FMCLA Musculoskeletal and Orthopedic Conditions 2 — Questions and Answers
Question 1: Which joint is most commonly affected in rheumatoid arthritis that is rarely involved in osteoarthritis?
- DIP joints
- First CMC joint
- MCP joints (Correct answer)
- Knee joint
Correct answer: MCP joints
Rheumatoid arthritis classically involves the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, sparing the DIP joints.
Question 2: A patient presents with positive Phalen's and Tinel's signs at the wrist. The most likely diagnosis is:
- De Quervain's tenosynovitis
- Carpal tunnel syndrome (Correct answer)
- Ulnar nerve entrapment
- Trigger finger
Correct answer: Carpal tunnel syndrome
Phalen's test and Tinel's sign at the carpal tunnel are classic provocative tests for median nerve compression (carpal tunnel syndrome).
Question 3: Which of the following is the most appropriate first-line treatment for fibromyalgia?
- Opioid analgesics
- Aerobic exercise and cognitive behavioral therapy (Correct answer)
- Corticosteroid injections
- NSAIDs alone
Correct answer: Aerobic exercise and cognitive behavioral therapy
Multimodal management including aerobic exercise and cognitive behavioral therapy is the most effective first-line treatment for fibromyalgia.
Question 4: A 55-year-old woman presents with pain and stiffness of the shoulder girdle and hip girdle, ESR 80 mm/hr, and CRP elevated. The most likely diagnosis is:
- Fibromyalgia
- Rheumatoid arthritis
- Polymyalgia rheumatica (Correct answer)
- Systemic lupus erythematosus
Correct answer: Polymyalgia rheumatica
Polymyalgia rheumatica presents with bilateral shoulder and hip girdle pain, morning stiffness, and markedly elevated inflammatory markers in patients over 50.
Question 5: What is the Ottawa Knee Rule used for?
- Diagnosing meniscal tears
- Determining the need for knee X-ray after injury (Correct answer)
- Grading ligamentous laxity
- Screening for osteoarthritis
Correct answer: Determining the need for knee X-ray after injury
The Ottawa Knee Rules identify clinical criteria that predict which patients with acute knee injury require radiographic evaluation to rule out fracture.
Question 6: Which test is most sensitive for diagnosing a meniscal tear?
- Lachman test
- McMurray test
- MRI of the knee (Correct answer)
- Plain X-ray of the knee
Correct answer: MRI of the knee
MRI has approximately 90% sensitivity for meniscal tears and is the preferred imaging test when clinical suspicion is high.
FMCLA Musculoskeletal and Orthopedic Conditions 2
Which joint is most commonly affected in rheumatoid arthritis that is rarely involved in osteoarthritis?