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ONP-C practice questions

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Question 1Assessment, Diagnosis, and Diagnostic Imaging

A 62-year-old runner reports lateral heel pain that is worst with the first steps in the morning. On examination, the pain is reproduced by passive dorsiflexion of the toes while the ankle is held in neutral. Which structure is being tensioned by this maneuver?

  1. Plantar fascia Correct answer.
  2. Tibialis posterior tendon
  3. Calcaneal fat pad
  4. Sural nerve

Explanation

Passive toe dorsiflexion with the ankle held in neutral tensions the plantar fascia along its origin at the medial calcaneal tubercle, reproducing the classic first-step pain of plantar fasciitis. The windlass mechanism makes this test fairly specific when the history fits.

Question 2Assessment, Diagnosis, and Diagnostic Imaging

Which imaging modality is considered the reference standard for detecting radiographically occult scaphoid fractures in a patient with snuffbox tenderness and normal initial radiographs?

  1. Computed tomography
  2. Diagnostic ultrasound
  3. Bone scintigraphy
  4. Magnetic resonance imaging Correct answer.

Explanation

MRI has the highest sensitivity and specificity for occult scaphoid fracture and can also identify bone contusion, ligament injury, and other causes of radial wrist pain. It allows earlier definitive management than repeat radiographs or delayed imaging.

Question 3Assessment, Diagnosis, and Diagnostic Imaging

A patient has pain over the anterior knee that worsens with stair descent and prolonged sitting. Which finding on examination most supports patellofemoral pain syndrome rather than patellar tendinopathy?

  1. Pain with a single-leg decline squat
  2. Tenderness localized 1 to 2 cm distal to the inferior pole
  3. Pain reproduced by resisted knee extension at 30 degrees
  4. Pain reproduced by patellar compression during a quadriceps contraction Correct answer.

Explanation

Patellofemoral pain is characteristically provoked by patellar compression against the trochlea during quadriceps contraction (the grind or Clarke test), reflecting joint-surface loading. Tendinopathy pain is instead focal at the tendon and load-dependent.

Question 4Assessment, Diagnosis, and Diagnostic Imaging

During a knee examination, the examiner holds the patient's heel with the knee flexed about 90 degrees, internally rotates the tibia, and applies a valgus force while extending the knee. The patient reports pain and a palpable clunk near 30 degrees of flexion. Which structure is most likely injured?

  1. Medial meniscus Correct answer.
  2. Iliotibial band
  3. Lateral meniscus
  4. Posterior cruciate ligament

Explanation

This is the McMurray maneuver, which loads the posterior horn of the meniscus by rotating the tibia and extending the knee. Internal rotation with valgus stress tensions the medial meniscus, and a clunk or pain implicates it.

Question 5Assessment, Diagnosis, and Diagnostic Imaging

Which radiographic view best demonstrates the presence of a glenohumeral dislocation in the anteroposterior plane when a posterior dislocation is suspected?

  1. Stryker notch view
  2. Grashey view
  3. Axillary lateral view Correct answer.
  4. Zanca view

Explanation

The axillary lateral view profiles the glenohumeral relationship in the anteroposterior direction and readily reveals posterior dislocation, which can appear nearly normal on a standard AP film. A scapular Y view is an alternative second orthogonal projection.

Question 6Assessment, Diagnosis, and Diagnostic Imaging

A patient reports burning pain and paresthesia in the ring and small fingers that worsens with prolonged elbow flexion. Which test, when positive, most specifically localizes the lesion to the cubital tunnel?

  1. Phalen test
  2. Cozen test
  3. Tinel sign at the elbow Correct answer.
  4. Finkelstein test

Explanation

Tinel percussion over the ulnar nerve as it passes behind the medial epicondyle reproduces distal paresthesia when the nerve is irritated at the cubital tunnel. It localizes the site better than a generalized wrist flexion test.

Question 7Assessment, Diagnosis, and Diagnostic Imaging

Which clinical feature most reliably distinguishes a rotator cuff tear from subacromial impingement syndrome on initial assessment?

  1. Positive Neer impingement sign
  2. Night pain when lying on the affected side
  3. Painful arc between 60 and 120 degrees of abduction
  4. Weakness with resisted external rotation that persists despite a subacromial injection Correct answer.

