American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the condition where pain is aggravated by sitting or lying down, particularly on hard surfaces?

1. Piriformis syndrome

2. Ischial bursitis

3. Trochanteric bursitis

4. Patellar tendinitis

The correct answer is: Ischial bursitis

Ischial bursitis is characterized by pain that is aggravated by sitting or lying down, particularly on hard surfaces. This condition involves inflammation of the bursa located near the ischial tuberosity, the bony prominence of the pelvis where a person sits. The pain typically occurs when pressure is applied to the affected area, which is why prolonged sitting, especially on hard surfaces, exacerbates discomfort. Patients often report pain when transitioning from sitting to standing or during activities that involve sitting for extended periods. Understanding the anatomy and the mechanism of symptom exacerbation helps in recognizing ischial bursitis as a significant contributor to pain in scenarios involving pressure on the buttocks. In contrast, other conditions listed, such as piriformis syndrome, typically involves sciatica-like pain due to irritation of the sciatic nerve, trochanteric bursitis generally presents with lateral hip pain aggravated by activities like walking or climbing stairs, and patellar tendinitis primarily affects the knee region and is related to activities involving jumping or running rather than seated positions.