NR 509 Musculoskeletal Documentation – Shadow Health
Practice Exam Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Time Limit: 60 minutes (inferred for this documentation exercise)
Mr. James Carter is a 58-year-old male (he/him) who presents to the outpatient clinic
with a chief complaint of right knee pain and swelling. He reports that three weeks ago,
he twisted his right knee while stepping off a curb. He felt a "pop" sensation followed by
immediate pain along the medial aspect of his right knee. The pain is described as
aching at rest and sharp with movement, localized to the medial joint line. He rates the
pain as 6/10 at its worst and 3/10 at rest. The pain is aggravated by weight bearing,
climbing stairs, squatting, and twisting motions. It is partially relieved by rest, ice, and
ibuprofen 400mg. He notes intermittent swelling that worsens by late afternoon and
reports two episodes of the knee "catching" when rising from a chair. Morning stiffness
lasts approximately 15 minutes and resolves with gentle movement. He denies fevers,
chills, or additional trauma beyond the twisting injury.
Past medical history is significant for hypertension, type 2 diabetes mellitus
(well-controlled), and a left ACL reconstruction 15 years ago following a skiing injury. He
has no history of gout, rheumatoid arthritis, or osteoporosis. Current medications
include metformin 1000mg twice daily, lisinopril 10mg daily, and ibuprofen 400mg every
6 hours as needed for knee pain. He reports no known drug allergies.
Review of systems: Musculoskeletal—positive for right knee pain, swelling, stiffness,
and catching sensation; negative for left knee pain, hip pain, ankle pain, or low back
, pain. He denies joint warmth, redness, or similar symptoms in other joints.
General—denies fatigue, weight loss, or fever. Neurological—denies numbness, tingling,
or weakness in the lower extremities.
Instructions: Document the following components based on the case above. Write your
answers on a separate sheet, then compare to the model answers below.
1. Write the history of present illness in paragraph form, using the patient's own
words when possible and incorporating all seven attributes of symptom analysis
(OLDCARTS).
Correct Answer:
Mr. Carter is a 58-year-old male presenting with a three-week history of right knee pain
following a twisting injury sustained while stepping off a curb. He describes feeling a
"pop" at the time of injury, followed by medial joint line pain that is aching at rest and
sharp with movement. The pain is aggravated by weight bearing, stair climbing,
squatting, and twisting, and partially relieved by rest, ice, and ibuprofen. He reports
intermittent swelling that worsens in the late afternoon, two episodes of the knee
"catching" when rising from a chair, and morning stiffness lasting approximately 15
minutes. He rates the pain as 6/10 at worst and 3/10 at rest. He denies fevers, chills, or
additional trauma.
Rationale:
A comprehensive HPI must include all seven attributes of symptom analysis—onset,
location, duration, characteristics, aggravating and relieving factors, timing, and
severity—to provide a complete clinical picture that guides differential diagnosis.
2. Document the focused musculoskeletal review of systems, including all pertinent
positives and negatives.
Correct Answer:
Musculoskeletal ROS: Positive for right knee pain, swelling, stiffness, and mechanical
catching sensation. Negative for left knee pain, hip pain, ankle pain, low back pain, joint
Practice Exam Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Time Limit: 60 minutes (inferred for this documentation exercise)
Mr. James Carter is a 58-year-old male (he/him) who presents to the outpatient clinic
with a chief complaint of right knee pain and swelling. He reports that three weeks ago,
he twisted his right knee while stepping off a curb. He felt a "pop" sensation followed by
immediate pain along the medial aspect of his right knee. The pain is described as
aching at rest and sharp with movement, localized to the medial joint line. He rates the
pain as 6/10 at its worst and 3/10 at rest. The pain is aggravated by weight bearing,
climbing stairs, squatting, and twisting motions. It is partially relieved by rest, ice, and
ibuprofen 400mg. He notes intermittent swelling that worsens by late afternoon and
reports two episodes of the knee "catching" when rising from a chair. Morning stiffness
lasts approximately 15 minutes and resolves with gentle movement. He denies fevers,
chills, or additional trauma beyond the twisting injury.
Past medical history is significant for hypertension, type 2 diabetes mellitus
(well-controlled), and a left ACL reconstruction 15 years ago following a skiing injury. He
has no history of gout, rheumatoid arthritis, or osteoporosis. Current medications
include metformin 1000mg twice daily, lisinopril 10mg daily, and ibuprofen 400mg every
6 hours as needed for knee pain. He reports no known drug allergies.
Review of systems: Musculoskeletal—positive for right knee pain, swelling, stiffness,
and catching sensation; negative for left knee pain, hip pain, ankle pain, or low back
, pain. He denies joint warmth, redness, or similar symptoms in other joints.
General—denies fatigue, weight loss, or fever. Neurological—denies numbness, tingling,
or weakness in the lower extremities.
Instructions: Document the following components based on the case above. Write your
answers on a separate sheet, then compare to the model answers below.
1. Write the history of present illness in paragraph form, using the patient's own
words when possible and incorporating all seven attributes of symptom analysis
(OLDCARTS).
Correct Answer:
Mr. Carter is a 58-year-old male presenting with a three-week history of right knee pain
following a twisting injury sustained while stepping off a curb. He describes feeling a
"pop" at the time of injury, followed by medial joint line pain that is aching at rest and
sharp with movement. The pain is aggravated by weight bearing, stair climbing,
squatting, and twisting, and partially relieved by rest, ice, and ibuprofen. He reports
intermittent swelling that worsens in the late afternoon, two episodes of the knee
"catching" when rising from a chair, and morning stiffness lasting approximately 15
minutes. He rates the pain as 6/10 at worst and 3/10 at rest. He denies fevers, chills, or
additional trauma.
Rationale:
A comprehensive HPI must include all seven attributes of symptom analysis—onset,
location, duration, characteristics, aggravating and relieving factors, timing, and
severity—to provide a complete clinical picture that guides differential diagnosis.
2. Document the focused musculoskeletal review of systems, including all pertinent
positives and negatives.
Correct Answer:
Musculoskeletal ROS: Positive for right knee pain, swelling, stiffness, and mechanical
catching sensation. Negative for left knee pain, hip pain, ankle pain, low back pain, joint
