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NSG6001 Musculoskeletal Immune Disorder Exam With Complete Solution
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NSG6001 Musculoskeletal Immune Disorder ExamWith Complete Solution
1. A patient has pain on the plantar aspect of the heel with weight bearing after rest. The
pain is worsened with dorsiflexion of the foot. What is the initial treatment for this
patient?
a. A series of steroid injections
b. Avoidance of all high-impact activities
c. Night splints
d. Wearing only flat shoes - ANSWER ANS: B
This patient has evidence of plantar fasciitis. Initial management is avoidance of all
high-impact activities. A single injection of steroid may be given; further injections may
be used if there is no improvement. Night splints are second-line treatment. The patient
should avoid flat shoes. REF: Plantar Fasciitis/Management
2. A patient injures an ankle while playing soccer and relates rolling the foot inward
while falling with immediate pain and swelling of the lateral part of the joint. The patient
is able to bear weight and denies hearing an audible sound at the time of injury. What
does this history suggest?
a. Likely ankle sprain with a possible fracture
b. Mild ankle injury without fracture
c. Mild soft tissue injury only
d. Severe ankle injury with probable fracture - ANWER ANS: A
Immediate swelling of the joint heightens the clinical suspicion of fracture or significant
joint involvement. None of the options can be excluded based on clinical findings
without radiographs.
3. A distance runner patient comes to the clinic with complaints of pain in one heel that
is worse in the morning and appears to improve with the exercise. The provider
identifies localized swelling and a bony prominence at the heel. What initial treatment
would you prescribe for this condition?
,a. Cessation of all sports activities and exercise
b. Crutches and partial weight bearing
c. Physical therapy for ultrasound therapy
d. Referral to an orthopedist for MRI and evaluation - ANSWER ANS: A
This patient has symptoms consistent with Achilles tendonitis. Immediate cessation of
sports and exercise is the first step in management. Crutches and partial weight bearing
may be indicated if symptoms do not improve with rest and NSAIDs. Physical therapy is
used as adjunctive therapy. Symptoms that do not improve require referral
1. Which of the following interventions can be used to treat bone pain related to tumors
of the bone?
Select all that apply.
a. Bisphosphonates
b. Exercise
c. External beam radiation
d. Massage
e. Vertebralplasty - ANSWER ANS: A, B, C, E
Bisphosphonates reduce pain by preventing new and existing bone lesions from
multiplying and growing. Exercises are helpful in maintaining function and reducing
pain. Most patients are helped by external beam radiation. Vertebralplasty involves the
injection of bone cement to stabilize the bone. Massage is not indicated.
2. A patient presents with complaints of chronic lower back pain and constipation. A
mass is discovered at the sacrum by digital rectal exam. What is the most appropriate
course of action by the primary care provider in the management of this patient?
a. X-rays of spine in 3 months
b. MRI of the sacrum
c. Refer the patient to an oncologist
, d. Schedule the patient for a biopsy - ANSWER C.
These symptoms, along with a palpable mass coming out of the sacrum, would be seen
in patients with chordoma, a type of sarcoma with a predilection for the sacrum. A
referral to an oncologist is required. These tumours have significant risk for malignancy,
and thus cannot wait 3 months. The oncologist will order a CT and body scan and
possibly biopsy or surgery.
3. A bone tumor is an incidental finding on a radiograph of a patient who has sustained
an injury to a ligament. The patient has not had any pain prior to the injury. What will the
provider do next?
a. Consult with an orthopedic specialist
b. Order a chest CT and full body scan
c. Refer the patient to for a bone biopsy
d. Repeat the radiograph in 6 to 12 months - ANSWER ANS: D
Latent bone tumors are usually incidental findings during evaluation for musculoskeletal
injury. If the injury is indeed the source of pain, the radiograph could be repeated in 6 to
12 months to reassess if it is increasing in size. Consultation with an orthopedic
specialist, referral for a biopsy, and further testing with chest CT or full body scanning
are done in instances where suspicion of active tumor exists.
1. An orthopedic specialist is examining a patient who presents with complaints of
shoulder pain and elicits erythema, warmth, and fluctuance of the shoulder joint. What is
the next step in management?
a. Admit to the hospital for intravenous antibiotics
b. Administer lidocaine into the joint and reassess in 5 to 10 minutes
c. Order a plain radiograph of the shoulder to identify possible fracture
d. Shoulder ultrasound to further investigate the cause - ANSWER ANS: A
Patients with symptoms of septic bursitis such as the symptoms above should be
immediately referred. A painful joint is injected with lidocaine to assess for improvement
in order to determine whether bursitis or tendonitis due to impingement is present. This
does not represent a consistent finding with fracture. An ultrasound is not indicated.
REF: Shoulder Bursitis/Management
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