Fitzgerald NP Certification Exam Review
FITZGERALD TEST MSK — All Answers Verified | Latest Fall 2026/2027
Musculoskeletal (MSK) Specialty Review for Advanced Practice Nursing
100 Multiple-Choice Questions • 7 Sections • NP Board Certification Preparation
Instructions: Select the single best answer for each question. Questions are scenario-based and
direct recall, aligned with the Fitzgerald Nurse Practitioner Certification Examination Review
musculoskeletal content. Correct answers are marked [CORRECT] and verified against Fall
2026/2027 evidence-based guidelines, ACR/EULAR criteria, USPSTF screening recommendations,
and primary care management standards. Each rationale explains the correct answer choice and
why distractors represent common NP certification exam pitfalls.
Section 1: Musculoskeletal Anatomy, Physiology, and Assessment
(Q1-Q15)
Q1: A 28-year-old male presents after twisting his knee during a basketball game. He
reports a "pop" and immediate swelling. On examination, the Lachman test is most
sensitive for evaluating which structure?
A. Medial meniscus
B. Lateral collateral ligament
C. Anterior cruciate ligament (ACL) [CORRECT]
D. Posterior cruciate ligament (PCL)
Correct Answer: C
Rationale: The Lachman test is the most sensitive clinical maneuver for ACL integrity, detecting
anterior tibial translation relative to the femur at 20-30° of flexion. A soft or absent endpoint
indicates ACL tear. McMurray tests the meniscus, varus/valgus stress tests evaluate collateral
ligaments, and the posterior drawer test assesses the PCL.
Q2: Which synovial joint structure is primarily responsible for producing synovial fluid
that lubricates the joint and provides nutrition to avascular cartilage?
A. Articular cartilage
B. Synovial membrane (intima) [CORRECT]
C. Meniscus
D. Joint capsule
Correct Answer: B
Rationale: The synovial membrane, particularly the intima layer composed of type B synoviocytes
(fibroblast-like), produces synovial fluid rich in hyaluronic acid and lubricin. Articular cartilage is
avascular and aneural, depending entirely on synovial fluid for nutrient diffusion. The meniscus
serves a shock-absorbing role, and the capsule provides structural stability.
Fitzgerald Test MSK Page 1 Fall 2026/2027 Edition
,Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q3: A 45-year-old female complains of morning hand stiffness lasting 90 minutes. Which
physical examination finding most strongly suggests inflammatory arthritis rather than
osteoarthritis?
A. Bony enlargement of the proximal interphalangeal (PIP) joints (Bouchard nodes)
B. Symmetrical soft-tissue swelling of the metacarpophalangeal (MCP) joints with
prolonged morning stiffness [CORRECT]
C. Crepitus with passive range of motion at the first carpometacarpal (CMC) joint
D. Heberden nodes at the distal interphalangeal (DIP) joints
Correct Answer: B
Rationale: Symmetrical soft-tissue swelling of MCPs with prolonged morning stiffness (>60
minutes) is the hallmark of rheumatoid arthritis, an inflammatory arthropathy. Bouchard and
Heberden nodes represent bony osteophyte formation typical of osteoarthritis, and CMC crepitus is
also osteoarthritic. Inflammatory arthritis features soft-tissue (synovitic) swelling, while OA
produces hard, bony enlargement.
Q4: When performing the McMurray test, the clinician applies valgus stress with external
rotation of the tibia while extending the knee from full flexion. A painful click along the
medial joint line suggests a tear of the:
A. Lateral meniscus
B. Medial meniscus [CORRECT]
C. Medial collateral ligament
D. Patellar tendon
Correct Answer: B
Rationale: The McMurray test compresses the posterior horn of the meniscus. External rotation
tests the medial meniscus, while internal rotation tests the lateral meniscus. A palpable or audible
click with pain along the medial joint line is positive for a medial meniscal tear. The medial
meniscus is torn approximately three times more often than the lateral due to its reduced mobility
and greater attachment to the medial collateral ligament.
Q5: Which anatomic structure limits shoulder internal rotation and abduction and is most
commonly affected in adhesive capsulitis (frozen shoulder)?
A. Rotator cuff tendons
B. Glenohumeral joint capsule and coracohumeral ligament [CORRECT]
C. Long head of the biceps tendon
D. Subacromial bursa
Correct Answer: B
Rationale: Adhesive capsulitis involves thickening and contracture of the glenohumeral joint
capsule, particularly the rotator interval and coracohumeral ligament. The hallmark is a capsular
pattern of restriction, with external rotation affected first and most severely, followed by abduction
and internal rotation. Primary idiopathic adhesive capsulitis is more common in diabetics and
women aged 40-60.
