Physician Assistant National Certifying Examination (PANCE) Musculoskeletal and Rheumatology Syllabus

Musculoskeletal and Rheumatology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Musculoskeletal and Rheumatology in Physician Assistant National Certifying Examination (PANCE), not a summary of it.

1. 1

   Trauma and Orthopedic Injuries

   4 topics

   • Fractures by region
     • Salter-Harris classification in children
     • Hip, wrist, and ankle fractures
   • Joint dislocations
   • Sprains, strains, and tendon injuries
   • Compartment syndrome and fat embolism
2. 2

   Degenerative and Overuse Disorders

   4 topics

   • Osteoarthritis
   • Rotator cuff disease and impingement
   • Epicondylitis and tendinopathy
   • Carpal tunnel and nerve entrapment syndromes
3. 3

   Spinal Disorders

   4 topics

   • Low back pain and disc herniation
   • Spinal stenosis and spondylolisthesis
   • Cauda equina syndrome
   • Scoliosis and kyphosis
4. 4

   Inflammatory and Autoimmune Arthropathies

   4 topics

   • Rheumatoid arthritis
     • Serologic markers and DMARD therapy
   • Seronegative spondyloarthropathies
     • Ankylosing spondylitis, psoriatic, reactive arthritis
   • Crystal arthropathies
     • Gout and pseudogout
   • Systemic lupus erythematosus and connective tissue disease
5. 5

   Bone and Soft Tissue Disorders

   4 topics

   • Osteoporosis and osteomalacia
   • Osteomyelitis and septic arthritis
   • Bone tumors and metastatic disease
   • Fibromyalgia and polymyalgia rheumatica

Musculoskeletal and Rheumatology flashcards for Physician Assistant National Certifying Examination (PANCE)

19 of 52 cards from the Musculoskeletal and Rheumatology deck — real questions with worked answers.

1. What is the Salter-Harris classification used for, and what does the mnemonic SALTR represent?

   It classifies pediatric physeal (growth plate) fractures (Types I-V). SALTR: I = Slipped (through physis), II = Above (metaphysis, most common), III = Lower (epiphysis, intra-articular), IV = Through/Transverse (both epiphysis and metaphysis), V = Ruined/cRush (compression of physis, worst prognosis).

2. What is a Colles fracture, and what is its classic deformity?

   A distal radius fracture with dorsal (posterior) displacement of the distal fragment, typically from a fall on an outstretched hand (FOOSH). It produces the classic 'dinner fork' deformity. A Smith fracture is the reverse, with volar (palmar) displacement ('garden spade' deformity).

3. Why is a scaphoid (navicular) fracture clinically important, and where is the tenderness?

   It is the most commonly fractured carpal bone (FOOSH), with tenderness in the anatomic snuffbox. Because blood supply is retrograde (distal to proximal), it risks avascular necrosis and nonunion. Even with negative initial X-rays, immobilize in a thumb spica cast and repeat imaging in 10-14 days.

4. What is a boxer's fracture?

   A fracture of the 5th metacarpal neck, typically from punching with a closed fist. Look for loss of the knuckle contour and check for rotational/angular deformity.

5. What is a Jones fracture and how does it differ from a pseudo-Jones fracture?

   A Jones fracture is a transverse fracture at the base (metaphyseal-diaphyseal junction) of the 5th metatarsal, prone to nonunion due to poor blood supply. A pseudo-Jones (avulsion) fracture is at the tuberosity from peroneus brevis traction and generally heals well.

6. How do femoral neck fractures classically present, and why are they orthopedic concerns?

   In elderly patients after a fall, the leg is shortened, abducted, and externally rotated. They threaten the femoral head's blood supply (medial femoral circumflex artery), risking avascular necrosis; displaced fractures often require arthroplasty rather than fixation.

7. What injury is suggested by posterior hip dislocation, and what is the limb position?

   The hip is flexed, adducted, and internally rotated. Posterior dislocation (most common, ~90%) often results from dashboard injury and risks sciatic nerve injury and femoral head avascular necrosis. Anterior dislocation presents abducted and externally rotated.

8. What is the most common direction of shoulder (glenohumeral) dislocation, and what nerve is at risk?

   Anterior dislocation is most common (~95%); the arm is held abducted and externally rotated. The axillary nerve is at risk - test sensation over the lateral deltoid (regimental badge area) and deltoid function before and after reduction.

9. What mechanism and finding suggest a posterior shoulder dislocation?

   Seizures and electrocution (massive internal rotator contraction). The arm is held adducted and internally rotated and resists external rotation; on AP X-ray it shows the 'light bulb' sign.

10. What is a nursemaid's elbow (radial head subluxation)?

    Subluxation of the radial head from the annular ligament in young children after axial traction on a pronated, extended arm. The child holds the arm pronated and slightly flexed and refuses to use it. Reduce by supination + flexion (or hyperpronation).

11. What is the Ottawa Ankle Rules' purpose?

    To decide when ankle/foot X-rays are needed after injury. Image if there is bony tenderness at the posterior edge/tip of either malleolus (ankle), the navicular or base of 5th metatarsal (foot), or inability to bear weight for 4 steps both immediately and in the ED.

12. Grade the severity classification of ligament sprains.

    Grade I = stretching/microscopic tears, mild pain, no instability. Grade II = partial tear, moderate pain, mild laxity. Grade III = complete rupture, marked instability with a positive stress test, sometimes less pain than Grade II.

13. What is the difference between a sprain and a strain?

    A sprain is an injury to a ligament (bone-to-bone). A strain is an injury to a muscle or tendon (muscle-to-bone). Both are graded I-III by severity.

14. What is the most commonly injured ligament in an inversion ankle sprain?

    The anterior talofibular ligament (ATFL), part of the lateral ligament complex. Tested with the anterior drawer test of the ankle.

15. Describe the presentation and test for an Achilles tendon rupture.

    Sudden 'pop' and pain in the posterior calf, often during push-off; the patient cannot push off (plantarflex) well. The Thompson test is positive: squeezing the calf produces no plantarflexion. Often a palpable gap is present.

16. What is the initial management mnemonic for acute soft-tissue (sprain/strain) injuries?

    RICE: Rest, Ice, Compression, Elevation (sometimes PRICE adding Protection, or POLICE - Protection, Optimal Loading, Ice, Compression, Elevation). NSAIDs for pain; early mobilization aids recovery.

17. What are the 6 P's of compartment syndrome, and which appears first?

    Pain (out of proportion, especially with passive stretch - the earliest and most reliable), Paresthesia, Pallor, Poikilothermia, Pulselessness, and Paralysis. Pulselessness is a late finding - do not wait for it.

18. At what compartment pressure is fasciotomy indicated in compartment syndrome?

    Absolute compartment pressure $>30 \text{ mmHg}$, or a delta pressure (diastolic BP minus compartment pressure) $<30 \text{ mmHg}$. Treatment is emergent fasciotomy; it is a clinical diagnosis and treatment should not be delayed.

19. Describe the classic triad of fat embolism syndrome and its typical timing.

    Triad: hypoxemia/respiratory distress, neurologic changes (confusion), and a petechial rash (often axillae, conjunctivae). It classically occurs 24-72 hours after long-bone or pelvic fractures. Treatment is supportive; early fracture fixation is preventive.

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