Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Fitzgerald NP Certification Exam Review
Musculoskeletal (MSK) Examination — Fall 2026/2027
100 Questions | All Answers Verified | Fitzgerald Test Format
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis • Question Style: 75% Scenario-Based | 25% Direct
Recall
Section 1: Musculoskeletal Anatomy, Physiology, and Assessment
Joint Structure, Muscle Function, & Physical Examination Techniques (Q1–Q15)
Q1. Which structure lies innermost to outermost in a synovial (diarthrodial) joint?
A. Synovial membrane, fibrous capsule, ligament, skin
B. Articular cartilage, synovial membrane, fibrous capsule, periosteum [CORRECT]
C. Fibrous capsule, synovial membrane, articular cartilage, marrow
D. Periosteum, articular cartilage, synovial membrane, fibrous capsule
Correct Answer: B
Rationale:
From deep to superficial, a synovial joint is composed of articular cartilage covering the bone ends, the synovial
membrane lining the inner non-articular surface, the fibrous capsule forming the outer boundary, and the periosteum
blending with the capsule. Choice B correctly sequences these layers. Choice A incorrectly places skin at the deep layer.
Choice C reverses the synovial membrane and articular cartilage. Choice D incorrectly places the periosteum deepest,
when it is actually outermost contiguous with the capsule.
Q2. A 24-year-old soccer player reports immediate 'pop' and knee instability after pivoting. The knee
is moderately swollen. Which examination maneuver most reliably confirms an anterior cruciate
ligament (ACL) tear?
A. McMurray test
B. Apley's compression test
C. Lachman test [CORRECT]
D. Posterior drawer test
Correct Answer: C
Rationale:
The Lachman test is the most sensitive (~80-95%) maneuver for an ACL tear, performed at 20-30° flexion with anterior
translation of the tibia on the femur; a soft endpoint is positive. McMurry evaluates the meniscus, Apley's compression
evaluates meniscal pathology, and the posterior drawer evaluates the PCL. The Lachman is preferred over the anterior
drawer test, which is less sensitive especially in acute injuries with guarding.
Page 1 — Advanced Practice Nursing MSK Certification Exam
,Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q3. A 32-year-old runner twists the knee while running on uneven terrain. On exam there is medial
joint line tenderness and a positive McMurray test with a palpable click during external rotation with
the knee in full flexion. What structure is most likely injured?
A. Lateral meniscus
B. Medial meniscus [CORRECT]
C. Medial collateral ligament
D. Patellar ligament
Correct Answer: B
Rationale:
A positive McMurray test with the tibia externally rotated stresses the medial meniscus, which is also concordant with
the medial joint line tenderness. The lateral meniscus is tested via internal rotation. The MCL is tested by valgus stress,
and the patellar ligament is evaluated by active extension against resistance. The combination of joint line tenderness
and a specific McMurray finding localizes pathology to the medial meniscus.
Q4. A 45-year-old dental hygienist complains of nocturnal hand numbness and paresthesias in the
thumb, index, and middle fingers. Which provocative test is most diagnostic when held for one
minute and reproduces her symptoms?
A. Tinel sign over the ulnar nerve at the elbow
B. Phalen test [CORRECT]
C. Finkelstein test
D. Drop arm test
Correct Answer: B
Rationale:
Phalen test (wrist flexion for one minute reproducing median nerve distribution paresthesias) is positive in carpal tunnel
syndrome. Tinel at the elbow tests cubital tunnel syndrome (ulnar nerve). Finkelstein tests De Quervain tenosynovitis
(radial pain). The drop arm test evaluates rotator cuff integrity. The patient's history of median nerve distribution
symptoms and occupation-related repetitive motion are classic for carpal tunnel syndrome.
Q5. A 38-year-old keyboard operator has tingling over the volar radial palm, thumb, index and
middle fingers. Tapping the volar wrist at the distal palmar crease reproduces tingling in the affected
digits. Which nerve is being irritated?
A. Ulnar nerve
B. Radial nerve
C. Median nerve [CORRECT]
D. Lateral antebrachial cutaneous nerve
Correct Answer: C
Rationale:
Tapping the median nerve at the carpal tunnel (Tinel sign) producing paresthesias in the median distribution (thumb,
index, middle, and radial half of the ring finger) indicates carpal tunnel syndrome. The ulnar nerve supplies the
hypothenar eminence and ulnar half of the ring and small fingers. The radial nerve supplies the dorsoradial hand. The
lateral antebrachial cutaneous nerve supplies the lateral forearm, not the digits.
