PANCE Musculoskeletal 4

Question 1

A 16-year-old obese male presents with left hip and knee pain and a limp. The hip is held in external rotation. What is the most likely diagnosis?

Accepted Answer

Slipped capital femoral epiphysis

Answer

Slipped capital femoral epiphysis (SCFE) occurs in obese adolescent males, presenting with hip/knee pain and obligate external rotation of the hip; urgent surgical pinning is required.

Question 2

A 55-year-old man presents with low back pain radiating down the posterior leg to the foot, worsened by sitting and relieved by standing. Straight leg raise is positive at 40°. What is the most likely diagnosis?

Accepted Answer

L4-L5 disc herniation

Answer

A positive straight leg raise test at less than 45° is highly sensitive for lumbar disc herniation causing nerve root compression and radiculopathy.

Question 3

A 70-year-old male presents with bilateral leg cramping when walking that is relieved by leaning forward or sitting. MRI shows narrowing of the lumbar spinal canal. What is the diagnosis?

Accepted Answer

Lumbar spinal stenosis

Answer

Lumbar spinal stenosis causes neurogenic claudication with pain relieved by flexion (leaning forward), distinguishing it from vascular claudication which improves with rest alone.

Question 4

A patient with a distal radius fracture develops loss of thumb opposition and thenar atrophy 3 months after casting. Which nerve is involved?

Accepted Answer

Median nerve

Answer

The median nerve innervates the thenar muscles and provides thumb opposition; it can be compressed in carpal tunnel syndrome, which is a known complication of distal radius fractures.

Question 5

A 25-year-old basketball player twists his knee and feels a pop. He develops a knee effusion within 2 hours and has a positive Lachman test. What structure is most likely injured?

Accepted Answer

Anterior cruciate ligament

Answer

ACL tears present with a pop, rapid hemarthrosis, and positive Lachman test; they are common in pivoting sports like basketball.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Musculoskeletal 4