2025 HESI Practice Exam: 200 Musculoskeletal
and Neurological Case Study Questions with
Answers for Physical Assessment Mastery
1. Low Back Pain vs Herniated Disc
Question:
Sam is a 25-year-old male diagnosed with low back strain. Which of the following
symptoms would alert the clinician to the more serious finding of a herniated nucleus
pulposus (ruptured disc)?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue
Correct Answer: b.
Rationale:
Radicular pain extending below the knee, especially if greater than the back pain, is a
hallmark sign of nerve root compression due to disc herniation. This contrasts with
mechanical low back pain, which is typically localized.
2. NSAID Use Education
Question:
Which of the following statements is most appropriate when teaching a 25-year-old
patient with low back strain about NSAID use?
a. Start with the lowest dose that is effective, due to the risk of GI disorders.
b. Start with the lowest dose to avoid tolerance development.
c. Take the maximum dose to avoid using narcotics.
d. Take NSAIDs on an empty stomach for better absorption.
Correct Answer: a.
Rationale:
NSAIDs can cause gastrointestinal irritation, ulcers, and bleeding. To minimize risks,
patients should use the lowest effective dose for the shortest duration.
,3. Cauda Equina Syndrome
Question:
A patient with a herniated disc at L5-S1 presents to the ER. Which symptom is most
concerning for cauda equina syndrome?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks
Correct Answer: d.
Rationale:
Cauda equina syndrome is a surgical emergency. "Saddle anesthesia" (numbness in the
perineum and buttocks) is a classic symptom, often accompanied by bowel/bladder
dysfunction and lower extremity weakness.
4. Herniated Disc Management
Question:
Which of the following statements about managing a herniated disc is accurate?
a. Muscle relaxants and narcotics are used but discontinued after 3 weeks.
b. Epidural injections help reduce leg pain after 3 weeks of symptoms.
c. Pain lasting longer than 3 months may require surgery.
d. All of the above.
Correct Answer: c.
Rationale:
Surgical intervention is typically reserved for patients with persistent, intolerable pain
lasting longer than 3 months or neurological deficits. Options a and b are sometimes
true but are not considered definitive management plans.
5. Meniscal Tear
Question:
A 16-year-old male injured his knee during football, heard a pop, and now cannot fully
extend the knee. What is the most appropriate test to assess for a meniscal tear?
a. Lachman test
b. McMurray circumduction test
,c. Anterior drawer test
d. Varus stress test
Correct Answer: b.
Rationale:
The McMurray test is used to detect meniscal tears. A positive result reproduces the
patient's symptoms with a palpable or audible click.
6. Patellar Instability
Question:
Testing for patellar instability involves lateral displacement of the patella and knee
flexion to 30 degrees. Pain or apprehension indicates:
a. Lachman test
b. McMurray sign
c. Apley’s test
d. Apprehension sign
Correct Answer: d.
Rationale:
The Apprehension sign detects patellar instability. The patient shows discomfort or fear
of dislocation when the patella is moved laterally.
7. Ankle Injury X-ray Indications
Question:
Which of the following findings would indicate the need for an ankle x-ray following
trauma?
a. Inability to bear weight after the injury
b. Marked swelling and discoloration
c. Crepitus on palpation
d. All of the above
Correct Answer: d.
Rationale:
According to the Ottawa ankle rules, inability to bear weight, swelling, discoloration,
and crepitus are all red flags indicating possible fracture and the need for imaging.
, 8. Osteoarthritis & Complementary Therapies
Question:
A 65-year-old patient with osteoarthritis prefers complementary therapies. What is the
best clinician response?
a. Only use complementary therapies after surgery fails.
b. Complementary therapies are not recommended.
c. Complementary therapies like acupuncture, acupressure, and tai-chi can be
effective when combined with medical therapy.
d. Avoid complementary therapies because they are unproven and risky.
Correct Answer: c.
Rationale:
Complementary therapies, especially when used alongside conventional treatments,
have shown benefit in managing osteoarthritis pain and improving function.
Normal estrogen function is important for preventing osteoporosis in both men and
women. Estrogen works to prevent osteoporosis in which of the following ways?
a. By decreasing the erosive activity of osteoclasts
b. By promoting osteoclastogenesis
c. By inhibiting osteoclast apoptosis
d. All of the above - - correct ans- -a. By decreasing the erosive activity of osteoclasts
Which of the following tests is considered the gold standard for definitively diagnosing
osteoporosis?
a. Bone alkaline phosphatase levels
b. Urinary N-telopeptide assay
c. Bone mass density measurement by densitometry
d. Magnetic resonance imaging - - correct ans- -c. Bone mass density measurement by
densitometry
and Neurological Case Study Questions with
Answers for Physical Assessment Mastery
1. Low Back Pain vs Herniated Disc
Question:
Sam is a 25-year-old male diagnosed with low back strain. Which of the following
symptoms would alert the clinician to the more serious finding of a herniated nucleus
pulposus (ruptured disc)?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue
Correct Answer: b.
