Pance Musculoskeletal - Final Test Review(Qns & Ans) - 2025, Exams of Nursing

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Pance Musculoskeletal Exam

Final Test Review

(Questions & Solutions)

1. Degenerative & Crystal Arthritides (6 questions) Q A 67-year-old woman with longstanding knee OA has failed maximal NSAIDs, weight loss, and two ultrasound-guided corticosteroid injections in the past year. Radiographs show Kellgren–Lawrence grade IV changes with 10° varus deformity. Which intervention offers the greatest likelihood of durable pain relief and functional restoration? A. Viscosupplementation series B. High-tibial valgus osteotomy C. Medial unicompartmental knee arthroplasty D. Total knee arthroplasty ANS : D Rationale: End-stage tricompartmental OA (grade IV) and malalignment are best treated by total joint replacement; osteotomy or partial arthroplasty are suited to isolated unicompartment disease, viscosupplementation provides only short-term symptom benefit.

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Q A 55-year-old man on hydrochlorothiazide presents with first-MTP erythema and exquisite pain. Serum urate is 7.4 mg/dL; synovial analysis shows negatively birefringent needle-shaped crystals. He has stage 3 CKD (eGFR 48 mL/min). Which oral agent is preferred for long-term urate lowering? A. Allopurinol 100 mg daily, titrated to urate < 6 mg/dL B. Febuxostat 80 mg daily C. Probenecid 1 g twice daily D. Colchicine 0.6 mg once daily ANS : A

hemiarthroplasty; reverse designs are reserved for cuff-deficient arthritis.

Q Pseudogout is precipitated by which metabolic abnormality most often? A. Hyperparathyroidism B. Hypothyroidism C. Hemochromatosis D. Hypomagnesemia ANS : A Rationale: Hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypophosphatasia are linked, but primary hyper-PTH is the most common metabolic association.

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Q A 72-year-old with tricompartmental OA remains symptomatic after NSAIDs but refuses surgery. Which intra-articular option offers the longest median duration of relief per meta-analysis? A. Triamcinolone acetonide B. High-molecular-weight hyaluronic acid C. PRP injection D. Sarilumab (IL-6 inhibitor) investigational use ANS : C Rationale: Platelet-rich plasma provides 6–12 months median pain relief, surpassing steroid (4–6 weeks) and HA (3–6 months); IL- 6 inhibitors are not approved.

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2. Traumatic Fractures & Dislocations (6 questions)

Q

A 28-year-old falls on an outstretched hand. X-ray: dorsally angulated, extra-articular distal radius fracture; ulnar variance +4 mm; dorsal tilt 21°. Acceptable management? A. Sugar-tong splint and repeat films in 1 week B. Closed reduction + percutaneous K-wires C. Volar locking-plate fixation D. External fixation with ligamentotaxis ANS : C Rationale: Unstable Colles fracture criteria (> 20° dorsal tilt, > 3 mm shortening) mandate operative fixation; volar plates correct tilt and variance with low complication rate.

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Q A high-energy MVC yields open tibial shaft fracture (8 cm laceration, moderate muscle trauma). According to Gustilo-Anderson, classification and first-dose IV antibiotic? A. Type II; cefazolin B. Type IIIa; cefazolin + gentamicin C. Type IIIb; cefazolin + gentamicin + penicillin G D. Type II; cefazolin + gentamicin ANS : B Rationale: Wound > 1 cm with moderate soft-tissue damage but adequate coverage = IIIa. Gram-positive + gram-negative coverage (cefazolin + aminoglycoside) is recommended; anaerobic coverage added if farm injury/soil contamination.

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B. Vertical displacement of hemipelvis > 1 cm C. Sacral ala comminution D. U-shaped sacral fracture ANS : A Rationale: Symphyseal widening > 2.5 cm signifies anterior ring disruption and posterior ligamentous injury—constituting APC II/III rotationally unstable patterns needing plate fixation or external fixation.

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Q Subtrochanteric femur fractures treated with long cephalomedullary nails risk non-union chiefly because of: A. Varus malreduction and lack of lateral cortex contact B. Reaming thermal necrosis C. Poor vascularity of the femoral head D. Hardware impingement on abductors ANS : A Rationale: Subtrochanteric zone is under high tensile stress; varus malalignment decreases compressive forces at the medial cortex, promoting non-union.

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3. Spine Disorders (5 questions) Q A 45-year-old warehouse worker develops acute bilateral leg pain after lifting. MRI: large central L4–L5 disc extrusion with cauda equina compression, urinary retention. Ideal management timeline? A. Epidural steroid within 24 h B. Urgent (within 48 h) decompressive laminectomy/discectomy C. Trial of PT and gabapentin for 6 weeks

D. Myelography then delayed surgery ANS : B Rationale: Cauda equina syndrome is a surgical emergency; decompression within 48 h maximizes neurologic recovery.

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Q Chronic neck pain with radiculopathy from cervical spondylosis at C6–7 in a smoker is treated with ACDF. What fusion adjunct shows highest evidence for improving fusion rate in high-risk hosts? A. Local autograft only B. Demineralized bone matrix (DBM) C. Recombinant human BMP-2 in a collagen sponge D. Osteoconductive calcium-phosphate putty ANS : C Rationale: rhBMP-2 is osteoinductive and increases fusion in smokers/osteoporotics; approved for anterior lumbar but off-label cervical use requires informed consent due to swelling risk.

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Q Scheuermann kyphosis diagnostic criteria on lateral radiograph include: A. > 40° thoracolumbar Cobb angle and ≥ 3 consecutive wedged vertebrae > 5° each B. Presence of Schmorl nodes alone C. Sagittal vertical axis > 5 cm D. Rib hump with Adam’s forward bend ANS : A Rationale: Classic definition—rigid thoracic kyphosis > 45° (or TL > 40°) plus ≥ 3 wedged vertebrae.

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A 35-year-old carpenter has progressive hand weakness. Exam: inability to make “OK” sign; pinch test shows loss of flexor pollicis longus and FDP index function. Lesion location? A. Carpal tunnel B. Pronator teres fibrous arch C. Anterior interosseous nerve branch of median nerve D. Cubital tunnel ANS : C Rationale: AIN palsy presents with motor deficits to FPL/FDP (index) and PQ—no sensory loss.

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Q Partial (< 50 %) articular-side supraspinatus tear refractory to rehab. Evidence-based arthroscopic treatment? A. Debridement with subacromial decompression B. Tear completion and repair (P-R CORT) C. Augmented patch graft repair D. Open deltoid-splitting repair ANS : B Rationale: Converting high-grade partial articular tear to full-thickness then repairing yields superior healing vs debridement alone.

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Q Lateral epicondylitis treated by platelet-rich plasma vs corticosteroid injection demonstrates what outcome at 1 year? A. Faster pain relief with PRP, no difference in function B. Superior pain and function with PRP

C. Equivalent outcomes D. Early superiority with steroid, long-term inferiority ANS : D Rationale: Steroids provide early symptom relief but higher recurrence; PRP slower onset yet better durability.

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Q A traumatic boutonnière deformity unresponsive to splinting 8 weeks shows PIP extensor lag 25°, full passive extension. Best surgical option? A. Central slip direct repair B. Tendon graft reconstruction C. Dynamic tenodesis using lateral bands D. PIP joint fusion ANS : C Rationale: Chronic stage with supple joint treated by dorsal repositioning/lateral-band tenodesis; acute primary repair viable only in first 3 weeks.

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Q Complex regional pain syndrome after distal radius fracture meets Budapest criteria. Evidence supports which medication to improve pain and hand function? A. Oral bisphosphonate (alendronate) B. Gabapentin C. Prednisone taper 3 weeks D. Topical capsaicin ANS : A Rationale: Randomized trials show alendronate or calcitonin reduce

Q

Patellar instability with high-grade trochlear dysplasia (Dejour B), TT-TG 18 mm. First-time dislocator. Surgical choice with lowest recurrence? A. Medial patellofemoral ligament (MPFL) reconstruction alone B. MPFL reconstruction + tibial tubercle medialization C. Arthroscopic lateral release D. Trochleoplasty + MPFL reconstruction ANS : D Rationale: Severe trochlear dysplasia requires sulcus-deepening trochleoplasty plus soft-tissue stabilization to address osseous deficiency.

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Q Meniscal root tear of posterior medial meniscus leads to: A. Increased hoop stress preservation B. Rapid progression of medial compartment OA akin to total meniscectomy C. Negligible biomechanical changes D. Improved tibiofemoral contact area ANS : B Rationale: Root detachment eliminates hoop stress, increasing peak contact pressures and accelerating arthritis comparable to meniscectomy. Degenerative & Crystal Arthritides A 65-year-old male presents with progressive knee pain and morning stiffness lasting less than 30 minutes. On ultrasound, you observe

irregular cartilage with osteophytes and joint space narrowing. What is the most likely diagnosis? A) Rheumatoid arthritis B) Gouty arthritis C) Osteoarthritis D) Septic arthritis ANS : C) Osteoarthritis Rationale: Osteoarthritis typically presents with degenerative changes such as cartilage thinning, osteophyte formation, and joint space narrowing. Morning stiffness is brief compared to inflammatory arthritides. A patient with a history of alcohol abuse presents with acute joint pain, erythema, and swelling in the first MTP joint. Ultrasound shows hyperechoic deposits on the articular cartilage that produce a "double contour sign." What is the crystalline arthropathy? A) Calcium pyrophosphate deposition (CPPD) disease B) Gout C) Hydroxyapatite deposition disease D) Rheumatoid arthritis ANS : B) Gout Rationale: The "double contour sign" on ultrasound indicates monosodium urate crystal deposition typical of gout, especially involving the first MTP joint. In a patient presenting with symmetrical polyarticular joint pain and evidence of chondrocalcinosis on ultrasound, what crystal is most likely involved? A) Monosodium urate B) Calcium hydroxyapatite C) Calcium pyrophosphate dihydrate (CPPD) D) Cortical bone fragments ANS : C) Calcium pyrophosphate dihydrate (CPPD) Rationale: CPPD is commonly seen as chondrocalcinosis on ultrasound, often causing pseudogout.

Rationale: The long head of the biceps tendon normally sits in the bicipital groove; its displacement along with humeral head location relative to glenoid confirms anterior shoulder dislocation. In a suspected scaphoid fracture with normal X-rays, what advantage does musculoskeletal ultrasound offer? A) Visualizes cortical discontinuity and hematoma B) Assesses bone marrow edema directly C) Provides superior visualization of the entire scaphoid compared to MRI D) Differentiates old from new fractures reliably ANS : A) Visualizes cortical discontinuity and hematoma Rationale: Ultrasound can sometimes detect cortical disruption and adjacent soft tissue hematoma, especially early when X-rays are negative; however, MRI is superior for marrow evaluation. Following a high-energy trauma, a patient suffers a posterior elbow dislocation. Ultrasound reveals complete rupture of the ulnar collateral ligament and joint effusion. What is the likely long-term complication if untreated? A) Carpal tunnel syndrome B) Chronic elbow instability C) Radial head fracture D) Osteoarthritis of the wrist ANS : B) Chronic elbow instability Rationale: Ulnar collateral ligament rupture with dislocation leads to elbow instability and predisposes to chronic dysfunction if not properly treated. Spine Disorders A 50-year-old patient with chronic lower back pain and leg numbness has an ultrasound showing displacement of the ligamentum flavum into the spinal canal. What spinal pathology does this finding suggest? A) Disc herniation B) Spinal stenosis C) Vertebral fracture

