ST.

FERDINAND COLLEGE
COLLEGE OF HEALTH SCIENCES
Sta. Ana St., Ilagan 3300, Isabela
Tel. No. (078) 622-3110
“ CHS – is a holistic department with dynamic staff that intend to produce a globally competitive health care provider”

MUSCULOSKELETAL DISORDERS

Name:__________________________________ Score:____________

Year and Section:__________________

MULTIPLE CHOICE: Write the letter of the correct answer before the number. Erasures and
alterations are considered erroneous.

1. Osteoblast activity is needed for which of the following functions?

a. Bone formation
b. Estrogen production
c. Hematopoiesis
d. Muscle formation
2. Which of the following conditions is the primary complication of osteoporosis?
a. Pain
b. Fractures
c. Hardening of the bones
d. Increased bone matrix and reminaralization
3. Which of the following conditions is the cause of primary osteoporosis?
a. Alcoholism
b. Hormonal imbalance
c. Malnutrition
d. Osteogenesis Imperfecta
4. Matadora, a 42-year old woman had a total hysterectomy. Is she at risk for osteoporosis?
a. No, because she still has her thyroid gland.
b. No, because she isn’t at risk until she’s older.
c. Yes, because she’s still producing hormones.
d. Yes, because she’s just had surgically induced menopause.
5. Primary prevention of osteoporosis includes which of the following measures?
a. Place items within the reach of the client.
b. Install bars in the bathroom to prevent falls.
c. Maintain the optimal Calcium intake, and use estrogen replacement therapy.
d. Use a professional alert system in the home in case a fall occurs when the client is alone.
6. Which of the following mechanisms is believed to cause gout?
a. Overproduction of calcium
b. Underproduction of calcium
c. Overproduction of uric acid
d. Underproduction of uric acid
7. In advanced gout, urate crystal deposits develop on the hands, knees, feet, forearms, ear and
Achilles tendon. Which of the following terms refers to these deposits?
a. Arthralgia
b. Gout nodules
c. Pinna
d. Tophi
8. Which of the following phrases best explains the usual patterns of nonchronic gout?
a. Frequent painful attacks
b. Generally painfully joints at all times.
c. Painful attacks with pain free periods
d. Painful attacks with less painful periods, but pain never subsides.
9. Cardo a 34 year old client has been prescribed a diet that limits protein rich foods. Which of the
following foods would the nurse teach him to avoid eating?
a. Bananas and dried fruits
b. Milk, ice cream and yogurt
c. Wine, cheese, preserved fruits, meats and vegetables
d. Anchovice, sardines, beans, sweet breads.
10. Tandang Lucio is recovering from an attackofgout. Client teaching would include the need to
lose weight for which of the following reasons?
a. Weight loss will decrease purine levels.
b. Weight loss will decrease inflammation.
c. Weight loss will increase uric acid levels and decrease stress to joints.
d. Weight loss will decrease uric acid levels and decrease stress on joints.
11. A physician tells a client diagnosed with gout that his X-rays are normal. Which of the following
responses would be the most appropriate when the client asks if he still has gout?
a. “Hindi, wala ka nang sakit.”
b. “Ang X-ray ay hindi mapagkakatiwalaan”
c. “Normal ang resulta ng X-ray sa simula ng gout”
d. “ang pagbabago sa Xray ay makikita lamang kung masakit ang gout”
12. Lakas has been diagnosed with gout and wants to know why colchicine is used in the treatment
of gout. Which of the following actions of colchicine explains why it’s effective for gout?
a. Replaces estrogen
b. Decreases infection
c. Decreases inflammation
d. Decreases bone demineralization
13. Patient Ganda has gout and is encouraged to increase fluid intake. Which of the following
statements best explains why increased fluids are encouraged for gout?
a. Fluids decreases inflammation
b. Fluids increase calcium absorption
c. Fluids promote the excretion of uric acid
d. Fluids provide a cushion for weakened bones.
14. Gout pain usually occurs in which of the following locations.
a. Joints
b. Tendons
c. Long bones
d. Areas of striated muscles
15. A client with gout is receiving indomethacin for pain. Which of the following statements should
be included in teaching a client who’s taking nonsteroidal anti inflammatory drugs (NSAIDs)?
a. “Hindi problema ang pagdurugo sa NSAIDs”
b. “isabay and NSAID sa pagkain ng di sumakit ang tiyan”
c. “Uminom ng NSAID na walang laman ang tiyan para sa mabilis nitong pagtalab.”
d. “Wag inumin and NSAID pag tulog. Di ka patutulugin nito.”
