Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Musculoskeletal questions are won at the exam table: which maneuver isolates the structure, which finding makes back pain urgent, which joint pattern points away from osteoarthritis.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Shoulder and knee: rotator cuff and ligament maneuvers, strength grading.
Systemic disease: lupus, polymyalgia rheumatica.
Injuries and gait: fractures, imaging rules, walking problems in older adults.
2
14 adult musculoskeletal questions
0 / 14 answered14 questions
Tap an option: why each one is right or wrong appears under it.
Adult musculoskeletal care
A 60-year-old man is being evaluated for right leg weakness after a lumbar disc herniation. He can lift his right leg off the examination table against gravity but cannot hold it up against even mild resistance from the examiner. Which strength grade should be documented?
Grade 3/5 is full movement against gravity but none against added resistance, which matches lifting the leg but not holding it against the examiner.
Grade 1/5 is a flicker of contraction without movement.
Grade 2/5 is movement only with gravity eliminated; he can lift the leg against gravity.
Grade 4/5 means movement against gravity with some resistance; he cannot hold the leg up against even mild resistance.
A 48-year-old man reports several months of low back pain. When characterizing the pain, which feature most helps localize its anatomic source and guide the differential?
Pain intensity tracks severity and response to treatment, but it does not show the anatomic source.
Earlier treatments and their response help plan therapy, not localize the source.
Morning stiffness can suggest inflammatory back pain, but timing alone localizes less than location and radiation.
Where the pain is and where it radiates (axial, buttock, below the knee in a dermatome) separates mechanical, radicular, and referred sources and guides the next step.
A 70-year-old reports hip and knee pain affecting walking. When performing a focused musculoskeletal examination, which element should be evaluated first?
Palpation follows inspection; touching first can cause pain that limits the rest of the exam.
A focused musculoskeletal exam starts with inspection, and watching gait and posture shows how hip and knee pain limit function before hands-on testing.
Range of motion is tested after inspection; starting with it skips what observation shows about function.
Strength testing comes later in the sequence, after inspection, palpation, and range of motion.
A 55-year-old man has 1 day of severe pain, warmth, and swelling in his right knee, with a temperature of 38.4 °C. He cannot bear weight, and there was no trauma. He has never had a similar episode. Which is the most appropriate next step?
Treating presumed gout without aspiration risks missing a septic joint, which can destroy cartilage within days.
A hot, swollen knee with fever and inability to bear weight is septic arthritis until proven otherwise; aspiration for cell count, Gram stain, culture, and crystals comes before antibiotics.
MRI delays diagnosis and cannot distinguish infection from crystals the way joint fluid analysis can.
Uric acid can be normal during a gout flare and does not exclude septic arthritis.
A 25-year-old soccer player felt a pop and his knee gave way while pivoting 2 weeks ago. He has a positive Lachman test, and MRI confirms a complete ACL tear. He wants to return to competitive soccer. Which is the most appropriate plan?
Cast immobilization causes stiffness and atrophy and has no role in ACL tears.
Rehabilitation alone suits less active patients who will not return to pivoting sports.
A brace does not prevent pivot-shift instability, and returning now risks further meniscal and cartilage injury.
A young athlete returning to pivoting sport after a complete ACL tear has a high risk of recurrent instability and meniscal damage without reconstruction, so orthopedic referral is standard, usually with prehabilitation PT.
A 50-year-old painter reports shoulder pain and weakness when lifting objects overhead. Which examination finding best indicates a supraspinatus (rotator cuff) tear?
The Trendelenburg test assesses hip abductor (gluteus medius) weakness.
The Phalen test reproduces median nerve symptoms in carpal tunnel syndrome.
Inability to lower the arm slowly from 90 degrees of abduction (positive drop-arm test) indicates a full-thickness supraspinatus tear.
Tinel sign at the wrist detects median nerve irritation, not a rotator cuff tear.
A 48-year-old man has 3 weeks of low back pain radiating down the right leg to the dorsum of the foot, with decreased sensation there. Strength, reflexes, and bladder and bowel function are normal. He has no fever, weight loss, or cancer history. Which is the most appropriate initial plan?
Bed rest slows recovery; staying active is recommended for back pain with or without sciatica.
Without red flags or motor deficit, L5 radiculopathy is managed conservatively with an NSAID and staying active, and most patients improve within 6 weeks.
Imaging is reserved for red flags, progressive deficits, or symptoms beyond 6 weeks in a surgical or injection candidate.
Epidural steroid injections are for persistent radicular pain after conservative treatment, not as first-line therapy at 3 weeks.
A 25-year-old woman has 2 months of painful swelling of the hands, a rash over her cheeks and nasal bridge that spares the nasolabial folds, painless oral ulcers, and fatigue. Labs show hemoglobin 10.1 g/dL, WBC 3,100/mm³, and 2+ protein on urinalysis. Which is the most likely diagnosis?
Rosacea involves the nasolabial folds and does not cause oral ulcers, leukopenia, or proteinuria.
Arthritis, a malar rash sparing the nasolabial folds, painless oral ulcers, anemia, leukopenia, and proteinuria in a young woman point to systemic lupus erythematosus.
Dermatomyositis causes a heliotrope rash, Gottron papules, and proximal muscle weakness rather than oral ulcers and proteinuria.
Parvovirus can cause arthritis, but not a malar rash with oral ulcers, cytopenias, and proteinuria.
