In this article, I would like to talk about what you need to know to understand musculoskeletal disorders.
How much do you know about musculoskeletal disorders?
As a certified judo therapist, musculoskeletal disorders are one of the main areas of my practice, but there are still many things I don't know about, so I have a lot to learn.
The research I am going to introduce in this article is about a tool that asks medical students how much they understand about musculoskeletal disorders. This study is about a questionnaire tool that asks medical students how well they understand musculoskeletal disorders.
I will describe the actual problem, so please try to solve it.
Problem
1) A 41-year-old woman complains of pain and swelling in her left elbow. She reports that she sustained a puncture wound to her elbow a few days ago, but denies any major trauma. On examination, her elbow is erythematous, very tender to palpation, and shows a deep puncture wound on the lateral aspect of the elbow. Active and passive range of motion is severely limited by pain, a temperature of 38°C, and other vital signs worth noting, but what is the best approach in management from the following?
A) Prescribe antibiotics.
B) Treat with colchicine and allopurinol
C) Arthrodesis
D) Relative rest, ice, and an NSAID
2) A 22-year-old male soccer player falls with his hand outstretched. He came to the clinic the next day complaining of wrist pain. Clinical examination shows abnormal anatomical sniffing tobacco, but negative radiographic examination of the wrist. Of the following options, what is the best approach in management?
A) Immediate referral to an orthopedic surgeon for surgical management
B) Relative rest for pain and administration of an NSAID
C) Short arm thumb spica cast and 2 week follow up
D) Long arm cast for 6 to 8 weeks
3) A 17-year-old rugby player clipped his ring finger on an opponent's shorts and felt immediate pain. On examination, there is swelling in the DIP ring finger; abnormal flexion of the DIP joint has occurred, what would be the appropriate post-game procedure to be performed?
A) Buddy tape the ring finger to the middle finger until the symptoms resolve.
B) Immobilize the finger with a splint for six weeks.
C) Refer to an orthopedic surgeon
D) Relative rest and reevaluation for two weeks
4) A 43-year-old man came to the clinic last week with worsening back pain. The pain is located in the lower back and is noted to be severe. On clinical examination, there is no bony tenderness but decreased sensation in the medial thighs bilaterally. Subsequently, two days of overflow incontinence are evident. What is the most appropriate next step in management?
A) NSAID and follow-up within 2 weeks
B) Physical therapy
C) Corticosteroid injection
D) Emergency MRI scan
5) A 16-year-old female long-distance runner comes to the clinic with pain in the anterior part of her left knee. She states that the pain feels like it is under her patella and is worse when she runs or walks up and down stairs. What is the most appropriate way to manage this condition?
A) Work on the underlying cause and targeted physical therapy.
B) Suggest that she get an MRI scan now.
C) Refer the patient to an orthopedic surgeon for surgical management
D) Straight knee immobilization for two weeks and gradual resumption of activity
6) An 18-year-old soccer player was injured during a game when he stepped on his foot and ankle. He is able to put weight on his foot, but has significant pain in the midfoot. Which of the following findings on history and physical examination is an indication for X-ray examination?
A) Weight bearing pain in the injured foot/ankle
B) Tenderness to palpation of the affected area
C) Tenderness in the lateral foot distal to the fibula
D) tenderness in front of the medial ankle
7) A 28-year-old woman complains of pain in her right wrist. It is painful distal to the radius, and on clinical examination, a forced ulnar deviation of the wrist with the thumb clenched in a fist reproduces the patient's pain. Which of the following is the most likely diagnosis?
A) Arthritis of the first carpometacarpal (CMC) joint
B) Distal radial joint avulsion
C) Tendon synovitis in de Quervain's disease
D) Triangular fibrocartilage complex injury
8) A 17-year-old football player is tackled, strikes his left shoulder on the ground, and feels pain. When asked where the pain is, he points to the side of his shoulder. On clinical examination, his pain is reproduced when he tries to reach across his body with the arm on the injured side. What is the most likely diagnosis?
A) Torn deltoid muscle
B) Acromioclavicular joint sprain
C) rotator cuff tear
D) Tear of the joint labrum
9) A 64-year-old man with hypertension, hyperlipidemia, and a history of prostate cancer comes to the hospital complaining of back pain that wakes him from sleep repeatedly. Physical examination shows no major features. Which of the following is the next best approach in management?
A) Physical therapy
B) NSAID administration
C) Spinal imaging
D) Follow-up after 2 weeks of rest
10) An 18-month-old infant is brought to the emergency department because of irritability, a fever of 101.5°F, and refusal to walk or weight bear. The infant refuses to move his right hip and cries with passive movements. An ultrasound of the hip joint showed edema in the joint. What is the most likely diagnosis from the following?