16. A client asks for information about osteoarthritis. Which of the following statements about
osteoarthritis is correct?
a. Osteoarthritis is rarely debilitating
b. Osteoarthritis is a rare form of arthritis
c. Osteoarthritis is the most common form of arthritis.
d. Osteoarthritis afflicts people over age 60.
17. Which of the following conditions or actions can cause primary osteoarthritis?
a. Overuse of joints, aging, obesity
b. Obesity, diabetes mellitus, aging
c. Congenital abnormality, aging, overuse of joints
d. Diabetes mellitus, congenital abnormality, aging
18. Heberden’s nodes are a common sign of osteoarthritis. Which of the following statements is
correct about this deformity?
a. It appears only in men
b. It appears on the distal interphalangeal joint
c. It appears on the proximal interphalangeal joint
d. It appears on the dorsolateral aspect of the interphalangeal joint.
19. The treatment for osteoarthritis commonly includes salicylates. Salicylates can be dangerous in
older people because they can cause which of the following adverse effects?
a. Hearing loss
b. Increased pain in joints
c. Decreases calcium absorption
d. Increased bone demineralization
20. Clients with osteoarthritis may be on bed for prolonged periods. Which of the following nursing
interventions would be appropriate for these clients?
a. Encourage coughing and deep breathing, and limit fluid intake.
b. Provide only passive ROM and decrease stimulation
c. Have the client lie as still as possible and give adequate pain medicine.
d. Turn the client every 2 hours and encourage coughing and deep breathing.
21. Which of the following statements explains the main difference between rheumatoid arthritis
and osteoarthritis?
a. Osteoarthritis is gender-specific, rheumatoid arthritis isn’t.
b. Osteoarthritis is a localized disease, rheumatoid arthritis is systemic.
c. Osteoarthritis is a systemic disease, rheumatoid arthritis is localized.
d. Osteoarthritis has dislocations and subluxations, rheumatoid arthritis doesn’t.
22. During the assessment of a client, signs of osteoarthritis are noted. Which of the following
assessment findings would indicate osteoarthritis?
a. Elevated sedimentation rate
b. Multiple subcutaneous nodules
c. Asymmetrical joint involvement.
d. Signs and symptoms of inflammation, such as heat fever, malaise.
23. Which of the following instructions would be considered primary prevention of injury from
osteoarthritis?
a. “Stay on bed rest”
b. “Avoid physical activity”
c. “Perform only repetitive tasks”
d. “warm up before exercise and avoid repetitive tasks”
24. A client with osteoarthritis wants to know what it is. Client teaching would include which of the
following descriptions for osteoarthritis?
a. A systemic inflammatory joint disease
b. A disease involving fusion of the joints in the hands.
c. An inflammatory joint disease, with degeneration and loss of articular cartilage in synovial
joints.
d. A noninflammatory joint disease, with degeneration and loss of articular cartilage in
synovial joints.
25. Use of which of the following articles or types of clothing would help a client with osteoarthritis
perform activities of daily living at home?
a. Zippered clothing
b. Tied shoes to promote stability
c. Velcro clothing, slip-on shoes and rubber grippers
d. Buttoned clothing, slip-on shoes and rubber grippers
26. A client with osteoarthritis is refusing to perform her own daily care. Which of the following
approaches would be most appropriate to use with this clients?
a. Perform the care for the client
b. Explain that she needs to maintain complete independence
c. Encourage her to perform as much care as her pain will allow.
d. Tell her that once she’s completed her care, she’ll receive her pain medication.
27. Client in the late stages of osteoarthritis often use which of the following terms to describe joint
pain?
a. Grating
b. Dull ache
c. Deep aching pain
d. Deep aching, relieved with rest
28. A client uses a cane for assistance in walking. Which of the following statements is true about a
cane or other assistive devices?
a. A walker is a better choice that a cane
b. The cane should be used on the affected side
c. The cane should be used on the unaffected side
d. A client with osteoarthritis should be encouraged to ambulate without the cane.