Explanation

True weakness that persists after an anesthetic subacromial injection indicates a structural tendon failure rather than pain inhibition from bursitis. This finding supports a full-thickness cuff tear and typically prompts imaging.

Question 8Assessment, Diagnosis, and Diagnostic Imaging

A 45-year-old woman has lateral hip pain over the greater trochanter that is worse when lying on that side. Which examination finding best supports gluteus medius tendinopathy?

  1. Positive Thomas test
  2. Pain reproduced by sustained single-leg stance on the affected side Correct answer.
  3. Pain reproduced by resisted hip adduction
  4. Pain with the FABER test localized to the groin

Explanation

Sustained single-leg stance loads the abductor mechanism and reproduces greater trochanteric pain when the gluteus medius tendon is involved. This is the basis of the 30-second single-leg stance test.

Question 9Assessment, Diagnosis, and Diagnostic Imaging

Which finding on lumbar magnetic resonance imaging in an asymptomatic adult is most common and therefore requires cautious correlation with the clinical picture?

  1. Cauda equina compression
  2. Spinal cord tumor
  3. Disc bulge Correct answer.
  4. Vertebral fracture

Explanation

Disc bulge and degenerative disc changes are highly prevalent in asymptomatic adults, so imaging findings must be interpreted alongside the history and physical examination. This is a key reason not to treat the image in isolation.

Question 10Assessment, Diagnosis, and Diagnostic Imaging

A patient with suspected cervical radiculopathy at C6 is being examined. Which finding is most consistent with this level?

  1. Weakness of wrist extension with a diminished brachioradialis reflex Correct answer.
  2. Weakness of elbow flexion with a diminished biceps reflex
  3. Weakness of thumb opposition with sensory loss over the thumb
  4. Weakness of shoulder abduction with sensory loss over the lateral arm

Explanation

The C6 nerve root supplies the brachioradialis reflex and wrist extensors, with sensory fibers over the lateral forearm and thumb. A C6 lesion therefore produces wrist extension weakness and a reduced brachioradialis reflex.

Question 11Assessment, Diagnosis, and Diagnostic Imaging

Which test is most appropriate for screening cognitive status before administering a detailed neuropsychological battery in an older adult with suspected dementia?

  1. Mini-Cog Correct answer.
  2. Patient Health Questionnaire-9
  3. Mini-Mental State Examination
  4. Montreal Cognitive Assessment

Explanation

The Mini-Cog combines a three-item recall with a clock-drawing task and takes only a few minutes, making it a validated screening instrument rather than a full assessment. Abnormal results then justify a formal battery.

Question 12Assessment, Diagnosis, and Diagnostic Imaging

A patient's Oswestry Disability Index score is 62 percent. How should this result be interpreted?

  1. Complete bed-bound status with no functional capacity
  2. Moderate disability requiring some lifestyle modification
  3. Mild disability with minimal functional limitation
  4. Severe disability with major limitation in most activities Correct answer.

Explanation

Oswestry scores are commonly grouped as minimal (0 to 20), moderate (21 to 40), severe (41 to 60), and crippled (61 to 80) or bed-bound (81 to 100). A score of 62 percent therefore falls in the severe-to-crippled range, indicating major limitation.

Question 13Assessment, Diagnosis, and Diagnostic Imaging

Which physical examination finding is most useful for identifying a meniscal tear rather than a collateral ligament sprain?

  1. Laxity with varus stress at 30 degrees of flexion
  2. Joint-line tenderness with pain on deep knee flexion Correct answer.
  3. Laxity with valgus stress at 30 degrees of flexion
  4. Increased anterior translation with the knee at 90 degrees

Explanation

Joint-line tenderness combined with pain at end-range flexion loads the meniscal horns and suggests meniscal pathology. Ligament tests instead assess capsular and collateral restraint.

Question 14Assessment, Diagnosis, and Diagnostic Imaging

A patient presents with acute swelling and pain in the first metatarsophalangeal joint. Which diagnostic step is most important before attributing the presentation to gout?

  1. Radiographs of the foot
  2. Erythrocyte sedimentation rate
  3. Joint aspiration with crystal analysis Correct answer.
  4. Serum uric acid measurement during the acute attack

Explanation

Demonstration of negatively birefringent needle-shaped monosodium urate crystals in synovial fluid is the definitive test for gout. It also excludes septic arthritis, which can mimic a gout flare.

