NR511 CH15: Musculoskeletal Problems (practice)

During a sports preparticipation physical examination, when you ask the client to rise up on his toes and raise his heels, you are observing for: A. Calf symmetry and leg strength. B. Hip, knee, and ankle symmetry. C. Hip, knee, and ankle motion. D. Scoliosis, hip motion, and hamstring tightness.

A

Jane, age 64, comes in for a visit. She has a cast on her right arm and tells you that she has a comminuted fracture of her radius. When she asks what that means, you tell her that in a comminuted fracture the: A. Bony fragments are in many pieces. B. Broken ends of the bone protrude through the soft tissues and skin. C. Bone breaks cleanly but does not penetrate the skin. D. Bone is crushed.

A

John, age 17, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago from improperly lifting heavy boxes. In discussing proper body mechanics with him to prevent future injuries, you tell him: A. "Bend your knees and face the object straight on." B. "Hold boxes away from your body at arm's length." C. "Bend and twist simultaneously as you lift." D. "Keep your feet firmly together."

A

Tara, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her? A. "Toe walking is considered normal until age 3." B. "Don't worry, she'll outgrow it." C. "Toe walking is normal until she starts kindergarten." D. "We should do further testing now."

A

When wrist and finger extension causes pain over the extensor carpi radialis brevis tendon, the extensor carpi radialis longus tendon, and the extensor digitorum communis, you would suspect: A. Tennis elbow. B. Golfer's elbow. C. De Quervain's disease. D. Intersection syndrome.

A

Carol, age 62, has swollen, bony proximal interphalangeal joints. You describe these as: A. Heberden's nodes. B. Bouchard's nodes. C. Osler's nodes. D. Murphy's nodes.

B

Cass, age 67, tells you that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows that it is caused by urate crystals that "get stuck in the joint and cause pain." Cass is on hydrochlorothiazide for management of her hypertension. You suspect a diagnosis of: A. Septic arthritis. B. Gout. C. Rheumatoid arthritis. D. Charcot neuro-osteoarthropathy.

B

Greg, age 26, runs marathons and frequently complains of painful contractions of his calf muscles after running. You attribute this to: A. Hypercalcemia. B. Hyponatremia. C. Heat exhaustion. D. Dehydration.

B

Jessie, age 49, states that she thinks she has rheumatoid arthritis. Before any diagnostic tests are ordered, you complete a physical examination and make a tentative diagnosis of osteoarthritis rather than rheumatoid arthritis. Which clinical manifestation rules out rheumatoid arthritis? A. Fatigue B. Affected joints are swollen, cool, and hard on palpation C. Decreased range of motion D. Stiffness

B

Mike, a golf pro, has had chronic back pain for many years. His work-up reveals that it is not the result of a degenerative disk problem. His back "goes out" about twice a year, and he is out of work for about a week each time. Which of the following should you advise him to do? A. Consider changing careers to a less physical job. B. Begin a planned exercise program to strengthen back muscles. C. Make an appointment with a neurosurgeon for a surgical consultation. D. Start a daily low-dose narcotic to take away the pain

B

Mr. McKinsey was recently given a diagnosis of degenerative joint disease. Which assessment test would you use to check for effusion on his knee? A. Thomas test B. Tinel's sign C. Bulge test D. Phalen's test

C

Mr. Miller is a 72-year-old African American with type 1 diabetes mellitus. He has been a chronic smoker for 50 years. He has been told recently that he must have an above-the-knee amputation because of a gangrenous foot. He has lost the will to live and states, "They shoot horses, don't they?" How do you respond? A. "You should be thankful they can save your life if not your leg." B. "Your wife needs you; you must think of her at this time." C. "How do you feel this surgery will affect you?" D. "I will stay with you before, during, and after the surgery, because I know that this is a difficult time for you."

C

Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to: A. Refer her to a hand surgeon. B. Take a more complete history. C. Try neutral position wrist splinting and order an oral NSAID. D. Order a nerve conduction study such as an electromyography.

C

Steve, age 15, has only one testicle. When he asks you if he can play on the soccer team at school, how do you respond? A. "No, you'd be taking too much of a chance of injuring your remaining testicle." B. "You can play any noncontact sport; however, soccer is too strenuous." C. "As long as you can protect the remaining testicle, go for it." D. "It should have no bearing on any activity."

C

When you elicit a painful Finkelstein's test, you are testing for: A. Carpal tunnel syndrome. B. Bursitis of the shoulder. C. De Quervain's tenosynovitis. D. Tennis elbow.

C

Which test is used to diagnose an Achilles tendon rupture? A. Boutonniere test B. Lachman test C. Thompson test D. Drawer test

C

For your client with a knee injury, you order an NSAID to be taken on a routine basis for the next 2 weeks. Your teaching should include which of the following? A. "You may take this medication on an empty stomach as long as you eat within 2 to 3 hours of taking it." B. "If one pill does not seem to help, you can double the dose for subsequent doses." C. "If you notice nausea/vomiting or black or bloody stools, take the next dose with a glass of milk or a full meal." D. "If you have additional pain, an occasional acetaminophen (Tylenol) is permitted in between the usual doses of the NSAID."

D

Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? A. Order physical therapy. B. Order a lumbar/sacral x-ray. C. Order extensive laboratory work. D. Refer to a neurosurgeon

D

You are assessing Maya, a 69-year-old Asian woman, for the first time. You are trying to differentiate between scoliosis and kyphosis. Kyphosis involves: A. Asymmetry of the shoulders, scapulae, and waist creases. B. A lateral curvature and vertebral rotation on posteroanterior x-rays. C. One leg appearing shorter than the other. D. A posterior rounding at the thoracic level.

D

You suspect Sarah, age 72, has a herniated disk. You elevate her affected leg when she is in the supine position, and doing so elicits back pain and sciatic nerve pain, which indicates a positive test. This is known as which test or sign? A. Femoral stretch test B. Cross straight-leg-raising test C. Doorbell sign D. Straight leg raising test

D