A. AAFP BOARD REVIEW – MSK
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
A 16-year-old female presents for follow-up after a tibial stress fracture. The fracture was
diagnosed 5 weeks ago by characteristic physical examination findings and radiographs showing
a transverse fracture of the tibial diaphysis. She was placed on non-weight-bearing status for 2
weeks and after that was advised to limit activities that caused discomfort. In addition, she was
placed on appropriate calcium and vitamin D supplementation based on results of her laboratory
workup. The patient is a basketball player and would like to begin practicing with the team in
1 week. She says she is now able to walk without discomfort but has not tried running or
jumping.
Which one of the following is necessary for this patient to be able to return to basketball
participation next week? (check one)
A. Consultation with a sports medicine physician
B. A normal physical examination of the affected area
C. Normal radiographs - ANSWER B. A normal physical examination of the affected area
In a patient with hyperuricemia who has experienced an attack of gout, which one of the following is
LEAST likely to precipitate another gout attack? (check one)
A. Red meat
B. Milk
C. Seafood
D. Nuts
E. Beans - ANSWER B. milk
- milk, unlike other dairy product, decrease gout attack
- nuts and beans are high in purines & worsens gout
,You test a patient's muscle strength and find that his maximum performance consists of the ability to
move with gravity neutralized. This qualifies as which grade of muscle strength, on
a scale of 0 to 5?
(check one)
A. 0
B. 1
C. 2
D. 3
E. 4 - ANSWER C. 2
Muscle strength is scored on a scale of 0 to 5.
0 - inability to contract a muscle is scored as 0.
1 - Contraction without movement constitutes
2- Movement with the effect of gravity neutralized 3- while movement against gravity only
4 - Movement against gravity plus some
additional resistance indicates grade 4
5 - normal movement against substantial resistance.
Question 7 of 10
Which one of the following is true concerning Paget's disease of bone? (check one)
A. It is a precursor of multiple myeloma
B. Both bone formation and bone resorption are increased
C. The treatment of choice for symptomatic disease is a calcium channel blocker
D. Pagetic bone pain is difficult to relieve and resistant to medical treatment
E. Extracellular calcium homeostasis is typically abnormal - ANSWER B. Both bone formation and bone
resorption area focal disorder of skeletal metabolism in which all elements of skeletal remodeling
(resorption, formation, and mineralization) are increased. increased
- Treatment: one of the newer bisphosphonate
- despite the massive bone turnover, extracellular calcium homeostasis is almost invariably normal.
,A factory worker sustains a forced flexion injury of the distal interphalangeal (DIP) joint, resulting in a
small bone fragment at the dorsal surface of the proximal distal phalanx (mallet fracture). Which one of
the following is the most appropriate management strategy?
A. Buddy taping and early range of motion
B. Splinting the DIP joint in extension
C. Splinting the DIP joint in flexion
D. Referral for surgical repair - ANSWER B. The recommended treatment for a mallet fracture is splinting
the distal interphalangeal (DIP) joint in extension (SOR B). The usual duration of splinting is 8 weeks.
- If the finger fracture involves >30% of the intra-articular surface, referral to a hand or
orthopedic surgeon can be considered.
- However, conservative therapy appears to have outcomes similar to those of surgical treatment and
therefore is generally preferred.
A 30-year-old white male visits your clinic after being in a bar fight. He describes hitting another man in
the mouth with his closed fist. He reports a painful distal fifth metacarpal with a superficial abrasion.
After assessing tetanus status and copiously irrigating the wound, you should do which one of the
following? (check one)
A. Obtain a radiograph and give prophylactic antibiotics
B. Obtain a radiograph only
C. Give prophylactic antibiotics only
D. Probe the abrasion - ANSWER A. Xray & prophylatic abx
- a common injury called a "fight bite."
- Radiographs are needed to determine if there is a distal metacarpal fracture so that it can be treated
appropriately.
