Pance Musculoskeletal Exam
Final Test Review
(Questions & Solutions)
2025
1
, 1. Degenerative & Crystal Arthritides (6 questions)
Q1
A 67-year-old woman with longstanding knee OA has failed maximal
NSAIDs, weight loss, and two ultrasound-guided corticosteroid injections
in the past year. Radiographs show Kellgren–Lawrence grade IV changes
with 10° varus deformity. Which intervention offers the greatest
likelihood of durable pain relief and functional restoration?
A. Viscosupplementation series
B. High-tibial valgus osteotomy
C. Medial unicompartmental knee arthroplasty
D. Total knee arthroplasty
ANS: D
Rationale: End-stage tricompartmental OA (grade IV) and
malalignment are best treated by total joint replacement; osteotomy or
partial arthroplasty are suited to isolated unicompartment disease,
viscosupplementation provides only short-term symptom benefit.
---
Q2
A 55-year-old man on hydrochlorothiazide presents with first-MTP
erythema and exquisite pain. Serum urate is 7.4 mg/dL; synovial analysis
shows negatively birefringent needle-shaped crystals. He has stage 3 CKD
(eGFR 48 mL/min). Which oral agent is preferred for long-term urate
lowering?
A. Allopurinol 100 mg daily, titrated to urate < 6 mg/dL
B. Febuxostat 80 mg daily
C. Probenecid 1 g twice daily
D. Colchicine 0.6 mg once daily
ANS: A
2
, Rationale: Xanthine-oxidase inhibition remains first-line in CKD;
allopurinol is safe if dose-escalated slowly. Febuxostat is second-line
given CV concerns; probenecid is contraindicated when CrCl < 50;
colchicine is prophylactic, not urate-lowering.
---
Q3
CPPD arthropathy of the knee demonstrates which characteristic
radiographic finding?
A. Central erosions with overhanging edges
B. Uniform joint-space narrowing sparing the patellofemoral
compartment
C. Chondrocalcinosis of the menisci and articular cartilage
D. Osteophyte formation primarily on the tibial spines
ANS: C
Rationale: CPP crystal deposition produces linear calcification within
hyaline and fibrocartilage—classically seen in menisci or articular
surfaces.
---
Q4
A 60-year-old golfer has glenohumeral OA with intact rotator cuff but <
30° external rotation despite PT. Best surgical option to restore motion
and relieve pain?
A. Arthroscopic debridement with capsular release
B. Hemiarthroplasty
C. Stemless anatomic total shoulder arthroplasty
D. Reverse total shoulder arthroplasty
ANS: C
Rationale: In primary OA with preserved cuff, an anatomic TSA
(including stemless designs) provides superior pain relief and motion vs
3
, hemiarthroplasty; reverse designs are reserved for cuff-deficient arthritis.
---
Q5
Pseudogout is precipitated by which metabolic abnormality most often?
A. Hyperparathyroidism
B. Hypothyroidism
C. Hemochromatosis
D. Hypomagnesemia
ANS: A
Rationale: Hyperparathyroidism, hemochromatosis, hypomagnesemia,
and hypophosphatasia are linked, but primary hyper-PTH is the most
common metabolic association.
---
Q6
A 72-year-old with tricompartmental OA remains symptomatic after
NSAIDs but refuses surgery. Which intra-articular option offers the
longest median duration of relief per meta-analysis?
A. Triamcinolone acetonide
B. High-molecular-weight hyaluronic acid
C. PRP injection
D. Sarilumab (IL-6 inhibitor) investigational use
ANS: C
Rationale: Platelet-rich plasma provides 6–12 months median pain
relief, surpassing steroid (4–6 weeks) and HA (3–6 months); IL-6
inhibitors are not approved.
---
2. Traumatic Fractures & Dislocations (6 questions)
4
Final Test Review
(Questions & Solutions)
2025
1
, 1. Degenerative & Crystal Arthritides (6 questions)
Q1
A 67-year-old woman with longstanding knee OA has failed maximal
NSAIDs, weight loss, and two ultrasound-guided corticosteroid injections
in the past year. Radiographs show Kellgren–Lawrence grade IV changes
with 10° varus deformity. Which intervention offers the greatest
likelihood of durable pain relief and functional restoration?
A. Viscosupplementation series
B. High-tibial valgus osteotomy
C. Medial unicompartmental knee arthroplasty
D. Total knee arthroplasty
ANS: D
Rationale: End-stage tricompartmental OA (grade IV) and
malalignment are best treated by total joint replacement; osteotomy or
partial arthroplasty are suited to isolated unicompartment disease,
viscosupplementation provides only short-term symptom benefit.
---
Q2
A 55-year-old man on hydrochlorothiazide presents with first-MTP
erythema and exquisite pain. Serum urate is 7.4 mg/dL; synovial analysis
shows negatively birefringent needle-shaped crystals. He has stage 3 CKD
(eGFR 48 mL/min). Which oral agent is preferred for long-term urate
lowering?
A. Allopurinol 100 mg daily, titrated to urate < 6 mg/dL
B. Febuxostat 80 mg daily
C. Probenecid 1 g twice daily
D. Colchicine 0.6 mg once daily
ANS: A
2
, Rationale: Xanthine-oxidase inhibition remains first-line in CKD;
allopurinol is safe if dose-escalated slowly. Febuxostat is second-line
given CV concerns; probenecid is contraindicated when CrCl < 50;
colchicine is prophylactic, not urate-lowering.
---
Q3
CPPD arthropathy of the knee demonstrates which characteristic
radiographic finding?
A. Central erosions with overhanging edges
B. Uniform joint-space narrowing sparing the patellofemoral
compartment
C. Chondrocalcinosis of the menisci and articular cartilage
D. Osteophyte formation primarily on the tibial spines
ANS: C
Rationale: CPP crystal deposition produces linear calcification within
hyaline and fibrocartilage—classically seen in menisci or articular
surfaces.
---
Q4
A 60-year-old golfer has glenohumeral OA with intact rotator cuff but <
30° external rotation despite PT. Best surgical option to restore motion
and relieve pain?
A. Arthroscopic debridement with capsular release
B. Hemiarthroplasty
C. Stemless anatomic total shoulder arthroplasty
D. Reverse total shoulder arthroplasty
ANS: C
Rationale: In primary OA with preserved cuff, an anatomic TSA
(including stemless designs) provides superior pain relief and motion vs
3
, hemiarthroplasty; reverse designs are reserved for cuff-deficient arthritis.
---
Q5
Pseudogout is precipitated by which metabolic abnormality most often?
A. Hyperparathyroidism
B. Hypothyroidism
C. Hemochromatosis
D. Hypomagnesemia
ANS: A
Rationale: Hyperparathyroidism, hemochromatosis, hypomagnesemia,
and hypophosphatasia are linked, but primary hyper-PTH is the most
common metabolic association.
---
Q6
A 72-year-old with tricompartmental OA remains symptomatic after
NSAIDs but refuses surgery. Which intra-articular option offers the
longest median duration of relief per meta-analysis?
A. Triamcinolone acetonide
B. High-molecular-weight hyaluronic acid
C. PRP injection
D. Sarilumab (IL-6 inhibitor) investigational use
ANS: C
Rationale: Platelet-rich plasma provides 6–12 months median pain
relief, surpassing steroid (4–6 weeks) and HA (3–6 months); IL-6
inhibitors are not approved.
---
2. Traumatic Fractures & Dislocations (6 questions)
4
