Musculoskeletal and Sports Medicine
Core concepts
MSK questions test anatomic localization, red flags, and conservative management. Know the difference between inflammatory and mechanical pain, and recognize red flags: fever, weight loss, night pain, neurologic deficits, and bowel/bladder changes (cauda equina). Understand common conditions: osteoarthritis (weight-bearing pain, stiffness <30 min), rheumatoid arthritis (symmetric, prolonged morning stiffness), gout (acutely inflamed joint, negatively birefringent crystals), and tendinopathies. Know the Ottawa ankle/knee rules to avoid unnecessary imaging. Sports medicine emphasizes return-to-play criteria and concussion management (gradual return, no same-day return).
Traps
- Missing cauda equina syndrome (saddle anesthesia, urinary retention)-emergency MRI.
- Treating acute low back pain with imaging or opioids; most improve with activity and NSAIDs.
- Confusing lateral epicondylitis (pain with resisted wrist extension) with medial epicondylitis.
- Returning an athlete to play the same day after concussion.
Worked example / rule of thumb
A patient with acute monoarthritis and fever: rule out septic arthritis with arthrocentesis before assuming gout. Rule of thumb: a hot joint plus fever is septic until proven otherwise.
Rehabilitation
Early mobilization, physical therapy, and graded return to activity outperform prolonged rest for most MSK conditions.
Practice Management and Professionalism
Core concepts
Practice management questions test systems thinking, quality improvement, and ethics. Understand the patient-centered medical home, care coordination, and quality metrics (HEDIS). Know basic billing and coding concepts (E/M levels, preventive vs problem-oriented visits, documentation requirements). Professionalism content covers informed consent, confidentiality (including HIPAA exceptions), boundaries, impaired colleagues, and conflict of interest. Understand error disclosure and apology laws, and the difference between negligence and malpractice (duty, breach, causation, damages).
Traps
- Breaching confidentiality without a legal exception (e.g., mandated reporting, serious threats).
- Failing to document shared decision-making and informed consent.
- Confusing quality improvement (system-level) with research (generalizable knowledge).
- Ignoring impaired colleague obligations-report through appropriate channels.
Worked example / rule of thumb
A colleague appears impaired at work: prioritize patient safety, remove from clinical duties, and report through the appropriate institutional channel. Rule of thumb: disclose errors honestly; apology laws protect the apology, not the documentation.
Quality improvement
Use the PDSA cycle, measure outcomes, and close the loop. Understand that most errors are systems errors, not individual failures.