A) Septic hip joint
B) Transient synovitis
C) Perthes disease
D) Developmental dysplasia of the hip joint
11) A man collapsed near the finish line of a marathon and was taken to the first aid booth. On clinical examination, he is confused and presents with a burning sensation and dry skin. His core temperature is 105°F. What is the next course of action in management?
A) Transport him to the nearest emergency department that can be reached in 30 minutes.
B) Immediate cooling by the best available method
C) Administer intravenous fluids
D) Rehydrate with oral fluids
12) A high school football player comes to the hospital after injuring his knee during practice. Examination of the knee revealed moderate effusion. Physical examination of the knee shows pain on the other side and limitation of movement. Which of the following should be included in the top differential diagnosis?
A) ACL injury
B) Osteochondral lesion
C) Medial meniscus tear
D) All of the above
13) An athlete suffers from a concussion and remains symptomatic, with light sensitivity and mild exertional headache. He can return to play if the following signs are present
A) symptoms have improved for at least two weeks
B) imaging of the head is normal
C) You are rested for at least a week so you can return to play
D) not allow her to return to play while she has symptoms
14) A 42-year-old woman comes to the clinic complaining of right-sided anterolateral shoulder pain for 3 weeks. The pain worsened at night when she was in a prone position with the affected side down. Bending the shoulder 90 degrees forward and forcing it into internal rotation reproduced the pain. Which of the following procedures should be the first step in the management of this condition?
A) Intra-articular corticosteroid injection
B) MRI examination for a suspected rotator cuff tear
C) Arthroscopic subacromial synovial fluid compression
D) Physical therapy with modification of daily activities
15) A 31-year-old man came to the hospital because he had back pain for 2 weeks after helping a friend move. He described the pain as dull, diffuse, but without any radiating pain in his legs. Clinical examination revealed only tenderness in the lumbar erector spinae. Which of the following would be the most appropriate approach in management?
A) X-ray of the lumbar spine
B) Oxycodone
C) Epidural steroids are suggested
D) None of the above
16) An 18-year-old woman who runs cross-country comes to the clinic with deep groin pain on the right side that has worsened over the past month. She complains that the pain gets even worse with weight-bearing daily activities. Through examination, we noted that she had amenorrhea and a BMI of 19. What is the best course of action to take next?
A) Various imaging tests
B) Physical therapy
C) Prescription of an NSAID
D) Intra-articular corticosteroid injection
17) A 25-year-old man fell last night and sustained a tibial fracture that was surgically repaired. Today, he complains of increasing pain in his leg and tingling in his toes. Clinical examination shows anterior swelling of the affected area with no fever. When consulting an on-call orthopedic surgeon, which of the following should you be most concerned about?
A) Infection
B) Deep vein thrombosis
C) Revision of a fracture
D) compartment syndrome
18) A 15-year-old girl fell on her bicycle and fell off her shoulder. She complains of severe pain associated with movement of her shoulder. There is bruising and tenderness at the midpoint of the clavicle; x-rays show an undisplaced mid-shaft clavicle fracture. Which of the following is the most appropriate treatment for this patient?
A) A sling for early range of motion and comfort
B) Referral to an orthopedic surgeon for surgical repair
C) Immobilization for 4 to 6 weeks until fracture healing is confirmed
D) return to acceptable activities without restrictions
19) A 21-year-old man presents with severe back and leg pain and dark urine after an intense weightlifting workout yesterday. His initial creatine kinase (CK) level is 17,523 U/L. What are the next steps in the management of this patient?
A) Aggressive hydration
B) Muscle biopsy
C) NSAID administration
D) Follow-up with CK level remeasurement after 72 hours
20) A 45-year-old woman who recently started playing tennis comes to the clinic with bilateral pain in her Achilles tendons. Ultrasonography showed moderate Achilles tendon damage bilaterally. Which of the following would be the most appropriate initial management of this condition?
A) Referral to an orthopedic surgeon for surgical management
B) Corticosteroid injection
C) Rehabilitation with a focus on eccentric exercises
Ⅾ) multiple platelet plasma injections
21) A 10-year-old basketball player comes to the clinic and complains of gradual pain in his left heel that worsens with running and jumping. On clinical examination, he was found to have gastrocnemius to soleus muscle complex tightness and pain due to calcaneal compression. Which of the following is the most likely diagnosis?
A) Seaver's disease
B) Calcaneal fatigue fracture
C) Achilles tendon disorder
D) plantar fasciitis
22) A 59-year-old woman comes to the hospital with 2 weeks of pain and numbness in her thumb, index finger, and long finger. She said that the pain was worse at night and that shaking or flicking her wrist would relieve the pain. Examination of the hand revealed atrophy of the ball of the thumb muscle. What is the next best course of action in management?
