MSN-FNP Musculoskeletal Disorders Questions and Correct Answers the Latest Update and Recommended Version
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Course
MSN-FNP
Institution
MSN-FNP
A 42 yo male who plays basketball on the weekends has medial knee pain after landing
on the extremity and pivoting sideways to pass. He felt a "pop" and experienced swelling
a few minutes later. He has pain with walking. He denies any instability but does feel like
it is "catching" with knee ...
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MSN-FNP Musculoskeletal Disorders
Questions and Correct Answers the
Latest Update and Recommended
Version
A 42 yo male who plays basketball on the weekends has medial knee pain after landing
on the extremity and pivoting sideways to pass. He felt a "pop" and experienced swelling
a few minutes later. He has pain with walking. He denies any instability but does feel like
it is "catching" with knee flexion. On exam, he has joint effusion, his Lachman's is
negative, and he has no pain with patella mobility. What is his most likely injury?
A. Anterior cruciate ligament
B. Meniscal injury
C. Tibial plateau fracture
D. Osgood-Schlatter disease
✓ B. Meniscal injury
A 33 yo female with PMH of DM c/o of pain in her wrist. The pain is located along the
radial side of the wrist and has been occurring for a long time. She feels a reduced
sensation along the radial side of her hand with occasional numbness and tingling. In
addition, she also feels an occasional temperature change in her hand that she describes
as a "cool feeling." She does not know exactly when the pain started and cannot recall
any trauma or injury to the site. V/S are normal. Exam reveals a well-circumscribed,
subcutaneous, soft, mobile wrist mass that is non-tender to palpitation and
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transilluminates with lighting. The patient has trouble gripping objects. What is the most
likely diagnosis?
A. Lipoma
B. Ganglion cyst
C. Radial artery aneurysm
D. Osteosarcoma
✓ B. Ganglion cyst
✓ Explanation: A ganglion cyst is a cystic swelling typically found on the dorsal side of the
wrist. These cyst are thought to arise from herniation of synovial tissue from a joint
capsule or tendon sheath. They present with chronic wrist pain and may be accompanied
by coolness of the hand, numbness/tingling, and possible parethesias. The mass itself is
mobile, may be tender to palpation, and transilluminates. (A) Limpoma is a benign tumor
of fat that can occur on the hand. Lipomas are soft to the touch and mobile. Unlike
Ganglion cyst, lipomas typically do not cause hand symptoms and are not well
circumscribed. They do not transilluminate either. (C) Radial artery aneurysms are dilations
of the radial artery that extend into the hand. While there is no history of trauma, they
present as pulsatile masses without any pain and do not transilluminate either. (D)
Osteosarcoma are cancerous tumors occurring in the bone. While they occur typically on
the shoulders, elbows, and knees, they can occur in the hand as well. Unlike ganglion cyst,
they are not well-circumscribed and are fixed rather than mobile.
Gymnast's wrist is associated with which of the following conditions?
A. Osteochondritis dissecans of capitellum
B. Apophyseal avulsion fracture of the humeral epicondyle
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✓ D. Injury to the distal radial physis
✓ Explanation: A gymnast wrist refers to injury to the distal radial physis, occurring as a
result of repetitive stresses due to weight bearing on the upper extremities. (A) (B)
Osteochondritis dissecans of the capitellum and apophyseal avulsion fracture of the
medial humeral epicondyle are associated with Leaguer's elbow. (C) Subluxation of the
radial head is associated with nursemaids elbow.
A 21 yo rugby player had a sudden onset of chest pain after tackling an opposing player.
He denies any dyspnea. He has no history of health problems or surgeries. On physical
exam, he has no pain or deformity in his clavicle. His rotator cuff muscles are intact. He
has an easily seen and palpable defect in the muscle belly of his chest inferior to his
clavicle. What is the most likely diagnosis?
A. Myocardial infarction
B. Manubrium fracture
C. Pneumothorax
D. Pectoral muscle tear
✓ D. Pectoral muscle tear
✓ Explanation: This is a common mechanism of injury for a pectoral muscle tear. A visible
defect in the muscle belly helps guide the diagnosis. Complete tears mainly occur at the
humeral insertion and require surgical repair. Partial tears my be difficult to diagnosis,
but strength is affected when compared to the contralateral side.
A 33 yo woman with PMH of DM complains of mild pain in her wrist. The pain is located
along the radial side of the wrist. She denies any loss of sensation or numbness/tingling.
She does not exactly when the pain and discomfort started and cannot recall any
traumatic or inciting event. VS or normal Exam reveals a well-circumscribed,
subcutaneous, soft, mobile wrist mass that is mildly tender to palpitation and
transilluminated with lighting. What is the next step in management?
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A. Conservative treatment (NSAIDs, physical therapy)
B. MRI of hand
C. Aspiration of mass
D. Surgical excision
✓ A. Conservative treatment (NSAIDs, physical therapy)
✓ Explanation: A ganglion cyst is a cystic swelling typically found on the dorsal side of the
wrist. These are thought to arise due to herniation of synovial tissue from a joint capsule
or tendon sheath. They present with chronic wrist pain and may be accompanied by
coolness of the hand, numbness/tingling, and possible parenthesis. The mass is mobile,
tender, and transilluminates. Most resolve spontaneously and heal within months of
conservative treatment.
A 50 yo Caucasian female presents to office with morning joint stiffness mostly in her feet
and hands that last up to 2 hours after starting her day. She reports this happened about a
month ago and her wrist were very sore, but she seemed to get better. She also reports
feeling tired lately, her cloths are looser, and sometimes she thinks she may have been
running a fever. Exam reveals swelling and warmth in the MCPs and PIPs of both hands.
Based on history, exam, and symptoms what is the most likely diagnosis?
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