Musculoskeletal Disorders Clinical
Competency Exam for Nurse
Practitioners 150Qs&A,Rationales
2025/2026
1. A 68-year-old woman presents with gradual onset of hip pain,
worse with weight-bearing, relieved by rest. X-ray shows joint
space narrowing, osteophytes, and subchondral sclerosis. What is
the most likely diagnosis?
A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Osteoarthritis
D. Septic arthritis
Correct answer: C
Rationale: The presentation of gradual onset hip pain in an older
adult, with radiographic findings of joint space narrowing,
osteophytes, and subchondral sclerosis, is characteristic of
osteoarthritis — a degenerative joint disease rather than
inflammatory arthritis.
2. Which of the following is a hallmark of inflammatory arthritis
(e.g., rheumatoid arthritis) as opposed to osteoarthritis?
A. Unilateral joint involvement
B. Morning stiffness lasting less than 10 minutes
C. Morning stiffness lasting more than 30 minutes
D. Pain improves with activity
Correct answer: C
Rationale: In inflammatory arthritis, such as rheumatoid
, arthritis, patients often experience prolonged morning stiffness
(often >30 minutes), whereas osteoarthritis-related stiffness
tends to be brief.
3. A 45-year-old man twists his ankle playing soccer. On exam:
swelling, tenderness just below the lateral malleolus, positive
anterior drawer test of the ankle. What is the most likely injury?
A. Deltoid ligament tear
B. Anterior talofibular ligament sprain
C. Achilles tendon rupture
D. Medial malleolus fracture
Correct answer: B
Rationale: A sprain of the anterior talofibular ligament is the
most common cause of lateral ankle sprain, especially with
inversion injury and positive anterior drawer test.
4. Which of the following compartments is most commonly affected
in acute compartment syndrome of the lower leg?
A. Superficial posterior
B. Lateral
C. Anterior
D. Deep posterior
Correct answer: C
Rationale: The anterior compartment of the lower leg is most
commonly involved in acute compartment syndrome, often from
tibial fractures or crush injuries.
5. A 25-year-old runner complains of anterior knee pain, worsened
when rising from a seated position and when descending stairs.
There is no swelling. What is the most likely diagnosis?
A. Meniscal tear
B. Patellar tendon rupture
, C. Patellofemoral pain syndrome (runner’s knee)
D. Osteoarthritis
Correct answer: C
Rationale: Young runners with anterior knee pain aggravated by
activities like stair descent and standing after sitting often have
patellofemoral pain syndrome rather than structural damage.
6. On physical exam, a patient has limited internal rotation and
abduction of the shoulder, with pain at end range. Radiographs
show calcific deposits in the rotator cuff. What condition is most
consistent with these findings?
A. Osteoarthritis of glenohumeral joint
B. Calcific tendinitis of rotator cuff
C. Adhesive capsulitis
D. Shoulder dislocation
Correct answer: B
Rationale: Calcific tendinitis — deposition of calcium in the
rotator cuff — often leads to pain and limited range of motion,
especially with internal rotation/abduction, and can be seen on
x-ray as calcific deposits.
7. A 55-year-old woman presents with pain in the lateral aspect of
her elbow, worse with wrist extension and gripping. What is the
likely diagnosis?
A. Medial epicondylitis
B. Golfer’s elbow
C. Lateral epicondylitis (tennis elbow)
D. Olecranon bursitis
Correct answer: C
Rationale: Lateral epicondylitis is characterized by pain over the
lateral elbow, exacerbated by wrist extension and gripping,
consistent with the patient’s presentation.
, 8. A 30-year-old man reports gradual shoulder weakness and dull
ache over months. On imaging, there is superior migration of the
humeral head and acetabulization of the acromion. What does
this most likely indicate?
A. Glenohumeral osteoarthritis
B. Labral tear
C. Massive rotator cuff tear
D. Frozen shoulder
Correct answer: C
Rationale: Superior migration of the humeral head and acromial
acetabulization suggest a chronic massive rotator cuff tear
leading to loss of humeral head support.
9. Which of the following lab values is most characteristic of acute
gouty arthritis, even between flares?
A. Normal uric acid
B. Elevated serum uric acid level (hyperuricemia)
C. Decreased serum uric acid
D. Elevated rheumatoid factor
Correct answer: B
Rationale: Hyperuricemia is commonly present in gout even
when the patient is asymptomatic; though not diagnostic alone,
it supports the diagnosis in context.
10. A 40-year-old diabetic patient presents with pain, swelling
and redness of the first metatarsophalangeal joint after a night of
heavy drinking. Synovial fluid shows needle-shaped, negatively
birefringent crystals. What is the best initial treatment?
