WorksheetsMusculoskeletal Disorders
Total questions: 20
Worksheet time: 10mins
A 54-year-old farm worker presents with low back pain of 3 weeks’ duration that radiates down his right leg. Examination reveals decreased sensation on the lateral side of the right lower leg, dorsum of the right foot, and the lateral edge of the right foot. The right patellar reflex is normal, but the right ankle reflex is absent. Motor examination is mostly normal, except that he has trouble standing on his toes. Reflexes in the left leg are normal; he denies urinary or fecal incontinence. If an MRI of the spine were obtained, what would it show?
Broad-based disc bulge compressing the cauda equina
Herniated disc between L5 and S1
Lytic lesion causing cord compression between L2 and L3
Spinal stenosis with narrowing at L3
A 58-year-old man presents with low back pain that shoots down the back of his left leg. He is having a difficult time with straining and prolonged sitting. With the patient lying supine, which of the following physical examination findings is most specific for a diagnosis of herniated disc?
Raising the patient’s straight left leg causes back pain
Raising the patient’s straight left leg causes back pain and radiation of pain down the posterior left leg
Raising the patient’s straight right leg causes back pain
Raising the patient’s straight right leg causes back pain and radiation of pain down the posterior left leg
Which of the following is the most common symptom in cauda equina syndrome?
Bilateral sciatica
Lower extremity weakness
Stool incontinence
Urinary retention
A 22-year-old man presents with low back pain. He says he has been “barely able to pee” over the past few days. Vital signs include P 105, R 16, T 38.2°C (100.8°F); Spo2 is 98% on room air. Examination reveals weakness in the patient’s right great toe and with dorsiflexion. Rectal tone is diminished. The patient admits to intravenous drug use and denies significant medical history and allergies to medications. Which of the patient’s signs and symptoms is most common with spinal epidural abscess?
Back pain
Fever
Motor weakness
Motor weakness
Which of the following statements regarding closed clavicle fractures in the hemodynamically stable patient is correct?
Clavicle fractures are most common in the distal third of the clavicle
Frozen shoulder complications decrease with immediate use of range of motion exercises
Greenstick or incomplete fractures do not occur due to the anatomy of the clavicle
Nonunion of the clavicle is rare after fracture
A 38-year-old man presents with elbow swelling of 2 weeks’ duration. He has full range of motion without difficulty. Which of the following is part of the correct approach to treatment?
Antibiotics
Incision and drainage
NSAIDs
Surgical consultation
A 67-year-old woman presents with a cough she has had “for weeks” that now produces blood-tinged sputum. She also reports fever, chills, shortness of breath, night sweats, and weight loss. Medical history includes hypertension, diabetes, asthma, and rheumatoid arthritis. Chest xray is normal. Which of her medications has put her at greatest risk for this most likely disease process?
Etanercept
Fluticasone
Metformin
Methotrexate
A 72-year-old woman presents with atraumatic joint pain that she has had “for years.” It is worse in her knees and worsens throughout the day with activity. She denies fever and recent illness. Considering the most likely diagnosis, what other clinical findings are expected on examination?
“Bamboo spine” on radiographic imaging
Nodes in the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the hand
Swan neck deformity of the hand
Swelling in the metacarpophalangeal (MP) and PIP joints of the hand
What is the best next step in treatment?
Discharge with antibiotics and follow-up instructions
Immobilize the finger for comfort
Perform incision and drainage
Start parenteral antibiotics
Which is Kanavel sign is incorrect?
Tenderness over the flexor tendon sheath
Symmetric finger swelling
Painless passive extension
Flexed positioning of the digit to minimize pain
What is the appropriate management of the condition shown?
Apply a dry occlusive dressing and prescribe an NSAID for symptom relief
Elevate the eponychial fold with a blade to allow the wound to drain
Make a unilateral longitudinal incision lateral to the infection to drain the wound
Start parenteral antibiotics and request emergent consultation with the hand surgeon
A 32-year-old woman presents with pain over the radial aspect of her right wrist. Examination reveals that the pain is exacerbated when she grasps her right thumb in her palm and ulnar deviates the affected wrist. Pain exacerbated by this motion is characteristically diagnostic of what condition?
Carpal tunnel syndrome
de Quervain tenosynovitis
Dupuytren contracture
Lateral epicondylitis
Which of the following is the strongest contraindication to arthrocentesis?
Presence of a hereditary clotting factor disorder
Suspected occult supracondylar humerus fracture
Suspected occult bacteremia
Suspected cellulitis overlying the arthrocentesis site
Melie aspirated this from a febrile 56year old male diabetic's shoulder. What will microscopic evaluation show?
Which of the following laboratory test results is the gold standard for diagnosing gout?
Absence of bacteria in aspirate
High uric acid levels in serum
Negatively birefringent crystals on aspirate
WBCs less than 2,000 and PMNs less than 25% on aspirate
Which senior is most likely to end up with the Gouch?
A 25-year-old woman presents with pain in her knees, left ankle, and bilateral heels and limited range of motion in her lower back. She recently completed a course of antibiotics for a chlamydial infection; she is otherwise healthy and not taking any other medications. Examination reveals inflammation of her Achilles tendon. What is the medication of choice to treat this most likely condition?
Ceftriaxone
Doxycycline
Indomethacin
Methotrexate
What are the key elements of Jeff Florek's weight program?
100 Pull Ups daily. Use the rack on the ambulance bay
2 Plant based shakes, 1 PBJ daily
Cooler full of meat
Drink the guacamole, cuz chips = carbs = fat = death
A 45 year old male smoker presents with burning left shoulder pain, that started last night, after painting his house. The next best step is to...
Give him 600mg of ibuprofen
Have him raise his arms over his head
Test for the painful arc sign, and perform a Neer test
Order an EKG
Which of the following maneuvers is Finkelstein's test?
