Physician Assistant Physician Assistant Musculoskeletal System Disorders 1 — Questions and Answers
Question 1: A 55-year-old woman presents with bilateral knee pain worse with activity and relieved by rest. X-ray shows joint space narrowing and osteophytes. What is the most likely diagnosis?
- Rheumatoid arthritis
- Osteoarthritis (Correct answer)
- Gout
- Psoriatic arthritis
Correct answer: Osteoarthritis
Osteoarthritis is characterized by joint space narrowing, osteophytes, and pain worsened by activity, most commonly affecting weight-bearing joints.
Question 2: Which laboratory finding is most characteristic of rheumatoid arthritis?
- Elevated uric acid
- Positive rheumatoid factor and anti-CCP antibodies (Correct answer)
- Elevated alkaline phosphatase
- Positive ANA with anti-dsDNA
Correct answer: Positive rheumatoid factor and anti-CCP antibodies
Rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide) antibodies are the hallmark serologic markers of rheumatoid arthritis.
Question 3: A 30-year-old male presents with acute monoarticular arthritis of the first metatarsophalangeal joint, erythema, and severe pain. Synovial fluid analysis shows negatively birefringent needle-shaped crystals. What is the treatment of choice for an acute attack?
- Allopurinol
- Colchicine or NSAIDs (Correct answer)
- Methotrexate
- Prednisone taper over 6 weeks
Correct answer: Colchicine or NSAIDs
Colchicine and NSAIDs are first-line treatments for acute gout attacks; allopurinol is used for long-term urate-lowering therapy, not acute episodes.
Question 4: Which finding on physical examination is most consistent with a complete rotator cuff tear?
- Painful arc between 60–120 degrees of abduction
- Inability to initiate abduction with preserved passive range of motion (Correct answer)
- Positive apprehension sign
- Tenderness over the acromioclavicular joint
Correct answer: Inability to initiate abduction with preserved passive range of motion
A complete rotator cuff tear results in inability to initiate active abduction while passive range of motion remains intact due to loss of musculotendinous continuity.
Question 5: A patient with low back pain radiating down the posterior leg to the foot has a positive straight leg raise at 45 degrees. Which nerve root is most likely involved?
- L2
- L3
- L4
- L5 or S1 (Correct answer)
Correct answer: L5 or S1
A positive straight leg raise combined with posterior leg pain radiating to the foot is classic for L5 or S1 nerve root compression, typically from a herniated disc.
Question 6: Which medication is classified as a disease-modifying antirheumatic drug (DMARD) and is first-line for rheumatoid arthritis?
- Ibuprofen
- Prednisone
- Methotrexate (Correct answer)
- Celecoxib
Correct answer: Methotrexate
Methotrexate is the anchor DMARD and first-line agent for rheumatoid arthritis, slowing disease progression and joint damage.
Physician Assistant Physician Assistant Musculoskeletal System Disorders 1
A 55-year-old woman presents with bilateral knee pain worse with activity and relieved by rest.
X-ray shows joint space narrowing and osteophytes.
What is the most likely diagnosis?