A. Antibiotics
B. NSAIDs (e.g., indomethacin)
C. Allopurinol
D. Colchicine prophylaxis
Competency Exam for Nurse
Practitioners 150Qs&A,Rationales
2025/2026
1. A 68-year-old woman presents with gradual onset of hip pain,
worse with weight-bearing, relieved by rest. X-ray shows joint
space narrowing, osteophytes, and subchondral sclerosis. What is
the most likely diagnosis?
A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Osteoarthritis
D. Septic arthritis
Correct answer: C
Rationale: The presentation of gradual onset hip pain in an older
adult, with radiographic findings of joint space narrowing,
osteophytes, and subchondral sclerosis, is characteristic of
osteoarthritis — a degenerative joint disease rather than
inflammatory arthritis.
2. Which of the following is a hallmark of inflammatory arthritis
(e.g., rheumatoid arthritis) as opposed to osteoarthritis?
A. Unilateral joint involvement
B. Morning stiffness lasting less than 10 minutes
C. Morning stiffness lasting more than 30 minutes
D. Pain improves with activity
Correct answer: C
Rationale: In inflammatory arthritis, such as rheumatoid
, arthritis, patients often experience prolonged morning stiffness
(often >30 minutes), whereas osteoarthritis-related stiffness
tends to be brief.
3. A 45-year-old man twists his ankle playing soccer. On exam:
swelling, tenderness just below the lateral malleolus, positive
anterior drawer test of the ankle. What is the most likely injury?
A. Deltoid ligament tear
B. Anterior talofibular ligament sprain
C. Achilles tendon rupture
D. Medial malleolus fracture
Correct answer: B
Rationale: A sprain of the anterior talofibular ligament is the
most common cause of lateral ankle sprain, especially with
inversion injury and positive anterior drawer test.
4. Which of the following compartments is most commonly affected
in acute compartment syndrome of the lower leg?
A. Superficial posterior
B. Lateral
C. Anterior
D. Deep posterior
Correct answer: C
Rationale: The anterior compartment of the lower leg is most
commonly involved in acute compartment syndrome, often from
tibial fractures or crush injuries.
5. A 25-year-old runner complains of anterior knee pain, worsened
when rising from a seated position and when descending stairs.
There is no swelling. What is the most likely diagnosis?
A. Meniscal tear
B. Patellar tendon rupture
, C. Patellofemoral pain syndrome (runner’s knee)
D. Osteoarthritis
Correct answer: C
Rationale: Young runners with anterior knee pain aggravated by
activities like stair descent and standing after sitting often have
patellofemoral pain syndrome rather than structural damage.
6. On physical exam, a patient has limited internal rotation and
abduction of the shoulder, with pain at end range. Radiographs
show calcific deposits in the rotator cuff. What condition is most
consistent with these findings?
A. Osteoarthritis of glenohumeral joint
B. Calcific tendinitis of rotator cuff
C. Adhesive capsulitis
D. Shoulder dislocation
Correct answer: B
Rationale: Calcific tendinitis — deposition of calcium in the
rotator cuff — often leads to pain and limited range of motion,
especially with internal rotation/abduction, and can be seen on
x-ray as calcific deposits.
7. A 55-year-old woman presents with pain in the lateral aspect of
her elbow, worse with wrist extension and gripping. What is the
likely diagnosis?
A. Medial epicondylitis
B. Golfer’s elbow
C. Lateral epicondylitis (tennis elbow)
D. Olecranon bursitis
Correct answer: C
Rationale: Lateral epicondylitis is characterized by pain over the
lateral elbow, exacerbated by wrist extension and gripping,
consistent with the patient’s presentation.
, 8. A 30-year-old man reports gradual shoulder weakness and dull
ache over months. On imaging, there is superior migration of the
humeral head and acetabulization of the acromion. What does
this most likely indicate?
A. Glenohumeral osteoarthritis
B. Labral tear
C. Massive rotator cuff tear
D. Frozen shoulder
Correct answer: C
Rationale: Superior migration of the humeral head and acromial
acetabulization suggest a chronic massive rotator cuff tear
leading to loss of humeral head support.
9. Which of the following lab values is most characteristic of acute
gouty arthritis, even between flares?
A. Normal uric acid
B. Elevated serum uric acid level (hyperuricemia)
C. Decreased serum uric acid
D. Elevated rheumatoid factor
Correct answer: B
Rationale: Hyperuricemia is commonly present in gout even
when the patient is asymptomatic; though not diagnostic alone,
it supports the diagnosis in context.
10. A 40-year-old diabetic patient presents with pain, swelling
and redness of the first metatarsophalangeal joint after a night of
heavy drinking. Synovial fluid shows needle-shaped, negatively
birefringent crystals. What is the best initial treatment?
A. Antibiotics
B. NSAIDs (e.g., indomethacin)
C. Allopurinol
D. Colchicine prophylaxis
