Family Practice Exam Musculoskeletal 5

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?

Accepted Answer

Slipped capital femoral epiphysis

Answer

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?

Accepted Answer

Basal joint arthritis

Answer

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?

Accepted Answer

Supraspinatus

Answer

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?

Accepted Answer

Medial calcaneal tuberosity (plantar fascia origin)

Answer

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?

Accepted Answer

Proximal interphalangeal and metacarpophalangeal joints

Answer

Rheumatoid arthritis preferentially involves the PIP and MCP joints with periarticular erosions, sparing the DIP joints (which are affected in OA).

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Family Practice Exam Musculoskeletal 5