MSK Quizzes

1. A 70-year-old female worsening low back pain radiates to right leg.He noticed the pain on pushing the cart.PE.Neurologic examination is positive for diminished sensation to light touch on the lower extremities bilaterally. Which of the following is the most likely cause of this patient’s symptoms?

2. A 62-year-old with 1-year history of bilateral knee pain, worse in the afternoon and after prolonged activity.PE swelling and tenderness to palpation of the DIP joints on both hands.crepitus heard with motion of the right knee. Which of the following is the most likely diagnosis

3. A 67-year-old man had three episodes of gout over the past 4 years. His physician advises him that certain lifestyle choices can affect his risk for recurrent episodes of gout.Which of the following is a risk factor for the development of gout?

4. A 62-year-old female with bilateral knee pain dull ache that worsens with activity and is relieved by rest with early morning stiffness.O/E obese women with decreased range of motion in both knees x-rays knees show bony spurs, subchondral sclerosis, joint space narrowing, and subchondral cysts. Intervention to decrease progression?

5. A 32-year-old woman comes to the dermatologist because she has noticed a raised pigmented lesion on her right leg. O/E 4 × 8 mm pinkish tan lesion with irregular borders. A biopsy of lesion shows atypical melanocytes arranged in nests and as single cells at the dermoepidermal junction but with no continuous growth or spread of melanocytes into the upper epidermis.

6. A 80-year-old man comes to his PCP c/o multiple episodes of gout for 4 years. What is the first line therapy in prophylaxis?

7. A 60-year-old man comes to the clinic because of increasing knee pain. He has a history of osteoarthritis unresponsive to acetaminophen, and H. pylori gastritis, for which he takes omeprazolE. Which is the best treatment?

8. A 32-year-old man injured his right ankle playing soccer.While lunging for the ball, he heard a sudden "pop" and felt pain in his right leg. O/E Right ankle is swollen and tender to palpation over the posterior aspect. Thompson test is positivE. What is the diagnosis?

9. A 22-year-old man comes to the clinic because of right knee pain for the past 2 weeks.He also has dysuria . O/E temperature is 37.8°C (100.6°F). PE reveals his conjunctival injection and right knee and both wrists are edematous with decreased ROM.GU examination reveals penile meatal edema and erythemA. These symptoms are most often associated with which of the following?

10. A 55-year-old woman presents to her primary care physician with progressively worsening joint pain in her hands for the past year. She has pain, swelling, and warmth in her hands bilaterally with every morning stiffness for an hour.She has fatigue and feveres.Which of the following medications will reduce the progression of disease?

11. A 26-year-old man came to the ED because of the acute onset of back pain after a fall from ladder this afternoon. His vitals are stablE. Physical examination shows that range of motion of the hip is limited by pain.What is the best next step for management of this patient's condition?

12. A 25 year-old college student comes to the ED and reports fevers, joint pain, fatigue, and a rash. Vitals show temp of 39.0°C (102.2°F). She has had joint pain for the last month and fevers for the last 2 weeks. PE show non itchy rash on his abdomen with fever.O/E there is lymphadenopathy and a macular salmon-colored rash on the trunk. Cultures are taken and the patient is admitted and started on empirical broad-spectrum antibiotics. After 1 week, cultures are negative and his symptoms are unchangeD. There is leukocytosis and an elevated ferritin concentration.What is the diagnosis?

13. A 30-year-old woman sustained second-degree burns covering 35% of his total body surface areA. She is intubated and morphine is initiateD. Three days later, the patient’s temperature is 38.3°C (101.6°F), blood pressure is 100/70 mmHg, HR is 115/min, and RR is 20/min. Bilateral crackles are heard on chest auscultation. Her trunk and lower extremities are diffusely erythematous with several patches of blisters and sloughed-off skin with pus covering the wounds. WBC is elevateD.

14. A 62-year-old woman reports pain and stiffness in her hands that has progressively worsened over the past year. She notes the pain is worse at the end of the day. She has had some relief with ibuprofen. O/E PIP and DIP joints bilaterally have limited flexion and are tender to palpation.The Histopathology shows?

15. A 68-year-old woman came with c/o bone and joint pain for the past year.She has also noticed difficulty hearing. She has dull lower leg aching that is exacerbated by exercisE. Vitals are stablE. Physical examination reveals bilateral bowing of her tibias.Which of the following laboratory abnormalities will be seen in this patient?

16. A 32-year-old man with hip and low back pain for years,worse in the morning and decreases with activity and with hot showers.PE decreased ROM of the lumbar spine and tender sacroiliac joints. X-ray spine shows Bamboo spine pattern. Labs human leukocyte antigen (HLA)-B27 positivE. The patient’s clinical presentation is associated with what other condition?

