Family Practice Exam Musculoskeletal 5 — Questions and Answers
Question 1: A 14-year-old overweight boy presents with a limp and dull hip pain referred to the knee. X-ray shows posterior and medial displacement of the femoral epiphysis. What is the diagnosis?
- Legg-Calvé-Perthes disease
- Slipped capital femoral epiphysis (Correct answer)
- Transient synovitis
- Developmental dysplasia of the hip
Correct answer: Slipped capital femoral epiphysis
SCFE occurs in overweight adolescents and presents with hip or knee pain; surgical pinning is the treatment.
Question 2: A 55-year-old woman presents with thumb carpometacarpal (CMC) joint pain aggravated by pinching and jar-opening. Grind test is positive. What is the most likely diagnosis?
- Trigger thumb
- Basal joint arthritis (Correct answer)
- De Quervain tenosynovitis
- Carpal tunnel syndrome
Correct answer: Basal joint arthritis
Basal joint (CMC) arthritis is the most common form of hand arthritis in women over 50, presenting with pain at the thumb base and a positive grind test.
Question 3: Which tendon is most commonly involved in a rotator cuff tear?
- Infraspinatus
- Supraspinatus (Correct answer)
- Subscapularis
- Teres minor
Correct answer: Supraspinatus
The supraspinatus tendon is the most commonly torn rotator cuff tendon due to its position under the acromion and poor blood supply at its insertion.
Question 4: A 48-year-old man presents with morning heel pain that is worst with the first steps after rest. It improves after walking a few minutes. Where is the tenderness localized?
- Achilles tendon insertion
- Medial calcaneal tuberosity (plantar fascia origin) (Correct answer)
- Lateral ankle ligament
- Peroneal tendon
Correct answer: Medial calcaneal tuberosity (plantar fascia origin)
Plantar fasciitis classically causes heel pain maximal at the medial calcaneal tuberosity, worst with first steps in the morning.
Question 5: A 65-year-old woman presents with bilateral hand deformity showing ulnar deviation of the fingers and swan-neck deformities. Labs show positive RF and anti-CCP. What joint erosions are expected on X-ray?
- Distal interphalangeal joints
- Proximal interphalangeal and metacarpophalangeal joints (Correct answer)
- First carpometacarpal joint
- Sacroiliac joints
Correct answer: Proximal interphalangeal and metacarpophalangeal joints
Rheumatoid arthritis preferentially involves the PIP and MCP joints with periarticular erosions, sparing the DIP joints (which are affected in OA).
Question 6: A 72-year-old man presents with low back and hip pain, worsened with walking and relieved when leaning forward (e.g., shopping cart sign). What is the most likely diagnosis?
- Peripheral artery disease
- Lumbar spinal stenosis (Correct answer)
- Hip osteoarthritis
- Piriformis syndrome
Correct answer: Lumbar spinal stenosis
Neurogenic claudication from lumbar spinal stenosis is relieved by flexion (leaning forward) which opens the spinal canal, unlike vascular claudication.
Question 7: A 22-year-old female presents with acute onset of a warm, swollen right knee. She denies trauma. She has a new sexual partner and had a pustular skin rash last week. What is the most likely diagnosis?
- Reactive arthritis
- Disseminated gonococcal infection (Correct answer)
- Lyme arthritis
- Septic arthritis from Staphylococcus
Correct answer: Disseminated gonococcal infection
Disseminated gonococcal infection is the most common cause of septic arthritis in sexually active young adults and may present with migratory arthritis and pustular skin lesions.
Family Practice Exam Musculoskeletal 5
A 14-year-old overweight boy presents with a limp and dull hip pain referred to the knee.
X-ray shows posterior and medial displacement of the femoral epiphysis.
What is the diagnosis?