29. Which of the following pinstructons about activity should be given to a client with osteoarthritis
after he returns home?
a. “Learn to pace activity”
b. “Remain as sedentary as possible”
c. “Return to a normal level of activity”
d. “Include vigorous exercise in your daily routine”
30. A client was prescribed an anti-inflammatory drug for osteoarthritis 5 days ago. He says the pain
has decreased some but not completely. Which of the following nursing interventions would be
the most appropriate?
a. Continue the present dose and offer other pain measures.
b. Notify the physician and suggest increasing the dose
c. Notify the physician and suggest stopping the medication.
d. Notify the physician and suggest adding another medication.
31. A client was diagnosed with a herniated nucleus pulposus or herniated disk. Which of the
following statements about a herniated disk is correct?
a. The disk slips out of alignment.
b. The disk shatters, and fragments place pressure on nerve roots
c. The nucleus tissue itself remains centralized and the surrounding tissue is displaced.
d. The nucleus of the disk puts pressure on the annulus, causing pressure on the nerve root.
32. Which of the following symptoms would occur with a herniated nucleus pulposus?
a. Pain, numbness, weakness, leg or foot pain.
b. Shortness of breath, weakness, leg or foot pain.
c. Inability to walk shortness of breath, weakness, leg or foot pain
d. Unstable gait, disorientation, numbness, weakness, leg or foot pain.
33. Conservative treatment of a herniated nucleus pulposus would include which of the following
measures?
a. Surgery
b. Bone fusion
c. Bed rest, pain medication, physiotherapy
d. Strenuous exercise, pain medication, physiotherapy.
34. Closed spine surgery is a new technique to fix a herniated disk. Which of the following
statements is true about closed spine surgery?
a. There is a greater associated risk.
b. Intense physical therapy is needed
c. An endoscope is used to perform the surgery.
d. Recovery time is twice as long as with open spine surgery.
35. Which of the following descriptions best identifies the position of an intervertebral disk?
a. Encloses the annulus fibrosus
b. Surrounds the nucleus pulposus
c. Located between the vertebrae and the spinal column
d. Located between the spinal nerves in the vertebral column
36. Herniation of a vertebral disk can occur under which of the following conditions?
a. Major trauma or stress
b. Minor trauma or stress
c. With a history of back problems
d. Either major or minor trauma or stress
37. Which of the following areas of vertebral herniation is the most common?
a. L1-L2, L4-L5
b. L1-L2, L5-S1
c. L4-L5, L5-S1
d. L5-S1, S2-S3
38. Which of the following tests may be used to diagnose a herniated nucleus pulposus?
a. Chest X-ray, magnetic resonance imaging, CT Scan
b. Lumbar puncture, Chest X-ray, myelography
c. Myelography, MRI, CT Scan
d. Lumbar puncture, chest X-ray, myelography
39. Which of the following instructions would be included when teaching a client how to protect his
back?
a. “Sleep on your side, and carry objects at arm’s length.”
b. “Sleep on your back, and carry objects at arm’s length”
c. “Sleep on your side and carry objects close to your body”
d. “Sleep on your back, and carry objects close to your body”
40. Skeletal muscle relaxants may be used in the acute treatment of herniated nucleus pulposus.
Which of the following instructions should be included in client teaching?
a. “Change your position quickly to avoid dizziness”
b. “Double a missed dose to ensure proper muscle relaxation”
c. “cough and colds medications are appropriate to take if needed”
d. “Avoid activities that require alertness; muscle relaxants can cause drowsiness”
41. A client with a recent fracture is suspected of having compartment syndrome. Assessment
findings may include which of the following symptoms?
a. Body-wide decrease in bone mass
b. A growth in and around the bone tissue
c. Inability to perform active movement; pain with passive movement
d. Inability to perform passive movement; pain with active movement
42. Compartment syndrome occurs under which of the following conditions?
a. Increase in scar tissue
b. Increase in bone mass
c. Decrease in bone mass
d. Hemorrhage into the muscle
43. The hemorrhage that occurs in compartment syndrome causes which of the following
symptoms?
a. Edema
b. Decreased venous pressure
c. Increased venous circulation
d. Increased arterial circulation
44. In compartment syndrome, how long would it take for tissue death to occur?
a. 2 to 4 hours
b. 6 to 8 hours
c. 24 hours
d. 72 hours
45. Treatment of compartment syndrome includes which of the following measures?
a. A,putation
b. Casting
c. Fasciotomy
d. Observation, no treatment is necessary
46. A client is admitted to the emergency department with a foot fracture. Which of the following
reasons explains why the foot is placed in a brace?
