Gold's NMS Diagnosis Review (NBCE Part II
Boards) QUESTIONS AND ANSWERS
Course
NBCE
1. A 45-year-old male presents with sharp, stabbing pain in his right shoulder,
which radiates down to his upper arm. The pain worsens at night and is
aggravated by overhead activities. He also has difficulty lifting his arm. Based on
this clinical presentation, which of the following diagnoses is most likely?
A. Rotator cuff tear
B. Frozen shoulder (Adhesive capsulitis)
C. Bursitis
D. Osteoarthritis
Correct Answer: A. Rotator cuff tear
Solution:
The patient's symptoms of sharp, stabbing pain, difficulty with overhead activities, and
radiating pain suggest a rotator cuff tear. Frozen shoulder tends to involve more stiffness and
limited range of motion, while bursitis typically causes pain without the characteristic radiation.
Osteoarthritis would have joint stiffness and tenderness but is less likely to present with
radiating pain from the shoulder.
2. A 55-year-old woman complains of low back pain that radiates down her left
leg, following the path of the sciatic nerve. The pain is worsened by coughing and
sneezing. Which of the following is the most likely diagnosis?
A. Lumbar disc herniation
B. Spinal stenosis
C. Sacroiliac joint dysfunction
D. Piriformis syndrome
Correct Answer: A. Lumbar disc herniation
Solution:
The classic presentation of low back pain radiating down the leg with coughing or sneezing
suggests lumbar disc herniation, which can irritate the nerve roots, causing sciatica. Spinal
stenosis typically causes pain with prolonged walking or standing, while sacroiliac joint
dysfunction is associated with localized pelvic pain. Piriformis syndrome presents with buttock
pain rather than radiating leg pain.
,3. A patient presents with a history of pain and tenderness over the lateral
epicondyle of the elbow. The pain is aggravated by gripping and lifting activities.
Which of the following is the most likely diagnosis?
A. Medial epicondylitis
B. Lateral epicondylitis
C. Cubital tunnel syndrome
D. Olecranon bursitis
Correct Answer: B. Lateral epicondylitis
Solution:
Lateral epicondylitis (Tennis elbow) is characterized by pain and tenderness over the lateral
epicondyle, particularly with gripping or lifting. Medial epicondylitis (Golfer’s elbow) affects
the medial side of the elbow. Cubital tunnel syndrome involves numbness and tingling in the
ulnar nerve distribution, and olecranon bursitis causes swelling at the back of the elbow, not
pain with gripping.
4. A 30-year-old patient presents with anterior knee pain that is aggravated by
activities such as climbing stairs and squatting. There is tenderness over the
patella, and the pain increases with resisted knee extension. What is the most
likely diagnosis?
A. Patellofemoral syndrome
B. Meniscal tear
C. ACL sprain
D. IT band syndrome
Correct Answer: A. Patellofemoral syndrome
Solution:
Patellofemoral syndrome (runner’s knee) typically presents with anterior knee pain,
especially during activities like climbing stairs and squatting, and is worsened by activities
such as resisted knee extension. Meniscal tears often present with locking or instability, while
ACL sprains involve more significant trauma and instability. IT band syndrome causes pain on
the lateral side of the knee.
5. A 65-year-old male presents with hip pain that is worse with activity and
improves with rest. He has a history of long-term weight-bearing activities, such
,as running. On examination, he has a reduced range of motion in the hip joint,
especially with internal rotation. What is the most likely diagnosis?
A. Hip osteoarthritis
B. Hip labral tear
C. Greater trochanteric bursitis
D. Piriformis syndrome
Correct Answer: A. Hip osteoarthritis
Solution:
Hip osteoarthritis is common in patients who have a history of weight-bearing activity,
leading to pain with movement, especially internal rotation. Hip labral tears cause pain in the
hip joint but are typically associated with a more specific history of trauma. Greater
trochanteric bursitis causes pain on the lateral hip but does not usually limit internal rotation.
Piriformis syndrome causes buttock pain rather than hip-specific joint pain.
6. A patient presents with a painful, swollen knee joint following a traumatic
injury. The knee is unstable, and the patient has difficulty bearing weight. On
examination, there is a positive Lachman’s test and anterior drawer test. What is
the most likely diagnosis?