Page 2 — Advanced Practice Nursing MSK Certification Exam
,Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q6. Which muscle is the primary abductor of the glenohumeral joint through the first 15 degrees of
motion?
A. Teres major
B. Supraspinatus [CORRECT]
C. Infraspinatus
D. Subscapularis
Correct Answer: B
Rationale:
The supraspinatus initiates the first 15 degrees of glenohumeral abduction; the deltoid then takes over for the remaining
range. The teres major is an internal rotator and adductor. The infraspinatus externally rotates, and the subscapularis
internally rotates the glenohumeral joint. Together these four muscles comprise the rotator cuff, with each having a
distinct primary action.
Q7. During palpation of an inflamed joint, which finding most strongly suggests active synovitis
rather than a mechanical or degenerative process?
A. Crepitus on passive range of motion
B. Boggy, spongy texture with warmth and prolonged morning stiffness [CORRECT]
C. Hard, bony enlargement with cool skin
D. Crepitus with end-range pain only
Correct Answer: B
Rationale:
Boggy, spongy joint texture with warmth and prolonged morning stiffness (>60 min) reflects synovial proliferation and
active inflammation typical of inflammatory arthropathies such as rheumatoid arthritis. Hard, bony enlargement with
cool skin and crepitus suggests osteoarthritis. Crepitus alone is mechanical and non-specific. End-range pain without
boggy texture is more consistent with degenerative or mechanical pathology.
Q8. A 50-year-old patient has a suspected shoulder capsular restriction. Active and passive range of
motion are equally limited in external rotation, abduction, and internal rotation. Which diagnosis is
most likely?
A. Rotator cuff tear
B. Adhesive capsulitis (frozen shoulder) [CORRECT]
C. Glenohumeral osteoarthritis
D. Cervical radiculopathy
Correct Answer: B
Rationale:
Adhesive capsulitis demonstrates a capsular pattern of restriction affecting external rotation greater than abduction
greater than internal rotation, with passive range of motion (PROM) limited to the same degree as active range of
motion (AROM). Rotator cuff tears typically demonstrate a greater PROM than AROM. Glenohumeral OA may show
capsular pattern but with crepitus and bony changes. Cervical radiculopathy produces pain and neurologic symptoms
rather than a true mechanical capsular restriction.
Page 3 — Advanced Practice Nursing MSK Certification Exam
, Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q9. On manual muscle testing, a patient can complete full range of motion against gravity but cannot
resist any additional pressure applied by the examiner. What grade on the standard 0-5 MMT scale
does this represent?
A. Grade 2
B. Grade 3 [CORRECT]
C. Grade 4
D. Grade 5
Correct Answer: B
Rationale:
Grade 3 means the patient completes full range of motion against gravity but cannot resist additional force. Grade 2
indicates full ROM with gravity eliminated. Grade 4 indicates movement against gravity with moderate resistance.
Grade 5 is normal strength against maximal resistance. The 0-5 scale (with + / - modifiers) is the standard manual
muscle test used in MSK examination.
Q10. Which structural characteristic distinguishes a tendon from a ligament?
A. Tendons are highly vascular, ligaments are avascular
B. Tendons connect muscle to bone, ligaments connect bone to bone [CORRECT]
C. Tendons contain elastic fibers exclusively, ligaments contain collagen only
D. Ligaments heal faster than tendons due to a richer blood supply
Correct Answer: B
Rationale:
Tendons connect muscle to bone and transmit muscular force to produce movement; ligaments connect bone to bone
and stabilize joints. Both are composed predominantly of type I collagen in a parallel fiber arrangement, both are
relatively avascular (which contributes to slow healing), and both have limited intrinsic healing capacity. Choice B is the
defining anatomic distinction and the foundation for understanding MSK biomechanics.
Q11. A 58-year-old woman cannot maintain her arm in an abducted position after you passively
abduct it to 90 degrees; the arm drops suddenly when you release it. This finding indicates injury to
which structure?
A. Biceps tendon (long head)
B. Supraspinatus tendon [CORRECT]
C. Acromioclavicular ligament
D. Long thoracic nerve
Correct Answer: B
Rationale:
The drop arm test is positive when the patient is unable to hold the arm in abduction after passive positioning to 90
degrees, indicating a full-thickness rotator cuff tear, most commonly of the supraspinatus. The biceps tendon is tested
with Speed or Yergason's tests. The AC ligament is tested with cross-body adduction. Long thoracic nerve injury
produces scapular winging, not a drop arm sign.