17. A 62-y.o male c/o breathlessness worsening over 6 months ,cough for 1 month. Initially breathless while walking, norway rest.℅ pain and swelling hands and body stiffness in the morning PE crackles at the lung bases bilaterally,enlarged MCP joints bilaterally; warm, swollen and tender.ulnar deviation of the fingers positive which is not reduciblE. PFT shows?

18. A 80-y.o man with lower back and leg pain.Pain increased on walking, steadily worsening over years,In the past, the pain was confined to his lower back and upper legs,.Diminished sensation to touch in the distal lower extremities.ABI is 1.1.What test?

19. A 68y.oman comes with months of intermittent symptoms of progressive muscle weakness, fatigue, eyelid drooping, double vision, and difficulty swallowing.Two months later, the patient comes to the ED with acute onset of difficulty breathing, diarrhea, and tremor. He reports accidentally taking three times his normal dose of medication. Pupils are 1 mm and poorly reactive to light with excessive salivation. Soft wheezing is heard in all lung fields. Bowel sounds are increaseD. After management of the patient's airway, what is the next treatment?

20. A 42-year-old woman comes with worsening fatiguE. She noticed difficulty opening her left eye and reports that she feels fine when she wakes up, but her head "feels heavy" toward the end of the day.What is the treatment?

21. A 29-year-old man has had low back pain and a swollen and painful left ankle and right knee for the past 6 days and also reports subjective fevers. 3 weeks ago he had bloody diarrhea, abdominal cramps, and a fever for a few days. His temperature is 39.0°C (102.2°F), pulse is 90/min, respiratory rate is 16/min, and blood pressure is 130/85 mm PE shows red conjunctivA. He has mild swelling of the right knee and left anklE. Labs show raised erythrocyte sedimentation rate (ESR). Diagnosis?

22. A 36-year-old attorney with chronic lower back pain and stiffness for the past several months. He states that the stiffness is most severe in the morning, lasting hours, and improves over the course of the day, especially after he exercises. Physical examination reveals decreased range of motion in the lumbar spine as well as a loss of natural lordosis. X-ray of the spine shows bamboo spine appearancE. Associated condition?

23. A 41-year old woman with a 6-month history of gradually worsening pain and swelling in her hands and worsening stiffness in her feet , Lasting for an hour on some days. Takes NSAIDS with no improvement.History include hypothyroidism and major depressive disorder, takes levothyroxine and fluoxetine, respectively.Vitals are stablE. PE shows bilateral erythema, warmth, and boggy swelling present over the MCP and PIP joints. Her range of motion is limited due to the pain and stiffness in the wrists. X ray of the hands shows ulnar deviation of the wrist. Treatment for preventing progression of disease?

24. A 55-year-old woman c/o painless mass at the angle of the mandible 1 week after undergoing a dental procedurE. O/E, mass is draining pus that, on microscopic examination, shows yellowish granules. Treatment?

25. A 23-year-old man with back and buttock pain for the past 4 months with morning stiffness in his back that resolves over the course of the day with worsening of symptoms after inactivity. Vitals stablE. O/E there is slight kyphosis and restricted range of motion of the thoracic and lumbar spine,mild tenderness in the lower spine and sacroiliac region, X-rays of spine show early arthritic changes in the sacroiliac joints bilaterally.HLA–B27 is positivE. Associated condition?

26. A 14-year-old boy reports bilateral knee pain which is worse when he is playing basketball. And pain at rest.Vital signs are within normal limits. PE reveals reproducible pain on palpation over the right and left tibial tubercles. Pain with resisted extension of the knees. X-rays of the knees show prominent and elevated tibial tubercles with anterior soft tissue swelling. Next Step?

27. A 72 -year-old woman reports a severe headache, described as a throbbing pain on the right side of her head that is worse in the morning.which is unlike other headaches she has had and has been present for the past 2 weeks, associated with scalp pain, tenderness near her right temple, and pain when chewing.Has pain and stiffness in her shoulders and hips for several weeks.stiffness is more prominent in the morning. ROS occasional fever subsides with acetaminophen. An erythrocyte sedimentation rate is ordered, and steroids are prescribeD. Associated comorbidity?

28. A 48-year-old woman comes for pain management. Has 20-year history of rheumatoid arthritis on methotrexatE. stopped taking the medication after adverse effects.Has persistent pain in her fingers and knees.Treatment?

29. A 70-year-old carpenter comes with lower back and buttock pain, gradually in onset over 5 years and takes NSAIDS with little relieE. Pain exacerbated by walking and relieved by sitting.Cart wheel sign positivE. Sensation is slightly diminished over the distal aspect of the lower extremities bilaterally.Diagnosis?

30. A 34-year-old man is brought after a motor vehicle collision. He denies any loss of consciousness but has severe pain in his right arm. His Pulse is 116/min other vitals are stablE. PE reveals swelling and ecchymosis over his right brachium with an obvious deformity. He is unable to extend his right wrist, and his thumb is in a flexed position. Light touch is lost in the following?

