Musculoskeletal

For a Grade I ankle sprain, weight-bearing should be avoided for at least: a. 24 hours b. 72 hours c. 1 week d. until full ROM is restored.

a. 24 hours

X-rays will fail to show changes in affected joints in approximately what percent of patients with RA at disease onset? a. 30% b. 50% c. 75% d. 95%

a. 30%

Which test is demonstrated when the examiner applies pressure to the top of the head with the neck bending forward, producing pain or numbness in the upper extremities? a. Spurling. b. McMurray. c. Lachman. d. Newman.

a. Spurling.

Taking a high dose of aspirin or ibuprofen causes: a. an increase in the drug's half-life b. enhanced renal excretion of the drug c. a change in the drug's mechanism of action d. a reduction of antiprostaglandin effect

a. an increase in the drug's half-life

Long-term effects of SLE can include all of the following except: a. birth defects when occurring in a pregnant female. b. kidney failure. c. avascular necrosis. d. pericarditis.

a. birth defects when occurring in a pregnant female.

First-line therapy for prepatellar bursitis should include: a. bursal aspiration. b. intrabursal corticosteroid injection. c. acetaminophen. d. knee splinting.

a. bursal aspiration.

You see a 48-year-old woman who reports low back pain. During the evaluation, she mentions new-onset loss of bowel and bladder control. This most likely indicates: a. cauda equina syndrome b. muscular spasm c. vertebral fracture d. sciatic nerve entrapment

a. cauda equina syndrome

Which of the following special examinations should be periodically obtained during hydroxychloroquine sulfate use? a. dilated eye retinal exam. b. bone marrow biopsy. c. pulmonary function tests. d. exercises tolerance test.

a. dilated eye retinal exam.

Which of the following tests is most specific to the diagnosis of RA? a. elevated levels of rheumatoid factor. b. abnormally high ESR. c. leukopenia. d. positive ANA titer.

a. elevated levels of rheumatoid factor.

Patient with gluteus medius or deep trochanteric bursitis typically present with: a. increased pain from resisted hip abduction. b. limited hip ROM. c. sciatic nerve pain. d. heat over the affected area.

a. increased pain from resisted hip abduction.

Cyclooxygenase-2 (COX-2) contributes to all of the following except: a. inflammatory response. b. pain transmission. c. maintenance of gastric protective mucosal layer. d. renal arteriole function.

a. inflammatory response.

Which of the following statements is most accurate concerning RA? a. joint erosions are often evident on radiographs or MRI. b. RA is seldom associated with other autoimmune diseases. c. a butterfly-shaped facial rash is common. d. parvovirus B19 infection can contribute to its development.

a. joint erosions are often evident on radiographs or MRI.

Early neurological changes in patients with lumbar radiculopathy include: a. loss of deep tendon reflexes b. poor two-point discrimination c. reduced muscle strength d. footdrop

a. loss of deep tendon reflexes

Criteria favoring hip replacement surgery for a patient with OA should include all of the following except: a. pain control requires daily use of NSAID therapy. b. >80% of articular cartilage is worn away. c. physical functioning is severely compromised. d. patient can tolerate the surgical procedure and rehabilitation.

a. pain control requires daily use of NSAID therapy.

Criteria favoring knee replacement surgery for a patient with OA should include all of the following except: a. pain control requires daily use of NSAID therapy. b. >80% of articular cartilage is worn away. c. physical functioning is severely compromised. d. patient can tolerate the surgical procedure and rehabilitation.

a. pain control requires daily use of NSAID therapy.

Clinical conditions with a presentation similar to acute bursitis include which of the following? (select all that apply) a. rheumatoid arthitis. b. septic arthritis. c. joint trauma. d. pseudogout.

a. rheumatoid arthitis. b. septic arthritis. c. joint trauma. d. pseudogout.

Recommended exercises for patients with OA of the knee include all of the following except: a. squatting with light weights. b. straight-leg raises without weights. c. quadriceps sets. d. limited weight-bearing aerobic exercises.

a. squatting with light weights.

Patient with olecranon bursitis typically present with: a. swelling and redness over the affected area. b. limited elbow range of motion (ROM). c. nerve impingement. d. destruction of the joint space.

a. swelling and redness over the affected area.

Common physical findings of SLE include all of the following except: a. weight gain. b. joint pain and swelling. c. fatigue. d. facial rash.

a. weight gain.

Changes to the joint during OA can typically include all of the following except: a. widening of the joint space. b. wearing away of articular cartilage. c. formation of bone spurs. d. synovial membrane thickens.

a. widening of the joint space.