Rationale:
Radicular pain extending below the knee, especially if greater than the back pain, is a
hallmark sign of nerve root compression due to disc herniation. This contrasts with
mechanical low back pain, which is typically localized.
2. NSAID Use Education
Question:
Which of the following statements is most appropriate when teaching a 25-year-old
patient with low back strain about NSAID use?
a. Start with the lowest dose that is effective, due to the risk of GI disorders.
b. Start with the lowest dose to avoid tolerance development.
c. Take the maximum dose to avoid using narcotics.
d. Take NSAIDs on an empty stomach for better absorption.
Correct Answer: a.
Rationale:
NSAIDs can cause gastrointestinal irritation, ulcers, and bleeding. To minimize risks,
patients should use the lowest effective dose for the shortest duration.
,3. Cauda Equina Syndrome
Question:
A patient with a herniated disc at L5-S1 presents to the ER. Which symptom is most
concerning for cauda equina syndrome?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks
Correct Answer: d.
Rationale:
Cauda equina syndrome is a surgical emergency. "Saddle anesthesia" (numbness in the
perineum and buttocks) is a classic symptom, often accompanied by bowel/bladder
dysfunction and lower extremity weakness.
4. Herniated Disc Management
Question:
Which of the following statements about managing a herniated disc is accurate?
a. Muscle relaxants and narcotics are used but discontinued after 3 weeks.
b. Epidural injections help reduce leg pain after 3 weeks of symptoms.
c. Pain lasting longer than 3 months may require surgery.
d. All of the above.
Correct Answer: c.
Rationale:
Surgical intervention is typically reserved for patients with persistent, intolerable pain
lasting longer than 3 months or neurological deficits. Options a and b are sometimes
true but are not considered definitive management plans.
5. Meniscal Tear
Question:
A 16-year-old male injured his knee during football, heard a pop, and now cannot fully
extend the knee. What is the most appropriate test to assess for a meniscal tear?
a. Lachman test
b. McMurray circumduction test
,c. Anterior drawer test
d. Varus stress test
Correct Answer: b.
Rationale:
The McMurray test is used to detect meniscal tears. A positive result reproduces the
patient's symptoms with a palpable or audible click.
6. Patellar Instability
Question:
Testing for patellar instability involves lateral displacement of the patella and knee
flexion to 30 degrees. Pain or apprehension indicates:
a. Lachman test
b. McMurray sign
c. Apley’s test
d. Apprehension sign
Correct Answer: d.
Rationale:
The Apprehension sign detects patellar instability. The patient shows discomfort or fear
of dislocation when the patella is moved laterally.
7. Ankle Injury X-ray Indications
Question:
Which of the following findings would indicate the need for an ankle x-ray following
trauma?
a. Inability to bear weight after the injury
b. Marked swelling and discoloration
c. Crepitus on palpation
d. All of the above
Correct Answer: d.
Rationale:
According to the Ottawa ankle rules, inability to bear weight, swelling, discoloration,
and crepitus are all red flags indicating possible fracture and the need for imaging.
, 8. Osteoarthritis & Complementary Therapies
Question:
A 65-year-old patient with osteoarthritis prefers complementary therapies. What is the
best clinician response?
a. Only use complementary therapies after surgery fails.
b. Complementary therapies are not recommended.
c. Complementary therapies like acupuncture, acupressure, and tai-chi can be
effective when combined with medical therapy.
d. Avoid complementary therapies because they are unproven and risky.
Correct Answer: c.
Rationale:
Complementary therapies, especially when used alongside conventional treatments,
have shown benefit in managing osteoarthritis pain and improving function.
Normal estrogen function is important for preventing osteoporosis in both men and
women. Estrogen works to prevent osteoporosis in which of the following ways?
a. By decreasing the erosive activity of osteoclasts
b. By promoting osteoclastogenesis
c. By inhibiting osteoclast apoptosis
d. All of the above - - correct ans- -a. By decreasing the erosive activity of osteoclasts
Which of the following tests is considered the gold standard for definitively diagnosing
osteoporosis?
a. Bone alkaline phosphatase levels
b. Urinary N-telopeptide assay
c. Bone mass density measurement by densitometry
d. Magnetic resonance imaging - - correct ans- -c. Bone mass density measurement by
densitometry
