Rosh LTC MSK UPDATED ACTUAL Questions and CORRECT Answers
1. A 73-year-old woman with a past medical history of os- Spinal kyphosis
teoporosis, degenerative disc disease, and knee pain
presents with a chief complaint of worsening dyspnea
and recent falls. Upon physical examination you notice
an excessive curve of her thoracic spine along with for-
ward-head posture. What is the most likely diagnosis?
2. A 65-year-old woman presents to your office to follow Alendronate
up on her recent osteoporosis screening. Her dual-en-
ergy X-ray absorptiometry scan results reveal a diag-
nosis of osteoporosis. Which of the following is the
most appropriate therapy?
3. A 67-year-old woman has a bone mineral density Osteoporosis
T-score of -2.8 standard deviations. Which of the fol-
lowing is the most likely diagnosis?
4. Which of the following biomarkers is the most specific Anti-cyclic citrullinated
for rheumatoid arthritis? peptide antibodies
5. In which setting is allopurinol contraindicated for the Acute attack of gout
treatment of gout?
6. A 63-year-old man with hypertension and dyslipidemia Ibuprofen
presents with pain and swelling of his left great toe. He
denies trauma or fever. Examination reveals an exquis-
itely tender and swollen first metatarsophalangeal
joint on his left foot. Arthrocentesis yields fluid, as
shown above. What is the first-line therapy for this
patient?
7. Which of the following causes secondary osteoporosis Corticosteroid use
in women?
, 8. A 73-year-old woman with a past medical history of hy- Furosemide
pertension, hyperlipidemia, coronary artery disease,
and chronic systolic heart failure presents to the clin-
ic complaining of acute onset of pain in her first
metatarsophalangeal joint. She denies recent trauma.
Her medications include metoprolol succinate, ator-
vastatin, aspirin, lisinopril, furosemide and potassium.
Which of the following medications is most likely con-
tributing to her acute joint pain?
9. A 57-year-old man presents to the emergency room Prednisone
after awakening with severe pain in his left big toe.
He ate at steakhouse and had several bottles of beer
the night before. He has a past medical history of
chronic kidney disease. His latest creatinine clearance
was 25 mL/min. Joint aspiration reveals negatively bire-
fringent crystals. Which of the following is the most
appropriate treatment?
10. A 42-year-old man presents with foot complaints. Last Podagra
night, he was awakened with severe pain in his right
great toe. He denies a history of recent injury. Exami-
nation reveals significant edema and erythema of the
first metatarsophalangeal joint. The overlying skin is
intact but warm. Range of motion, both passive and
active, are limited. Which of the following is the most
likely diagnosis?
11. Which finding on synovial fluid analysis is most consis- Positively birefringent cal-
tent with the diagnosis of pseudogout? cium pyrophosphate dihy-
drate crystals
1. A 73-year-old woman with a past medical history of os- Spinal kyphosis
teoporosis, degenerative disc disease, and knee pain
presents with a chief complaint of worsening dyspnea
and recent falls. Upon physical examination you notice
an excessive curve of her thoracic spine along with for-
ward-head posture. What is the most likely diagnosis?
2. A 65-year-old woman presents to your office to follow Alendronate
up on her recent osteoporosis screening. Her dual-en-
ergy X-ray absorptiometry scan results reveal a diag-
nosis of osteoporosis. Which of the following is the
most appropriate therapy?
3. A 67-year-old woman has a bone mineral density Osteoporosis
T-score of -2.8 standard deviations. Which of the fol-
lowing is the most likely diagnosis?
4. Which of the following biomarkers is the most specific Anti-cyclic citrullinated
for rheumatoid arthritis? peptide antibodies
5. In which setting is allopurinol contraindicated for the Acute attack of gout
treatment of gout?
6. A 63-year-old man with hypertension and dyslipidemia Ibuprofen
presents with pain and swelling of his left great toe. He
denies trauma or fever. Examination reveals an exquis-
itely tender and swollen first metatarsophalangeal
joint on his left foot. Arthrocentesis yields fluid, as
shown above. What is the first-line therapy for this
patient?
7. Which of the following causes secondary osteoporosis Corticosteroid use
in women?
, 8. A 73-year-old woman with a past medical history of hy- Furosemide
pertension, hyperlipidemia, coronary artery disease,
and chronic systolic heart failure presents to the clin-
ic complaining of acute onset of pain in her first
metatarsophalangeal joint. She denies recent trauma.
Her medications include metoprolol succinate, ator-
vastatin, aspirin, lisinopril, furosemide and potassium.
Which of the following medications is most likely con-
tributing to her acute joint pain?
9. A 57-year-old man presents to the emergency room Prednisone
after awakening with severe pain in his left big toe.
He ate at steakhouse and had several bottles of beer
the night before. He has a past medical history of
chronic kidney disease. His latest creatinine clearance
was 25 mL/min. Joint aspiration reveals negatively bire-
fringent crystals. Which of the following is the most
appropriate treatment?
10. A 42-year-old man presents with foot complaints. Last Podagra
night, he was awakened with severe pain in his right
great toe. He denies a history of recent injury. Exami-
nation reveals significant edema and erythema of the
first metatarsophalangeal joint. The overlying skin is
intact but warm. Range of motion, both passive and
active, are limited. Which of the following is the most
likely diagnosis?
11. Which finding on synovial fluid analysis is most consis- Positively birefringent cal-
tent with the diagnosis of pseudogout? cium pyrophosphate dihy-
drate crystals
