PANCE Musculoskeletal 2 — Questions and Answers
Question 1: A 55-year-old woman presents with bilateral knee pain worsened by climbing stairs and improved with rest. X-ray shows joint space narrowing and osteophytes. What is the most likely diagnosis?
- Rheumatoid arthritis
- Osteoarthritis (Correct answer)
- Gout
- Pseudogout
Correct answer: Osteoarthritis
Osteoarthritis presents with pain worsened by activity, relieved by rest, and X-ray findings of joint space narrowing, subchondral sclerosis, and osteophytes.
Question 2: A 25-year-old male presents after a fall on an outstretched hand with anatomical snuffbox tenderness. X-ray is negative. What is the next best step?
- Reassure and discharge
- MRI or CT scan of the wrist (Correct answer)
- Splint and follow-up in 4 weeks
- Immediate surgical referral
Correct answer: MRI or CT scan of the wrist
Anatomical snuffbox tenderness suggests scaphoid fracture; MRI or CT is needed when X-ray is negative because scaphoid fractures can be occult and risk avascular necrosis if untreated.
Question 3: A 40-year-old male with gout has his second attack in 6 months. Serum uric acid is 9.2 mg/dL. He tolerates NSAIDs well. What is the most appropriate long-term management?
- Colchicine indefinitely
- Allopurinol therapy (Correct answer)
- High-dose aspirin
- Dietary restriction alone
Correct answer: Allopurinol therapy
Allopurinol, a xanthine oxidase inhibitor, is indicated for urate-lowering therapy in patients with recurrent gout attacks to prevent future episodes.
Question 4: A 70-year-old woman with osteoporosis fractures her vertebra after minor trauma. DEXA scan shows T-score of -2.8. Which medication reduces both vertebral and hip fracture risk?
- Raloxifene
- Calcitonin
- Alendronate (Correct answer)
- Calcium supplementation alone
Correct answer: Alendronate
Bisphosphonates like alendronate reduce both vertebral and non-vertebral (including hip) fracture risk and are first-line treatment for osteoporosis.
Question 5: A 35-year-old runner presents with pain at the inferior pole of the patella that worsens with jumping. No effusion is present. What is the most likely diagnosis?
- Patellar tendinopathy (Correct answer)
- Patellofemoral syndrome
- Prepatellar bursitis
- Osgood-Schlatter disease
Correct answer: Patellar tendinopathy
Patellar tendinopathy (jumper's knee) presents with focal tenderness at the inferior patellar pole, exacerbated by jumping and resisted knee extension.
Question 6: A 60-year-old man presents with symmetric morning stiffness lasting over 1 hour, swelling of MCPs and PIPs, and positive anti-CCP antibodies. What is the first-line DMARD therapy?
- Hydroxychloroquine
- Methotrexate (Correct answer)
- Sulfasalazine
- Leflunomide
Correct answer: Methotrexate
Methotrexate is the anchor DMARD for rheumatoid arthritis due to its efficacy, tolerability, and long track record.
Question 7: A 14-year-old male presents with knee pain and a tender tibial tubercle that is worse with activity. No joint effusion. What is the diagnosis?
- Patellar tendinopathy
- Osgood-Schlatter disease (Correct answer)
- Legg-Calvé-Perthes disease
- Slipped capital femoral epiphysis
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle in adolescents during growth spurts, presenting with localized tenderness and swelling.
PANCE Musculoskeletal 2
A 55-year-old woman presents with bilateral knee pain worsened by climbing stairs and improved with rest.
X-ray shows joint space narrowing and osteophytes.
What is the most likely diagnosis?