Fitzgerald Test MSK Page 2 Fall 2026/2027 Edition
,Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q6: During a neurological examination of the upper extremity, the biceps reflex primarily
tests which spinal nerve roots?
A. C5 and C6 [CORRECT]
B. C7 and C8
C. C3 and C4
D. T1 and T2
Correct Answer: A
Rationale: The biceps reflex tests C5 and C6 nerve roots. The brachioradialis reflex also tests C5-C6,
the triceps reflex tests C7-C8, and the patellar reflex tests L2-L4. Root-level testing complements
manual muscle testing: elbow flexion (C5-C6), wrist extension (C6-C7), elbow extension (C7-C8),
finger flexion (C8), and finger abduction (T1).
Q7: A patient is being evaluated for carpal tunnel syndrome. Which combination of
physical examination findings best confirms the diagnosis?
A. Positive Phalen test, Tinel sign at the wrist, and thenar atrophy in advanced disease
[CORRECT]
B. Positive Finkelstein test, pain over the anatomic snuffbox, and ulnar deviation of the wrist
C. Positive Hawkins-Kennedy test, painful arc, and Neer impingement sign
D. Positive Spurling test, pain with cervical rotation, and shoulder abduction relief
Correct Answer: A
Rationale: Carpal tunnel syndrome involves median nerve compression at the wrist. Phalen test
(flexion reproducing symptoms within 60 seconds), Tinel sign (tapping over the median nerve at the
wrist), and thenar atrophy in chronic cases are classic findings. Finkelstein tests for de Quervain
tenosynovitis; Hawkins-Kennedy and Neer test for shoulder impingement; Spurling evaluates
cervical radiculopathy.
Q8: Which muscle is the primary knee extensor innervated by the femoral nerve (L2-L4)?
A. Hamstring complex
B. Gastrocnemius
C. Quadriceps femoris [CORRECT]
D. Tibialis anterior
Correct Answer: C
Rationale: The quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus
intermedius) is the primary knee extensor, innervated by the femoral nerve (L2-L4). The hamstrings
(sciatic nerve, L5-S2) flex the knee. Gastrocnemius (tibial nerve, S1-S2) plantarflexes the ankle, and
tibialis anterior (deep peroneal nerve, L4-L5) dorsiflexes the foot.
Fitzgerald Test MSK Page 3 Fall 2026/2027 Edition
, Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q9: The Thomas test is performed to assess for the presence of:
A. Hip joint effusion
B. Fixed hip flexion contracture [CORRECT]
C. Hip osteoarthritis severity
D. Iliotibial band tightness
Correct Answer: B
Rationale: The Thomas test evaluates for a fixed hip flexion contracture. The patient lies supine
with one knee held to the chest to flatten the lumbar lordosis; the contralateral leg is observed. If
the contralateral thigh cannot rest flat on the table, a flexion contracture exists. This finding is
common in hip OA, capsular tightening, or prolonged positioning, and may contribute to
compensatory lumbar hyperlordosis.
Q10: A 32-year-old runner presents with lateral knee pain. On examination,
distal-to-the-knee tenderness is reproduced 30 degrees of knee flexion, and Noble
compression test reproduces pain. What structure is most likely affected?
A. Iliotibial (IT) band at the lateral femoral epicondyle [CORRECT]
B. Lateral collateral ligament
C. Lateral meniscus
D. Biceps femoris tendon
Correct Answer: A
Rationale: Iliotibial band syndrome is the most common cause of lateral knee pain in runners,
caused by friction of the distal IT band over the lateral femoral epicondyle at approximately 30° of
flexion. The Noble compression test (pressure applied over the lateral epicondyle during repeated
knee flexion-extension) reproduces symptoms. Treatment focuses on activity modification, IT band
stretching, gluteal strengthening, and addressing training errors.
Q11: The Apley compression (weight-bearing) test is performed with the patient prone and
the knee flexed to 90°. Downward pressure with simultaneous internal and external
rotation most directly evaluates the:
A. Patellofemoral joint
B. Menisci [CORRECT]
C. Cruciate ligaments
D. Collateral ligaments
Correct Answer: B
Rationale: The Apley compression test applies axial load to a flexed knee with rotation, reproducing
pain in meniscal tears (compression between femoral condyle and tibial plateau). The Apley
distraction test, performed by applying traction with the same rotation, evaluates ligamentous pain.
Pain with compression but relief with distraction suggests meniscal pathology; pain with both
suggests ligamentous or capsular involvement.
