MSN-FNP Musculoskeletal Disorders Exam Questions With Complete Solutions
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MSN-FNP Musculoskeletal Disorders
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MSN-FNP Musculoskeletal Disorders
MSN-FNP Musculoskeletal Disorders Exam Questions With Complete Solutions
- Answer-De Quervain's disease can be diagnosed with a positive sign. Pain in the gentle deviation of the fist in which the thumb is tucked under the four fingers to the ulnar side is a positive Finkelstein's sign and De Qu...
- Answer-De Quervain's disease can be diagnosed with a positive sign. Pain in the
gentle deviation of the fist in which the thumb is tucked under the four fingers to the
ulnar side is a positive Finkelstein's sign and De Quervain's disease, which is swelling
and tenderness over the volar portion of the "snuff box" resulting in chronic
tenosynovitis.
/.A 14 year-old female presents for pre-sports physical. She c/o back discomfort when
she "sits for a long time." Her exam reveals scoliosis with a left-sided curve. An MRI of
the spine is indicated to rule out which of the following conditions?
A. Intraspinal syrinx
B. Narrowing of disc space
C. Schmorl nodes
D. Irregularities in vertebral endplates - Answer-A. Intraspinal syrinx
Explanation: About 80% if scoliosis cases appear as a right thoracic curve. A left sided
pattern is associated with risk for intraspinal syrinx or tumor, which can be detected on
MRI. The remainder of findings are associated with Schneurmann kyphosis, the 2nd
most common cause of spinal deformities in pediatrics. A scoliotic curve must measure
greater than or equal to 10 degress on a spinal radiography via the COBB method (a
special tool that measures the angle on radiograph) to meet the criteria for diagnosing
scoliosis, but most patients do not exhibit clinically significant respiratory symptoms until
the curves measure 60 to 100 degrees.
/.A 14 yo female soccer player felt a pop in her knee while running. She has immediate
pain and swelling in the knee and cannot bear weight. She feels unstable while walking.
ON exam on the sideline, she has an overt effusion and tenderness along the tibial
plateau. What orthopedic exam test would be helpful in making a diagnosis?
A. McMurray's test
B. Stork test
C. Lachman's test
D. Tinel's test - Answer-C. Lachman's test
Explanation: Exam and history are most likely an anterior cruciate ligament (ACL) tear.
Lachman's test assess the integrity of the ACL. IN this test, the femur is held steadily
while the tibia is moved anteriorly. A firm end-point and symmetry of anterior translation
as compared to the contralateral side indicates low likelihood of an ACL tear. (A)
McMurray's test assess meniscal injury. Knee pain with external and internal movement
of the tibia (to compress the meniscus between the femur and tibia) indicates a positive
test and raises concern for a tear. (B) the assessment of the Stork test is a test of
mobility of the sacroiliac joint and involves palpitation of the posterior superior iliac spine
(PSIS). (D) A positive Tinel's test involves paresthesia in the median nerve distribution
,with tapping the area of the median nerve. A positive test raises concern for carpal
tunnel syndrome.
/.A 14 yo football player returns 1 week after being diagnosed with mononucleosis by
Monospot test and 2 weeks after his symptoms began. VS normal. What is the next
step in management?
A. Obtain abdominal ultrasound 1x per week for 4 weeks to assess spleen size.
B. Obtain repeat Monospot test and EBV serology.
C. Obtain weekly liver-function test and perform weekly abdominal exams.
D. Advise avoidance of football for 3- week minimum from start of symptoms. Patient
may return to activity when all symptoms have resolved. - Answer-D. Advise avoidance
of football for 3-week minimum from start of symptoms. Patient may return to activity
when all symptoms have resolved.
Explanation: Mononucleosis is a common diagnosis in the adolescent population. While
recommendations that do exist identify 3 weeks from initial of symptoms minimum to
refrain from contact sports because of the risk of splenic rupture. Once 3 weeks have
passed and the athlete is afebrile, has resumed appropriate nutritional intake, and is a
normal energy levels. resumption of participation can be discussed.
/.A 15 yo competitive swimmer presents with pain in the right shoulder aggravated by
movement. Exam is significant for tenderness on palpitation and muscle weakness in
the affected arm. Physical fractures and apophysitis have been ruled out. What is the
most likely diagnosis?
