Musculoskeletal (MSK) Medicine 10 Single Best Answer (SBA)
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1. A 45-year-old office worker presents with numbness and tingling in the ring and little fingers of their right hand, which worsens after prolonged elbow flexion. Examination reveals a positive Tinel's sign over the cubital tunnel. What is the most appropriate initial conservative management?
Answer: Elbow splinting and activity modification
Splinting to keep the elbow in a less flexed position, along with modifying aggravating activities, is first-line management for ulnar nerve compression.
2. A 55-year-old woman presents with nocturnal hand numbness and difficulty gripping objects. Phalen’s test reproduces her symptoms. What is the most appropriate first-line management?
Answer: Wrist splinting at night
Splinting the wrist in a neutral position overnight reduces median nerve compression and helps alleviate symptoms in early carpal tunnel syndrome.
3. A 32-year-old new mother presents with pain on the radial side of her wrist, worsened by lifting her baby. Finkelstein’s test is positive. What is the most appropriate initial treatment?
Answer: Rest and thumb spica splinting
De Quervain's tenosynovitis is best managed initially with activity modification, a thumb spica splint, and rest to allow the inflamed tendons to settle.
4. A 65-year-old man presents with progressive thickening of the palmar fascia and difficulty extending his ring finger. What is the definitive treatment for this condition?
Answer: Surgical fasciotomy
Dupuytren’s contracture causing significant finger flexion deformities ultimately requires surgical release for definitive correction.
5. A 28-year-old skier presents with pain and instability at the base of the thumb after a fall. Stress testing reveals laxity at the ulnar collateral ligament. What is the most appropriate next step?
Answer: Thumb spica splinting
For a skier’s thumb or mild collateral ligament injury, a thumb spica cast or splint stabilizes the joint and promotes healing.
6. A 35-year-old man presents with redness, swelling, and pain around his fingernail after biting it. There is no abscess formation. What is the most appropriate treatment?
Answer: Warm soaks and topical antibiotics
Early paronychia without abscess often resolves with conservative care: warm water soaks, topical antiseptics, and possibly topical antibiotics.
7. A 22-year-old basketball player presents with pain and swelling in the middle finger after jamming it against the ball. X-ray is negative for fracture. What is the most appropriate management?
Answer: Buddy taping
Minor finger sprains (often called “jammed fingers”) are commonly treated with buddy taping to minimize movement and provide support.
8. A 40-year-old golfer presents with medial elbow pain that worsens with wrist flexion and gripping. What is the most appropriate initial treatment?
Answer: Activity modification and physiotherapy
Golfer’s elbow (medial epicondylitis) typically improves with rest, avoiding provocative activities, and specific physiotherapy exercises.
9. A 45-year-old painter presents with lateral elbow pain exacerbated by gripping and wrist extension. What is the most effective conservative management?
Answer: Rest, activity modification, and physiotherapy
Tennis elbow (lateral epicondylitis) improves with reducing repetitive stress, rehabilitation exercises, and proper ergonomics.
10. A 50-year-old manual labourer presents with a swollen, painless lump over the olecranon. There is no erythema or warmth. What is the most appropriate next step?
Answer: Conservative management with rest and NSAIDs
Non-infected olecranon bursitis is initially managed by avoiding repetitive pressure, resting the joint, and using NSAIDs for pain/inflammation.
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