A. Anterior cruciate ligament (ACL) tear
B. Posterior cruciate ligament (PCL) tear
C. Meniscal tear
D. Patellar dislocation
Correct Answer: A. Anterior cruciate ligament (ACL) tear
Solution:
The positive Lachman’s and anterior drawer tests are indicative of an ACL tear, which
results in knee instability, especially following trauma. PCL tears often present with posterior
instability and are tested with a posterior drawer test. Meniscal tears cause joint line pain and
mechanical symptoms like locking, while patellar dislocation typically presents with a visible
deformity.
7. A 50-year-old male complains of gradual onset of shoulder pain that worsens
with overhead activities and sleeping on the affected side. On examination, there
is tenderness over the acromion process, and the patient has limited abduction
and external rotation of the shoulder. What is the most likely diagnosis?
, A. Rotator cuff tendinitis
B. Frozen shoulder
C. Acromioclavicular joint arthritis
D. Bursitis
Correct Answer: A. Rotator cuff tendinitis
Solution:
Rotator cuff tendinitis presents with pain on overhead activities, sleeping on the affected
side, and limited motion, especially in abduction and external rotation. Frozen shoulder
(adhesive capsulitis) causes more generalized stiffness with progressive loss of motion in all
directions. Acromioclavicular joint arthritis causes pain localized to the AC joint and is
aggravated by shoulder movements like lifting. Bursitis presents with pain over the bursa but
does not restrict motion as much as tendinitis.
8. A 60-year-old woman presents with a history of neck pain that radiates down
the right arm to the thumb and index finger. There is numbness and tingling in
the affected hand, and pain is worsened with neck extension. What is the most
likely diagnosis?
A. Cervical radiculopathy
B. Thoracic outlet syndrome
C. Carpal tunnel syndrome
D. Rotator cuff tear
Correct Answer: A. Cervical radiculopathy
Solution:
Cervical radiculopathy is characterized by neck pain radiating down the arm, often along the
C6 or C7 nerve roots, which causes numbness and tingling in the hand. Thoracic outlet
syndrome presents with symptoms of upper extremity ischemia, carpal tunnel syndrome
affects the median nerve, and rotator cuff tears cause shoulder pain, not radicular arm pain.
9. A 25-year-old athlete presents with anterior hip pain that worsens with
running and jumping. On physical examination, there is tenderness over the
anterior hip joint, and the patient has pain with resisted hip flexion. What is the
most likely diagnosis?
A. Iliopsoas tendinitis
B. Hip labral tear
Boards) QUESTIONS AND ANSWERS
Course
NBCE
1. A 45-year-old male presents with sharp, stabbing pain in his right shoulder,
which radiates down to his upper arm. The pain worsens at night and is
aggravated by overhead activities. He also has difficulty lifting his arm. Based on
this clinical presentation, which of the following diagnoses is most likely?
A. Rotator cuff tear
B. Frozen shoulder (Adhesive capsulitis)
C. Bursitis
D. Osteoarthritis
Correct Answer: A. Rotator cuff tear
Solution:
The patient's symptoms of sharp, stabbing pain, difficulty with overhead activities, and
radiating pain suggest a rotator cuff tear. Frozen shoulder tends to involve more stiffness and
limited range of motion, while bursitis typically causes pain without the characteristic radiation.
Osteoarthritis would have joint stiffness and tenderness but is less likely to present with
radiating pain from the shoulder.
2. A 55-year-old woman complains of low back pain that radiates down her left
leg, following the path of the sciatic nerve. The pain is worsened by coughing and
sneezing. Which of the following is the most likely diagnosis?
A. Lumbar disc herniation
B. Spinal stenosis
C. Sacroiliac joint dysfunction
D. Piriformis syndrome
Correct Answer: A. Lumbar disc herniation
Solution:
The classic presentation of low back pain radiating down the leg with coughing or sneezing
suggests lumbar disc herniation, which can irritate the nerve roots, causing sciatica. Spinal
stenosis typically causes pain with prolonged walking or standing, while sacroiliac joint
dysfunction is associated with localized pelvic pain. Piriformis syndrome presents with buttock
pain rather than radiating leg pain.
,3. A patient presents with a history of pain and tenderness over the lateral
epicondyle of the elbow. The pain is aggravated by gripping and lifting activities.
Which of the following is the most likely diagnosis?
A. Medial epicondylitis
B. Lateral epicondylitis
C. Cubital tunnel syndrome
D. Olecranon bursitis
Correct Answer: B. Lateral epicondylitis
Solution:
Lateral epicondylitis (Tennis elbow) is characterized by pain and tenderness over the lateral
epicondyle, particularly with gripping or lifting. Medial epicondylitis (Golfer’s elbow) affects
the medial side of the elbow. Cubital tunnel syndrome involves numbness and tingling in the
ulnar nerve distribution, and olecranon bursitis causes swelling at the back of the elbow, not
pain with gripping.