A) Occupational therapy
B) Corticosteroid injections
C) Lifestyle changes
D) Referral to an orthopedic surgeon
23) A 68-year-old man comes to the hospital with worsening radiating pain to the right arm and neck pain consistent with cervical radiculopathy. Which of the following signs in the results of the clinical examination would result in an immediate referral to a specialist?
A) Pain worsens by forcibly stretching the neck.
B) Hyperreflexia in the lower extremities
C) Decreased sensation to light contact on the lateral arm
D) Pain only in the shoulder girdle
24) A 24-year-old man presents with back pain of several months' duration, lasting 60 minutes in the morning, improving with activity but not with rest. Clinical examination reveals tenderness in the sacroiliac joints and a positive FABER test. On interview, there is increased malaise. Which of the following would be characteristic of the radiographic findings in this condition?
A) Sclerosis of the iliac side of the sacroiliac joint
B) Anterior displacement of L5 on S1
C) Excessive lumbar kyphosis
D) Fracture of the interphalangeal area
25) A 13-year-old boy who is tall and has a weak back has vague left knee pain and has limped for a week. On clinical examination, he presents with knee pain and pain on internal rotation of the lower back. What is the next best course of action in management?
A) Allow the patient to return to sports as tolerated.
B) Refer for physical therapy and follow up in 4 to 6 weeks
C) Joint aspiration and synovial fluid analysis
D) Create a non-weight bearing situation immediately and refer to orthopedic surgery
26) A 12-year-old boy has a badly twisted ankle; an X-ray shows only soft tissue swelling. He shows hypermobility only in the distal aspect of the fibula. In addition to ligamentous sprain, what other diagnoses should be considered?
A) Physical trauma
B) Syndesmotic fracture
C) Peroneal tendon rupture
D) tarsal tunnel syndrome
27) A 21-year-old man has determined that he has a fracture of the neck of the fifth metacarpal and a trauma that reveals a 3-mm wound proximal to the fracture. What is the next best method of management?
A) Closed reduction and casting
B) Collateral fixation after the fracture is dressed and oral antibiotics are administered
C) Cleaning and wound excision of the fifth MCP joint
D) Open reduction and internal fixation of the fracture
28) A 32-year-old man started training for a marathon and two weeks later experienced left heel pain that worsened with the first few steps in the morning and got better as the day went on. What part of the foot should be checked for clues to diagnosis?
A) Medial calcaneal tuberosity
B) Achilles tendon insertion
C) Scaphoid tuberosity
D) Lateral calcaneal tuberosity
29) A 62-year-old woman with hypertension, diabetes mellitus, and obesity presents to the clinic with chronic left knee pain. X-rays at anterior and posterior weight-bearing of the knee show narrowing of the medial joint space and formation of osteophytes. Which of the following is the most appropriate initial management?
A) Referral to an orthopedic surgeon for joint replacement
B) Add an MRI scan of the knee
C) Limit weight-bearing until pain resolves
D) Recommend a weight loss and exercise program
30) Which of the following findings on a physical examination of a 16-year-old male prior to his participation in athletics does NOT need to be followed up before allowing him to compete?
A) Blood pressure of 138/89
B) A systolic heart murmur that increases in intensity with the Valsalva maneuver
C) History of a recent concussion
D) Family history of an uncle who died unexpectedly at age 26
Answers
1) C
2) C
3) C
4) D
5)A
6)B
7)C
8)B
9)C
10) A
11) B
12)D
13)D
14)D
15)D
16)A
17) D
18) A
19) A
20) A
21)D
22) D
23) B
24)D
25)D
26)A
27)C
28)A
29)D
30)A
Please note that some parts may not have been fully translated or may have been mistranslated.
Cummings DL, Smith M, Merrigan B, Leggit J. MSK30: a validated tool to assess clinical musculoskeletal knowledge. BMJ Open Sport Exerc Med. 2019;5(1):e 000495. published 2019 Mar 1. doi:10.1136/bmjsem-2018-000495
Summary.
What do you think of the actual solution?
For those of you who are qualified to deal with musculoskeletal disorders, I'm sure it was easy to solve.In the study, it seems that 22 was the median score, with the highest being 27 and the lowest being 16.
Some people may think that the content is like a national exam and not useful for clinical practice, but surprisingly, this kind of thinking ability is needed for clinical decision making.
It is not possible to judge everything with these 30 questions, but you should at least try to solve these 30 questions! This was a study of the contents.