A 58-year-old woman with type 2 diabetes reports that her right ring finger catches when she makes a fist and sometimes locks bent, requiring her to straighten it with the other hand, worst in the morning. There is a tender nodule at the base of the finger on the palm side that moves with flexion. What is the most likely diagnosis?
A finger that catches and locks with a tender nodule at the A1 pulley that moves with the tendon is stenosing flexor tenosynovitis (trigger finger), which is more common in diabetes.
PIP osteoarthritis causes bony enlargement (Bouchard nodes) and stiffness, not catching at the palm.
De Quervain tenosynovitis causes pain over the radial wrist with a positive Finkelstein test, not a locking finger.
A tendon sheath ganglion is a small, firm, fixed nodule on the palmar finger that does not catch or lock with flexion.
A 46-year-old man who injects heroin has 3 weeks of worsening, constant low back pain that is present at rest and at night, with subjective fevers. Temperature is 38.2°C, and there is marked tenderness to percussion over the L3 spinous process. Strength, sensation, and reflexes are normal. ESR is 92 mm/h, and CRP is elevated. What is the most likely diagnosis?
Axial spondyloarthritis causes chronic inflammatory back pain in younger adults, without fever or point tenderness.
A muscle strain improves with rest and does not cause fever or a high ESR.
A herniated disc causes radicular pain made worse by movement, not fever and night pain with high inflammatory markers.
Constant pain at rest and at night, fever, spinous process tenderness, and high inflammatory markers in a person who injects drugs indicate vertebral osteomyelitis; MRI and blood cultures are needed.
A 62-year-old woman with 15 years of seropositive rheumatoid arthritis reports progressive neck pain, hand clumsiness, and gait imbalance. Exam shows hyperreflexia in the lower limbs and a positive Hoffman sign. A lateral flexion cervical radiograph shows a gap of more than 5 mm between the front of C1 and the dens. What is the most likely diagnosis?
Osteoporotic compression fractures occur in the thoracic and lumbar spine and do not widen the atlanto-dental interval.
Spondylotic myelopathy results from degenerative narrowing at lower cervical levels; a widened atlanto-dental interval points to C1–C2.
An atlanto-dental interval over 5 mm on flexion views with myelopathic signs in long-standing RA indicates atlantoaxial subluxation, which needs urgent spine referral.
Ankylosing spondylitis causes inflammatory back pain and a fused spine, not instability at C1–C2 in long-standing RA.
A 72-year-old woman reports several weeks of bilateral shoulder and hip-girdle aching and morning stiffness lasting over an hour, with difficulty rising from a chair. Muscle strength is preserved. Which laboratory test best supports the likely diagnosis?
Bilateral shoulder and hip-girdle aching with long morning stiffness and preserved strength in an older adult suggests polymyalgia rheumatica, which is supported by a markedly raised ESR (and CRP).
Anti-CCP supports rheumatoid arthritis, which causes small-joint synovitis of the hands rather than girdle stiffness.
Rheumatoid factor is usually negative in PMR; a positive result would point toward rheumatoid arthritis.
CK is normal in PMR; it rises in inflammatory myopathies, which cause true weakness rather than stiffness with preserved strength.
A 72-year-old man with symptomatic knee osteoarthritis has a BMI of 33 kg/m². He uses acetaminophen as needed with partial relief and asks which nonsurgical treatment offers the most long-term benefit. Which is the most appropriate recommendation?
TENS is conditionally recommended against for knee OA and gives little long-term benefit.
Platelet-rich plasma is not recommended for knee OA by ACR because the evidence is inconsistent.
Structured exercise combined with weight loss gives the largest long-term improvement in pain and function in knee OA and is strongly recommended (ACR 2019).
Lateral-wedge insoles are recommended against for knee OA because they do not reduce pain.
A 62-year-old woman with knee osteoarthritis reports increased stiffness. The knee looks slightly fuller than the other side, but patellar ballottement is negative. Which maneuver is most sensitive for detecting a small knee effusion?
The bulge (milk) sign detects small effusions that are too small to float the patella.
The anterior drawer test assesses anterior cruciate ligament integrity, not joint fluid.
The McMurray test looks for a meniscal tear.
Patellar ballottement (tap) needs a larger effusion; it is already negative, so it misses small amounts of fluid.
A running total sits here; it fills in after your last pick.
3
Joint and back errors
Missing a back-pain red flag. The findings that change the workup include urinary retention or saddle anesthesia, a progressing motor deficit, a cancer history, fever, immunosuppression, and major trauma or osteoporosis.
Holding urate-lowering therapy during a gout flare. ACR 2020 allows starting it during a flare, with anti-inflammatory prophylaxis, and says not to stop therapy a patient already takes. Allopurinol is the preferred first drug, started low and titrated to a serum urate below 6 mg/dL.
Allopurinol without HLA-B*5801 testing in higher-risk groups. ACR 2020 advises testing patients of Southeast Asian descent and African American patients first, because of the risk of severe hypersensitivity.
Fluoroquinolones and tendons. An FDA boxed warning covers tendinitis and tendon rupture, with higher risk over age 60, with corticosteroids and after organ transplant.
An X-ray for every ankle sprain. The Ottawa ankle rules limit films to bone tenderness at the posterior edge or tip of a malleolus, or inability to bear weight for four steps both right after the injury and at the visit.
The American College of Rheumatology 2020 guideline. Its main change from older teaching is that urate-lowering therapy no longer waits for a flare to settle.
Are children's orthopedic problems covered here?
No. Children's limb and gait problems belong to pediatric primary care; this site practices them in the CPNP-PC practice test.