Fitzgerald Test MSK Page 4 Fall 2026/2027 Edition
FITZGERALD TEST MSK — All Answers Verified | Latest Fall 2026/2027
Musculoskeletal (MSK) Specialty Review for Advanced Practice Nursing
100 Multiple-Choice Questions • 7 Sections • NP Board Certification Preparation
Instructions: Select the single best answer for each question. Questions are scenario-based and
direct recall, aligned with the Fitzgerald Nurse Practitioner Certification Examination Review
musculoskeletal content. Correct answers are marked [CORRECT] and verified against Fall
2026/2027 evidence-based guidelines, ACR/EULAR criteria, USPSTF screening recommendations,
and primary care management standards. Each rationale explains the correct answer choice and
why distractors represent common NP certification exam pitfalls.
Section 1: Musculoskeletal Anatomy, Physiology, and Assessment
(Q1-Q15)
Q1: A 28-year-old male presents after twisting his knee during a basketball game. He
reports a "pop" and immediate swelling. On examination, the Lachman test is most
sensitive for evaluating which structure?
A. Medial meniscus
B. Lateral collateral ligament
C. Anterior cruciate ligament (ACL) [CORRECT]
D. Posterior cruciate ligament (PCL)
Correct Answer: C
Rationale: The Lachman test is the most sensitive clinical maneuver for ACL integrity, detecting
anterior tibial translation relative to the femur at 20-30° of flexion. A soft or absent endpoint
indicates ACL tear. McMurray tests the meniscus, varus/valgus stress tests evaluate collateral
ligaments, and the posterior drawer test assesses the PCL.
Q2: Which synovial joint structure is primarily responsible for producing synovial fluid
that lubricates the joint and provides nutrition to avascular cartilage?
A. Articular cartilage
B. Synovial membrane (intima) [CORRECT]
C. Meniscus
D. Joint capsule
Correct Answer: B
Rationale: The synovial membrane, particularly the intima layer composed of type B synoviocytes
(fibroblast-like), produces synovial fluid rich in hyaluronic acid and lubricin. Articular cartilage is
avascular and aneural, depending entirely on synovial fluid for nutrient diffusion. The meniscus
serves a shock-absorbing role, and the capsule provides structural stability.
Fitzgerald Test MSK Page 1 Fall 2026/2027 Edition
,Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q3: A 45-year-old female complains of morning hand stiffness lasting 90 minutes. Which
physical examination finding most strongly suggests inflammatory arthritis rather than
osteoarthritis?
A. Bony enlargement of the proximal interphalangeal (PIP) joints (Bouchard nodes)
B. Symmetrical soft-tissue swelling of the metacarpophalangeal (MCP) joints with
prolonged morning stiffness [CORRECT]
C. Crepitus with passive range of motion at the first carpometacarpal (CMC) joint
D. Heberden nodes at the distal interphalangeal (DIP) joints
Correct Answer: B
Rationale: Symmetrical soft-tissue swelling of MCPs with prolonged morning stiffness (>60
minutes) is the hallmark of rheumatoid arthritis, an inflammatory arthropathy. Bouchard and
Heberden nodes represent bony osteophyte formation typical of osteoarthritis, and CMC crepitus is
also osteoarthritic. Inflammatory arthritis features soft-tissue (synovitic) swelling, while OA
produces hard, bony enlargement.
Q4: When performing the McMurray test, the clinician applies valgus stress with external
rotation of the tibia while extending the knee from full flexion. A painful click along the
medial joint line suggests a tear of the:
A. Lateral meniscus
B. Medial meniscus [CORRECT]
C. Medial collateral ligament
D. Patellar tendon
Correct Answer: B
Rationale: The McMurray test compresses the posterior horn of the meniscus. External rotation
tests the medial meniscus, while internal rotation tests the lateral meniscus. A palpable or audible
click with pain along the medial joint line is positive for a medial meniscal tear. The medial
meniscus is torn approximately three times more often than the lateral due to its reduced mobility
and greater attachment to the medial collateral ligament.
Q5: Which anatomic structure limits shoulder internal rotation and abduction and is most
commonly affected in adhesive capsulitis (frozen shoulder)?
A. Rotator cuff tendons
B. Glenohumeral joint capsule and coracohumeral ligament [CORRECT]
C. Long head of the biceps tendon
D. Subacromial bursa
Correct Answer: B
Rationale: Adhesive capsulitis involves thickening and contracture of the glenohumeral joint
capsule, particularly the rotator interval and coracohumeral ligament. The hallmark is a capsular
pattern of restriction, with external rotation affected first and most severely, followed by abduction
and internal rotation. Primary idiopathic adhesive capsulitis is more common in diabetics and
women aged 40-60.
