MCQ Quiz: Musculoskeletal Patient Care

Musculoskeletal disorders are a leading cause of pain and disability, ranging from acute injuries like sprains to chronic conditions like osteoarthritis and gout. Pharmacists are key in managing these conditions, from recommending appropriate self-care for minor aches and pains to managing complex pharmacotherapy for chronic diseases. This quiz will test your knowledge on the assessment and management of these common conditions.

1. A patient with osteoarthritis of the knee asks for a self-care recommendation for mild pain. What is the appropriate first-line pharmacologic option?

• a. An oral opioid
• b. An oral NSAID
• c. Acetaminophen
• d. A muscle relaxant

Answer: c. Acetaminophen

2. The pathophysiology of gout is characterized by the deposition of what type of crystals in the joints?

• a. Calcium pyrophosphate
• b. Monosodium urate
• c. Cholesterol
• d. Calcium oxalate

Answer: b. Monosodium urate

3. What is the first-line pharmacologic therapy for treating an acute gout flare?

• a. Allopurinol
• b. An NSAID (e.g., naproxen, indomethacin), colchicine, or a corticosteroid.
• c. Probenecid
• d. Acetaminophen

Answer: b. An NSAID (e.g., naproxen, indomethacin), colchicine, or a corticosteroid.

4. Allopurinol is a medication used for the chronic management of gout. What is its mechanism of action?

• a. It increases the renal excretion of uric acid.
• b. It is a potent anti-inflammatory agent.
• c. It inhibits xanthine oxidase, the enzyme responsible for producing uric acid.
• d. It dissolves existing uric acid crystals.

Answer: c. It inhibits xanthine oxidase, the enzyme responsible for producing uric acid.

5. A patient with an acute ankle sprain should be advised to use RICE therapy. The “I” in RICE stands for:

• a. Ibuprofen
• b. Immobilize
• c. Ice
• d. Injection

Answer: c. Ice

6. The “Pain & Fever Self-Care” module is part of which course?

• a. PHA5781 Patient Care I
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5787C Patient Care 5

Answer: a. PHA5781 Patient Care I

7. A key counseling point for a patient starting allopurinol for gout prophylaxis is:

• a. It should only be taken during an acute flare.
• b. It should not be started during an acute flare, and it may precipitate a flare when first initiated.
• c. It has an immediate effect on lowering uric acid.
• d. The dose should be doubled if a flare occurs.

Answer: b. It should not be started during an acute flare, and it may precipitate a flare when first initiated.

8. For a patient with osteoarthritis of the knee who cannot tolerate oral NSAIDs due to GI risk, what is a good alternative?

• a. A topical NSAID like diclofenac gel.
• b. A high-dose opioid.
• c. An increase in their acetaminophen dose.
• d. A different oral NSAID.

Answer: a. A topical NSAID like diclofenac gel.

9. Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain and is thought to involve:

• a. Peripheral nerve damage.
• b. Joint destruction.
• c. Central pain sensitization.
• d. An autoimmune process.

Answer: c. Central pain sensitization.

10. Which of the following medications is FDA-approved for the treatment of fibromyalgia?

• a. Morphine
• b. Ibuprofen
• c. Pregabalin and duloxetine
• d. Acetaminophen

Answer: c. Pregabalin and duloxetine

11. The “Introduction to Pain and Treatment Options” is a module within the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

12. A patient taking colchicine for an acute gout flare should be counseled about what common, dose-limiting side effect?

• a. Headache
• b. Drowsiness
• c. Hypertension
• d. Diarrhea

Answer: d. Diarrhea

13. Which of the following is a non-pharmacologic recommendation for a patient with osteoarthritis of the knee?

• a. A sedentary lifestyle to rest the joint.
• b. Low-impact exercise and weight loss.
• c. Wearing high-heeled shoes.
• d. Avoiding all physical activity.

Answer: b. Low-impact exercise and weight loss.

14. A patient with acute, non-specific low back pain should be advised to:

• a. Remain on strict bed rest for one week.
• b. Continue to stay active as tolerated and use heat therapy.
• c. Immediately get an MRI.
• d. Start a long-acting opioid.

Answer: b. Continue to stay active as tolerated and use heat therapy.