Which of the following best describes the presentation of a patient with OA? a. worse symptoms in weight-bearing joints later in the day. b. symmetrical early morning stiffness. c. sausage-shaped digits with associate skin lesions. d. back pain with rest and anterior uveitis.

a. worse symptoms in weight-bearing joints later in the day.

Approximately what percentage of patients with radiological findings of OA of the knee will report having symptoms? a. 25%. b. 50%. c. 70%. d. 95%.

b. 50%.

Deformity of the proximal interphalangeal joints found in an elderly patient with OA is known as: a. Heberden nodes. b. Bouchard nodes. c. hallus valgus. d. Dupuytren contracture.

b. Bouchard nodes.

A positive ANA test is a sensitive marker for the presence of: a. hyperparathyroidism. b. SLE. c. Kawasaki disease. d. leukocytosis.

b. SLE.

A lumbosacral x-ray would be most helpful to aid in the diagnosis of new-onset low back pain in which of the following individuals? a. a 49-year-old man 1 day after performing rigorous yard work. b. a 52-year-old woman who slipped on an icy sidewalk. c. a 54-year-old obese man who reports pain radiating to the buttocks. d. a 64-year-old woman reporting pain after attempting to lift her grandson.

b. a 52-year-old woman who slipped on an icy sidewalk.

Risk factors for lumbar radiculopathy include all of the following except: a. male gender. b. age <50 years. c. being overweight. d. cigarette smoking.

b. age <50 years.

You see a 67-year-old woman who has been treated for pain due to OA for the hip for the past 6 months and who asks about hip replacement surgery. She complains of pain even at night when sleeping and avoids walking even moderate distances unless absolutely necessary. In counseling the patient, you mention all of the following except: a. arthroplasty can be considered when pain is not adequately controlled. b. arthroplasty is not needed if the patient can walk even short distances. c. arthroplasty candidates must be able to tolerate a long surgical procedure. d. rehabilitation following surgery is essential to achieve maximal function of the joint.

b. arthroplasty is not needed if the patient can walk even short distances.

You see a 54-year-old man complaining of low back pain and is diagnosed with acute lumbosacral strain. Which of the following is the best advice to give about exercising? a. you should not exercise until you are free of pain b. back-strengthening exercises can cause mild muscle soreness c. electric-like pain in response to exercise is to be expected d. conditioning exercises should be started immediately

b. back-strengthening exercises can cause mild muscle soreness

An adverse effect associated with the use of glucosamine is: a. elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST). b. bronchospasm. c. increased bleeding risk. d. QT prolongation.

b. bronchospasm.

The leading cause of death among individuals with RA: a. infection. b. cardiovascular events. c. cancer. d. renal failure.

b. cardiovascular events.

Risk factors for the development of low back pain include all of the following except: a. older age. b. carpal tunnel syndrome. c. scoliosis. d. spinal stenosis.

b. carpal tunnel syndrome.

First-line treatment of SLE in a patient with mild symptoms is: a. systemic corticosteroids. b. hydroxychloroquine plus NSAIDs. c. anakinra. d. methotrexate.

b. hydroxychloroquine plus NSAIDs.

A significant adverse effect of biologic therapy (e.g., abatacept) for treating RA is: a. myopathy. b. infections. c. renal impairment. d. elevated liver enzymes.

b. infections.

The most common cause of acute bursitis is: a. inactivity. b. joint overuse. c. fibromyalgia. d. bacterial infection.

b. joint overuse.

Mrs. Sanchez is a 42-year-old mother of three who reports pain and stiffness in multiple joints that have lasted for more than 6 months. She is diagnosed with rheumatoid arthritis. She has no other clinical conditions of significance. You recommend which of the following treatments for first-line therapy? a. topical analgesics and oral NSAIDS b. methotrexate plus oral NSAIDS c. acetaminophen plus leflunomide d. anakinra and systemic corticosteroids

b. methotrexate plus oral NSAIDS

Risk factors for ankle sprain include all of the following except: a. poor conditioning. b. running on paved surfaces. c. inappropriate footwear. d. lack of a warm-up period prior to exercising.

b. running on paved surfaces.

A patient with a lumbosacral strain will typically report: a. numbness in the extremities. b. stiffness, spasm, and reduced ROM. c. "electric" sensation running down one of both legs. d. pain at its worst when in sitting position.

b. stiffness, spasm, and reduced ROM.