Question 15Assessment, Diagnosis, and Diagnostic Imaging

Which electrodiagnostic finding is characteristic of a demyelinating neuropathy rather than an axonal neuropathy?

  1. Reduced compound muscle action potential amplitude with normal conduction velocity
  2. Normal sensory nerve action potentials with reduced motor amplitudes
  3. Fibrillation potentials on needle electromyography
  4. Prolonged distal latency with marked slowing of conduction velocity Correct answer.

Explanation

Demyelination slows conduction, producing prolonged distal latencies and reduced conduction velocities, often with conduction block or temporal dispersion. Axonal loss instead reduces response amplitudes with relatively preserved velocities.

Question 16Assessment, Diagnosis, and Diagnostic Imaging

A 30-year-old sustains an inversion ankle injury. Which examination maneuver best assesses the integrity of the anterior talofibular ligament?

  1. Anterior drawer with the ankle in slight plantar flexion Correct answer.
  2. Talar tilt with the ankle in dorsiflexion
  3. External rotation stress with the knee flexed
  4. Squeeze test of the proximal tibia

Explanation

The anterior talofibular ligament is the most commonly injured lateral ligament, and the anterior drawer performed in slight plantar flexion isolates it. Laxity or a soft endpoint compared with the uninjured side indicates rupture.

Question 17Assessment, Diagnosis, and Diagnostic Imaging

Which imaging study is preferred to evaluate suspected Achilles tendon rupture when the clinical diagnosis is uncertain?

  1. Plain radiography
  2. Computed tomography
  3. Bone scan
  4. Diagnostic ultrasound Correct answer.

Explanation

Ultrasound directly visualizes the tendon, showing discontinuity, gap, and retraction, and can be performed dynamically. It is the preferred bedside confirmatory study when the Thompson test is equivocal.

Question 18Assessment, Diagnosis, and Diagnostic Imaging

A patient reports weakness when raising the arm overhead and has a positive drop arm test. Which structure is most likely involved?

  1. Long head of the biceps tendon
  2. Teres minor tendon
  3. Supraspinatus tendon Correct answer.
  4. Subscapularis tendon

Explanation

The drop arm test assesses the supraspinatus, which initiates abduction and is the most frequently torn cuff tendon. Inability to lower the arm smoothly from abduction indicates a significant tear.

Question 19Assessment, Diagnosis, and Diagnostic Imaging

Which feature on a peripheral blood smear supports a diagnosis of iron deficiency anemia rather than anemia of chronic disease?

  1. Normocytic red cells with increased ferritin
  2. Normocytic red cells with normal ferritin
  3. Macrocytic red cells with elevated ferritin
  4. Microcytic hypochromic red cells with low ferritin Correct answer.

Explanation

Iron deficiency produces microcytic, hypochromic red cells with depleted iron stores, reflected by a low ferritin. Anemia of chronic disease typically shows normal or increased ferritin with normocytic cells.

Question 20Assessment, Diagnosis, and Diagnostic Imaging

Which test is used to assess for thoracic outlet syndrome by reproducing symptoms with the shoulder abducted and externally rotated while the head is turned toward the affected side?

  1. Roos elevated arm stress test
  2. Adson maneuver
  3. Halstead test
  4. Wright test Correct answer.

Explanation

The Wright test hyperabducts and externally rotates the arm while the head is turned toward the affected side, compressing the neurovascular bundle under the pectoralis minor. Reproduction of symptoms suggests hyperabduction syndrome.

Question 21Assessment, Diagnosis, and Diagnostic Imaging

A patient with suspected lumbar spinal stenosis reports bilateral leg pain that worsens with walking and eases with leaning forward. Which examination finding is most consistent with this diagnosis?

  1. Pain relief with lumbar extension
  2. Positive straight leg raise at 30 degrees
  3. Widened stance with relief on forward flexion Correct answer.
  4. Absent ankle reflexes bilaterally

Explanation

Spinal stenosis symptoms are classically relieved by lumbar flexion, which increases canal dimensions, and worsened by extension. Patients may adopt a flexed posture and report relief when leaning on a shopping cart.