31. An 80-year-old woman comes with a 2-day history of ankle pain. sudden onset that has become progressively worsE. Had recent H/O pyelonephritis took ciprofloxacin.PE mild swelling of the ankle,tenderness over the posterior and lateral aspects of the ankle, Sensations are intact. Strength is 4/5 dorsiflexion and 2/5 plantar flexion. X-rays of the ankle show moderate soft tissue swelling. Diagnosis?

32. A 45-year-old woman c/o difficulty sleeping and extreme fatigue with minimal exertion for 3 months. She has stiff ache throughout her back and shoulders.Exertion leaves her muscles aching, and she has little relief with ibuprofen.she has points of increased tenderness over the medial aspect of the upper border of the trapezius muscle bilaterally, above the medial border of the scapular spine, and multiple other areas.Treatment?

33. A 82-year-old woman comes with a 6-week history of headaches and blurred vision in her right eyE. first noticed blurring of her vision while reading a book at night in low light. Since then, she has noticed worsening of both symptoms. Has general fatigue and stiffness and pain in her neck and shoulders on awakening, which she has had for the past month.PE appears fatigued and has low-grade fever.Treatment?

34. A 4-year-old sickle cell anemia is brought with pain in his lower arms for 3 days. On physical examination his right upper extremity is swollen, tender, and erythematous. He is febrile and complains of chills.Labs show Leukocytosis with predominant neutrophils.Treatment?

35. A 78-year-old man comes with 2-month history of aching pain in his bilateral shoulders and groin. he lost a 10-kg (22-lb) and increasing difficulty getting dressed in the morning because of shoulder stiffness.Has sharp, one-sided headache more frequent in 2 weeks.One episode of blindness yesterday.PE temporal tenderness to palpation.Motor examination show limited active bilateral shoulder abduction.Labs:ESR is elevated and CK is normal.Treatment?

36. A 16-year-old boy is brought to ED after a motor vehicle collision. He reports severe pain in his arm.Vitals are stablE. PE shows deformity in the middle of the right humerus with ecchymosis and swelling.A 3-cm laceration over the middle of his shin. X-ray of the right arm shows a closed midshaft humerus fracturE. Risk of complication?

37. A 80-year-old woman comes with muscle soreness and stiffness in her arms and neck. Difficulty reaching shelves.Had h/o fever, malaise, and weight loss.medication includes SSRI for MDD. PE, minimal joint swelling is observeD. Has limited ROM Laboratory tests show: ESR is elevated and CK is normal. Diagnosis?

38. A 22-year-old man comes with back pain that has become more severe progressively, decreases with activity. The pain wakes him up during the night and goes away with walking.vitals normal, PE shows tenderness of spinE. He cannot fully flex or extend at the hips has limited hip abduction due to the pain,strength is normal.. An x-ray of the spine shows bamboo spine appearancE. Associated cognition?

39. A 60-year-old woman comes with osteoporosis and wants to reduce the likelihood of breaking a hip. Her menopause was 3 years ago, Takes thyroid replacement. Diagnosed with breast cancer 4 years ago in remission after radiation and chemotherapy. A DEXA scan showed mild osteopenia with a T-score of -1.7 in her femoral neck. This patient’s recent laboratory values are as follows: Treatment?

40. A 50-year-old woman with type I diabetes mellitus comes with weakness. she has had difficulty lifting items above her head and climbing stairs for a month. Has sore arm and legs.Has H/O migraines, diabetes, and hyperlipidemiA. Takes Insulin.She has 2/5 strength in the upper arms bilaterally, but 5/5 strength in the hands. She has 3/5 strength in the quadriceps, but 5/5 strength in the lower legs bilaterally. Her muscles are diffusely tender. Laboratory studies show CK is elevated, ALT: 84 U/L, AST: 92 U/L. EMG shows myopathic changes.

41. A 62-year-old man comes with a 3-week history of lower back pain which is dull and constant in naturE. His past medical history is significant for hypertension and hyperlipidemia for the past 10 years which are treated with lisinopril and atorvastatin, respectively. PE shows mild tenderness over the paraspinous muscles on palpation. Labs normal. What suggests benign etiology?

42. A 62-year-old woman comes with increasing pain in her hands while doing her job as a housekeeper.The pain gradually resolves with rest and is associated with a brief period of morning stiffness. Ibuprofen provides some relieE. PE mild swelling and tenderness around PIP and DIP. An x-ray of her hands shows joint space narrowing.Labs are normal. What is seen on joint aspiration?

43. A 70-year-old man with hypertension and type 2 diabetes mellitus comes because of severe pain in his right first toE. Pain started suddenly last night and is severE. Relieved mildly with Ibuprofen.He takes hydrochlorothiazide and metformin. His temperature is 37.8°C (100.1°F) other vitals are normal. PE shows the affected toe is warm, swollen, and extremely tender to the touch.WHat is expected in workup?