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MSN 620 musculoskeletal module 4 Questions with complete solution
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MSN 620 musculoskeletal module 4 Questions with complete solution A 67-year-old female presents with an 18-month history of slowly worsening bilateral knee pain. She complains of moderate pain, particularly after walking or gardening. She has a past medical history of breast cancer, which was treat...

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  • August 18, 2024
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  • 2024/2025
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MSN 620 musculoskeletal module 4
A 67-year-old female presents with an 18-month history of slowly worsening
bilateral knee pain. She complains of moderate pain, particularly after walking
or gardening. She has a past medical history of breast cancer, which was
treated with primary surgery and radiotherapy 10 years ago. Her medications
include letrozole and acetaminophen. The patient's body mass index (BMI) is
30 kg/m2. Examination demonstrates bilateral knee swelling and crepitus with
active flexion. Lab results show white blood cell count, C-reactive protein, and
erythrocyte sedimentation rate within their normal range, and rheumatoid
factor is negative. The x-ray findings of each knee demonstrate joint space
narrowing with several osteophytes. Which of the following is essential to
prevent the progression of this patient's condition? - correct answer ✔Weight
reduction


A 65-year-old woman is worried about her inability to perform various activities
because of severe lower back pain and pain in both wrist joints. She has a
body mass index of 35 kg/m². She has a history of hypertension and takes
amlodipine regularly. She has been taking prescribed doses of ibuprofen for
the last month but with no relief. Her clinical examination reveals tender wrist
joints, palpable swelling at the base of the right thumb, mild tenderness in the
lower back, and hip joint pain with movements. Her lumbar spine hip joint x-
ray reveals increased subchondral bone density. What is the best treatment
plan for her? - correct answer ✔Weight loss


A 74-year-old woman presents with increasing right hip pain over the last 2
months. A review of systems reveals no history of trauma or falls and it has
decreased her mobility and made her more dependent on family. Vital signs
are blood pressure 130/90 mmHg, heart rate 80 bpm, and body mass index
32 kg/m2. Her physical examination reveals palpable swellings on the
proximal interphalangeal joints of her hands and painful restricted movements
at the hip joint. Laboratory testing reveals negative rheumatoid factor (RA)
and anti-nuclear antibodies (ANA). Her plain x-ray suggests a narrowing of
joint space and cartilage erosions. What is the most common hand joint

, involved in postmenopausal women? - correct answer ✔First
carpometacarpal joint


A 61-year-old man with a body mass index of 31 kg/m^2 presents for a 6-
month history of gradual onset right medial knee pain. Examination reveals a
small effusion, stable ligaments, a normally tracking patella, and mild medial
joint line tenderness. Standing radiographs show mild medial joint space
narrowing. Which of the following is the most appropriate treatment at this
stage of the disease?
Well done! - correct answer ✔Weight loss and low-impact exercises


A 65-year-old woman presents to the clinic for evaluation. She has a history of
chronic bilateral knee pain, which has been gradually worsening. She is
currently on acetaminophen 1000 mg 3 times daily, naproxen 500 mg twice
daily, and tramadol 50 mg twice daily for knee pain, but these do not seem to
help anymore. She has tried physical therapy and intraarticular corticosteroids
without much response in the past. She has a past medical history of obesity,
diabetes, and hypertension. Her other current medications include insulin and
hydrochlorothiazide. Vitals are blood pressure 140/98 mm Hg and heart rate
88 bpm. Exam reveals tenderness in both knees along the medial joint line
with swelling, effusion, and decreased range of motion. X-ray shows bone-on-
bone and joint space narrowing in the medial compartment bilaterally, along
with osteophyte formation. What is the next best step in the treatment of this
patient? - correct answer ✔Evaluation for knee replacement


A 65-year-old man with a past medical history of hypertension presents to the
medical clinic with worsening left knee pain. He has chronic pain in the left
knee for 15 years that has recently increased in intensity and is associated
with less than 30 minutes of morning stiffness. He participates in aquatic
aerobics three times per week. His current medications are lisinopril,
duloxetine, and pantoprazole. He cannot tolerate oral nonsteroidal anti-
inflammatory drugs (NSAIDs). His physical examination reveals that the right
knee is bulky with varus deformity, and crepitus is noted. Knee erythema,
effusion, or warmth are absent. He is traveling to Europe next month for a
vacation, and he would like to improve his pain in order to tolerate physical

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