Page 4 — Advanced Practice Nursing MSK Certification Exam
Fitzgerald NP Certification Exam Review
Musculoskeletal (MSK) Examination — Fall 2026/2027
100 Questions | All Answers Verified | Fitzgerald Test Format
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis • Question Style: 75% Scenario-Based | 25% Direct
Recall
Section 1: Musculoskeletal Anatomy, Physiology, and Assessment
Joint Structure, Muscle Function, & Physical Examination Techniques (Q1–Q15)
Q1. Which structure lies innermost to outermost in a synovial (diarthrodial) joint?
A. Synovial membrane, fibrous capsule, ligament, skin
B. Articular cartilage, synovial membrane, fibrous capsule, periosteum [CORRECT]
C. Fibrous capsule, synovial membrane, articular cartilage, marrow
D. Periosteum, articular cartilage, synovial membrane, fibrous capsule
Correct Answer: B
Rationale:
From deep to superficial, a synovial joint is composed of articular cartilage covering the bone ends, the synovial
membrane lining the inner non-articular surface, the fibrous capsule forming the outer boundary, and the periosteum
blending with the capsule. Choice B correctly sequences these layers. Choice A incorrectly places skin at the deep layer.
Choice C reverses the synovial membrane and articular cartilage. Choice D incorrectly places the periosteum deepest,
when it is actually outermost contiguous with the capsule.
Q2. A 24-year-old soccer player reports immediate 'pop' and knee instability after pivoting. The knee
is moderately swollen. Which examination maneuver most reliably confirms an anterior cruciate
ligament (ACL) tear?
A. McMurray test
B. Apley's compression test
C. Lachman test [CORRECT]
D. Posterior drawer test
Correct Answer: C
Rationale:
The Lachman test is the most sensitive (~80-95%) maneuver for an ACL tear, performed at 20-30° flexion with anterior
translation of the tibia on the femur; a soft endpoint is positive. McMurry evaluates the meniscus, Apley's compression
evaluates meniscal pathology, and the posterior drawer evaluates the PCL. The Lachman is preferred over the anterior
drawer test, which is less sensitive especially in acute injuries with guarding.
Page 1 — Advanced Practice Nursing MSK Certification Exam
,Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q3. A 32-year-old runner twists the knee while running on uneven terrain. On exam there is medial
joint line tenderness and a positive McMurray test with a palpable click during external rotation with
the knee in full flexion. What structure is most likely injured?
A. Lateral meniscus
B. Medial meniscus [CORRECT]
C. Medial collateral ligament
D. Patellar ligament
Correct Answer: B
Rationale:
A positive McMurray test with the tibia externally rotated stresses the medial meniscus, which is also concordant with
the medial joint line tenderness. The lateral meniscus is tested via internal rotation. The MCL is tested by valgus stress,
and the patellar ligament is evaluated by active extension against resistance. The combination of joint line tenderness
and a specific McMurray finding localizes pathology to the medial meniscus.
Q4. A 45-year-old dental hygienist complains of nocturnal hand numbness and paresthesias in the
thumb, index, and middle fingers. Which provocative test is most diagnostic when held for one
minute and reproduces her symptoms?
A. Tinel sign over the ulnar nerve at the elbow
B. Phalen test [CORRECT]
C. Finkelstein test
D. Drop arm test
Correct Answer: B
Rationale:
Phalen test (wrist flexion for one minute reproducing median nerve distribution paresthesias) is positive in carpal tunnel
syndrome. Tinel at the elbow tests cubital tunnel syndrome (ulnar nerve). Finkelstein tests De Quervain tenosynovitis
(radial pain). The drop arm test evaluates rotator cuff integrity. The patient's history of median nerve distribution
symptoms and occupation-related repetitive motion are classic for carpal tunnel syndrome.
Q5. A 38-year-old keyboard operator has tingling over the volar radial palm, thumb, index and
middle fingers. Tapping the volar wrist at the distal palmar crease reproduces tingling in the affected
digits. Which nerve is being irritated?
A. Ulnar nerve
B. Radial nerve
C. Median nerve [CORRECT]
D. Lateral antebrachial cutaneous nerve
Correct Answer: C
Rationale:
Tapping the median nerve at the carpal tunnel (Tinel sign) producing paresthesias in the median distribution (thumb,
index, middle, and radial half of the ring finger) indicates carpal tunnel syndrome. The ulnar nerve supplies the
hypothenar eminence and ulnar half of the ring and small fingers. The radial nerve supplies the dorsoradial hand. The
lateral antebrachial cutaneous nerve supplies the lateral forearm, not the digits.
Page 2 — Advanced Practice Nursing MSK Certification Exam
,Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q6. Which muscle is the primary abductor of the glenohumeral joint through the first 15 degrees of
motion?
