Musculoskeletal PANCE Questions with
correct answers
Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?
A Supraspinatus
B Infraspinatus
C Teres minor
D Subscapularis correct answer A
Abduction against resistance tests the supraspinatus
A 22 year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following knee maneuvers does this represent?
A Abduction stress test
B Anterior drawer sign
C Lachman test
D McMurray test correct answer C
The Lachman test is performed to evaluate the anterior cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of the hip.
A 12 year-old female presents for a routine sports physical. The physical exam reveals asymmetry of the posterior chest wall on forward bending. This is the most striking and consistent abnormality of which of the following?
A Spondylolysis
B Spondolisthesis
C Scoliosis D Herniated disc correct answer C
Asymmetry of the posterior chest wall on forward bending is the most striking and consistent abnormality in patients with idiopathic scoliosis.
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following?
A Ehlers-Danlos syndrome
B Marfan syndrome
C Achondroplasia
D Osteogenesis imperfecta correct answer D
Mild osteogenesis imperfecta presents with blue sclerae, history of recurrent fractures and presenile deafness.
A 65 year-old female presents to the office with a six-month history of back pain. The patient states that she is shrinking and thinks she is about an inch shorter than she was a year ago. Serum
parathyroid hormone, calcium, phosphorus, and alkaline phosphatase are all normal. Which of the following would you most likely see on the x-ray of her spine?
A Radiolucent lesions
B Demineralization
C Chondrocalcinosis
D Subperiosteal resorption correct answer B
Osteoporosis presents with varying degrees of back pain and loss of height is common. The serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase are normal. X- ray findings demonstrate demineralization in the spine and pelvis.
In a trauma patient who has a suspected cervical spine injury, the x-ray view that will identify the
majority of significant injuries is
A lateral. B oblique
C anteroposterior
D odontoid correct answer A
The lateral view shows 70-80% of significant injuries. It is important to visualize all seven cervical vertebrae and the upper margin of T1 to avoid missing possible pathology.The oblique view is usually not included in the initial set of x-rays taken. Bilateral supine oblique is a view that may be ordered if all seven cervical vertebrae are not seen on the lateral view.
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken
to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done?
A X-ray of the lower leg and ankle.
B Doppler studies.
C Bone scan.
D Compartment pressure correct answer D
Compartmental pressures should be obtained as soon as possible. If they are elevated this is a surgical emergency.
A 32-year-old male presents with an acute onset of pain and swelling in his left ankle. On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis?
A Gout
B Pseudogout
C Acute rheumatic fever
D Septic arthritis correct answer D Leukocytosis and a low synovial glucose are indicative of septic arthritis.
A 32-year-old male presents with migratory arthralgias and profound malaise and fatigue. He states that one week ago he returned from a hunting trip in Pennsylvania. He is also complaining of a lesion on his left thigh that he noticed about 3 days ago. Physical exam reveals a large annular lesion with a bright red outer border and partial central clearing. Which of the following is the most likely diagnosis?
A Rheumatoid arthritis
B Kawasaki disease
C Lyme disease
D Nongonococcal arthritis correct answer C
After an incubation period of 3 to 32 days, erythema migrans develops at the site of the tick bite. Within days or weeks after the onset of erythema migrans the patients develop a severe headache, mild stiffness of the neck, migratory musculoskeletal pain, arthralgias and profound malaise and fatigue.
A 22 year-old male presents with pain along the medial tibia. The pain initially began towards the end of soccer practice but now it is present earlier on. Physical exam reveals pain to palpation
over the posterior tibialis muscle body. What is the most likely diagnosis?
A Shin splint
B Stress fracture
C Osgood-Schlatter disease
D Patellofemoral pain syndrome correct answer A
Shin splints cause pain over the posterior tibialis muscle body as opposed to discrete pain over the tibia with a stress fracture.
A patient who demonstrates pain on the radial aspect of the wrist with abrupt ulnar movements while the thumb is flexed into the closed palm most likely has
A carpal tunnel syndrome.
correct answers
Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?