15. Counseling patients on self-care for pain is a key objective for student pharmacists.

• a. True
• b. False

Answer: a. True

16. A patient is taking allopurinol and develops a severe rash. This could be a sign of:

• a. A normal side effect.
• b. A hypersensitivity syndrome that can be life-threatening.
• c. An interaction with their diet.
• d. That the drug is working.

Answer: b. A hypersensitivity syndrome that can be life-threatening.

17. The “Pharmacotherapy of Pain” is a topic within the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

18. What is the role of a muscle relaxant like cyclobenzaprine in acute low back pain?

• a. It is a first-line treatment for all back pain.
• b. It can be used for short-term relief of muscle spasms, but is limited by sedative side effects.
• c. It has anti-inflammatory properties.
• d. It can be used for up to 6 months.

Answer: b. It can be used for short-term relief of muscle spasms, but is limited by sedative side effects.

19. A key dietary counseling point for a patient with gout is to limit:

• a. Dairy products
• b. Foods high in purines, such as red meat and seafood, and alcohol.
• c. Leafy green vegetables
• d. Complex carbohydrates

Answer: b. Foods high in purines, such as red meat and seafood, and alcohol.

20. An active learning session on pain management is part of the Patient Care 3 course.

• a. True
• b. False

Answer: a. True

21. A “red flag” symptom in a patient with low back pain that requires immediate medical referral is:

• a. Mild muscle ache.
• b. Pain that radiates down the leg.
• c. New onset of bowel or bladder incontinence.
• d. Stiffness in the morning.

Answer: c. New onset of bowel or bladder incontinence.

22. A patient is taking probenecid for chronic gout. Probenecid works by:

• a. Decreasing the production of uric acid.
• b. Increasing the renal excretion of uric acid.
• c. Acting as an anti-inflammatory.
• d. Blocking the effects of purines.

Answer: b. Increasing the renal excretion of uric acid.

23. The pharmacology of analgesics is a lecture within the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

24. An active learning session on pain is part of which course?

• a. PHA5878C Patient Care 3
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5878C Patient Care 3

25. A pharmacist’s role in managing musculoskeletal disorders includes:

• a. Recommending appropriate OTC analgesics.
• b. Counseling on non-pharmacologic therapies.
• c. Identifying “red flag” symptoms that require a referral.
• d. All of the above.

Answer: d. All of the above.

26. Which of the following is NOT a first-line therapy for fibromyalgia?

• a. Patient education
• b. Exercise (aerobic and strength training)
• c. Opioids
• d. An SNRI like duloxetine

Answer: c. Opioids

27. The pathophysiology of osteoarthritis involves the:

• a. Autoimmune destruction of the joint lining.
• b. Deposition of uric acid crystals.
• c. Progressive loss of articular cartilage.
• d. Central nervous system sensitization.

Answer: c. Progressive loss of articular cartilage.

28. An active learning session on pain is part of which course module?

• a. Module 1: Introduction to Pain and Treatment Options
• b. Module 3: Dyslipidemia
• c. Module 5: Acute Coronary Syndrome
• d. Module 8: Introduction to Pulmonary Disease

Answer: a. Module 1: Introduction to Pain and Treatment Options

29. A patient should be counseled that topical capsaicin cream for osteoarthritis pain:

• a. Provides immediate relief.
• b. Must be applied regularly for several weeks for full effect and may cause a burning sensation.
• c. Should be applied to broken skin.
• d. Has no side effects.

Answer: b. Must be applied regularly for several weeks for full effect and may cause a burning sensation.

30. The management of pain is a lecture within the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

31. A patient with a history of heart failure should be cautious with which class of medications for osteoarthritis pain?

• a. Acetaminophen
• b. Oral NSAIDs
• c. Topical lidocaine
• d. Tramadol

Answer: b. Oral NSAIDs

32. The goal of using colchicine during the initiation of allopurinol is to:

• a. Increase the efficacy of allopurinol.
• b. Prevent an acute gout flare that can be precipitated by the initiation of urate-lowering therapy.
• c. Treat the patient’s pain.
• d. Lower uric acid levels more rapidly.

Answer: b. Prevent an acute gout flare that can be precipitated by the initiation of urate-lowering therapy.

33. The principles of self-care for pain are covered in the Patient Care I course.

• a. True
• b. False

Answer: a. True

34. A patient with chronic low back pain would benefit most from:

• a. Long-term bed rest.
• b. A referral to physical therapy and staying active.
• c. A chronic opioid prescription as first-line therapy.
• d. Daily use of a muscle relaxant.

