually detected by which initial diagnostic evaluation? - Correct Answer-X-ray of the spine
- A mother brings her 14 month-old son to your clinic. Earlier today she lifted her son by grabbing him by the wrists and pulling him up off the floor. The child is sitting in his mother's lap with his left forearm is extended and in pronation. He is refusing to move the left arm, forearm or wrist. The arm and joints appear normal with no noted deformities, edema or erythema. Distal pulses and capillary refill are normal and he can move his fingers. Which of the following is the most likely diagnosis? - Correct Answer- Nursemaid's elbow
- A patient presents with chronic back pain. On physical examination testing, the patient is found to have
abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected? - Correct Answer-Posterior column
- In adults and intravenous drug abusers, which of the following bones is most commonly affected with acute osteomyelitis? - Correct Answer-Vertebral spine
- Which of the following medications is the treatment of choice for patients with chronic gout to prevent recurrence of symptoms during its quiescent phase? - Correct Answer- Allopurinol (Zyloprim)
- Intraarticular injection of hyaluronic acid has been approved for treatment of patients with which of the following: - Correct Answer-Osteoarthritis of the knee
- A 25-year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows fracture of the proximal 1/3rd of the ulna. There is an associated anterior radial head dislocation. What is the proper name for this condition? - Correct Answer-Monteggia fracture
- A 75 year-old female presents with medial knee pain that worsens with stair climbing. Physical examination reveals swelling and point tenderness inferior and medial to the patella and tenderness overlying the medial tibial plateau. Which of the following is the most likely diagnosis? - Correct Answer-Pes anserine bursitis
- A 28-year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear lymphocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis? - Correct Answer-Septic arthritis
- A 44 year-old female presents with ongoing arthralgias and myalgias with intermittent flares of arthritis. She is found to have a malar rash that worsens with sun exposure. She is known to have progressive renal damage and has recurrent infections that areslow to respond to therapy. She takes ibuprofen (Motrin) as needed for her joint pain and takes no other medication. Which of the following tests would be the initial test recommended to screen for this diagnosis? - Correct Answer-Anti-nuclear antibodies (ANA)
- A 53-year-old patient presents with severe pain at the base of the thumb and no other finger involvement. The pain is worse with activity and lasts a short period of time following rest. There is no specific history of trauma to the thumb but the patient admits working with her hands as a typist. Which of the following is the most likely diagnosis? - Correct Answer-Osteoarthritis
- Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius? - Correct Answer-Ace wrap or anterior splinting
- An 80-year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with osteoporotic compression fracture. Which of the following treatment modalities has the potential to cause analgesia of the fracture site with its use? - Correct Answer-Calcitonin (Miacalcin) nasal spray
- Which of the following views on plain films is preferred to identify spondylolysis? - Correct Answer-Oblique
- A 15-year-old softball player presents after jamming the distal tip of her finger into severe flexion. She is unable to
extend the distal phalanx and she has pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to reveal any associated avulsion fracture. Which of the following is the treatment of choice? - Correct Answer-Continuous extension of the DIP with splinting
- A 75-year-old female falls on her outstretched arm. She sustains a humeral mid-shaft fracture. Nerve impingement occurs due to the fracture. What is the most likely physical examination abnormality that will be encountered? - Correct Answer-Inability to extend the wrist against resistance
- A 55 year-old female presents with complaints of stiffness, aching, and pain in the muscles of her neck, shoulders, lower back, hips, and thighs. There is no weakness associated with the stiffness and achiness. Laboratory evaluation shows an elevated C reactive protein and erythrocyte sedimentation rate. Which of the following medications is used to treat this condition immediately and will also serve to prevent a known complication from this disorder? - Correct Answer- Glucocorticoids
- An 18-year-old male presents with pain in his wrist after he fell off of a moving motor cycle. Physical examination reveals tenderness in the anatomic snuffbox. No fracture is
noted on plain radiography of the wrist. Which of the following is the recommended treatment for this patient? - Correct Answer-Thumb spica cast application
- A 53-year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory? - Correct Answer-Angiography
- Which of the following preventive strategies against osteoporosis-associated vertebral fractures has a known side effect of increasing the incidence of hot flashes when used in a perimenopausal female? - Correct Answer-Raloxifene (Evista)
- A 65-year-old male presents with back pain two days after he was shoveling snow. The patient complains of pain in his low back that radiates into his buttocks, posterior thigh and calf, and the bottom of his foot. There is associated numbness of his lateral and plantar surface of his foot. Which of the following disc herniations is most likely to be affected? - Correct Answer-L5/S
- Endotracheal intubation should be performed with caution in patients with which of the following underlying conditions due to the propensity to cause subluxation of C1 on C2? - Correct Answer-Rheumatoid arthritis
- A 55-year-old secretary presents with ongoing pain and numbness in her hand. These symptoms are worse at night and she must shake her hand to regain feeling in it. Which of the following physical examination signs will be present? - Correct Answer-Weakness of thumb abduction
- Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament? - Correct Answer-Supraspinatus
- Which of the following is the treatment of choice for stage one Lyme disease in a patient less than 12 years of age? - Correct Answer-Amoxicillin
- Which of the following treatment strategies is most likely to promote optimal health and limit the morbidity and
mortality associated with rheumatoid arthritis? - Correct Answer-Methotrexate
- Which of the following leads to retropatellar pain? - Correct Answer-Increased Q angle