a. To act as a splint
b. To prevent infection
c. To allow for movement
d. To encourage direct contact
47. After treatment of compartment syndrome, a client reports experiencing paresthesia. Which of
the following symptoms would be seen with paresthesia?
a. Fever and chills
b. Change in range of motion
c. Pain and blanching
d. Numbness and tingling
48. Which of the following characteristics of the fascia can cause it to develop compartment
syndrome?
a. It’s highly flexible
b. It’s fragile and weak
c. It’s unable to expand
d. It’s the only tissue within the compartment
49. Compartment syndrome can occur from which of the following conditions?
a. Internal pressure
b. External pressure
c. Increased blood pressure
d. Internal and external pressure
50. Which of the following symptoms is an early sign of compartment syndrome?
a. Heat
b. Paresthesia
c. Skin pallor
d. Swelling
51. Which of the following symptoms are considered a sign of fracture?
a. Tingling, coolness, loss of pulses
b. Loss of sensation, redness, coolness
c. Coolness, redness, new site of pain
d. Redness, warmth, pain at the site of injury
52. Which of the following areas would be included in a neurovascular assessment?
a. Orientation, movement, pulses, warmth
b. Capillary refill, movement, pulses, warmth
c. Orientation, pupillary response, temperature, pulses
d. Respiratory pattern, orientation, pulses, temperature
53. Which of the following methods is the correct way to assess limb circumference?
a. Use a measuring tape
b. Visually compare limbs bilaterally
c. Check the client’s medical history
d. Follow the standardized chart for limb circumference.
54. If pulses aren’t palpable, which of the following interventions should be performed first?
a. Check again in 1 hour
b. Alert the nurse in charge immediately
c. Verify the findings with Doppler ultrasonography
d. Alert the physician immediately
55. A client describes a foul odor from his cast. Which of the following responses or interventions
would be the most appropriate?
a. Assess further because this may be a sign of infection
b. Teach him proper cast care, including hygiene measure
c. This is normal, especially when a cast is place for a few weeks
d. Assess further because this may be a sign of neurovascular compromise
56. To reduce the roughness of a cast, which of the following measures should be used?
a. Petal the edges
b. Elevate the limb
c. Break off the rough area
d. Distribute pressure evenly
57. Elevating the limb with a cast will prevent swelling. Which of the following actions best
describes how this is done?
a. Place the limb with the cast close to the body
b. Place the limb with the cast at the level of the heart
c. Place the limb with the cast below the level of the heart
d. Place the limb with the cast above the level of the heart
58. A client asks why a cast can’t get wet. Which of the following responses would be the most
appropriate?
a. A wet cast can cause a foul odor
b. A wet cast will weaken or be destroyed
c. A wet cast is heavy and difficult to maneuver
d. It’s alright to get the cast wet, just use a hair dryer to dry it off.
59. A client comes to the emergency department complaining of dull, deep bone pain unrelated to
movement. Which of the following statement is correct to help decide if the bone pain is caused
by a fracture?
a. These are classic symptoms of a fracture.
b. Fracture pain is sharp and related to movement.
c. Fracture pain is sharp and unrelated to movement.
d. Fracture pain is dull and deep related to movement.
60. Which of the following fractures is classic for occurring from trauma?
a. Brachial and clavicle
b. Brachial and humerus
c. Humerus and clavicle
d. Occipital and humerus
61. Which of the following characteristics applies to a closed fracture?
a. Extensive tissue damage
b. Increased risk of infection
c. Same as for a compound fracture
d. Intact skin over the fracture site
62. A client is put in traction before surgery. Which of the following reasons for the traction is
correct?
a. Prevents skin breakdown
b. Aids in turning the client
c. Helps the client become active
d. Prevents trauma and overcomes muscle spasm
63. When the fracture line is straight across the bone, the fracture is known as which of the
following types?
a. Linear
b. Longitudinal
c. Oblique
d. Transverse
64. Which of the following fractures commonly occurs with such bone diseases as osteomalacia and
Paget’s disease?
