MD - Doctor of Medicine Musculoskeletal and Connective Tissue Questions and Answers

Question 1

A 28-year-old African American female presents with fatigue, a facial rash that worsens with sun exposure, and joint pain in her hands and wrists.
Laboratory workup is initiated for a suspected autoimmune condition.
Which of the following clinical findings is most characteristic of Systemic Lupus Erythematosus (SLE)?

Accepted Answer

Painless oral ulcers

Answer

Proximal muscle weakness

Answer

Sclerodactyly

Answer

Asymmetric oligoarthritis

Question 2

A 72-year-old woman is diagnosed with osteoporosis after a DEXA scan reveals a T-score of -2.8 at the femoral neck. She has no contraindications to standard therapy. Which of the following best describes the mechanism of action of bisphosphonates, the first-line treatment for this condition?

Accepted Answer

Inhibits osteoclast-mediated bone resorption

Answer

Stimulates osteoblasts to increase bone formation

Answer

Acts as a selective estrogen receptor modulator in bone

Answer

Increases intestinal calcium absorption and renal calcium reabsorption

Question 3

A 35-year-old man with a history of intravenous drug use presents to the emergency department with a 2-day history of severe right knee pain, swelling, and an inability to bear weight. On examination, the knee is erythematous, warm, and exquisitely tender. He has a fever of 39.0°C (102.2°F). What is the most crucial next step in the diagnosis and management of this patient?

Accepted Answer

Perform an immediate arthrocentesis

Answer

Obtain an MRI of the knee

Answer

Initiate empiric intravenous antibiotics

Answer

Order blood cultures and C-reactive protein

Question 4

A 65-year-old male with a history of chronic kidney disease (stage 3) presents with excruciating pain, redness, and swelling in his right great toe that began overnight. Arthrocentesis reveals negatively birefringent, needle-shaped crystals. What is the most appropriate initial pharmacologic treatment for this patient's acute gout flare?

Accepted Answer

Prednisone

Answer

Allopurinol

Answer

High-dose NSAIDs (e.g., indomethacin)

Answer

Probenecid

Question 5

A 45-year-old female presents with a 6-month history of symmetric pain and swelling in her metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, associated with morning stiffness lasting over an hour. Which of the following laboratory findings is most specific for the diagnosis of rheumatoid arthritis?

Accepted Answer

Positive anti-cyclic citrullinated peptide (anti-CCP) antibody

Answer

Positive antinuclear antibody (ANA)

Answer

Elevated C-reactive protein (CRP)

Answer

Elevated rheumatoid factor (RF)

Question 6

A 75-year-old woman was recently diagnosed with polymyalgia rheumatica (PMR). During a follow-up visit, she reports developing a new, unilateral headache over her right temple and jaw claudication when chewing. Which of the following conditions is most likely associated with her PMR and new symptoms?

Accepted Answer

Giant Cell Arteritis (GCA)

Answer

Fibromyalgia

Answer

Trigeminal neuralgia

Answer

Cervical spondylosis