A. Teres major
B. Supraspinatus [CORRECT]
C. Infraspinatus
D. Subscapularis
Correct Answer: B
Rationale:
The supraspinatus initiates the first 15 degrees of glenohumeral abduction; the deltoid then takes over for the remaining
range. The teres major is an internal rotator and adductor. The infraspinatus externally rotates, and the subscapularis
internally rotates the glenohumeral joint. Together these four muscles comprise the rotator cuff, with each having a
distinct primary action.
Q7. During palpation of an inflamed joint, which finding most strongly suggests active synovitis
rather than a mechanical or degenerative process?
A. Crepitus on passive range of motion
B. Boggy, spongy texture with warmth and prolonged morning stiffness [CORRECT]
C. Hard, bony enlargement with cool skin
D. Crepitus with end-range pain only
Correct Answer: B
Rationale:
Boggy, spongy joint texture with warmth and prolonged morning stiffness (>60 min) reflects synovial proliferation and
active inflammation typical of inflammatory arthropathies such as rheumatoid arthritis. Hard, bony enlargement with
cool skin and crepitus suggests osteoarthritis. Crepitus alone is mechanical and non-specific. End-range pain without
boggy texture is more consistent with degenerative or mechanical pathology.
Q8. A 50-year-old patient has a suspected shoulder capsular restriction. Active and passive range of
motion are equally limited in external rotation, abduction, and internal rotation. Which diagnosis is
most likely?
A. Rotator cuff tear
B. Adhesive capsulitis (frozen shoulder) [CORRECT]
C. Glenohumeral osteoarthritis
D. Cervical radiculopathy
Correct Answer: B
Rationale:
Adhesive capsulitis demonstrates a capsular pattern of restriction affecting external rotation greater than abduction
greater than internal rotation, with passive range of motion (PROM) limited to the same degree as active range of
motion (AROM). Rotator cuff tears typically demonstrate a greater PROM than AROM. Glenohumeral OA may show
capsular pattern but with crepitus and bony changes. Cervical radiculopathy produces pain and neurologic symptoms
rather than a true mechanical capsular restriction.
Page 3 — Advanced Practice Nursing MSK Certification Exam
, Fitzgerald NP Certification Exam Review — MSK — Fall 2026/2027 100 Questions | All Answers Verified
Q9. On manual muscle testing, a patient can complete full range of motion against gravity but cannot
resist any additional pressure applied by the examiner. What grade on the standard 0-5 MMT scale
does this represent?
A. Grade 2
B. Grade 3 [CORRECT]
C. Grade 4
D. Grade 5
Correct Answer: B
Rationale:
Grade 3 means the patient completes full range of motion against gravity but cannot resist additional force. Grade 2
indicates full ROM with gravity eliminated. Grade 4 indicates movement against gravity with moderate resistance.
Grade 5 is normal strength against maximal resistance. The 0-5 scale (with + / - modifiers) is the standard manual
muscle test used in MSK examination.
Q10. Which structural characteristic distinguishes a tendon from a ligament?
A. Tendons are highly vascular, ligaments are avascular
B. Tendons connect muscle to bone, ligaments connect bone to bone [CORRECT]
C. Tendons contain elastic fibers exclusively, ligaments contain collagen only
D. Ligaments heal faster than tendons due to a richer blood supply
Correct Answer: B
Rationale:
Tendons connect muscle to bone and transmit muscular force to produce movement; ligaments connect bone to bone
and stabilize joints. Both are composed predominantly of type I collagen in a parallel fiber arrangement, both are
relatively avascular (which contributes to slow healing), and both have limited intrinsic healing capacity. Choice B is the
defining anatomic distinction and the foundation for understanding MSK biomechanics.
Q11. A 58-year-old woman cannot maintain her arm in an abducted position after you passively
abduct it to 90 degrees; the arm drops suddenly when you release it. This finding indicates injury to
which structure?
A. Biceps tendon (long head)
B. Supraspinatus tendon [CORRECT]
C. Acromioclavicular ligament
D. Long thoracic nerve
Correct Answer: B
Rationale:
The drop arm test is positive when the patient is unable to hold the arm in abduction after passive positioning to 90
degrees, indicating a full-thickness rotator cuff tear, most commonly of the supraspinatus. The biceps tendon is tested
with Speed or Yergason's tests. The AC ligament is tested with cross-body adduction. Long thoracic nerve injury
produces scapular winging, not a drop arm sign.
Page 4 — Advanced Practice Nursing MSK Certification Exam
