Question 1

Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician's resistance. These are typical signs of:

Accepted Answer

The symptoms described, including point tenderness on the elbow and pain upon wrist flexion against resistance, are characteristic of epicondylitis, commonly known as "tennis elbow" or "golfer's elbow" depending on the location. This condition is an inflammation of the tendons that join the forearm muscles on the outside of the elbow.

Question 2

A 3-year-old male toddler complains of sudden arm pain. The mother indicated that pain occurred suddenly while his 9-year-old sister was helping him get dressed. The child presents with the arm flexed while protecting his elbow. On physical examination, there is tenderness along the radius with no swelling or evidence of trauma. This is a typical history of:

Accepted Answer

Nursemaid's elbow, also known as radial head subluxation, commonly occurs in young children when a sudden pull on the extended pronated arm leads to subluxation of the radial head from under the annular ligament. The typical presentation includes a child refusing to use the arm, holding it in a flexed and pronated position, often after an event involving pulling on the arm.

Question 3

A 46-year-old administrative assistant complains of pain in the wrist that radiates into the palm and into the fingers. The clinician can test the patient for carpal tunnel syndrome by eliciting which of the following signs?

Accepted Answer

Phalen's sign is a diagnostic test for carpal tunnel syndrome, where the patient flexes the wrists maximally and holds the backs of the hands against each other for about a minute. A positive test is indicated by tingling or numbness in the distribution of the median nerve, which is consistent with carpal tunnel syndrome.

Question 4

A 34-year-old baseball pitcher complains of pain in the left shoulder, particularly with raising the left arm when attempting to pitch. Which of the following is a test used to diagnose rotator cuff injury?

Accepted Answer

Hawkin's test is used to diagnose rotator cuff injury. It involves the examiner placing the patient's arm in a position of external rotation and abduction, and then applying a downward force on the arm. If the patient experiences pain, the test is considered positive for a rotator cuff injury.

Question 5

A 33-year-old male marathon runner presents with knee pain. Which of the following tests is positive if the meniscus of the knee is torn?

Accepted Answer

McMurray's test is specifically designed to detect tears in the meniscus of the knee by manipulating the knee and listening for a click or detecting pain, which can indicate a tear.

Question 6

Which of the following describes the pathology of De Quervain's tenosynovitis?

Accepted Answer

De Quervain's tenosynovitis is characterized by irritation and inflammation of the tendons on the radial side of the wrist, near the thumb, leading to pain and tenderness in that area.

Question 7

Which of the following is a sign of glenohumeral instability?

Accepted Answer

The positive apprehension test is indicative of glenohumeral instability, as it suggests discomfort or fear of subluxation when the shoulder is placed in positions of potential instability.

Question 8

A 23-year-old female presents with ankle pain due to a fall while walking on ice 1 hour ago. You watch her limp as she walks into the emergency room. On physical examination, the ankle is erythematous, swollen, and tender to touch. The patient cannot stand on the affected ankle. Range of motion is severely limited on inversion of the ankle. On palpation, there is no pain with pressure on the medial or lateral malleolus. Should this patient be sent for ankle x-rays according to the Ottawa ankle rules?

Accepted Answer

The Ottawa ankle rules suggest that an ankle X-ray is necessary if there is pain in the malleolar zone and any one of the following: bone tenderness at the posterior edge or tip of the lateral malleolus, bone tenderness at the posterior edge or tip of the medial malleolus, inability to bear weight both immediately and in the emergency department for four steps. This patient's inability to bear weight on the affected ankle meets the criteria for an X-ray.

Question 9

A 36-year-old female patient complains of foot pain when she wears high heels. There is no history of trauma or arthritis. On physical examination, there is tenderness at the space between the third and fourth metatarsal bones. Foot x-ray shows no evidence of stress fracture. This history is typical of:

Accepted Answer

Morton's neuroma typically presents with pain in the forefoot, particularly between the third and fourth metatarsal heads, often exacerbated by tight shoes or high heels. The absence of trauma or arthritis and normal X-rays further support this diagnosis over the others listed.

Question 10

What is the most common cause of hip pain in older adults?

Accepted Answer

Osteoarthritis is the most common cause of hip pain in older adults, as it is a degenerative joint disease that affects the cartilage and bones within the joint, leading to pain and stiffness.

Question 11

A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an x-ray of the feet be ordered?

Accepted Answer

The Ottawa foot rules suggest that an x-ray is necessary if there is pain in the midfoot zone and either bone tenderness at the base of the fifth metatarsal or the navicular bone, or if the patient cannot bear weight both immediately and in the emergency department. Since the patient has tenderness at the base of the fifth metatarsal and cannot bear weight, both criteria A and C are met, making an x-ray necessary.

Quiz 14: Musculoskeletal System