- prophylactic antibiotics are recommended with any break in the skin
A mother brings her 2-year-old daughter to your office because the child is not using her left arm. Earlier
in the day the mother left the toddler under the supervision of her 12-year-old sister while she went to
the store. When she returned the toddler was playing with toys using only her
right arm, and was holding the left arm slightly pronated, flexed, and close to her body. The older
daughter was unaware of any injury to the girl's arm, and the child does not seem distressed or
traumatized.
, Physical examination of the child's clavicle, shoulder, wrist, and hand do not elicit any signs of pain or
change in function. She does seem to have some tenderness near the lateral elbow and resists your
attempts to examine that area. There is no ecchymosis, swelling, or deformity of the elbow.
Which one of the following would be most appropriate at this point?
A. Plain radiographs of the affected elbow
B. Ultrasonograp - ANSWER D. Attempted reduction of the subluxed radial head
A 5-year-old white male is brought to your office with a chief complaint of chronic nocturnal limb pain.
His mother states that his pain is often severe enough that it awakens him at night and she often gives
him ibuprofen to help alleviate his calf pain, but she has never seen him limp or heard him complain of
pain during the day. She also has not noticed any grossly swollen joints, fever, rash, or weight change.
She is concerned because of a family history of juvenile rheumatoid arthritis in a distant cousin. The
physical examination is within normal limits, as are a CBC and an erythrocyte sedimentation rate.
Which one of the following would be most appropriate at this point?
A. Bilateral plain radiographs of the lower extremities
B. Testing for antinuclear antibody
C. Testing for rheumatoid factor
D. Referral to orthopedic surgery
E. No further workup - ANSWER E. No further workup
benign nocturnal limb pains
Which one of the following is necessary to make a diagnosis of polymyalgia rheumatica? (check one)
A. Joint swelling
B. Early morning stiffness
C. Reduction of symptoms with high-dose NSAID therapy
D. An erythrocyte sedimentation rate ≥60 mm/hr
E. Bilateral shoulder or hip stiffness and aching - ANSWER E. Bilateral shoulder or hip stiffness and
aching
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
A 16-year-old female presents for follow-up after a tibial stress fracture. The fracture was
diagnosed 5 weeks ago by characteristic physical examination findings and radiographs showing
a transverse fracture of the tibial diaphysis. She was placed on non-weight-bearing status for 2
weeks and after that was advised to limit activities that caused discomfort. In addition, she was
placed on appropriate calcium and vitamin D supplementation based on results of her laboratory
workup. The patient is a basketball player and would like to begin practicing with the team in
1 week. She says she is now able to walk without discomfort but has not tried running or
jumping.
Which one of the following is necessary for this patient to be able to return to basketball
participation next week? (check one)
A. Consultation with a sports medicine physician
B. A normal physical examination of the affected area
C. Normal radiographs - ANSWER B. A normal physical examination of the affected area
In a patient with hyperuricemia who has experienced an attack of gout, which one of the following is
LEAST likely to precipitate another gout attack? (check one)
A. Red meat
B. Milk
C. Seafood
D. Nuts
E. Beans - ANSWER B. milk
- milk, unlike other dairy product, decrease gout attack
- nuts and beans are high in purines & worsens gout
,You test a patient's muscle strength and find that his maximum performance consists of the ability to
move with gravity neutralized. This qualifies as which grade of muscle strength, on
a scale of 0 to 5?
(check one)
A. 0
B. 1
C. 2
D. 3
E. 4 - ANSWER C. 2
Muscle strength is scored on a scale of 0 to 5.
0 - inability to contract a muscle is scored as 0.
1 - Contraction without movement constitutes
2- Movement with the effect of gravity neutralized 3- while movement against gravity only
4 - Movement against gravity plus some
additional resistance indicates grade 4
5 - normal movement against substantial resistance.