Fitzgerald Test MSK Page 2 Fall 2026/2027 Edition
,Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q6: During a neurological examination of the upper extremity, the biceps reflex primarily
tests which spinal nerve roots?
A. C5 and C6 [CORRECT]
B. C7 and C8
C. C3 and C4
D. T1 and T2
Correct Answer: A
Rationale: The biceps reflex tests C5 and C6 nerve roots. The brachioradialis reflex also tests C5-C6,
the triceps reflex tests C7-C8, and the patellar reflex tests L2-L4. Root-level testing complements
manual muscle testing: elbow flexion (C5-C6), wrist extension (C6-C7), elbow extension (C7-C8),
finger flexion (C8), and finger abduction (T1).
Q7: A patient is being evaluated for carpal tunnel syndrome. Which combination of
physical examination findings best confirms the diagnosis?
A. Positive Phalen test, Tinel sign at the wrist, and thenar atrophy in advanced disease
[CORRECT]
B. Positive Finkelstein test, pain over the anatomic snuffbox, and ulnar deviation of the wrist
C. Positive Hawkins-Kennedy test, painful arc, and Neer impingement sign
D. Positive Spurling test, pain with cervical rotation, and shoulder abduction relief
Correct Answer: A
Rationale: Carpal tunnel syndrome involves median nerve compression at the wrist. Phalen test
(flexion reproducing symptoms within 60 seconds), Tinel sign (tapping over the median nerve at the
wrist), and thenar atrophy in chronic cases are classic findings. Finkelstein tests for de Quervain
tenosynovitis; Hawkins-Kennedy and Neer test for shoulder impingement; Spurling evaluates
cervical radiculopathy.
Q8: Which muscle is the primary knee extensor innervated by the femoral nerve (L2-L4)?
A. Hamstring complex
B. Gastrocnemius
C. Quadriceps femoris [CORRECT]
D. Tibialis anterior
Correct Answer: C
Rationale: The quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus
intermedius) is the primary knee extensor, innervated by the femoral nerve (L2-L4). The hamstrings
(sciatic nerve, L5-S2) flex the knee. Gastrocnemius (tibial nerve, S1-S2) plantarflexes the ankle, and
tibialis anterior (deep peroneal nerve, L4-L5) dorsiflexes the foot.
Fitzgerald Test MSK Page 3 Fall 2026/2027 Edition
, Fitzgerald NP Certification Exam Review - MSK | Fall 2026/2027 100 Questions - All Answers Verified
Q9: The Thomas test is performed to assess for the presence of:
A. Hip joint effusion
B. Fixed hip flexion contracture [CORRECT]
C. Hip osteoarthritis severity
D. Iliotibial band tightness
Correct Answer: B
Rationale: The Thomas test evaluates for a fixed hip flexion contracture. The patient lies supine
with one knee held to the chest to flatten the lumbar lordosis; the contralateral leg is observed. If
the contralateral thigh cannot rest flat on the table, a flexion contracture exists. This finding is
common in hip OA, capsular tightening, or prolonged positioning, and may contribute to
compensatory lumbar hyperlordosis.
Q10: A 32-year-old runner presents with lateral knee pain. On examination,
distal-to-the-knee tenderness is reproduced 30 degrees of knee flexion, and Noble
compression test reproduces pain. What structure is most likely affected?
A. Iliotibial (IT) band at the lateral femoral epicondyle [CORRECT]
B. Lateral collateral ligament
C. Lateral meniscus
D. Biceps femoris tendon
Correct Answer: A
Rationale: Iliotibial band syndrome is the most common cause of lateral knee pain in runners,
caused by friction of the distal IT band over the lateral femoral epicondyle at approximately 30° of
flexion. The Noble compression test (pressure applied over the lateral epicondyle during repeated
knee flexion-extension) reproduces symptoms. Treatment focuses on activity modification, IT band
stretching, gluteal strengthening, and addressing training errors.
Q11: The Apley compression (weight-bearing) test is performed with the patient prone and
the knee flexed to 90°. Downward pressure with simultaneous internal and external
rotation most directly evaluates the:
A. Patellofemoral joint
B. Menisci [CORRECT]
C. Cruciate ligaments
D. Collateral ligaments
Correct Answer: B
Rationale: The Apley compression test applies axial load to a flexed knee with rotation, reproducing
pain in meniscal tears (compression between femoral condyle and tibial plateau). The Apley
distraction test, performed by applying traction with the same rotation, evaluates ligamentous pain.
Pain with compression but relief with distraction suggests meniscal pathology; pain with both
suggests ligamentous or capsular involvement.
Fitzgerald Test MSK Page 4 Fall 2026/2027 Edition