a. Linear
b. Longitudinal
c. Oblique
d. Transverse
65. Which of the following fractures is commonly seen in the upper extremeties and is related to
physical abuse?
a. Linear
b. Longitudinal
c. Spiral
d. Transverse
66. Which of the following mechanisms or conditions causes healing of a fracture?
a. Scar tissue
b. Displacement
c. Necrotic tissue formation
d. Formation of new bone tissue
67. Which of the following conditions is a serious complication of a femoral shaft fracture?
a. Constipation
b. Decreased urine output
c. Hemorrhage
d. Pain
68. Which of the following serious complications can occur with long bone fractures?
a. Bone emboli
b. Fat emboli
c. Platelet emboli
d. Serous emboli
69. Which of the following signs and symptoms can occur with fat emboli?
a. Tachypnea, tachycardia, shortness of breath, paresthesia
b. Paresthesia, bradypnea, bradycardia, petechial rash on chest and neck
c. Bradypnea, bradycardia, shortness of breath, petechial rash on chest and neck
d. Tachypnea, tachycardia, shortness of breath, petechial rash on chest and neck
70. Treatment of a fat embolus may include which of the following therapies?
a. Albuterol, oxygen, IV fluids, steroids
b. Oxygen, IV fluids, steroids, antibiotics
c. Morphine, oxygen, IV fluids, antibiotics
d. Theophylline, morphine, oxygen, IV fluids
71. A high protein diet is ordered for a client recovering from fracture. High protein is ordered for
which of the following reasons?
a. Protein promotes gluconeogenesis
b. Protein has anti-inflammatory properties
c. Protein promotes cell growth and bone union
d. Protein decreases pain medication requirements.
72. Which of the following weights is commonly applied to an extremity for Buck’s traction in an
adult?
a. 1 to 2 lb
b. 1 to 5 lb
c. 5 to 7 lb
d. 8 to 10 lb
73. Which of the following types of traction is used for leg traction?
a. Bryant’s traction
b. Buck’s traction
c. Pelvic belt
d. Russell traction
74. Vitamin D intake is important in the healing of fractures for which of the following reasons?
a. It reduces the excretion of calcium and phosphorous
b. It increases the excretion of calcium and phosphorous
c. It reduces the absorption and use of calcium and phosphorous
d. It increases the absorption and use of calcium and phosphorous
75. After surgical repair of a hip, which of the following positions is best for the client’s legs and
hips?
a. Abduction
b. Adduction
c. Prone
d. Subluxated
76. After a hip replacement, which of the following activity levels is usually ordered?
a. Bed rest
b. No restrictions
c. No weight bearing
d. Limited weight bearing
77. Which of the following interventions would help prevent deep vein thrombosis after hip
surgery?
a. Bed rest
b. Egg crate mattress
c. Vigorous pulmonary care
d. Subcutaneous heparin and pneumatic compression boots
78. Which of the following discharge instructions should be given to a client after surgery or repair
of a hip fracture?
a. “Don’t flex the hip more than 30 degrees, don’t cross your legs, get help putting on your
shoes.”
b. “Don’t flex the hip more than 60 degrees, don’t cross your legs, get help putting on your
shoes.”
c. “Don’t flex the hip more than 90 degrees, don’t cross your legs, get help putting on your
shoes.”
d. “Don’t flex the hip more than 120 degrees, don’t cross your legs, get help putting on your
shoes.”
79. At the scene of an accident, which of the following interventions applies to a client with
suspected fracture?
a. Don’t move the client.
b. Move the client to safety immediately.
c. Sit the client up to facilitate his airway.
d. Immobilize the extremity, and move the client to safety
80. Which of the following statements is true about fracture reduction?
a. All fractures can be reduced.
b. Fracture reduction restores alignment
c. Nondisplaced fractures may be reduced
d. Fracture reduction is usually performed with minimal discomfort
81. A client with a right hip fracture is complaining of left sided leg pain and edema and has a
positive Homan’s sign. Which of the following conditions would show those symptoms?
a. Deep vein thrombosis (DVT)
b. Fat emboli
c. Infection
d. Pulmonary embolism
82. Which of the following nursing interventions is appropriate for a client in traction?
a. Assess the pin sites every shift and as needed.
b. Add and remove weights as the client wants.
c. Make sure the knots in the rope catch on the pulley
d. Give range of motion to all joints
83. After helping the physician apply a cast, which of the following nursing interventions is included
in the immediate cast care?
a. Rets the cast on the bedside table
b. Dispose of the plaster water in the sink.
c. Support the cast with the palms of the hands.
d. Wait until the cast dries before cleaning the surrounding skin.