Question 7 of 10
Which one of the following is true concerning Paget's disease of bone? (check one)
A. It is a precursor of multiple myeloma
B. Both bone formation and bone resorption are increased
C. The treatment of choice for symptomatic disease is a calcium channel blocker
D. Pagetic bone pain is difficult to relieve and resistant to medical treatment
E. Extracellular calcium homeostasis is typically abnormal - ANSWER B. Both bone formation and bone
resorption area focal disorder of skeletal metabolism in which all elements of skeletal remodeling
(resorption, formation, and mineralization) are increased. increased
- Treatment: one of the newer bisphosphonate
- despite the massive bone turnover, extracellular calcium homeostasis is almost invariably normal.
,A factory worker sustains a forced flexion injury of the distal interphalangeal (DIP) joint, resulting in a
small bone fragment at the dorsal surface of the proximal distal phalanx (mallet fracture). Which one of
the following is the most appropriate management strategy?
A. Buddy taping and early range of motion
B. Splinting the DIP joint in extension
C. Splinting the DIP joint in flexion
D. Referral for surgical repair - ANSWER B. The recommended treatment for a mallet fracture is splinting
the distal interphalangeal (DIP) joint in extension (SOR B). The usual duration of splinting is 8 weeks.
- If the finger fracture involves >30% of the intra-articular surface, referral to a hand or
orthopedic surgeon can be considered.
- However, conservative therapy appears to have outcomes similar to those of surgical treatment and
therefore is generally preferred.
A 30-year-old white male visits your clinic after being in a bar fight. He describes hitting another man in
the mouth with his closed fist. He reports a painful distal fifth metacarpal with a superficial abrasion.
After assessing tetanus status and copiously irrigating the wound, you should do which one of the
following? (check one)
A. Obtain a radiograph and give prophylactic antibiotics
B. Obtain a radiograph only
C. Give prophylactic antibiotics only
D. Probe the abrasion - ANSWER A. Xray & prophylatic abx
- a common injury called a "fight bite."
- Radiographs are needed to determine if there is a distal metacarpal fracture so that it can be treated
appropriately.
- prophylactic antibiotics are recommended with any break in the skin
A mother brings her 2-year-old daughter to your office because the child is not using her left arm. Earlier
in the day the mother left the toddler under the supervision of her 12-year-old sister while she went to
the store. When she returned the toddler was playing with toys using only her
right arm, and was holding the left arm slightly pronated, flexed, and close to her body. The older
daughter was unaware of any injury to the girl's arm, and the child does not seem distressed or
traumatized.
, Physical examination of the child's clavicle, shoulder, wrist, and hand do not elicit any signs of pain or
change in function. She does seem to have some tenderness near the lateral elbow and resists your
attempts to examine that area. There is no ecchymosis, swelling, or deformity of the elbow.
Which one of the following would be most appropriate at this point?
A. Plain radiographs of the affected elbow
B. Ultrasonograp - ANSWER D. Attempted reduction of the subluxed radial head
A 5-year-old white male is brought to your office with a chief complaint of chronic nocturnal limb pain.
His mother states that his pain is often severe enough that it awakens him at night and she often gives
him ibuprofen to help alleviate his calf pain, but she has never seen him limp or heard him complain of
pain during the day. She also has not noticed any grossly swollen joints, fever, rash, or weight change.
She is concerned because of a family history of juvenile rheumatoid arthritis in a distant cousin. The
physical examination is within normal limits, as are a CBC and an erythrocyte sedimentation rate.
Which one of the following would be most appropriate at this point?
A. Bilateral plain radiographs of the lower extremities
B. Testing for antinuclear antibody
C. Testing for rheumatoid factor
D. Referral to orthopedic surgery
E. No further workup - ANSWER E. No further workup
benign nocturnal limb pains
Which one of the following is necessary to make a diagnosis of polymyalgia rheumatica? (check one)
A. Joint swelling
B. Early morning stiffness
C. Reduction of symptoms with high-dose NSAID therapy
D. An erythrocyte sedimentation rate ≥60 mm/hr
E. Bilateral shoulder or hip stiffness and aching - ANSWER E. Bilateral shoulder or hip stiffness and
aching