Question 22Assessment, Diagnosis, and Diagnostic Imaging

Which finding on magnetic resonance imaging is most specific for a full-thickness rotator cuff tear?

  1. Fluid signal extending through the full thickness of the tendon Correct answer.
  2. Increased signal in the tendon on T2-weighted images
  3. Tendon thickening with intermediate signal
  4. Subacromial bursal fluid

Explanation

A full-thickness tear is diagnosed when fluid signal traverses the entire tendon from the articular to the bursal surface. Partial tears show intrasubstance signal that does not span the full thickness.

Question 23Assessment, Diagnosis, and Diagnostic Imaging

Which screening instrument is designed to identify patients at risk for falls and includes items on fear of falling and functional status?

  1. Falls Efficacy Scale Correct answer.
  2. Berg Balance Scale
  3. Timed Up and Go test
  4. Dynamic Gait Index

Explanation

The Falls Efficacy Scale measures confidence in performing daily activities without falling, capturing fear of falling as a fall risk factor. It is a self-report measure rather than a performance test.

Question 24Assessment, Diagnosis, and Diagnostic Imaging

A patient has a positive Spurling test with radiating pain into the arm. What does this finding most suggest?

  1. Thoracic outlet syndrome
  2. Cervical radiculopathy Correct answer.
  3. Carpal tunnel syndrome
  4. Rotator cuff tendinopathy

Explanation

Spurling test involves cervical extension, lateral bending, and axial compression, narrowing the neural foramen and reproducing radicular symptoms. A positive result supports cervical nerve root compression.

Question 25Assessment, Diagnosis, and Diagnostic Imaging

Which laboratory marker is most useful for monitoring disease activity in a patient with suspected polymyalgia rheumatica?

  1. Antinuclear antibody titer
  2. Rheumatoid factor
  3. Serum uric acid
  4. Erythrocyte sedimentation rate Correct answer.

Explanation

Polymyalgia rheumatica characteristically produces a markedly elevated ESR and C-reactive protein, which track disease activity and response to corticosteroids. These markers support the diagnosis when the clinical picture is typical.

Question 26Assessment, Diagnosis, and Diagnostic Imaging

A patient is being evaluated for suspected carpal tunnel syndrome. Which finding on the Phalen test is considered a positive result that supports the diagnosis?

  1. Pain over the lateral epicondyle with resisted wrist extension
  2. Numbness in the small finger with percussion at the elbow
  3. Reproduction of median nerve symptoms within 60 seconds of wrist flexion Correct answer.
  4. Radicular pain into the arm with cervical extension and rotation

Explanation

The Phalen test places the wrist in maximal flexion, increasing pressure within the carpal tunnel and compressing the median nerve. A positive result is the reproduction of median-distribution symptoms (thumb, index, middle, and radial half of the ring finger) within about 60 seconds. Symptoms outside the median territory or pain at other sites do not constitute a positive Phalen test.

Question 27Assessment, Diagnosis, and Diagnostic Imaging

A clinician wants a validated, self-report instrument to quantify a patient's shoulder pain and functional disability before starting rehabilitation. Which instrument is designed specifically for this purpose?

  1. Oswestry Disability Index
  2. Visual Analog Scale for pain intensity
  3. Disabilities of the Arm, Shoulder and Hand questionnaire Correct answer.
  4. Lower Extremity Functional Scale

Explanation

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a region-specific patient-reported outcome measure covering symptoms and function of the upper limb, including the shoulder. A visual analog scale captures only pain intensity and does not measure disability. The Oswestry and Lower Extremity Functional Scale target the spine and lower limb, respectively.

Question 28Assessment, Diagnosis, and Diagnostic Imaging

A 58-year-old man has chronic lateral elbow pain. His clinician suspects lateral epicondylopathy and wants to localize the involved tendon. Which physical examination maneuver most directly provokes the common extensor origin?

  1. Resisted wrist extension with the elbow extended Correct answer.
  2. Resisted shoulder external rotation at 90 degrees of abduction
  3. Passive wrist flexion with the elbow fully extended
  4. Resisted wrist flexion with the forearm supinated

Explanation

Lateral epicondylopathy involves the common extensor tendon origin at the lateral epicondyle. Resisted wrist extension, especially with the elbow extended to place the extensor group on tension, reproduces pain at that origin. The other maneuvers load different tendons or the shoulder and would not localize to the common extensor origin.

