MSN 620 Musculoskeletal Module 4 Questions And
Answers Rated A+
A 67-year-old female presents with an 18-month history of slowly worsening bilateral knee pain. She complains of
moderate pain, particularly after walking or gardening. She has a past medical history of breast cancer, which was
treated with primary surgery and radiotherapy 10 years ago. Her medications include letrozole and acetaminophen.
The patient's body mass index (BMI) is 30 kg/m2. Examination demonstrates bilateral knee swelling and crepitus
with active flexion. Lab results show white blood cell count, C-reactive protein, and erythrocyte sedimentation rate
within their normal range, and rheumatoid factor is negative. The x-ray findings of each knee demonstrate joint
space narrowing with several osteophytes. Which of the following is essential to prevent the progression of this
patient's condition? ANS Weight reduction
A 65-year-old woman is worried about her inability to perform various activities because of severe lower back pain
and pain in both wrist joints. She has a body mass index of 35 kg/m². She has a history of hypertension and takes
amlodipine regularly. She has been taking prescribed doses of ibuprofen for the last month but with no relief. Her
clinical examination reveals tender wrist joints, palpable swelling at the base of the right thumb, mild tenderness in
the lower back, and hip joint pain with movements. Her lumbar spine hip joint x-ray reveals increased subchondral
bone density. What is the best treatment plan for her? ANS Weight loss
A 74-year-old woman presents with increasing right hip pain over the last 2 months. A review of systems reveals no
history of trauma or falls and it has decreased her mobility and made her more dependent on family. Vital signs are
blood pressure 130/90 mmHg, heart rate 80 bpm, and body mass index 32 kg/m2. Her physical examination reveals
palpable swellings on the proximal interphalangeal joints of her hands and painful restricted movements at the hip
joint. Laboratory testing reveals negative rheumatoid factor (RA) and anti-nuclear antibodies (ANA). Her plain x-
ray suggests a narrowing of joint space and cartilage erosions. What is the most common hand joint involved in
postmenopausal women? ANS First carpometacarpal joint
A 61-year-old man with a body mass index of 31 kg/m^2 presents for a 6-month history of gradual onset right
medial knee pain. Examination reveals a small effusion, stable ligaments, a normally tracking patella, and mild
medial joint line tenderness. Standing radiographs show mild medial joint space narrowing. Which of the following
is the most appropriate treatment at this stage of the disease?
Well done! ANS Weight loss and low-impact exercises
A 65-year-old woman presents to the clinic for evaluation. She has a history of chronic bilateral knee pain, which
has been gradually worsening. She is currently on acetaminophen 1000 mg 3 times daily, naproxen 500 mg twice
daily, and tramadol 50 mg twice daily for knee pain, but these do not seem to help anymore. She has tried physical
therapy and intraarticular corticosteroids without much response in the past. She has a past medical history of
obesity, diabetes, and hypertension. Her other current medications include insulin and hydrochlorothiazide. Vitals
are blood pressure 140/98 mm Hg and heart rate 88 bpm. Exam reveals tenderness in both knees along the medial
joint line with swelling, effusion, and decreased range of motion. X-ray shows bone-on-bone and joint space
narrowing in the medial compartment bilaterally, along with osteophyte formation. What is the next best step in the
treatment of this patient? ANS Evaluation for knee replacement
, A 65-year-old man with a past medical history of hypertension presents to the medical clinic with worsening left
knee pain. He has chronic pain in the left knee for 15 years that has recently increased in intensity and is associated
with less than 30 minutes of morning stiffness. He participates in aquatic aerobics three times per week. His current
medications are lisinopril, duloxetine, and pantoprazole. He cannot tolerate oral nonsteroidal anti-inflammatory
drugs (NSAIDs). His physical examination reveals that the right knee is bulky with varus deformity, and crepitus is
noted. Knee erythema, effusion, or warmth are absent. He is traveling to Europe next month for a vacation, and he
would like to improve his pain in order to tolerate physical activity. What is the best therapeutic option for this
patient? ANS Corticosteroid injection
A 66-year-old man with a history of gastric bypass surgery, a strong family history of diabetes mellitus, and an
allergy to shellfish presents with a 6-month history of left knee pain worse with climbing stairs and hills.
Radiographs reveal the loss of joint space and osteophytosis of the patellofemoral joint space. His friend advised
him to try glucosamine sulfate supplementation for his condition, and he asked his provider what he thought about
the idea. Which of the following would be the best response? ANS There are no specific contraindications to this
patient trying glucosamine.
A 35-year-old man presents with right shoulder pain. He denies any previous history of shoulder pain but reports
playing volleyball 3 times a week for fitness. He jumped up to spike the ball and as he contacted the ball he felt an
intense sharp pain under the shoulder, and he was unable to continue playing. He's been icing, resting, and taking
ibuprofen for the past few days, and while his pain has been decreasing, he still has a limited range of motion. On
examination of the shoulder, the range of motion is limited to 60 degrees of abduction, with positive Speed's, empty
can, shoulder shrug, Neer's, and Hawkins tests. Which of his rotator cuff muscles is most likely injured? ANS
Supraspinatus
A 66-year-old woman presents with 12 months of increasing right shoulder pain. The pain is on the lateral shoulder,
does not radiate, and is worse with overhead activity. She has pain at night when trying to sleep on her side, and has
tried taking over-the-counter ibuprofen intermittently for pain relief. She denies any history of trauma or injury. She
states that her normal activities include gardening, yoga, pickleball, and walking. The patient is right-handed. On
physical examination, her symptoms are reproduced with both empty and full can test, and there is no external
rotation lag sign. Magnetic resonance imaging shows a <50% supraspinatus tear. Which of the following treatments
is recommended? ANS Physical therapy
A 65-year-old woman presents with persistent left shoulder pain for the last 12 months. She does not recall specific
trauma but reports the pain increases when reaching overhead. She is left-hand dominant. Her physical examination
demonstrates a positive empty can test and a positive Hawkin's test. An uncontrolled drop of the left arm is present
on the drop arm test. Which of the following is the imaging modality of choice? ANS Magnetic resonance
imaging
A 40-year-old man presents with left shoulder pain for the past month. He is left-handed and plays shortstop at
softball once or twice a week. Over the previous month, he reports having increased left shoulder pain and difficulty
doing work overhead. Two days ago, he went to make a throw and felt a pop in the shoulder. Since then, he has been
unable to elevate or abduct the arm above 90°. Also, when lowering the arm, he cannot hold it up. On physical
examination, he has a positive shoulder shrug and external rotation lag sign. What is the best next step in
management? ANS Magnetic resonance imaging