Answer: b. A referral to physical therapy and staying active.

35. A pharmacist’s role includes helping a patient differentiate between:

• a. Acute pain appropriate for self-care and chronic pain requiring a physician’s diagnosis.
• b. The different brands of ibuprofen.
• c. The different types of health insurance.
• d. The role of a pharmacist versus a physician.

Answer: a. The different brands of ibuprofen.

36. A key part of managing any chronic musculoskeletal pain condition is:

• a. Setting realistic expectations with the patient.
• b. Focusing on improvements in function, not just a pain score.
• c. A multimodal treatment plan.
• d. All of the above.

Answer: d. All of the above.

37. Which of the following is NOT a non-pharmacologic treatment for osteoarthritis?

• a. Weight loss
• b. Physical therapy
• c. Use of a cane or brace
• d. A diet high in purines

Answer: d. A diet high in purines

38. The lecture “Self-Care for Pain and Fever” is part of which course?

• a. PHA5781 Patient Care I
• b. PHA5163L Professional Skills Lab 3
• c. PHA5784C Patient Care 4
• d. PHA5782C Patient Care 2

Answer: a. PHA5781 Patient Care I

39. A patient is taking allopurinol. They should be counseled on the importance of:

• a. Limiting fluid intake.
• b. Maintaining good hydration to help prevent kidney stones.
• c. Taking the medication on an empty stomach.
• d. Taking the medication only when they have a gout flare.

Answer: b. Maintaining good hydration to help prevent kidney stones.

40. An active learning session covering pain management is part of which course?

• a. PHA5878C Patient Care 3
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5878C Patient Care 3

41. The use of intra-articular corticosteroid injections for osteoarthritis provides:

• a. A long-term cure for the disease.
• b. Short-term relief of pain and inflammation.
• c. A method to rebuild cartilage.
• d. A way to avoid physical therapy.

Answer: b. Short-term relief of pain and inflammation.

42. Which of the following is a risk factor for gout?

• a. Hypertension
• b. Obesity
• c. Use of thiazide diuretics
• d. All of the above

Answer: d. All of the above

43. A pharmacist’s role in the self-care of musculoskeletal injuries is critical for ensuring patient safety and appropriate treatment.

• a. True
• b. False

Answer: a. True

44. What is the maximum number of days an adult should self-treat a minor musculoskeletal pain with an OTC analgesic before seeing a physician?

• a. 3 days
• b. 5 days
• c. 10 days
• d. There is no limit.

Answer: c. 10 days

45. Which of the following best describes the management of fibromyalgia?

• a. It is easily cured with a short course of medication.
• b. It is primarily managed with opioids.
• c. It requires a multimodal approach with a strong emphasis on exercise and patient education.
• d. It is managed with high-dose corticosteroids.

Answer: c. It requires a multimodal approach with a strong emphasis on exercise and patient education.

46. A patient with an acute musculoskeletal injury should use ice for the first ____, then may switch to heat.

• a. 1 hour
• b. 12 hours
• c. 24-48 hours
• d. 1 week

Answer: c. 24-48 hours

47. The pharmacology of analgesics is a key topic in the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

48. An active learning session on pain is part of which course module?

• a. Module 1: Introduction to Pain and Treatment Options
• b. Module 2: Hypertension
• c. Module 4: Ischemic Heart Disease
• d. Module 7: Arrhythmias

Answer: a. Module 1: Introduction to Pain and Treatment Options

49. The overall management of chronic musculoskeletal pain requires:

• a. A “one-size-fits-all” approach.
• b. A patient-centered approach that sets functional goals.
• c. The use of opioids as a first-line therapy.
• d. A focus on pharmacotherapy alone.

Answer: b. A patient-centered approach that sets functional goals.

50. The ultimate goal of learning about the management of musculoskeletal disorders is to:

• a. Be able to help patients manage their pain and improve their quality of life using safe and effective evidence-based strategies.
• b. Memorize the brand names of all NSAIDs.
• c. Pass the final exam.
• d. Convince all patients with back pain to get surgery.

Answer: a. Be able to help patients manage their pain and improve their quality of life using safe and effective evidence-based strategies.