FMCLA Musculoskeletal and Orthopedic Conditions 1 — Questions and Answers
Question 1: A patient presents with acute monoarthritis of the first MTP joint with overlying erythema and severe pain. Synovial fluid shows negatively birefringent crystals. The diagnosis is:
- Pseudogout
- Gout (Correct answer)
- Septic arthritis
- Rheumatoid arthritis
Correct answer: Gout
Gout is caused by monosodium urate crystals, which appear needle-shaped and negatively birefringent under polarized light microscopy.
Question 2: Which imaging modality is first-line for evaluating suspected rotator cuff tear?
- Plain X-ray
- CT scan
- MRI (Correct answer)
- Bone scan
Correct answer: MRI
MRI is the gold standard for evaluating soft tissue structures including the rotator cuff, providing excellent detail of tear size and location.
Question 3: A 16-year-old male basketball player presents with anterior knee pain below the patella that worsens with activity. The most likely diagnosis is:
- Patellofemoral syndrome
- Osgood-Schlatter disease (Correct answer)
- Patellar fracture
- Meniscus tear
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease causes tibial tubercle apophysitis due to repetitive quadriceps traction in adolescent athletes.
Question 4: Which maneuver is used to test for anterior cruciate ligament (ACL) integrity?
- McMurray test
- Valgus stress test
- Lachman test (Correct answer)
- Patellar grind test
Correct answer: Lachman test
The Lachman test is the most sensitive clinical test for ACL rupture, assessing anterior tibial translation at 20–30° knee flexion.
Question 5: First-line treatment for acute uncomplicated low back pain in a 40-year-old without neurological deficits includes:
- Opioid analgesics
- Bed rest for 2 weeks
- NSAIDs and continued activity (Correct answer)
- Lumbar MRI immediately
Correct answer: NSAIDs and continued activity
NSAIDs combined with continued physical activity are evidence-based first-line treatments for acute low back pain without red flags.
Question 6: Which finding on physical exam is a 'red flag' in a patient presenting with low back pain?
- Pain worse with prolonged sitting
- Bilateral lower extremity weakness and saddle anesthesia (Correct answer)
- Lumbar paraspinal muscle tenderness
- Pain radiating to the posterior thigh
Correct answer: Bilateral lower extremity weakness and saddle anesthesia
Bilateral weakness, saddle anesthesia, and bowel/bladder dysfunction suggest cauda equina syndrome, a surgical emergency.
FMCLA Musculoskeletal and Orthopedic Conditions 1
A patient presents with acute monoarthritis of the first MTP joint with overlying erythema and severe pain.
Synovial fluid shows negatively birefringent crystals.
The diagnosis is: