NR 509 Week 8 Final Exam - Musculoskeletal Disorders MCQs and Explanations
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Ques琀椀on: A 54-year-old man presents with sudden, excrucia琀椀ng pain and swelling in his right great toe a昀琀er a琀琀ending a weekend barbecue. He drinks several beers daily. On exam, the 1st MTP joint is erythematous, warm, and exquisitely tender. Joint aspira琀椀on shows needle-shaped, nega琀椀vely birefringent crystals. Which of the following medica琀椀ons most likely contributed to his condi琀椀on? A) Hydrochlorothiazide B) Furosemide C) Lisinopril D)Amlodipine Answer: A) Hydrochlorothiazide Explana琀椀on: Thiazide diure琀椀cs ↓ uric acid excre琀椀on, precipita琀椀ng gout a琀琀acks. Furosemide can also raise uric acid, but thiazides are more classically tested. Lisinopril and amlodipine don’t cause gout. 4. Ankylosing Spondyli琀椀s (AS) Ques琀椀on: A 28-year-old man presents with chronic low back pain and s琀椀昀昀ness that improves with exercise but not rest. He has also developed pain in both heels. Exam shows limited spinal 昀氀exion and tenderness over the sacroiliac joints. Chest expansion is decreased. Which of the following addi琀椀onal 昀椀ndings is most characteris琀椀c of his condi琀椀on? A)Erosions of DIP joints B) Uvei琀椀s C) Tophi deposi琀椀on D)Subcutaneous nodules Answer: B) Uvei琀椀s Explana琀椀on: AS (a seronega琀椀ve spondyloarthropathy, HLA-B27+) → sacroilii琀椀s, morning s琀椀昀昀ness, and uvei琀椀s. Pain improves with ac琀椀vity — unlike mechanical back pain. 5. Spinal Stenosis Ques琀椀on: ChatGPT said: Perfect — here’s Set 2: Advanced, Tricky Musculoskeletal MCQs that go beyond the basic pa琀琀erns. Each ques琀椀on is designed to mimic board-style nuance — overlapping features, subtle clues, or misleading presenta琀椀ons — to test deep clinical reasoning. 1. Osteoarthri琀椀s (OA) — Mimicking in昀氀ammatory arthri琀椀s Ques琀椀on: A 68-year-old man presents with joint pain in both knees and s琀椀昀昀ness in his 昀椀ngers. He reports s琀椀昀昀ness in the morning that lasts about 25 minutes and improves with movement. On examina琀椀on, there is crepitus in both knees and enlargement of the distal interphalangeal joints. No warmth or redness is present. Laboratory tests show: ESR: mildly elevated (28 mm/hr) Rheumatoid factor: nega琀椀ve Which of the following is the most likely diagnosis? A)Early rheumatoid arthri琀椀s B) Osteoarthri琀椀s C) Psoria琀椀c arthri琀椀s D)Polymyalgia rheuma琀椀ca Answer: B) Osteoarthri琀椀s Trick: Mildly elevated ESR may appear in OA, especially in elderly or obese pa琀椀ents — don’t assume in昀氀amma琀椀on = RA unless you see symmetric small-joint synovi琀椀s. 2. Rheumatoid Arthri琀椀s (RA) — Mimicking lupus or viral arthri琀椀s Ques琀椀on: A 32-year-old woman presents with 3 months of hand pain and swelling in the wrists and PIP joints. She reports fa琀椀gue, occasional low-grade fevers, and morning s琀椀昀昀ness las琀椀ng over an hour. Exam shows tender, swollen wrists and PIP joints bilaterally. No rash or oral ulcers. Labs: ANA: posi琀椀ve (1:160) RF: posi琀椀ve an琀椀-CCP: posi琀椀ve Which addi琀椀onal 昀椀nding would you most likely expect? A)Posi琀椀ve rheumatoid factor B) Posi琀椀ve HLA-B27 C) Posi琀椀ve ANA D)Hyperuricemia Answer: B) Posi琀椀ve HLA-B27 Trick: Back pain improving with exercise and sacroilii琀椀s on X-ray = AS, even if the pa琀椀ent appears “too young” for arthri琀椀s. RF and ANA are nega琀椀ve (“seronega琀椀ve spondyloarthropathy”). 5. Spinal Stenosis — Versus peripheral vascular disease Ques琀椀on: A 72-year-old man reports pain and numbness in both legs when walking. The pain improves when he leans on his shopping cart in the grocery store but not when
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