Question 29Assessment, Diagnosis, and Diagnostic Imaging

A 34-year-old woman has a several-week history of diffuse hand numbness and Raynaud phenomenon. Her clinician orders nailfold capillaroscopy. Which finding most suggests an underlying connective tissue disease rather than primary Raynaud phenomenon?

  1. Evenly spaced, hairpin-shaped capillary loops
  2. Enlarged, dilated capillary loops with dropout and avascular areas Correct answer.
  3. Symmetrical blanching of all digits on cold exposure
  4. Increased pain with cold water immersion

Explanation

Nailfold capillaroscopy in primary Raynaud phenomenon typically shows regular, hairpin-shaped loops without major architectural change. Enlarged or dilated loops, microhemorrhages, and avascular areas (dropout) reflect microvascular injury and are associated with scleroderma-spectrum connective tissue disease. Cold-provoked symptoms alone do not distinguish primary from secondary Raynaud.

Question 30Assessment, Diagnosis, and Diagnostic Imaging

A patient is evaluated for suspected thoracic myelopathy. Magnetic resonance imaging shows a dorsal epidural mass with a broad dural attachment and a dural tail, and the lesion compresses the cord. Which diagnosis best fits this description?

  1. Synovial cyst of a facet joint
  2. Epidural hematoma
  3. Intramedullary ependymoma
  4. Spinal meningioma Correct answer.

Explanation

Spinal meningiomas are typically extramedullary, intradural masses with a broad dural attachment and an enhancing dural tail, and they compress rather than arise within the cord. An intramedullary ependymoma expands the cord from within. Facet synovial cysts arise from the joint capsule and are usually lateral, while an epidural hematoma has a different clinical tempo and signal pattern.

Question 31Musculoskeletal Conditions and Disorders

A patient with a distal radius fracture has a dorsal angulation of the distal fragment. Which eponym describes this deformity pattern?

  1. Barton deformity
  2. Smith deformity
  3. Colles deformity Correct answer.
  4. Chauffeur deformity

Explanation

Colles fracture involves dorsal displacement and dorsal angulation of the distal radial fragment, typically from a fall on an outstretched hand. The deformity produces the classic dinner-fork appearance on inspection.

Question 32Musculoskeletal Conditions and Disorders

Which finding best distinguishes a complete rotator cuff tear from a subacromial impingement syndrome on physical examination?

  1. Pain with overhead activity
  2. Weakness with resisted external rotation Correct answer.
  3. Positive Neer impingement sign
  4. Nocturnal shoulder pain

Explanation

Profound weakness with resisted testing in a specific cuff muscle suggests a full-thickness tendon tear rather than pain-limited impingement. Impingement typically produces pain with provocative maneuvers while strength remains relatively preserved.

Question 33Musculoskeletal Conditions and Disorders

An older adult sustains a low-energy hip fracture. Which radiographic feature most suggests an underlying pathologic (fragility) cause rather than a purely traumatic fracture?

  1. A transverse fracture line through the femoral neck
  2. Cortical thinning with a lytic lesion at the fracture site Correct answer.
  3. Comminution of the greater trochanter
  4. Intertrochanteric location

Explanation

A lytic lesion with cortical destruction at the fracture site raises concern for a pathologic fracture through abnormal bone, such as a metastasis or myeloma deposit. Simple osteoporotic fractures lack a discrete destructive lesion.

Question 34Musculoskeletal Conditions and Disorders

Which laboratory marker is most useful for monitoring bone resorption activity in a patient being treated for osteoporosis?

  1. Serum alkaline phosphatase
  2. Serum calcium
  3. C-terminal telopeptide of type I collagen Correct answer.
  4. Serum phosphorus

Explanation

C-terminal telopeptide (CTX) is a collagen degradation product released during osteoclastic resorption and is used to monitor response to antiresorptive therapy. Alkaline phosphatase reflects osteoblast activity and is less specific for resorption.

Question 35Musculoskeletal Conditions and Disorders

A patient reports lateral elbow pain worsened by gripping and resisted wrist extension. Which condition is most consistent with this presentation?