- A 34-year-old female, with a past medical history of irritable bowel syndrome and migraines, presents with fatigue, generalized aching and stiffness of the trunk, hip, and shoulder girdles. She complains of pain and tightness in the neck and across the upper posterior shoulders. She complains of poor sleep, but denies depression. Physical examination is unremarkable except for numerous tender points on palpation. Laboratory evaluation was unremarkable. Which of the following is the best intervention for this patient? - Correct Answer-Supervised exercise program
- A 14-year-old male who is overweight presents with complaints of left knee and anteromedial thigh pain for the past month. He states the pain gets better with rest and denies any known trauma. On examination of the gait, a slight limp is noted. X-ray films of the left knee are normal. The most likely diagnosis is: - Correct Answer-Slipped capital femoral epiphysis
- A 23-year-old female presents with ongoing arthralgias with intermittent flares of arthritis. She is found to have a malar rash and an abnormal urinalysis. Serum ANA and anti- double-stranded DNA antibodies are present. Which of the following tests should be ordered to assess her risk for thrombotic events and future risk of spontaneous abortion? - Correct Answer-Anti-phospholipid antibodies
- Which of the following fractures is associated with the greatest risk of avascular necrosis of the femoral head? - Correct Answer-Femoral neck
- A 22-year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 20 degrees of flexion and the tibia is forced forward while the femur is stabilized. Which of the following knee maneuvers does this represent? - Correct Answer- Lachman test
- Which of the following would demonstrate rotational misalignment in a patient with a fracture of the 4th metacarpal? - Correct Answer-Ring finger of the closed hand overlaps the little finger
- A 32-year-old medical transcriptionist presents with burning and tingling in her right wrist and hand for the past month. On physical exam, Phalen's test is positive; however, there is no atrophy of the thenar eminence. Which of the following is the initial step in management of this patient? - Correct Answer-Wrist splints
- An X-ray reveals a break in the cortex of one side of the ulna shaft without a separation or break of the opposite cortex describes what type of fracture? - Correct Answer- Greenstick
- A 67-year-old female presents with progressive pain in her left knee that is worse with activity and relieved with rest. She notes stiffness of the knee that last about 20 minutes after activity is resumed. She exercises regularly. No known drug allergies. On physical exam she is 5' 5", 225 pounds. Her left knee exam reveals mild effusion without erythema or warmth. Radiographs of the left knee reveal medial joint space narrowing and subchondral bone sclerosis. Her sodium is 138 mEq/L, potassium 4.3 mEq/L, bicarbonate 24 mEq/L, chloride 104 mEq/L, BUN 23 mg/dl and creatinine 1.8 mg/dl. Which of the following medications is most appropriate for this patient's worsening pain? - Correct Answer- Acetaminophen
- An 18-year-old patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the patient presents with increased pain despite adequate doses of analgesics and immobilization. Which of the following is the most likely diagnosis? - Correct Answer-Compartment syndrome
- A 58 year-old male presents complaining of anterior right shoulder pain the day after performing extensive yard work. The pain is localized over the anterior proximal humerus with distinct point tenderness. There are no visible abnormalities. The patient has full range of motion and strength with all shoulder movements. The pain is reproduced by asking the patient to resist the examiner during supination of the right elbow. Which of the following is the most likely diagnosis? - Correct Answer-Bicipital tendonitis
- A 12-year-old female presents for a routine sports physical. The physical exam reveals asymmetry of the posterior chest wall on forward bending. This is most consistent with which of the following? - Correct Answer- Scoliosis
- The most reliable site from which to identify the causative organism in cases of osteomyelitis is the: - Correct Answer- Bone
- Which of the following osteoporosis therapies is so poorly absorbed that it must be taken alone and on an empty stomach? - Correct Answer-Alendronate (Fosamax)
- A 43-year-old male with a history of a right medial meniscectomy and a strong family history of osteoarthritis presents to the clinic for a routine physical exam. He states he is very active and runs 20-25 miles a week and competes routinely in 5 km races. He is 5' 10" and 160 lbs, BP is 128/ and P 72. His physical examination is unremarkable. Which of the following would you recommend to this patient to delay the onset of osteoarthritis? - Correct Answer-Consider swimming or biking instead of running
- Which of the following clinical manifestations is commonly seen in a patient with rheumatoid arthritis? - Correct Answer- Symmetric joint swelling
- A 20-year-old male presents with pain along the medial tibia. The pain initially began towards the end of soccer
practice but now it is present earlier on during practice. Physical exam reveals pain to palpation over the posterior tibialis muscle body. What is the most likely diagnosis? - Correct Answer-Shin splint
- A 36-year-old male has a history of recurrent low back pain. When lifting a stack of books yesterday, he experienced sudden, severe pain in the lumbar area. He denies radicular pain. His lower extremity examination is unremarkable, and his back examination is remarkable for paraspinal muscle tenderness and increased pain with flexion at the waist. Which of the following management options should be instituted at this time? - Correct Answer-Continue ordinary activities as tolerated
- A 35-year-old patient with lupus is being treated for mild arthralgias and rash with hydroxychloroquine. Which of the following clinical manifestations is the most common side effect of this medication? - Correct Answer-Impaired night vision
- A 42 year-old female experiences pain on the plantar surface of her left foot in the area of the third metatarsal head. The pain is associated with wearing tight shoes and is relieved by removing shoes. Examination reveals a palpable
mass and reproduction of pain with deep palpation of the third intermetatarsal space. The patient has tried wearing wider shoes with metatarsal cushions and taking NSAIDS but her symptoms persist. What is the best therapeutic option at this point? - Correct Answer-Steroid injection
- Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?
