PANCE, Medical exams, 8%

Musculoskeletal System

Musculoskeletal questions cover fractures, joint and spine disorders, rheumatologic disease, and orthopedic emergencies. Physical-examination maneuvers and radiographic buzz-phrases carry many of the points in this content area.

Position: 4 of 15 content areas
Published weighting: 8% in the official framework
Topics covered: 8 topics in this guide

What is covered

Topics inside this content area.

These topics describe the scope students most often review for this part of PANCE. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Fractures and dislocations: Named fracture patterns, neurovascular checks, and reduction or referral thresholds.
Sprains, strains, and overuse injuries: Ligament grading, tendinopathies, and return-to-activity guidance by joint.
Degenerative and crystal arthropathies: Osteoarthritis versus gout and pseudogout, including synovial-fluid findings.
Autoimmune rheumatologic disease: Rheumatoid arthritis, lupus, spondyloarthropathies, and their serologic signatures.
Bone and joint infections: Septic arthritis and osteomyelitis: organisms, diagnostics, and urgency of intervention.
Spinal disorders: Radiculopathy levels, stenosis, cauda equina red flags, and conservative-care windows.
Osteoporosis and metabolic bone disease: Screening criteria, DEXA interpretation, and fracture-prevention therapy.
Compartment syndrome and orthopedic emergencies: The pressure-related and vascular emergencies that cannot wait for imaging.

Study tips

How to practice Musculoskeletal.

Section-specific guidance that follows from how this material is usually tested.

Pair every special test with the structure it stresses; test-to-structure pairs are frequent one-liners.
Learn nerve and artery injuries by fracture site as a single combined card, not separate facts.
Use image-based flashcards for classic radiographs so recognition survives exam-day pressure.

Where this fits

Musculoskeletal System is 4 of 15 content areas in the PANCE guide, and it carries a published weighting of 8% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the PANCE guide Official exam information

Sample Musculoskeletal questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Arthrocentesis of an acutely swollen, exquisitely tender first metatarsophalangeal joint yields synovial fluid containing needle-shaped, negatively birefringent crystals. What is the diagnosis?
1. AGout
2. BCalcium pyrophosphate deposition disease
3. CSeptic arthritis
4. DRheumatoid arthritis
Show answer
Answer: A. Gout
Monosodium urate crystals are needle shaped and negatively birefringent under polarized light, and the first metatarsophalangeal joint is the classic site of an acute gout flare. Calcium pyrophosphate deposition disease is the tempting distractor, but its crystals are rhomboid and positively birefringent and it favors the knee and wrist.
Key insight: Needle shaped and negative means urate; rhomboid and positive means pseudogout.
Question 2Foundational
Which nerve is most commonly injured by a fracture of the surgical neck of the humerus?
1. ARadial nerve
2. BAxillary nerve
3. CMedian nerve
4. DUlnar nerve
Show answer
Answer: B. Axillary nerve
The axillary nerve wraps around the surgical neck of the humerus, so a fracture there can weaken the deltoid and cause numbness over the lateral shoulder. The radial nerve is the tempting distractor because it is the classic humerus nerve injury, but it runs in the spiral groove of the midshaft and produces wrist drop instead.
Key insight: Surgical neck injures the axillary nerve; midshaft spiral groove injures the radial nerve.
Question 3Intermediate
A 55-year-old with low back pain now has urinary retention, saddle anesthesia, and bilateral lower extremity weakness. Which diagnosis requires emergent imaging and surgical decompression?
1. ALumbar spinal stenosis
2. BCauda equina syndrome
3. CLumbar disc herniation with sciatica
4. DAnkylosing spondylitis
Show answer
Answer: B. Cauda equina syndrome
Compression of the lumbosacral nerve roots below the conus produces the combination of saddle anesthesia, new bowel or bladder dysfunction, and bilateral leg weakness, and delayed decompression risks permanent deficits. Lumbar spinal stenosis is the tempting distractor because it also causes bilateral leg symptoms, but it produces positional neurogenic claudication rather than acute retention and saddle numbness.
Key insight: Saddle anesthesia plus new urinary retention is a surgical emergency, not a conservative-care back complaint.
Question 4Intermediate
Which autoantibody is the most specific serologic marker for rheumatoid arthritis?
1. ARheumatoid factor
2. BAntinuclear antibody
3. CAnti-cyclic citrullinated peptide antibody
4. DAnti-double-stranded DNA antibody
Show answer
Answer: C. Anti-cyclic citrullinated peptide antibody
Anti-cyclic citrullinated peptide antibodies have similar sensitivity to rheumatoid factor but far greater specificity, and they can appear years before symptoms begin. Rheumatoid factor is the tempting distractor because it is ordered constantly, yet it also turns positive in hepatitis C, endocarditis, Sjogren syndrome, and healthy older adults.
Key insight: Rheumatoid factor is sensitive but promiscuous; anti-CCP is what makes the diagnosis convincing.
Question 5Advanced
What is the earliest and most reliable clinical finding of acute compartment syndrome of the lower leg?
1. AAbsent dorsalis pedis pulse
2. BPallor of the foot
3. CPain out of proportion to the injury that worsens with passive stretch
4. DParalysis of the ankle dorsiflexors
Show answer
Answer: C. Pain out of proportion to the injury that worsens with passive stretch
Rising compartment pressure first produces ischemic pain that is far greater than the injury explains and that intensifies when the muscles in the compartment are passively stretched. Pulselessness is the tempting distractor because it appears on every list of the classic findings, but arterial pressure exceeds compartment pressure until very late, so waiting for it guarantees irreversible muscle and nerve damage.
Key insight: Compartment syndrome is diagnosed on pain with passive stretch; a present pulse never rules it out.

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Musculoskeletal System