BRAINSCAPE1
Musculoskeletal PANCE Exam with
complete solutions latest version
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 - CORRECT ANSWER-A
Abduction against resistance tests the 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?
A Abduction stress test
B Anterior drawer sign
C Lachman test
D McMurray test - CORRECT ANSWER-C
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 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 - CORRECT ANSWER-C
Asymmetry of the posterior chest wall on forward bending is the most striking and
consistent abnormality in patients with idiopathic 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
, BRAINSCAPE1
D Osteogenesis imperfecta - CORRECT ANSWER-D
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 - CORRECT ANSWER-B
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 - CORRECT ANSWER-A
The lateral view shows 70-80% of significant injuries. It is important to visualize all
seven cervical vertebrae and the upper margin of T1 to avoid missing possible
pathology.The oblique view is usually not included in the initial set of x-rays taken.
Bilateral supine oblique is a view that may be ordered if all seven cervical vertebrae are
not seen on the lateral view.
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?
A X-ray of the lower leg and ankle.
B Doppler studies.
C Bone scan.
D Compartment pressure - CORRECT ANSWER-D
Compartmental pressures should be obtained as soon as possible. If they are elevated
this is a surgical emergency.
A 32-year-old male presents with an acute onset of pain and swelling in his left ankle.
On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the
, BRAINSCAPE1
synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the
most likely diagnosis?
A Gout
B Pseudogout
C Acute rheumatic fever
D Septic arthritis - CORRECT ANSWER-D
Leukocytosis and a low synovial glucose are indicative of 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?
A Rheumatoid arthritis
B Kawasaki disease
C Lyme disease
D Nongonococcal arthritis - CORRECT ANSWER-C
After an incubation period of 3 to 32 days, erythema migrans develops at the site of the
tick bite. Within days or weeks after the onset of erythema migrans the patients develop
a severe headache, mild stiffness of the neck, migratory musculoskeletal pain,
arthralgias and profound malaise and fatigue.
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 - CORRECT ANSWER-A
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 - CORRECT ANSWER-C
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?
, BRAINSCAPE1
A Start an exercise program
B Brace the affected joint
C Rest the joint
D Inject steroids monthly - CORRECT ANSWER-A
Patients with osteoarthritis who exercise are able to maintain range of motion,
strengthen periarticular muscles, and improve physical fitness.
Bone mass measurement should be considered in all women by what age?
A 30 - 35
B 40 - 45
C 50 - 55
D 60 - 65 - CORRECT ANSWER-D
According to the National Osteoporosis Foundation, all women should have a bone
mass measurement by age 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?
A Wrist splint for 2-6 weeks
B Corticosteroid injection
C Surgical referral
D Darvocet - CORRECT ANSWER-A
The treatment of carpal tunnel syndrome is aimed at relieving the pressure on the
median nerve. This is best accomplished by having the patient wear a wrist splint during
the activities that increase the pressure on the median nerve.
Which of the following is the correct treatment for a Grade II ankle sprain resulting from
an inversion injury?
A Corticosteroid injection
B Rest, ice, compression, elevation
C Moist heat and a walking cast
D Surgical intervention - CORRECT ANSWER-B
The majority of ankle sprains are treated with RICE (rest, ice, compression and
elevation). Corticosteroid injections, moist heat, and a walking cast provide no benefit.
Surgical intervention for repair of a ruptured ligament is only necessary in chronically
unstable joints.
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?
A Rest, ice, elevation
B Immobilize, antibiotics, orthopedics referral
C Splint for 48 hours, aspirin, ice
D Surgical referral for amputation of digit - CORRECT ANSWER-B
Musculoskeletal PANCE Exam with
complete solutions latest version
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 - CORRECT ANSWER-A
Abduction against resistance tests the 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?
A Abduction stress test
B Anterior drawer sign
C Lachman test
D McMurray test - CORRECT ANSWER-C
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 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 - CORRECT ANSWER-C
Asymmetry of the posterior chest wall on forward bending is the most striking and
consistent abnormality in patients with idiopathic 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
, BRAINSCAPE1
D Osteogenesis imperfecta - CORRECT ANSWER-D
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 - CORRECT ANSWER-B
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 - CORRECT ANSWER-A
The lateral view shows 70-80% of significant injuries. It is important to visualize all
seven cervical vertebrae and the upper margin of T1 to avoid missing possible
pathology.The oblique view is usually not included in the initial set of x-rays taken.
Bilateral supine oblique is a view that may be ordered if all seven cervical vertebrae are
not seen on the lateral view.
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?
A X-ray of the lower leg and ankle.
B Doppler studies.
C Bone scan.
D Compartment pressure - CORRECT ANSWER-D
Compartmental pressures should be obtained as soon as possible. If they are elevated
this is a surgical emergency.
A 32-year-old male presents with an acute onset of pain and swelling in his left ankle.
On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the
, BRAINSCAPE1
synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the
most likely diagnosis?
A Gout
B Pseudogout
C Acute rheumatic fever
D Septic arthritis - CORRECT ANSWER-D
Leukocytosis and a low synovial glucose are indicative of 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?
A Rheumatoid arthritis
B Kawasaki disease
C Lyme disease
D Nongonococcal arthritis - CORRECT ANSWER-C
After an incubation period of 3 to 32 days, erythema migrans develops at the site of the
tick bite. Within days or weeks after the onset of erythema migrans the patients develop
a severe headache, mild stiffness of the neck, migratory musculoskeletal pain,
arthralgias and profound malaise and fatigue.
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 - CORRECT ANSWER-A
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 - CORRECT ANSWER-C
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?
, BRAINSCAPE1
A Start an exercise program
B Brace the affected joint
C Rest the joint
D Inject steroids monthly - CORRECT ANSWER-A
Patients with osteoarthritis who exercise are able to maintain range of motion,
strengthen periarticular muscles, and improve physical fitness.
Bone mass measurement should be considered in all women by what age?
A 30 - 35
B 40 - 45
C 50 - 55
D 60 - 65 - CORRECT ANSWER-D
According to the National Osteoporosis Foundation, all women should have a bone
mass measurement by age 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?
A Wrist splint for 2-6 weeks
B Corticosteroid injection
C Surgical referral
D Darvocet - CORRECT ANSWER-A
The treatment of carpal tunnel syndrome is aimed at relieving the pressure on the
median nerve. This is best accomplished by having the patient wear a wrist splint during
the activities that increase the pressure on the median nerve.
Which of the following is the correct treatment for a Grade II ankle sprain resulting from
an inversion injury?
A Corticosteroid injection
B Rest, ice, compression, elevation
C Moist heat and a walking cast
D Surgical intervention - CORRECT ANSWER-B
The majority of ankle sprains are treated with RICE (rest, ice, compression and
elevation). Corticosteroid injections, moist heat, and a walking cast provide no benefit.
Surgical intervention for repair of a ruptured ligament is only necessary in chronically
unstable joints.
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?
A Rest, ice, elevation
B Immobilize, antibiotics, orthopedics referral
C Splint for 48 hours, aspirin, ice
D Surgical referral for amputation of digit - CORRECT ANSWER-B