A. Rotator cuff tendinopathy
B. Sprengel deformity
C. Spondylolysis
D. Spondylolisthesis - Answer-A. Rotator cuff tendinopathy
Explanation: Rotator cuff tendinopathy is an overuse injury commonly found in
swimmers. Therapy includes ice, anti-inflammatories, activity modification, and physical
therapy. (B) Sprengel deformity refers to congenital elevation of the scapula, which can
be associated with webbed neck, low posterior hairline, and Klippel-Feil syndrome. (C)
Spondylolysis refers to abnormalities of he pars interarticularis of the vertebrae. (D)
Spondylolisthesis is defined as slippage of the superior over the inferior vertebrae. This
occurs more commonly in adolescents in participating in sports requiring frequent back
extension (gymnastics and diving)
/.A 15 yo male with no PMH presents with shoulder pain that has occurred for several
months. He has been playing baseball for the last 3 years and began feeling pain in his
left arm and shoulder when he started learning and practicing in the breaking-ball pitch
over the last 6 months. He denies any trauma. Pain only occurs when the patient is
pitching and is relieved by rest. Pain also tends to occur in the deceleration portion f his
pitch and is relieved by rest. Pain also tends to occur in the deceleration portion of his
pitch and is not related to temperature or time of the day. The patient's VS are normal.
Exam shows pinpoint tenderness where the shoulder meets with the arm. What is the
most likely diagnosis?
A. Thoracic outlet syndrome
, B. Rotator cuff tendinitis
C. Shoulder impingement
D. Proximal humerus stress injury (little leaguer's shoulder) - Answer-D. Proximal
humerus stress injury (little leaguer's shoulder)
Explanation: PHS injury affects the growth plate of the proximal humerus after repeated
microtrauma.
/.A 15 yo male with no PMH presents with shoulder pain that occurred for more than 4
months. He has been a baseball pitcher for most of his life, and he started feeling
tenderness around his shoulder region 4 months ago. He denies any trauma but does
state that several months ago, he felt a pull on his shoulder when the threw a fast ball,
resulting in pain after the incident. The pain has not progressed since the incident and
has improved with lidocaine injection. The pain is not related to temperature but tends to
worsen during the evening. VS are normal. Exam shows tremendous difficulty in lifting
his left arm above his head accompanied by pain. What is the most likely diagnosis?
A. Thoracic outlet syndrome
B. Rotator cuff tendonitis
C. Shoulder impingement
D. Proximal humerus stress injury (Little Leaguer's shoulder) - Answer-C. Shoulder
impingement
Explanation: Shoulder impingement is a clinical syndrome that occurs when the tendons
of the rotator cuff become irritated and inflamed as they pass through the subacromial
space. It presents with pain, weakness, and decreased ROM in the shoulder. Pain is
often exacerbated by shoulder movement, especially when lifting the arm over the head.
Onset of the pain may be acute or chronic, and it can be accompanied by grinding
sensation during shoulder movement. Typically, pain in impingement is not related to
temperatures, worsens in the evening, and improves with lidocaine injection. (A)
Thoracic outlet syndrome occurs when there is compression at the superior thoracic
outlet resulting from excess pressure placed on a neurovascular bundle between the
scalene muscles. Because the nerves of the upper limp and/or vessels pass through the
outlet, all of them can be affected. Typically, the syndrome is caused by congenital
abnormalities such as cervical rig or prolonged transverse process, or by trauma or
repetitive strain. Patients present with sharp, burning n the upper arm, forearm, and /or
fingers. Decreased coloring of the hands and coldness re commonly found in addition to
tingling. Our patient lacks the sharp burning symptoms and tingling required for
diagnosis.
(B) Rotator cuff tendinitis is the swelling of the rotator cuff tendons from repetitive
activities associated with overuse of the arm and shoulder, especially in physical
activities such as volleyball or baseball. Symptoms involve shoulder weakness and
difficulty lifting the arm over the head. In addition, there may be pain and swelling in the
front of the shoulder, a clicking sound when the arm is raised, and stiffness. Resting the
shoulder and icing it along with ibuprofen treatment should improve the symptoms. (D)
Proximal humerus stress
/.A 15 yo with no PMH presents with shoulder pain that has occurred for several years.
He has been playing baseball since he was 10, and the shoulder pain has increased
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