Advanced NP Musculoskeletal Disorders
Mastery Exam – 150 High-Yield Clinical
Questions Answers And Rationale 2025/2026
1. A 62-year-old woman presents with morning stiffness lasting longer
than 45 minutes and symmetrical swelling of the MCP joints. Which
diagnosis is most likely?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Polymyalgia rheumatica
D. Gout
Rationale: RA causes prolonged morning stiffness and symmetrical
small-joint involvement, unlike OA which has brief stiffness.
2. A patient with chronic steroid use reports new hip pain. Physical
exam shows pain with internal rotation. What condition is suspected?
A. Trochanteric bursitis
B. Hip labral tear
C. Avascular necrosis
D. Osteoarthritis
Rationale: Long-term corticosteroids are strongly associated with
avascular necrosis, especially of the femoral head.
3. Which finding is most consistent with osteoarthritis of the knee?
,A. Warm, erythematous joint
B. Symmetric joint swelling
C. Prolonged morning stiffness
D. Crepitus with movement
Rationale: OA is characterized by crepitus, bony enlargement, and
short-lived morning stiffness.
4. A positive Lachman test suggests injury to which structure?
A. PCL
B. ACL
C. Medial meniscus
D. LCL
Rationale: Lachman is the most sensitive test for ACL tear.
5. A patient presents with pain at the base of the thumb worsened by
pinching or gripping. What condition is likely?
A. Carpal tunnel syndrome
B. Lateral epicondylitis
C. Thumb carpometacarpal osteoarthritis
D. Trigger thumb
Rationale: CMC OA presents with pain at the base of thumb and
decreased grip strength.
6. A 45-year-old man has “tennis elbow.” Which maneuver
reproduces symptoms?
A. Wrist flexion against resistance
B. Wrist extension against resistance
,C. Forearm pronation
D. Elbow flexion
Rationale: Lateral epicondylitis involves wrist extensors; resisted
extension triggers pain.
7. Which lab test is most specific for rheumatoid arthritis?
A. ESR
B. CRP
C. ANA
D. Anti-CCP
Rationale: Anti-CCP antibodies have high specificity for RA.
8. A young athlete presents with knee pain and swelling after a
twisting injury. You suspect a meniscal tear. What is the best initial
diagnostic test?
A. Ultrasound
B. X-ray
C. MRI
D. CT scan
Rationale: MRI is the gold standard for soft tissue injury including
meniscus.
9. A patient reports numbness in the lateral thigh without weakness
after weight gain. Diagnosis?
A. Sciatica
B. Meralgia paresthetica
C. Femoral neuropathy
, D. Peripheral neuropathy
Rationale: Meralgia paresthetica is compression of the lateral femoral
cutaneous nerve.
10. A 34-year-old with plantar heel pain worse with first steps in the
morning most likely has:
A. Achilles tendinopathy
B. Stress fracture
C. Plantar fasciitis
D. Tarsal tunnel syndrome
Rationale: Classic symptom of plantar fasciitis is morning first-step
pain.
11. Which medication is first-line for gout flare?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. NSAIDs
Rationale: NSAIDs are first-line acute therapy; allopurinol is not used
during flare initiation.
12. A 16-year-old with anterior knee pain and tibial tubercle swelling
most likely has:
A. Patellofemoral pain syndrome
B. Osgood–Schlatter disease
C. Baker’s cyst
D. Meniscal tear
Mastery Exam – 150 High-Yield Clinical
Questions Answers And Rationale 2025/2026
1. A 62-year-old woman presents with morning stiffness lasting longer
than 45 minutes and symmetrical swelling of the MCP joints. Which
diagnosis is most likely?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Polymyalgia rheumatica
D. Gout
Rationale: RA causes prolonged morning stiffness and symmetrical
small-joint involvement, unlike OA which has brief stiffness.
2. A patient with chronic steroid use reports new hip pain. Physical
exam shows pain with internal rotation. What condition is suspected?
A. Trochanteric bursitis
B. Hip labral tear
C. Avascular necrosis
D. Osteoarthritis
Rationale: Long-term corticosteroids are strongly associated with
avascular necrosis, especially of the femoral head.
3. Which finding is most consistent with osteoarthritis of the knee?
,A. Warm, erythematous joint
B. Symmetric joint swelling
C. Prolonged morning stiffness
D. Crepitus with movement
Rationale: OA is characterized by crepitus, bony enlargement, and
short-lived morning stiffness.
4. A positive Lachman test suggests injury to which structure?
A. PCL
B. ACL
C. Medial meniscus
D. LCL
Rationale: Lachman is the most sensitive test for ACL tear.
5. A patient presents with pain at the base of the thumb worsened by
pinching or gripping. What condition is likely?
A. Carpal tunnel syndrome
B. Lateral epicondylitis
C. Thumb carpometacarpal osteoarthritis
D. Trigger thumb
Rationale: CMC OA presents with pain at the base of thumb and
decreased grip strength.
6. A 45-year-old man has “tennis elbow.” Which maneuver
reproduces symptoms?
A. Wrist flexion against resistance
B. Wrist extension against resistance
,C. Forearm pronation
D. Elbow flexion
Rationale: Lateral epicondylitis involves wrist extensors; resisted
extension triggers pain.
7. Which lab test is most specific for rheumatoid arthritis?
A. ESR
B. CRP
C. ANA
D. Anti-CCP
Rationale: Anti-CCP antibodies have high specificity for RA.
8. A young athlete presents with knee pain and swelling after a
twisting injury. You suspect a meniscal tear. What is the best initial
diagnostic test?
A. Ultrasound
B. X-ray
C. MRI
D. CT scan
Rationale: MRI is the gold standard for soft tissue injury including
meniscus.
9. A patient reports numbness in the lateral thigh without weakness
after weight gain. Diagnosis?
A. Sciatica
B. Meralgia paresthetica
C. Femoral neuropathy
, D. Peripheral neuropathy
Rationale: Meralgia paresthetica is compression of the lateral femoral
cutaneous nerve.
10. A 34-year-old with plantar heel pain worse with first steps in the
morning most likely has:
A. Achilles tendinopathy
B. Stress fracture
C. Plantar fasciitis
D. Tarsal tunnel syndrome
Rationale: Classic symptom of plantar fasciitis is morning first-step
pain.
11. Which medication is first-line for gout flare?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. NSAIDs
Rationale: NSAIDs are first-line acute therapy; allopurinol is not used
during flare initiation.
12. A 16-year-old with anterior knee pain and tibial tubercle swelling
most likely has:
A. Patellofemoral pain syndrome
B. Osgood–Schlatter disease
C. Baker’s cyst
D. Meniscal tear