A Supraspinatus
B Infraspinatus
C Teres minor
D Subscapularis correct answer A
Abduction against resistance tests the supraspinatus
A 22 year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following knee maneuvers does this represent?
A Abduction stress test
B Anterior drawer sign
C Lachman test
D McMurray test correct answer C
The Lachman test is performed to evaluate the anterior cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of the hip.
A 12 year-old female presents for a routine sports physical. The physical exam reveals asymmetry of the posterior chest wall on forward bending. This is the most striking and consistent abnormality of which of the following?
A Spondylolysis
B Spondolisthesis
C Scoliosis D Herniated disc correct answer C
Asymmetry of the posterior chest wall on forward bending is the most striking and consistent abnormality in patients with idiopathic scoliosis.
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following?
A Ehlers-Danlos syndrome
B Marfan syndrome
C Achondroplasia
D Osteogenesis imperfecta correct answer D
Mild osteogenesis imperfecta presents with blue sclerae, history of recurrent fractures and presenile deafness.
A 65 year-old female presents to the office with a six-month history of back pain. The patient states that she is shrinking and thinks she is about an inch shorter than she was a year ago. Serum
parathyroid hormone, calcium, phosphorus, and alkaline phosphatase are all normal. Which of the following would you most likely see on the x-ray of her spine?
A Radiolucent lesions
B Demineralization
C Chondrocalcinosis
D Subperiosteal resorption correct answer B
Osteoporosis presents with varying degrees of back pain and loss of height is common. The serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase are normal. X- ray findings demonstrate demineralization in the spine and pelvis.
In a trauma patient who has a suspected cervical spine injury, the x-ray view that will identify the
majority of significant injuries is
A lateral. B oblique
C anteroposterior
D odontoid correct answer A
The lateral view shows 70-80% of significant injuries. It is important to visualize all seven cervical vertebrae and the upper margin of T1 to avoid missing possible pathology.The oblique view is usually not included in the initial set of x-rays taken. Bilateral supine oblique is a view that may be ordered if all seven cervical vertebrae are not seen on the lateral view.
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken
to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done?
A X-ray of the lower leg and ankle.
B Doppler studies.
C Bone scan.
D Compartment pressure correct answer D
Compartmental pressures should be obtained as soon as possible. If they are elevated this is a surgical emergency.
A 32-year-old male presents with an acute onset of pain and swelling in his left ankle. On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis?
A Gout
B Pseudogout
C Acute rheumatic fever
D Septic arthritis correct answer D Leukocytosis and a low synovial glucose are indicative of septic arthritis.
A 32-year-old male presents with migratory arthralgias and profound malaise and fatigue. He states that one week ago he returned from a hunting trip in Pennsylvania. He is also complaining of a lesion on his left thigh that he noticed about 3 days ago. Physical exam reveals a large annular lesion with a bright red outer border and partial central clearing. Which of the following is the most likely diagnosis?
A Rheumatoid arthritis
B Kawasaki disease
C Lyme disease
D Nongonococcal arthritis correct answer C
After an incubation period of 3 to 32 days, erythema migrans develops at the site of the tick bite. Within days or weeks after the onset of erythema migrans the patients develop a severe headache, mild stiffness of the neck, migratory musculoskeletal pain, arthralgias and profound malaise and fatigue.
A 22 year-old male presents with pain along the medial tibia. The pain initially began towards the end of soccer practice but now it is present earlier on. Physical exam reveals pain to palpation
over the posterior tibialis muscle body. What is the most likely diagnosis?
A Shin splint
B Stress fracture
C Osgood-Schlatter disease
D Patellofemoral pain syndrome correct answer A
Shin splints cause pain over the posterior tibialis muscle body as opposed to discrete pain over the tibia with a stress fracture.
A patient who demonstrates pain on the radial aspect of the wrist with abrupt ulnar movements while the thumb is flexed into the closed palm most likely has
A carpal tunnel syndrome.
