Family Practice Exam Musculoskeletal 3 — Questions and Answers
Question 1: A 40-year-old woman presents with pain and swelling over the radial aspect of the wrist, worsened by thumb movement. Finkelstein's test is positive. What is the diagnosis?
- Carpal tunnel syndrome
- De Quervain tenosynovitis (Correct answer)
- Trigger finger
- Dupuytren contracture
Correct answer: De Quervain tenosynovitis
De Quervain tenosynovitis involves the abductor pollicis longus and extensor pollicis brevis tendons, diagnosed by a positive Finkelstein test.
Question 2: A 50-year-old construction worker presents with gradual numbness and tingling in the thumb, index, and middle fingers, worst at night. Tinel's and Phalen's signs are positive. What is the first-line treatment?
- Surgical carpal tunnel release
- Wrist splinting at night (Correct answer)
- Corticosteroid injection
- Physical therapy
Correct answer: Wrist splinting at night
Nocturnal wrist splinting in a neutral position is the first-line conservative treatment for mild to moderate carpal tunnel syndrome.
Question 3: A 35-year-old runner presents with lateral hip pain radiating down the thigh, worsened by stairs and lying on that side. Palpation over the greater trochanter is tender. What is the most likely diagnosis?
- Hip osteoarthritis
- Greater trochanteric pain syndrome (Correct answer)
- Meralgia paresthetica
- Piriformis syndrome
Correct answer: Greater trochanteric pain syndrome
Greater trochanteric pain syndrome (formerly trochanteric bursitis) causes lateral hip pain with tenderness directly over the greater trochanter.
Question 4: Which of the following best describes the Lachman test?
- Anterior tibial translation with knee at 90° flexion
- Anterior tibial translation with knee at 20-30° flexion (Correct answer)
- Lateral tibial rotation with knee extension
- Medial tibial translation with valgus stress
Correct answer: Anterior tibial translation with knee at 20-30° flexion
The Lachman test assesses ACL integrity by applying anterior force to the tibia with the knee at 20-30° of flexion, and is more sensitive than the anterior drawer test.
Question 5: A 25-year-old female presents with a tender, soft lump over the dorsum of her wrist that transilluminates. It has been present for months and fluctuates in size. What is the most appropriate management?
- Urgent biopsy
- Aspiration or observation (Correct answer)
- Immediate surgical excision
- MRI with contrast
Correct answer: Aspiration or observation
Ganglion cysts are benign synovial fluid-filled cysts; observation or aspiration is appropriate as many resolve spontaneously.
Question 6: A 65-year-old man presents with symmetric proximal muscle weakness affecting the hips and shoulders, along with elevated CK and an erythematous heliotrope rash around the eyes. What is the most likely diagnosis?
- Polymyalgia rheumatica
- Dermatomyositis (Correct answer)
- Fibromyalgia
- Inclusion body myositis
Correct answer: Dermatomyositis
Dermatomyositis presents with proximal muscle weakness, elevated CK, and characteristic skin findings including heliotrope rash and Gottron's papules.
Question 7: A 58-year-old woman with polymyalgia rheumatica presents with new-onset headache, jaw claudication, and scalp tenderness. ESR is 110. What complication should be immediately excluded?
- Cervical spondylosis
- Giant cell arteritis (Correct answer)
- Tension headache
- Trigeminal neuralgia
Correct answer: Giant cell arteritis
Giant cell arteritis (temporal arteritis) is strongly associated with PMR and must be urgently treated to prevent irreversible vision loss.
Family Practice Exam Musculoskeletal 3
A 40-year-old woman presents with pain and swelling over the radial aspect of the wrist, worsened by thumb movement.
Finkelstein's test is positive.
What is the diagnosis?