  1. Medial epicondylitis
  2. Lateral epicondylitis Correct answer.
  3. Olecranon bursitis
  4. Cubital tunnel syndrome

Explanation

Lateral epicondylitis involves the common extensor origin at the lateral epicondyle and is provoked by resisted wrist extension and gripping. Pain localizes to the lateral elbow rather than the medial side.

Question 36Musculoskeletal Conditions and Disorders

Which feature on history most strongly raises suspicion for cauda equina syndrome in a patient with acute low back pain?

  1. Unilateral radicular pain below the knee
  2. Paraspinal muscle spasm
  3. Pain relieved by flexion
  4. New urinary retention with saddle anesthesia Correct answer.

Explanation

Saddle anesthesia combined with new bladder dysfunction suggests compression of the cauda equina and is a surgical emergency requiring urgent imaging. Radicular pain alone is far more common and less specific.

Question 37Musculoskeletal Conditions and Disorders

A patient with rheumatoid arthritis develops progressive cervical myelopathy. Which radiographic finding is most relevant to this complication?

  1. Cervical rib
  2. Atlantoaxial subluxation Correct answer.
  3. Diffuse idiopathic skeletal hyperostosis
  4. Cervical spondylolisthesis at C7

Explanation

Atlantoaxial instability from pannus-related ligamentous laxity is a well-recognized cause of cervical myelopathy in rheumatoid arthritis. It warrants careful evaluation before any procedure requiring neck manipulation.

Question 38Musculoskeletal Conditions and Disorders

Which physical examination test is used to assess for anterior cruciate ligament integrity?

  1. McMurray test
  2. FABER test
  3. Lachman test Correct answer.
  4. Thomas test

Explanation

The Lachman test applies an anterior tibial translation force with the knee slightly flexed to assess the anterior cruciate ligament. It is more sensitive than the anterior drawer in the acute setting.

Question 39Musculoskeletal Conditions and Disorders

A patient with a suspected Achilles tendon rupture is assessed with the Thompson test. Which result indicates a complete rupture?

  1. Absence of plantar flexion when the calf is squeezed Correct answer.
  2. Pain at the calcaneal insertion with dorsiflexion
  3. Crepitus over the posterior ankle
  4. Plantar flexion of the foot when the calf is squeezed

Explanation

The Thompson test squeezes the calf; a normal intact tendon transmits force to produce plantar flexion. Absence of plantar flexion indicates loss of continuity of the Achilles tendon.

Question 40Musculoskeletal Conditions and Disorders

Which medication class is most strongly associated with atypical subtrochanteric femoral fractures after long-term use?

  1. Calcium supplements
  2. Selective estrogen receptor modulators
  3. Bisphosphonates Correct answer.
  4. Recombinant parathyroid hormone

Explanation

Prolonged bisphosphonate therapy suppresses bone turnover and has been linked to atypical low-energy subtrochanteric and diaphyseal femoral fractures. These fractures often begin with a lateral cortical stress reaction.

Question 41Musculoskeletal Conditions and Disorders

A young athlete reports anterior knee pain that worsens with descending stairs and prolonged sitting, with tenderness over the inferior pole of the patella. Which condition best fits this description?

  1. Pes anserine bursitis
  2. Patellar tendinopathy Correct answer.
  3. Meniscal tear
  4. Patellofemoral osteoarthritis

Explanation

Patellar tendinopathy produces focal pain at the inferior patellar pole, aggravated by loading the extensor mechanism such as descending stairs or jumping. Focal point tenderness rather than diffuse joint pain is characteristic.

Question 42Musculoskeletal Conditions and Disorders

Which pattern of joint involvement is most characteristic of osteoarthritis?

  1. Symmetrical small joint synovitis of the hands
  2. Sacroiliac fusion with iritis
  3. Asymmetrical weight-bearing joint pain with brief morning stiffness Correct answer.
  4. Migratory polyarthritis with fever

Explanation

Osteoarthritis favors weight-bearing joints such as the knees and hips and produces brief morning stiffness lasting under about thirty minutes. Symmetrical small joint inflammation is more typical of rheumatoid disease.

Question 43Musculoskeletal Conditions and Disorders

A patient presents with acute monoarthritis of the first metatarsophalangeal joint. Which diagnostic step is most appropriate to confirm the suspected diagnosis?

