Family Medicine EOR Orthopedics-Rheumatology
Exam (2026/2027) | QUESTIONS AND ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Orthopedics &
Rheumatology Examination | Core Domains: Musculoskeletal History & Physical Exam
(MSK), Common Acute Injuries (Sprains, Strains, Fractures, Dislocations), Osteoarthritis &
Inflammatory Arthritis (RA, Gout, Psoriatic), Back & Neck Pain Evaluation, Soft Tissue &
Overuse Syndromes (Bursitis, Tendinopathy), Connective Tissue Diseases (Lupus,
Scleroderma), Osteoporosis & Metabolic Bone Disease, and MSK Imaging & Injection Basics |
Physician Assistant Education Focus | Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Orthopedics-Rheumatology exam for the 2026/2027 academic cycle
is an 85-question, multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Orthopedics-Rheumatology exam guide for the 2026/2027 cycle
prepares Physician Assistant students for the combined musculoskeletal and rheumatology End
of Rotation examination. The content assesses the diagnosis, initial management, and
appropriate referral of common orthopedic injuries and rheumatic diseases in an outpatient
setting, emphasizing physical exam skills, interpretation of basic imaging, and the use of
pharmacologic and non-pharmacologic therapies.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that integrate mechanism of injury, physical exam findings (e.g.,
special tests), differentiate between inflammatory and non-inflammatory arthritis, justify initial
treatment (RICE, NSAIDs, DMARDs), and outline indications for orthopedic or rheumatology
referral.
Question 1: A 24-year-old man falls on an outstretched hand during a basketball game and
now has pain and swelling at the base of his right thumb. X-ray shows a fracture of the scaphoid
bone. Which of the following is the most serious potential complication if not properly
managed?
(A) Median nerve compression
(B) Ulnar nerve palsy
(C) Avascular necrosis
,(D) Compartment syndrome
(E) Reflex sympathetic dystrophy
Correct Answer: (C) Avascular necrosis
Rationale: The scaphoid bone has a retrograde blood supply, with the proximal pole
dependent on vessels entering distally. Fractures through the waist or proximal pole disrupt this
supply, leading to avascular necrosis (AVN) and nonunion. AVN can cause chronic pain, wrist
instability, and post-traumatic arthritis. Treatment includes cast immobilization or surgical
fixation depending on location and displacement. Early recognition and immobilization are
critical. Median nerve compression (carpal tunnel) is unrelated. Compartment syndrome is rare
in the hand.
Question 2: A 65-year-old woman presents with bilateral knee pain that worsens with activity
and improves with rest. She reports morning stiffness lasting less than 30 minutes. X-rays show
joint space narrowing, osteophytes, and subchondral sclerosis. Which of the following is the
most appropriate initial management?
(A) Methotrexate
(B) Prednisone
(C) Acetaminophen and exercise
(D) Colchicine
(E) TNF-alpha inhibitor
Correct Answer: (C) Acetaminophen and exercise
Rationale: This patient has classic osteoarthritis (OA)—a degenerative, non-inflammatory
arthritis characterized by activity-related pain, brief morning stiffness (<30 min), and
radiographic changes (joint space narrowing, osteophytes). First-line management includes
weight loss (if overweight), low-impact exercise (e.g., swimming, walking), acetaminophen, and
topical NSAIDs. Oral NSAIDs may be used cautiously in patients without contraindications.
,Methotrexate, prednisone, and biologics are for inflammatory arthritides like rheumatoid
arthritis (RA). Colchicine is for gout.
Question 3: A 45-year-old man presents with sudden-onset severe pain, redness, and swelling
in his right first metatarsophalangeal (MTP) joint. He denies trauma. Synovial fluid analysis
shows negatively birefringent needle-shaped crystals. Which of the following is the most
appropriate acute treatment?
(A) Allopurinol
(B) Probenecid
(C) Colchicine
(D) Febuxostat
(E) Pegloticase
Correct Answer: (C) Colchicine
Rationale: This is acute gout, confirmed by synovial fluid showing monosodium urate crystals
(negatively birefringent under polarized light). Acute treatment includes NSAIDs, colchicine, or
corticosteroids. Colchicine is most effective if started within 12–24 hours of symptom onset.
