Muscoskeletal
Final Test Review
(Questions & Solutions)
2025
1
,CHEST/RIB DISORDERS
1. A 35-year-old motorcyclist presents after frontal chest trauma. He has
paradoxical, inward motion of three adjacent ribs during inspiration and
shallow respirations.
A) Flail chest
B) Costochondritis
C) Pneumothorax
D) Rib contusion
Correct ANS: A
Rationale: Multiple adjacent rib fractures create a free segment that
moves paradoxically (flail chest) and impairs ventilation.
2. A 60-year-old with severe osteoporosis falls and complains of mid-back
pain; X-ray shows anterior wedging of T8 and T9 vertebral bodies.
A) Compression fracture
B) Sternal fracture
C) Rib stress fracture
D) Spinous process avulsion
Correct ANS: A
Rationale: Osteoporotic vertebral bodies collapse anteriorly under axial
load, causing wedge compression fractures.
3. A 28-year-old firefighter develops painful swelling over the costal
margin intensified by deep breathing and chest wall tenderness but
normal chest X-ray.
A) Costochondritis
B) Rib stress fracture
C) Pneumonia
D) Pneumothorax
Correct ANS: A
Rationale: Costochondritis presents with reproducible chest wall pain at
costosternal junctions and a normal imaging study.
2
, 4. A 17-year-old gymnast presents with mid-shaft fifth rib tenderness
after repetitive trunk flexion. The best diagnostic study is:
A) Bone scan
B) Chest X-ray
C) MRI of spine
D) CT angiogram
Correct ANS: A
Rationale: Early rib stress fractures may not appear on X-ray; bone scan is
more sensitive for stress injuries.
COMPARTMENT SYNDROME
5. A cyclist falls and sustains a tibial fracture. Two hours later he develops
severe pain out of proportion to exam, pulselessness, paresthesia, and
tense swelling. Next step?
A) Fasciotomy
B) Elevation and ice
C) IV opioids only
D) Splint in traction
Correct ANS: A
Rationale: Acute compartment syndrome with 5 Ps (pain, pallor,
paresthesia, pulselessness, paralysis) mandates emergent fasciotomy to
prevent permanent damage.
6. A patient in a cast for a forearm fracture reports increasing pain
unrelieved by analgesics, tense swelling, and numbness in the hand.
Most appropriate action?
A) Bivalve the cast
B) Continue observation
C) Warm soaks
D) Increase cast padding
Correct ANS: A
Rationale: Early cast bivalving relieves pressure and prevents progression
to compartment syndrome.
7. A severe crush injury patient has intracompartmental pressure
3
Final Test Review
(Questions & Solutions)
2025
1
,CHEST/RIB DISORDERS
1. A 35-year-old motorcyclist presents after frontal chest trauma. He has
paradoxical, inward motion of three adjacent ribs during inspiration and
shallow respirations.
A) Flail chest
B) Costochondritis
C) Pneumothorax
D) Rib contusion
Correct ANS: A
Rationale: Multiple adjacent rib fractures create a free segment that
moves paradoxically (flail chest) and impairs ventilation.
2. A 60-year-old with severe osteoporosis falls and complains of mid-back
pain; X-ray shows anterior wedging of T8 and T9 vertebral bodies.
A) Compression fracture
B) Sternal fracture
C) Rib stress fracture
D) Spinous process avulsion
Correct ANS: A
Rationale: Osteoporotic vertebral bodies collapse anteriorly under axial
load, causing wedge compression fractures.
3. A 28-year-old firefighter develops painful swelling over the costal
margin intensified by deep breathing and chest wall tenderness but
normal chest X-ray.
A) Costochondritis
B) Rib stress fracture
C) Pneumonia
D) Pneumothorax
Correct ANS: A
Rationale: Costochondritis presents with reproducible chest wall pain at
costosternal junctions and a normal imaging study.
2
, 4. A 17-year-old gymnast presents with mid-shaft fifth rib tenderness
after repetitive trunk flexion. The best diagnostic study is:
A) Bone scan
B) Chest X-ray
C) MRI of spine
D) CT angiogram
Correct ANS: A
Rationale: Early rib stress fractures may not appear on X-ray; bone scan is
more sensitive for stress injuries.
COMPARTMENT SYNDROME
5. A cyclist falls and sustains a tibial fracture. Two hours later he develops
severe pain out of proportion to exam, pulselessness, paresthesia, and
tense swelling. Next step?
A) Fasciotomy
B) Elevation and ice
C) IV opioids only
D) Splint in traction
Correct ANS: A
Rationale: Acute compartment syndrome with 5 Ps (pain, pallor,
paresthesia, pulselessness, paralysis) mandates emergent fasciotomy to
prevent permanent damage.
6. A patient in a cast for a forearm fracture reports increasing pain
unrelieved by analgesics, tense swelling, and numbness in the hand.
Most appropriate action?
A) Bivalve the cast
B) Continue observation
C) Warm soaks
D) Increase cast padding
Correct ANS: A
Rationale: Early cast bivalving relieves pressure and prevents progression
to compartment syndrome.
7. A severe crush injury patient has intracompartmental pressure
3