  1. Radiograph of the foot
  2. Erythrocyte sedimentation rate
  3. Joint aspiration with polarized light microscopy Correct answer.
  4. Serum uric acid level alone

Explanation

Definitive diagnosis of crystal arthropathy requires synovial fluid analysis demonstrating negatively birefringent needle-shaped crystals under polarized light. Serum uric acid can be normal during an acute attack.

Question 44Musculoskeletal Conditions and Disorders

Which finding on examination is most consistent with a posterior cruciate ligament injury?

  1. Positive posterior drawer test Correct answer.
  2. Positive McMurray test
  3. Positive anterior drawer test
  4. Positive Ober test

Explanation

The posterior drawer test detects posterior translation of the tibia relative to the femur, indicating posterior cruciate ligament insufficiency. It is the most direct examination for this structure.

Question 45Musculoskeletal Conditions and Disorders

A patient with long-standing diabetes develops a painless, swollen foot with midfoot collapse and rocker-bottom deformity on radiographs. Which condition is most likely?

  1. Plantar fasciitis
  2. Acute gouty arthritis
  3. Charcot neuroarthropathy Correct answer.
  4. Osteomyelitis of the calcaneus

Explanation

Charcot neuroarthropathy presents with a warm, swollen, often painless foot in a patient with neuropathy, progressing to midfoot collapse and a rocker-bottom deformity. Recognition matters because early offloading prevents further destruction.

Question 46Musculoskeletal Conditions and Disorders

Which feature most reliably differentiates mechanical low back pain from an inflammatory spondyloarthropathy?

  1. Pain that improves with activity and worsens with rest Correct answer.
  2. Pain limited to a single dermatome
  3. Pain associated with muscle spasm
  4. Pain that improves with rest

Explanation

Inflammatory back pain characteristically improves with activity and is worse at rest or at night, often with prolonged morning stiffness. Mechanical back pain tends to worsen with activity and improve with rest.

Question 47Musculoskeletal Conditions and Disorders

A patient has a suspected scaphoid fracture with normal initial radiographs. Which management approach is most appropriate?

  1. Range-of-motion exercises as tolerated
  2. Immobilization and repeat imaging or advanced imaging in one to two weeks Correct answer.
  3. Reassurance and discharge without follow-up
  4. Immediate corticosteroid injection of the wrist

Explanation

Scaphoid fractures are frequently occult on initial radiographs, and missed injuries risk nonunion and avascular necrosis. Immobilization with repeat radiographs or early magnetic resonance imaging is the standard approach.

Question 48Musculoskeletal Conditions and Disorders

Which clinical feature is most suggestive of carpal tunnel syndrome rather than cervical radiculopathy at C6?

  1. Paresthesias in the thumb, index, and middle fingers that worsen at night Correct answer.
  2. Pain reproduced by neck extension and rotation
  3. Neck pain with ipsilateral arm pain
  4. Diminished biceps reflex

Explanation

Nocturnal paresthesias in the median nerve distribution that are relieved by shaking the hand favor carpal tunnel syndrome. Cervical radiculopathy more often produces neck-related pain and reflex changes.

Question 49Musculoskeletal Conditions and Disorders

Which underlying condition most commonly predisposes a patient to avascular necrosis of the femoral head?

  1. Iron deficiency anemia
  2. High-dose corticosteroid therapy Correct answer.
  3. Hypothyroidism
  4. Vitamin D excess

Explanation

Corticosteroid use is one of the leading risk factors for atraumatic femoral head osteonecrosis, along with alcohol use and certain systemic diseases. The mechanism involves disruption of the tenuous blood supply to the femoral head.

Question 50Musculoskeletal Conditions and Disorders

A patient has a displaced femoral neck fracture with disruption of the medial femoral circumflex artery blood supply. Which complication is most directly related to this vascular injury?

  1. Heterotopic ossification
  2. Nonunion of the greater trochanter
  3. Avascular necrosis of the femoral head Correct answer.
  4. Sciatic nerve palsy

Explanation

The medial femoral circumflex artery provides the primary blood supply to the femoral head, and disruption in displaced intracapsular fractures leads to avascular necrosis. This risk drives the choice of arthroplasty in older patients.