Family Practice Exam Musculoskeletal 4 — Questions and Answers
Question 1: A 28-year-old male presents with a painful, warm, swollen knee after a minor fall. Arthrocentesis reveals WBC 85,000/µL with 95% neutrophils. What is the most likely diagnosis?
- Gout
- Septic arthritis (Correct answer)
- Hemarthrosis
- Reactive arthritis
Correct answer: Septic arthritis
Synovial fluid WBC >50,000/µL with neutrophil predominance is highly suggestive of septic arthritis and requires urgent treatment.
Question 2: A 55-year-old diabetic woman presents with shoulder pain and severely limited range of motion in all planes for 4 months. X-ray is normal. What is the most likely diagnosis?
- Rotator cuff tear
- Adhesive capsulitis (Correct answer)
- Glenohumeral osteoarthritis
- Subacromial bursitis
Correct answer: Adhesive capsulitis
Adhesive capsulitis (frozen shoulder) causes global shoulder motion restriction and is more common in diabetics.
Question 3: Which of the following is the MOST appropriate initial imaging for suspected lumbar disc herniation in a patient with 6 weeks of radiculopathy?
- Plain X-ray
- CT scan without contrast
- MRI of the lumbar spine (Correct answer)
- Bone scan
Correct answer: MRI of the lumbar spine
MRI is the gold standard for evaluating lumbar disc herniation and nerve root compression.
Question 4: A 70-year-old man presents with acute onset of severe low back pain after lifting. X-ray shows a vertebral compression fracture at L2. What is the most important underlying condition to evaluate?
- Lumbar spinal stenosis
- Osteoporosis (Correct answer)
- Multiple myeloma
- Paget's disease
Correct answer: Osteoporosis
Vertebral compression fractures in elderly patients most commonly result from osteoporosis and warrant DEXA scanning and fracture risk assessment.
Question 5: A 45-year-old female presents with diffuse musculoskeletal pain, fatigue, sleep disturbance, and multiple tender points for >3 months. Labs and imaging are normal. What is the first-line pharmacologic treatment?
- NSAIDs
- Duloxetine or pregabalin (Correct answer)
- Opioids
- Prednisone
Correct answer: Duloxetine or pregabalin
FDA-approved treatments for fibromyalgia include duloxetine, milnacipran, and pregabalin; opioids and steroids are not recommended.
Question 6: A 62-year-old man on allopurinol presents with an acute gout flare. His serum urate is 5.5 mg/dL. What is the best approach?
- Stop allopurinol immediately
- Treat the flare; continue allopurinol at current dose (Correct answer)
- Double the allopurinol dose
- Switch to febuxostat
Correct answer: Treat the flare; continue allopurinol at current dose
Allopurinol should not be stopped during a gout flare; the flare is treated separately and the urate-lowering therapy is continued.
Question 7: A child with sickle cell disease presents with bone pain, fever, and an elevated WBC. Which organism is the MOST common cause of osteomyelitis in this population?
- Staphylococcus aureus
- Salmonella species (Correct answer)
- Streptococcus pneumoniae
- Escherichia coli
Correct answer: Salmonella species
Salmonella is the most common cause of osteomyelitis specifically in patients with sickle cell disease, though Staphylococcus aureus remains the most common overall.
Family Practice Exam Musculoskeletal 4
A 28-year-old male presents with a painful, warm, swollen knee after a minor fall.
Arthrocentesis reveals WBC 85,000/µL with 95% neutrophils.
What is the most likely diagnosis?