Allopurinol, febuxostat, probenecid, and pegloticase are urate-lowering therapies used for
chronic management—not during acute flares, as they can prolong or worsen the attack. Initiate
urate-lowering therapy only after the flare resolves.
Question 4: A 30-year-old woman presents with 6 weeks of symmetric joint pain and swelling
in her hands and wrists, morning stiffness lasting more than 1 hour, and fatigue. Rheumatoid
factor and anti-CCP antibodies are positive. Which of the following is the most appropriate next
step in management?
(A) Start ibuprofen as needed
(B) Begin methotrexate
, (C) Order hand X-rays and observe
(D) Prescribe prednisone 60 mg daily
(E) Refer to physical therapy only
Correct Answer: (B) Begin methotrexate
Rationale: This patient meets criteria for rheumatoid arthritis (RA)—symmetric polyarthritis,
prolonged morning stiffness, and positive serologies (RF, anti-CCP). Early initiation of
disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, is critical to
prevent joint erosion and disability. Delaying treatment worsens long-term outcomes. NSAIDs
and short-course prednisone may provide symptomatic relief but do not alter disease
progression. Referral to rheumatology is also appropriate, but methotrexate should not be
delayed.
Question 5: A 50-year-old man presents with low back pain radiating down the posterior right
leg to the foot, with associated numbness in the lateral calf and weakness in ankle dorsiflexion.
Straight leg raise test is positive on the right. Which nerve root is most likely compressed?
(A) L3
(B) L4
(C) L5
(D) S1
(E) S2
Correct Answer: (C) L5
Rationale: L5 radiculopathy typically causes pain radiating down the posterior thigh, lateral
calf, and dorsum of the foot, with numbness in the same distribution. Motor findings include
weakness in ankle dorsiflexion (tibialis anterior), big toe extension (extensor hallucis longus),
Exam (2026/2027) | QUESTIONS AND ANSWERS
Physician Assistant (PA) Family Medicine End of Rotation (EOR) Orthopedics &
Rheumatology Examination | Core Domains: Musculoskeletal History & Physical Exam
(MSK), Common Acute Injuries (Sprains, Strains, Fractures, Dislocations), Osteoarthritis &
Inflammatory Arthritis (RA, Gout, Psoriatic), Back & Neck Pain Evaluation, Soft Tissue &
Overuse Syndromes (Bursitis, Tendinopathy), Connective Tissue Diseases (Lupus,
Scleroderma), Osteoporosis & Metabolic Bone Disease, and MSK Imaging & Injection Basics |
Physician Assistant Education Focus | Specialty-Specific EOR Exam Format
Exam Structure
The Family Medicine EOR Orthopedics-Rheumatology exam for the 2026/2027 academic cycle
is an 85-question, multiple-choice question (MCQ) examination.
Introduction
This Family Medicine EOR Orthopedics-Rheumatology exam guide for the 2026/2027 cycle
prepares Physician Assistant students for the combined musculoskeletal and rheumatology End
of Rotation examination. The content assesses the diagnosis, initial management, and
appropriate referral of common orthopedic injuries and rheumatic diseases in an outpatient
setting, emphasizing physical exam skills, interpretation of basic imaging, and the use of
pharmacologic and non-pharmacologic therapies.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green,
followed by detailed rationales that integrate mechanism of injury, physical exam findings (e.g.,
special tests), differentiate between inflammatory and non-inflammatory arthritis, justify initial
treatment (RICE, NSAIDs, DMARDs), and outline indications for orthopedic or rheumatology
referral.
Question 1: A 24-year-old man falls on an outstretched hand during a basketball game and
now has pain and swelling at the base of his right thumb. X-ray shows a fracture of the scaphoid
bone. Which of the following is the most serious potential complication if not properly
managed?