- Correct Answer-Supraspinatus
- A 26-year-old male who is an avid swimmer has been experiencing right shoulder pain for the past month. On examination, pain is elicited with palpation below the anterior acromion. Anterior shoulder pain is also reported when the patient flexes and extends his arm. Which of the following diagnostic tests is most appropriate at this time? - Correct Answer-Subacromial lidocaine injection
- A 22-year-old female complains of worsening pain, swelling, and tenderness in her left heel for 1 week. She sustained a penetrating injury to the heel two weeks ago when she stepped on a nail while running in tennis shoes. Examination reveals a draining puncture wound with surrounding erythema and exquisite tenderness. X-ray of the left foot demonstrates periosteal reaction associated with the
wound. Which organism is classically responsible for this infection? - Correct Answer-Pseudomonas aeruginosa
- Which of the following is an established risk factor for osteoporosis? - Correct Answer-Low body weight
- A 60-year-old female injured her right wrist when she slipped and fell onto her outstretched hand. Radiographs show a fracture through the metaphysis of the distal radius with dorsal displacement and angulation. Which of the following splints is the best method of temporary immobilization? - Correct Answer-Volar forearm
- A 32-year-old male presents with an acute onset of pain and swelling to his left ankle. On physical examination the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis? - Correct Answer-Septic arthritis
- An obese 15 year-old male presents with complaint of a limp and right knee pain for two weeks. He denies recent trauma or history of previous injury. Physical examination of the right knee is unremarkable. Examination of the right hip
reveals pain with passive range of motion and limited internal rotation and abduction. Flexion of the hip results in external rotation of the thigh. Gait is antalgic with the right hip externally rotated. Which of the following radiographic findings supports the most likely diagnosis? - Correct Answer- Displacement of the femoral epiphysis
- A 57-year-old male presents with acute bilateral lower extremity weakness and urinary incontinence that began after he fell earlier today. His examination is significant for bilateral lower extremity sensory deficits and weakness along with decreased rectal sphincter tone. Which of the following is the most appropriate intervention? - Correct Answer-Surgery
- Which of the following is the most sensitive to determine whether there is a small effusion in the knee? - Correct Answer-Milk the medial aspect of the knee, press lateral margin of the patella, and note a bulge of returning fluid medial to the patella
- A 41-year-old female complains of 3 weeks of gradually worsening pain at the base of the thumb and radial aspect of the wrist. She and her husband have been renovating their home for the past 2 months and it has become increasingly difficult for her to hold a hammer. She denies numbness or
tingling. She denies any history of previous trauma to the wrist. On examination, there is tenderness over the distal radial styloid and pain reproduced with ulnar deviation of a fist clenched over the abducted thumb. Which of the following is the most likely diagnosis? - Correct Answer- DeQuervain's tenosynovitis
- A football player complains of burning pain, numbness, and tingling extending from the left shoulder down into the hand after he tackled a player. These symptoms resolved spontaneously in minutes. Following resolution of the symptoms, he has full strength and normal sensation in the left arm. What is the most likely etiology of his symptoms? - Correct Answer-Stretching of nerve roots and brachial plexus
- A 43-year-old female presents with a two-year history of frequent episodes of pain and morning stiffness in both hands and wrists. She experiences some symptomatic relief with ibuprofen, but feels that the episodes are becoming more frequent and severe. On examination, you observe joint swelling of several MCP joints on both hands. X-ray of the hands shows joint space narrowing of the MCP joints. In addition to NSAIDs, what is the most appropriate first- line long-term medication to treat this patient? - Correct Answer- Methotrexate (Rheumatrex)