MSN-FNP Musculoskeletal Disorders Exam Questions with Correct Answers

MSN-FNP Musculoskeletal Disorders Exam Questions with Correct Answers A 42 yo male who plays basketball on the weekends has medial knee pain after landing on the extremity and pivoting sideways to pass. He felt a "pop" and experienced swelling a few minutes later. He has pain with walking. He denies any instability but does feel like it is "catching" with knee flexion. On exam, he has joint effusion, his Lachman's is negative, and he has no pain with patella mobility. What is his most likely injury? A. Anterior cruciate ligament B. Meniscal injury C. Tibial plateau fracture D. Osgood-Schlatter disease - ANSWER B. Meniscal injury A 33 yo female with PMH of DM c/o of pain in her wrist. The pain is located along the radial side of the wrist and has been occurring for a long time. She feels a reduced sensation along the radial side of her hand with occasional numbness and tingling. In addition, she also feels an occasional temperature change in her hand that she describes as a "cool feeling." She does not know exactly when the pain started and cannot recall any trauma or injury to the site. V/S are normal. Exam reveals a well- circumscribed, subcutaneous, soft, mobile wrist mass that is non-tender to palpitation and transilluminates with lighting. The patient has trouble gripping objects. What is the most likely diagnosis? A. Lipoma B. Ganglion cyst C. Radial artery aneurysm D. Osteosarcoma - ANSWER B. Ganglion cyst Explanation: A ganglion cyst is a cystic swelling typically found on the dorsal side of the wrist. These cyst are thought to arise from herniation of synovial tissue from a joint capsule or tendon sheath. They present with chronic wrist pain and may be accompanied by coolness of the hand, numbness/tingling, and possible parethesias. The mass itself is mobile, may be tender to palpation, and transilluminates. (A) Limpoma is a benign tumor of fat that can occur on the hand. Lipomas are soft to the touch and mobile. Unlike Ganglion cyst, lipomas typically do not cause hand symptoms and are not well circumscribed. They do not transilluminate either. (C) Radial artery aneurysms are dilations of the radial artery that extend into the hand. While there is no history of trauma, they present as pulsatile masses without any pain and do not transilluminate either. (D) Osteosarcoma are cancerous tumors occurring in the bone. While they occur typically on the shoulders, elbows, and knees, they can occur in the hand as well. Unlike ganglion cyst, they are not well-circumscribed and are fixed rather than mobile. Gymnast's wrist is associated with which of the following conditions? A. Osteochondritis dissecans of capitellum B. Apophyseal avulsion fracture of the humeral epicondyle C. Subluxation of the radial head D. Injury to the distal radial physis - ANSWER D. Injury to the distal radial physis Explanation: A gymnast wrist refers to injury to the distal radial physis, occurring as a result of repetitive stresses due to weight bearing on the upper extremities. (A) (B) Osteochondritis dissecans of the capitellum and apophyseal avulsion fracture of the medial humeral epicondyle are associated with Leaguer's elbow. (C) Subluxation of the radial head is associated with nursemaids elbow. A 21 yo rugby player had a sudden onset of chest pain after tackling an opposing player. He denies any dyspnea. He has no history of health problems or surgeries. On physical exam, he has no pain or deformity in his clavicle. His rotator cuff muscles are intact. He has an easily seen and palpable defect in the muscle belly of his chest inferior to his clavicle. What is the most likely diagnosis? A. Myocardial infarction B. Manubrium fracture C. Pneumothorax D. Pectoral muscle tear - ANSWER D. Pectoral muscle tear Explanation: This is a common mechanism of injury for a pectoral muscle tear. A visible defect in the muscle belly helps guide the diagnosis. Complete tears mainly occur at the humeral insertion and require surgical repair. Partial tears my be difficult to diagnosis, but strength is affected when compared to the contralateral side. A 33 yo woman with PMH of DM complains of mild pain in her wrist. The pain is located along the radial side of the wrist. She denies any loss of sensation or numbness/tingling. She does not exactly when the pain and discomfort started and cannot recall any traumatic or inciting event. VS or normal Exam reveals a well- circumscribed, subcutaneous, soft, mobile wrist mass that is mildly tender to palpitation and transilluminated with lighting. What is the next step in management? A. Conservative treatment (NSAIDs, physical therapy) B. MRI of hand C. Aspiration of mass D. Surgical excision - ANSWER A. Conservative treatment (NSAIDs, physical therapy) Explanation: A ganglion cyst is a cystic swelling typically found on the dorsal side of the wrist. These are thought to arise due to herniation of synovial tissue from a joint capsule or tendon sheath. They present with chronic wrist pain and may be accompanied by coolness of the hand, numbness/tingling, and possible parenthesis. The mass is mobile, tender, and transilluminates. Most resolve spontaneously and heal within months of conservative treatment. A 50 yo Caucasian female presents to office with morning joint stiffness mostly in her feet and hands that last up to 2 hours after starting her day. She reports this happened about a month ago and her wrist were very sore, but she seemed to get better. She also reports feeling tired lately, her cloths are looser, and sometimes she thinks she may have been running a fever. Exam reveals swelling and warmth in the MCPs and PIPs of both hands. Based on history, exam, and symptoms what is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Systemic lupus erythematous D. Carpal tunnel - ANSWER A. Rheumatoid arthritis Explanation: These are classic symptoms of RA which include systemic symptoms and symmetric inflammation of MCP and PIP of the hands (may have sausage digits). Other commonly affected joints are the wrist, metatarsophalangeal joints of the feet, ankles, elbows, and shoulders. RA is associated with relapsing and remitting symptoms. Articular symptoms may pe associated with systemic symptoms such as weight loss, weakness, fatigue, decreased appetite, and aching. RA affects females more than males and tends to present in the middle age. Joint stiffness last longer than OA. (B) OA does not present with systematic symptoms, does not have symmetrical distribution and generally presents without inflammation. OA tends to affect the hips, knees, DIPs and PIPs. Symptoms are exacerbated by activity and relieved by rest. (C) SLE is associated with relapsing and remitting symptoms. However, it tends to present in women of childbearing age and presents with anorexia, seizures, oral ulcers, fatigue, rash, and arthritis ) of two or more peripheral joints). (D) carpal tunnel is associated with joint pain as well as numbness, tingling, weakness due to impingement of the median nerve. Symptoms often resents as wrist pain with numbness, and tingling of the thumb, index, middle, and ring finger. May also notice marked weakness, inability to grip objects, and nighttime numbness. Tow important test are Tinel's sign and Phalen test. Risk factors include repetitive movements and overuse.