MUSCULOSKELETAL SMARTY PANCE QUESTIONS
AND ANSWERS
Abduction of the shoulder against resistance helps localize pain in which of the following
muscles of the shoulder girdle?
A
Supraspinatus
B
Infraspinatus
C
Teres minor
D
Subscapularis - Answers - Abduction against resistance tests the supraspinatus
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?
A
Supraspinatus
B
Infraspinatus
C
Teres minor
D
Subscapularis - Answers - Impingement of the shoulder is most commonly seen with
the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial
bursa.
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?
A
Spondylolysis
B
Spondolisthesis
C
Scoliosis
D
Herniated disc - Answers - Scoliosis
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent
fractures indicates which of the following?
A
,Ehlers-Danlos syndrome
B
Marfan syndrome
C
Achondroplasia
D
Osteogenesis imperfecta - Answers - Mild osteogenesis imperfecta presents with blue
sclerae, history of recurrent fractures and presenile deafness.
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?
A
Radiolucent lesions
B
Demineralization
C
Chondrocalcinosis
D
Subperiosteal resorption - Answers - Demineralization
Osteoporosis presents with varying degrees of back pain and loss of height is common.
The serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase are
normal. X- ray findings demonstrate demineralization in the spine and pelvis
In a trauma patient who has a suspected cervical spine injury, the x-ray view that will
identify the majority of significant injuries is
A
lateral.
B
oblique
C
anteroposterior
D
odontoid - Answers - lateral view
It is important to visualize all seven cervical vertebrae and the upper margin of T1 to
avoid missing possible pathology.
1) 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?
A
X-ray of the lower leg and ankle.
B
Doppler studies.
C
Bone scan.
D
Compartment pressure
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?
A
Abduction stress test
B
Anterior drawer sign
C
Lachman test
D
McMurray test - Answers - The Lachman test is performed to evaluate the anterior
cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of
the hip.
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?
A
abduction stress test
B
anterior drawer sign
C
Lachman test
D
McMurray test - Answers - The Lachman test is performed to evaluate the anterior
cruciate ligament. The knee is placed in 20 degrees of flexion
2) 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 - Answers - 1)
Compartmental pressures should be obtained as soon as possible. If they are elevated
this is a surgical emergency
, 2) Compartment syndrome is characterized by a pathological increase of pressure
within a closed space and results from edema or bleeding within the compartment. It
may occur as an early local complication of fracture.
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?
A
Shin splint
B
Stress fracture
C
Osgood-Schlatter disease
D
Patellofemoral pain syndrome
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? - Answers - Shin splints cause pain over the posterior tibialis
muscle body as opposed to discrete pain over the tibia with a stress fracture.
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
A
carpal tunnel syndrome.
B
radial tunnel syndrome.
C
tenosynovitis.
D
gamekeeper's thumb. - Answers - Tenosynovitis is diagnosed using Finkelstein
maneuver. The patient's thumb is placed in the palm of the hand and the wrist is
abruptly deviated to the ulnar aspect of the wrist, causing pain on the radial aspect.
The most important preventive medicine recommendation for patients with osteoarthritis
is which of the following?
A
Start an exercise program
B
Brace the affected joint
C
Rest the joint
AND ANSWERS
Abduction of the shoulder against resistance helps localize pain in which of the following
muscles of the shoulder girdle?
A
Supraspinatus
B
Infraspinatus
C
Teres minor
D
Subscapularis - Answers - Abduction against resistance tests the supraspinatus
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?
A
Supraspinatus
B
Infraspinatus
C
Teres minor
D
Subscapularis - Answers - Impingement of the shoulder is most commonly seen with
the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial
bursa.
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?
A
Spondylolysis
B
Spondolisthesis
C
Scoliosis
D
Herniated disc - Answers - Scoliosis
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent
fractures indicates which of the following?
A
,Ehlers-Danlos syndrome
B
Marfan syndrome
C
Achondroplasia
D
Osteogenesis imperfecta - Answers - Mild osteogenesis imperfecta presents with blue
sclerae, history of recurrent fractures and presenile deafness.
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?
A
Radiolucent lesions
B
Demineralization
C
Chondrocalcinosis
D
Subperiosteal resorption - Answers - Demineralization
Osteoporosis presents with varying degrees of back pain and loss of height is common.
The serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase are
normal. X- ray findings demonstrate demineralization in the spine and pelvis
In a trauma patient who has a suspected cervical spine injury, the x-ray view that will
identify the majority of significant injuries is
A
lateral.
B
oblique
C
anteroposterior
D
odontoid - Answers - lateral view
It is important to visualize all seven cervical vertebrae and the upper margin of T1 to
avoid missing possible pathology.
1) 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?
A
X-ray of the lower leg and ankle.
B
Doppler studies.
C
Bone scan.
D
Compartment pressure
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?
A
Abduction stress test
B
Anterior drawer sign
C
Lachman test
D
McMurray test - Answers - The Lachman test is performed to evaluate the anterior
cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of
the hip.
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?
A
abduction stress test
B
anterior drawer sign
C
Lachman test
D
McMurray test - Answers - The Lachman test is performed to evaluate the anterior
cruciate ligament. The knee is placed in 20 degrees of flexion
2) 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 - Answers - 1)
Compartmental pressures should be obtained as soon as possible. If they are elevated
this is a surgical emergency
, 2) Compartment syndrome is characterized by a pathological increase of pressure
within a closed space and results from edema or bleeding within the compartment. It
may occur as an early local complication of fracture.
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?
A
Shin splint
B
Stress fracture
C
Osgood-Schlatter disease
D
Patellofemoral pain syndrome
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? - Answers - Shin splints cause pain over the posterior tibialis
muscle body as opposed to discrete pain over the tibia with a stress fracture.
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
A
carpal tunnel syndrome.
B
radial tunnel syndrome.
C
tenosynovitis.
D
gamekeeper's thumb. - Answers - Tenosynovitis is diagnosed using Finkelstein
maneuver. The patient's thumb is placed in the palm of the hand and the wrist is
abruptly deviated to the ulnar aspect of the wrist, causing pain on the radial aspect.
The most important preventive medicine recommendation for patients with osteoarthritis
is which of the following?
A
Start an exercise program
B
Brace the affected joint
C
Rest the joint
