Family Practice Exam Musculoskeletal 2 — Questions and Answers
Question 1: A 55-year-old woman presents with bilateral knee pain worsened by activity and relieved by rest. X-ray shows joint space narrowing and osteophytes. What is the most likely diagnosis?
- Rheumatoid arthritis
- Osteoarthritis (Correct answer)
- Gout
- Pseudogout
Correct answer: Osteoarthritis
Osteoarthritis is characterized by joint space narrowing, osteophytes, and pain worsened with activity in older patients.
Question 2: A 30-year-old male athlete presents with anterior knee pain worsened by climbing stairs and prolonged sitting. There is pain on palpation of the patellar tendon. What is the most likely diagnosis?
- Patellofemoral pain syndrome
- Patellar tendinopathy (Correct answer)
- Meniscal tear
- Iliotibial band syndrome
Correct answer: Patellar tendinopathy
Patellar tendinopathy (jumper's knee) causes tenderness at the patellar tendon, common in jumping athletes.
Question 3: Which finding on physical exam is most specific for a lateral collateral ligament (LCL) injury of the knee?
- Positive anterior drawer test
- Valgus stress test laxity at 30°
- Varus stress test laxity at 30° (Correct answer)
- Positive McMurray test
Correct answer: Varus stress test laxity at 30°
Varus stress testing at 30° of knee flexion assesses the lateral collateral ligament specifically.
Question 4: A 70-year-old man presents with acute monoarthritis of the first MTP joint. Arthrocentesis shows negatively birefringent, needle-shaped crystals. What is the treatment of choice for acute flare?
- Allopurinol
- Indomethacin or colchicine (Correct answer)
- Probenecid
- Hydroxychloroquine
Correct answer: Indomethacin or colchicine
Acute gout flares are treated with NSAIDs (e.g., indomethacin), colchicine, or corticosteroids.
Question 5: A 45-year-old woman has morning stiffness >1 hour, symmetric small joint swelling, and elevated RF and anti-CCP antibodies. Which medication is considered a first-line DMARD?
- Prednisone
- Methotrexate (Correct answer)
- Celecoxib
- Adalimumab
Correct answer: Methotrexate
Methotrexate is the anchor DMARD for rheumatoid arthritis and is typically the first agent initiated.
Question 6: A 16-year-old male presents with insidious onset of low back pain and morning stiffness that improves with exercise. HLA-B27 is positive. What is the most likely diagnosis?
- Lumbar disc herniation
- Ankylosing spondylitis (Correct answer)
- Psoriatic arthritis
- Reactive arthritis
Correct answer: Ankylosing spondylitis
Ankylosing spondylitis presents in young males with inflammatory back pain, morning stiffness, and strong HLA-B27 association.
Question 7: A 60-year-old woman with a history of long-term corticosteroid use is found to have a T-score of -2.7 on DEXA scan. What is the most appropriate next step?
- Calcium and vitamin D supplementation only
- Initiate bisphosphonate therapy (Correct answer)
- Refer for parathyroidectomy
- Start estrogen replacement therapy
Correct answer: Initiate bisphosphonate therapy
A T-score of -2.5 or below indicates osteoporosis, and bisphosphonates (e.g., alendronate) are first-line pharmacologic treatment.
Family Practice Exam Musculoskeletal 2
A 55-year-old woman presents with bilateral knee pain worsened by activity and relieved by rest.
X-ray shows joint space narrowing and osteophytes.
What is the most likely diagnosis?