84. Synthetic cast take approximately how long to set?
a. Immediately
b. 30minutes
c. 45 minutes
d. 2 hours
85. As a cast is drying, a client complains of heat from the cast. Which of the following interventions
is the most appropriate?
a. Remove the cast immediately
b. Explain this is a normal sensation
c. Notify the physician
d. Assess the client for other signs of infection
86. To prevent foot drop in a leg with a cast, which of the following interventions is appropriate?
a. Encourage bedrest
b. Support the foot with 45 degrees of flexion
c. Support the foot with 90 degrees of flexion
d. Place a stocking on the foot to provide warmth.
87. A client with a hip-spica cast should avoid gas forming foods. Which of the following rationales
best explains why?
a. To prevent flatus
b. To prevent diarrhea
c. To prevent constipation
d. To prevent abdominal distention
88. Which of the following descriptions of touch down weight bearing is correct?
a. Full weight bearing on affected extremity
b. 30% to 50% weight bearing on the affected extremity
c. No weight on the extremity, but may touch the floor with it.
d. No weight on the extremity, and keep it elevated at all times.
89. Which of the following interventions is the most effective way to prevent sports-related
injuries?
a. Warming up
b. Pacing the activity
c. Building strength
d. Working with moderate intensity
90. Which of the following tissues forms new tissue after an injury instead of scar tissue?
a. Bone tissue
b. Brain tissue
c. Kidney tissue
d. Liver tissue
91. Which of the following reactions is not an immune reaction to injury?
a. Tumor growth at a long bone fracture
b. Swelling and redness at the site of a cut
c. Torn ligament with exudate below the torn ends
d. Necrotic tissue with mast cells at the fracture site
92. Which of the following statements explains an open reduction of a fractured femur?
a. Traction will be used
b. A cast will be applied
c. Crutches will be used after surgery.
d. Some form of screw, plate, nail, or wire is usually used to maintain alignment.
93. Dislocation of the hip includes which of the following symptoms?
a. Pain relieved with pressure
b. Pain in the inguinal area, abnormal gait
c. Internal rotation of the knee, abduction of the leg.
d. Pain in the hip, the thigh appears longer than the unaffected leg.
 94. A 20-year old client developed osteomyelitis 2 weeks after a fish hook was removed from his
foot. Which of the following rationales best explains the expected long term antibiotic therapy
needed?
a. Bone has poor circulation
b. Tissue trauma requires antibiotics
c. Feet are normally more difficult to treat
d. Fish hook injuries are highly contaminated.
95. Degenerative joint disease also commonly known as osteoarthritis is a term describing which of
the following conditions?
a. Noninflammatory joint disease
b. Immune-mediated joint disease
c. Joint inflammation after a viral infection
d. Joint inflammation related to systemic infections
96. Client education about gout includes which of the following information?
a. Good foot care will reduce complications
b. Increased dietary intake of purine is needed.
c. Production of uric acid in the kidney affects joints
d. Uric acid crystals cause inflammatory destruction of the joint.
97. If IV antibiotics don’t eliminate osteomyelitis, which of the following treatments is most
commonly used next?
a. Bone grafts
b. Hyperbaric oxygen therapy
c. Amputation of the extremity
d. Debridement of necrotic tissue
98. Osteomyelitis most commonly results from which of the following mechanisms?
a. Immune suppression
b. IV drug use
c. Surgery
d. Trauma
99. Nursing intervention to treat a musculoskeletal injury may include cold or heat therapy. Cold
therapy decreases pain by which of the following actions?
a. Promotes analgesia and circulation
b. Numbs the nerves and dilates the vessels
c. Promotes circulation and reduces muscle spasm
d. Causes local vasoconstriction and prevents edema or muscle spasm.
100. What discharge information should be given to a client with cast?
a. “Use powder under the cast as needed”
b. “Itching under the cast indicates infection”
c. “Keep the extremity in a dependent position”
d. ”report fever and foul odors around the cast”

Prepared by:

STEVE M. ESTEBAN RN, MSN, MAN, LPT