The Musculoskeletal System Multiple Choice

1. A 42-year-old female office worker presents to your clinic complaining of awakening with an exquisitely tender, red, swollen right knee. She has never had this occur before and has had no history of trauma or recent illness. She has no significant past medical history. A family history reveals that her father had similar problems in middle age. On exam, she has a red, warm, tender right knee with decreased range of motion. Tapping the fluid in the knee showed no signs of infection indicating a probable arthritic cause. The most likely form of arthritis would be:

(A)

Rheumatoid arthritis

(B)

Degenerative joint disease

(C)

Gouty arthritis

(D)

Polymyalgia rheumatica

2. A 54-year-old woman who works at a dry cleaners presents to your office complaining that she cannot do overhead work with her right arm. She states that she can no longer lift her arm over her head without using her other arm to prop it up. She remembers no specific injury but has been doing overhead work at the dry cleaners for over 15 years. Her past medical history is significant for three spontaneous vaginal deliveries and 15 years of hypertension. On exam, she has demonstrative weakness with internal and external rotation on the right. When she attempts to abduct her arm, there is obvious shrugging of the shoulder. On inspection of her back, you note atrophy of the muscles surrounding the shoulder and scapula. She is nontender over any on active range it to shoulder

(A) Rotator cuff tendonitis

(B) Bicipital tendonitis

(C) Acrominoclavicular arthritis

(D) Rotator cuff tear boney prominence in the shoulder. Her passive range of motion is normal, while of motion she is unable to elevate her arm more than 12 inches and cannot raise level. What shoulder problem is the most likely diagnosis?

3. A 13-year-old boy is brought into the urgent care clinic by his father with a complaint of swelling around his right elbow. He is in 8th grade football and has been lifting weights, despite having just started puberty. He has no significant past medical history and recalls no specific incident of trauma to the elbow. On exam, the patient has a soft swelling around the posterior of the elbow. He has no redness or warmth and minimal pain. He is nontender over the bony prominences of the ulna, radial head, and humorous. What disorder of the elbow is the most likely diagnosis?

(A)

Arthritis

(B)

Olecranon bursitis

(C)

Epicondylitis

(D)

Rheumatoid nodules

4. A 28-year-old male waiter presents to your office complaining of a growth on the back of his left hand. He states it started slowly months ago but has now enlarged enough to be embarrassing. He states it only hurts when he is holding a tray of food up in the air with his left hand. He has no significant past medical history and no one else in the family has this problem. On exam, you note a 2-cm round cystic-like lesion on the dorsum of his left wrist over the carpals. It is more prominent when he flexes his wrist. What is the most likely cause of his hand swelling?

(A) Ganglion

(B) Chronic tophaceous gout

(C) Acute rheumatoid arthritis

(D) Heberden's nodes

5. A 32-year-old attorney comes to your clinic complaining of severe neck pain when he tries to turn his head to the right. He reports to you that he was the restrained driver in a MVA the day before, when he was hit from behind at approximately 40 mph. He states he did not hit his head and he did not lose consciousness. He refused to be evaluated by EMS at the scene. He states he felt okay after the accident but today woke up in extreme pain. He is having no numbness or tingling in his right hand and states he has no problems holding a pen. He has no symptoms below the neck. He has no significant past medical history. On exam, he has difficulty turning his head to the right or tilting it to the right. He also has difficulty with extending his head. He is able to flex his neck and turn and tilt to the left. On palpation, he is tender over the right trapezius and rhomboid muscles. He has no tenderness along the cervical vertebrae or the clavicle or scapula. He has normal reflexes in his biceps, triceps, and brachioradialis. He has normal strength in his elbow and wrist and has normal two-point discrimination. Having the patient cough does not increase his symptoms. What type of neck pain best describes his problem?

(A) Cervical sprain

(B) Muscle ache

(C) Neck pain with dermatomal radiation

(D) Neck pain from cervical spinal stenosis

6. An 85-year-old retired secretary presents to your office complaining of severe lower back pain. She states that it started 4-5 months ago and has gradually been getting worse. She takes Daypro for arthritis but that hasn't helped her very much. She says that lying down or sleeping does not seem to help. She doesn't recall any trauma to her back. She has had no unusual problems with strength in her legs or bowel or bladder control. Her past medical history is significant for 30 years of hypertension and right-sided breast cancer 10 years ago. She had a mastectomy and radiation therapy. She did not take any chemotherapy. She denies tobacco or alcohol use. On exam, you find a thin, cachectic-appearing woman in no acute distress. Her heart and lung exam are normal. She is tender over the L4 and L5 vertebrae. She has normal sensation, strength, and reflexes in her lower extremities. She is nontender over the para spinal muscles around the lumbar region and has a negative straight leg rise bilaterally.

(A) Mechanical low back pain

(B) Radicular back pain

(C) Back pain from metastatic disease

(D) Spinal stenosis

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