D) Spondylolisthesis ANS : B) Spinal stenosis Rationale: Thickening or displacement of ligamentum flavum reduces canal diameter, a hallmark of spinal stenosis causing neurogenic claudication and radiculopathy. In ultrasound evaluation of lumbar facet joints for osteoarthritis, which finding best indicates active inflammation? A) Bony spur formation B) Joint space narrowing C) Doppler signal within the synovium D) Thickened hyperechoic joint capsule ANS : C) Doppler signal within the synovium Rationale: Increased Doppler signal suggests synovitis, indicating active inflammation in osteoarthritic facet joints. In a patient with suspected cauda equina syndrome, which feature on an ultrasound exam of the lumbosacral spine would be an important red flag? A) Dilated nerve root sheaths with hypoechoic content B) Normal flow on Doppler within spinal vessels C) Absence of spinal canal effusion D) Sagittal alignment preserved ANS : A) Dilated nerve root sheaths with hypoechoic content Rationale: Dilated nerve root sheaths filled with hypoechoic fluid suggest compressive pathology, correlating with cauda equina syndrome. Which spinal level is most accessible and reliably assessed by ultrasound in adult patients? A) Cervical spine B) Thoracic spine C) Lumbar spine D) Sacral spine ANS : C) Lumbar spine Rationale: Lumbar spine is best suited for ultrasound due to less bone

enhancement and no vascularity on Doppler. In evaluation of cubital tunnel syndrome, what ultrasound finding would be most supportive? A) Flattening and hypoechoic swelling of the ulnar nerve at the medial epicondyle B) Increased echogenicity of the triceps tendon C) Thickening of the median nerve in the carpal tunnel D) Absence of ulnar nerve blood flow ANS : A) Flattening and hypoechoic swelling of the ulnar nerve at the medial epicondyle Rationale: The ulnar nerve may be compressed at the cubital tunnel causing focal swelling and reduced echogenicity. Knee & Lower Extremity Ligaments A patient complains of acute knee pain after trauma. Ultrasound shows discontinuity of the hyperechoic band of the anterior cruciate ligament (ACL) and associated joint effusion. What is the most likely diagnosis? A) Partial medial meniscal tear B) Complete ACL rupture C) Chronic ligament laxity D) Patellar tendonitis ANS : B) Complete ACL rupture Rationale: Ultrasound can visualize the ACL as a hyperechoic band which, if discontinuous with effusion, indicates rupture. Which finding on ultrasound is characteristic of a medial collateral ligament (MCL) injury? A) Hypoechoic thickening with fiber disruption along the medial knee line B) Complete normal echo pattern C) Bony spurs at tibial insertion without soft tissue changes D) Tendinous calcification in lateral collateral ligament ANS : A) Hypoechoic thickening with fiber disruption along the medial knee line Rationale: MCL injury demonstrates hypoechoic changes and fiber

discontinuity at its medial location. In ultrasound evaluation of patellar tendinopathy, what is the typical sonographic appearance? A) Thickened, hypoechoic tendon with increased vascularity on Doppler B) Normal tendon with no Doppler flow C) Anechoic fluid collection adjacent to the tendon D) Hyperostosis of the patella ANS : A) Thickened, hypoechoic tendon with increased vascularity on Doppler Rationale: Tendinopathy shows thickening, hypoechoic areas, and neovascularization correlates with pain. What ultrasound findings are consistent with a partial tear of the Achilles tendon? A) Focal hypoechoic area with intact fibrillar pattern and peritendinous fluid B) Normal fibrillar pattern of the tendon C) Complete fiber discontinuity with loss of tendon tension D) Thickened tendon with calcifications only ANS : A) Focal hypoechoic area with intact fibrillar pattern and peritendinous fluid Rationale: Partial tears disrupt some fibers causing hypoechoic defects but retain partial fibrillar continuity; complete tears show full discontinuity. Pediatric Orthopedics In an infant presenting with limited hip abduction and leg length discrepancy, ultrasound shows irregular femoral head ossification and shallow acetabulum. What is the most likely diagnosis? A) Transient synovitis B) Congenital hip dysplasia (DDH) C) Septic arthritis D) Slipped capital femoral epiphysis ANS : B) Congenital hip dysplasia (DDH)