4. A 30-year-old patient presents with anterior knee pain that is aggravated by
activities such as climbing stairs and squatting. There is tenderness over the
patella, and the pain increases with resisted knee extension. What is the most
likely diagnosis?
A. Patellofemoral syndrome
B. Meniscal tear
C. ACL sprain
D. IT band syndrome
Correct Answer: A. Patellofemoral syndrome
Solution:
Patellofemoral syndrome (runner’s knee) typically presents with anterior knee pain,
especially during activities like climbing stairs and squatting, and is worsened by activities
such as resisted knee extension. Meniscal tears often present with locking or instability, while
ACL sprains involve more significant trauma and instability. IT band syndrome causes pain on
the lateral side of the knee.
5. A 65-year-old male presents with hip pain that is worse with activity and
improves with rest. He has a history of long-term weight-bearing activities, such
,as running. On examination, he has a reduced range of motion in the hip joint,
especially with internal rotation. What is the most likely diagnosis?
A. Hip osteoarthritis
B. Hip labral tear
C. Greater trochanteric bursitis
D. Piriformis syndrome
Correct Answer: A. Hip osteoarthritis
Solution:
Hip osteoarthritis is common in patients who have a history of weight-bearing activity,
leading to pain with movement, especially internal rotation. Hip labral tears cause pain in the
hip joint but are typically associated with a more specific history of trauma. Greater
trochanteric bursitis causes pain on the lateral hip but does not usually limit internal rotation.
Piriformis syndrome causes buttock pain rather than hip-specific joint pain.
6. A patient presents with a painful, swollen knee joint following a traumatic
injury. The knee is unstable, and the patient has difficulty bearing weight. On
examination, there is a positive Lachman’s test and anterior drawer test. What is
the most likely diagnosis?
A. Anterior cruciate ligament (ACL) tear
B. Posterior cruciate ligament (PCL) tear
C. Meniscal tear
D. Patellar dislocation
Correct Answer: A. Anterior cruciate ligament (ACL) tear
Solution:
The positive Lachman’s and anterior drawer tests are indicative of an ACL tear, which
results in knee instability, especially following trauma. PCL tears often present with posterior
instability and are tested with a posterior drawer test. Meniscal tears cause joint line pain and
mechanical symptoms like locking, while patellar dislocation typically presents with a visible
deformity.
7. A 50-year-old male complains of gradual onset of shoulder pain that worsens
with overhead activities and sleeping on the affected side. On examination, there
is tenderness over the acromion process, and the patient has limited abduction
and external rotation of the shoulder. What is the most likely diagnosis?
, A. Rotator cuff tendinitis
B. Frozen shoulder
C. Acromioclavicular joint arthritis
D. Bursitis
Correct Answer: A. Rotator cuff tendinitis
Solution:
Rotator cuff tendinitis presents with pain on overhead activities, sleeping on the affected
side, and limited motion, especially in abduction and external rotation. Frozen shoulder
(adhesive capsulitis) causes more generalized stiffness with progressive loss of motion in all
directions. Acromioclavicular joint arthritis causes pain localized to the AC joint and is
aggravated by shoulder movements like lifting. Bursitis presents with pain over the bursa but
does not restrict motion as much as tendinitis.
8. A 60-year-old woman presents with a history of neck pain that radiates down
the right arm to the thumb and index finger. There is numbness and tingling in
the affected hand, and pain is worsened with neck extension. What is the most
likely diagnosis?
A. Cervical radiculopathy
B. Thoracic outlet syndrome
C. Carpal tunnel syndrome
D. Rotator cuff tear
Correct Answer: A. Cervical radiculopathy
Solution:
Cervical radiculopathy is characterized by neck pain radiating down the arm, often along the
C6 or C7 nerve roots, which causes numbness and tingling in the hand. Thoracic outlet
syndrome presents with symptoms of upper extremity ischemia, carpal tunnel syndrome
affects the median nerve, and rotator cuff tears cause shoulder pain, not radicular arm pain.
9. A 25-year-old athlete presents with anterior hip pain that worsens with
running and jumping. On physical examination, there is tenderness over the
anterior hip joint, and the patient has pain with resisted hip flexion. What is the
most likely diagnosis?
A. Iliopsoas tendinitis
B. Hip labral tear