(A) Median nerve compression
(B) Ulnar nerve palsy
(C) Avascular necrosis
,(D) Compartment syndrome
(E) Reflex sympathetic dystrophy
Correct Answer: (C) Avascular necrosis
Rationale: The scaphoid bone has a retrograde blood supply, with the proximal pole
dependent on vessels entering distally. Fractures through the waist or proximal pole disrupt this
supply, leading to avascular necrosis (AVN) and nonunion. AVN can cause chronic pain, wrist
instability, and post-traumatic arthritis. Treatment includes cast immobilization or surgical
fixation depending on location and displacement. Early recognition and immobilization are
critical. Median nerve compression (carpal tunnel) is unrelated. Compartment syndrome is rare
in the hand.
Question 2: A 65-year-old woman presents with bilateral knee pain that worsens with activity
and improves with rest. She reports morning stiffness lasting less than 30 minutes. X-rays show
joint space narrowing, osteophytes, and subchondral sclerosis. Which of the following is the
most appropriate initial management?
(A) Methotrexate
(B) Prednisone
(C) Acetaminophen and exercise
(D) Colchicine
(E) TNF-alpha inhibitor
Correct Answer: (C) Acetaminophen and exercise
Rationale: This patient has classic osteoarthritis (OA)—a degenerative, non-inflammatory
arthritis characterized by activity-related pain, brief morning stiffness (<30 min), and
radiographic changes (joint space narrowing, osteophytes). First-line management includes
weight loss (if overweight), low-impact exercise (e.g., swimming, walking), acetaminophen, and
topical NSAIDs. Oral NSAIDs may be used cautiously in patients without contraindications.
,Methotrexate, prednisone, and biologics are for inflammatory arthritides like rheumatoid
arthritis (RA). Colchicine is for gout.
Question 3: A 45-year-old man presents with sudden-onset severe pain, redness, and swelling
in his right first metatarsophalangeal (MTP) joint. He denies trauma. Synovial fluid analysis
shows negatively birefringent needle-shaped crystals. Which of the following is the most
appropriate acute treatment?
(A) Allopurinol
(B) Probenecid
(C) Colchicine
(D) Febuxostat
(E) Pegloticase
Correct Answer: (C) Colchicine
Rationale: This is acute gout, confirmed by synovial fluid showing monosodium urate crystals
(negatively birefringent under polarized light). Acute treatment includes NSAIDs, colchicine, or
corticosteroids. Colchicine is most effective if started within 12–24 hours of symptom onset.
Allopurinol, febuxostat, probenecid, and pegloticase are urate-lowering therapies used for
chronic management—not during acute flares, as they can prolong or worsen the attack. Initiate
urate-lowering therapy only after the flare resolves.
Question 4: A 30-year-old woman presents with 6 weeks of symmetric joint pain and swelling
in her hands and wrists, morning stiffness lasting more than 1 hour, and fatigue. Rheumatoid
factor and anti-CCP antibodies are positive. Which of the following is the most appropriate next
step in management?
(A) Start ibuprofen as needed
(B) Begin methotrexate
, (C) Order hand X-rays and observe
(D) Prescribe prednisone 60 mg daily
(E) Refer to physical therapy only
Correct Answer: (B) Begin methotrexate
Rationale: This patient meets criteria for rheumatoid arthritis (RA)—symmetric polyarthritis,
prolonged morning stiffness, and positive serologies (RF, anti-CCP). Early initiation of
disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, is critical to
prevent joint erosion and disability. Delaying treatment worsens long-term outcomes. NSAIDs
and short-course prednisone may provide symptomatic relief but do not alter disease
progression. Referral to rheumatology is also appropriate, but methotrexate should not be
delayed.
Question 5: A 50-year-old man presents with low back pain radiating down the posterior right
leg to the foot, with associated numbness in the lateral calf and weakness in ankle dorsiflexion.
Straight leg raise test is positive on the right. Which nerve root is most likely compressed?
(A) L3
(B) L4
(C) L5
(D) S1
(E) S2
Correct Answer: (C) L5
Rationale: L5 radiculopathy typically causes pain radiating down the posterior thigh, lateral
calf, and dorsum of the foot, with numbness in the same distribution. Motor findings include
weakness in ankle dorsiflexion (tibialis anterior), big toe extension (extensor hallucis longus),