Which of the following best describes the presentation of a person with RA? a. worst symptoms in weight-bearing joints later in the day. b. symmetrical early-morning stiffness. c. sausage-shaped digits with characteristic skin lesions. d. back pain with rest and anterior events.

b. symmetrical early-morning stiffness.

When considering the use of muscle relaxants for treatment of low back pain in a 46-year-old construction worker, the NP advises all of the following except that: a. these agents have an abuse potential. b. these agents must be used consistently for at least 2 weeks before seeing peak effect. c. use at night can improve sleep. d. caution should be used when operating heavy machinery while taking these medications.

b. these agents must be used consistently for at least 2 weeks before seeing peak effect.

Serious adverse effects associated with the use of belimumab (Benlysta) include all of the following except: a. increased suicidal ideation. b. thrombocytopenia. c. progressive multifocal leukoencephalopathy. d. life-threatening infections.

b. thrombocytopenia.

Prior to initiating biologic therapy for a 50-year-old woman with RA, vaccination against all of the following is recommended except: a. pneumococcal disease. b. hepatitis B. c. Haemophilus influenzae type B. d. influenza.

c. Haemophilus influenzae type B.

Which of the following hemograms would be expected for a 46-year-old woman with poorly controlled RA? a. Hg=11.1 g/dL (12-14 g/dL); MCV=66 fL (80-96 fL); reticulocytes=0.8% (1%-2%) b. Hg=10.1 g/dL (12-14 g/dL); MCV=103 fL (80-96 fL); reticulocytes=1.2% (1%-2%) c. Hg=9.7 g/dL (12-14 g/dL); MCV=87 fL (80-96 fL); reticulocytes=0.8% (1%-2%) d. Hg=11.4 g/dL (12-14 g/dL); MCV=84 fL (80-96 fL); reticulocytes=2.3% (1%-2%)

c. Hg=9.7 g/dL (12-14 g/dL); MCV=87 fL (80-96 fL); reticulocytes=0.8% (1%-2%)

The most common sites for lumbar disk herniation are: a. L1 to L2 and L2 to L3. b. L2 to L3 and L4 to L5. c. L4 to L5 and L5 to S1. d. L5 to L1 and S1 to S2.

c. L4 to L5 and L5 to S1.

With the straight-leg test, the NP is evaluating tension on which of the following nerve roots? a. L1 and L2. b. L3 and L4. c. L5 and S1. d. S2 and S3.

c. L5 and S1.

Loss of Achilles tendon reflex most likely indicates a lesion at: a. L1 to L2. b. L3 to L4. c. L5 to S1. d. S2 to S3.

c. L5 to S1.

Loss of posterior tibial reflex often indicates a lesion at: a. L3. b. L4. c. L5. d. S1.

c. L5.

Which of the following tests yields the greatest amount of clinical information in a patient with acute lumbar radiculopathy? a. lumbosacral radiograph series. b. ESR measurement. c. MRI. d. bone scan.

c. MRI.

You see a 26-year-old woman who has been recently diagnosed with SLE and has initiated therapy to control moderate symptoms of the disease, including fatigue and joint pain. She mentions that she and her husband are hoping to start a family soon. In counseling her about pregnancy, you consider that: a. there is a low probability of conception during symptomatic flares of SLE b. most treatments for SLE must be discontinued once a woman becomes pregnant c. SLE is associated with a high risk of pregnancy loss d. there is a higher risk of gestational diabetes in women with SLE

c. SLE is associated with a high risk of pregnancy loss

A 52-year-old woman has RA. She now presents with decreased tearing, "gritty"-feeling eyes, and a dry mouth. You consider a diagnosis of: a. SLE. b. vasculitis. c. Sjogren syndrome. d. scleroderma.

c. Sjogren syndrome.

The American Academy of Orthopaedic Surgeouns (AAOS) favors all of the following in the management of symptomatic OA of the knee except: a. low-impact aerobic exercises. b. weight loss for those with a BMI >25. c. acupuncture. d. strengthening exercises.

c. acupuncture.

You see a 37 y/o man with RA who has been treated with hydroxychloroquine and oral NSAIDs for the past 3 months with little improvement in symptoms. Radiography indicates slight progression of RA in several major joints. You recommend: a. maintaining the current regimen. b. increasing the dose of NSAIDs. c. adding methotrexate to his regimen. d. switching from hydroxychloroquine to a biologic agent.

c. adding methotrexate to his regimen.

The most common site of sprain is the: a. wrist. b. shoulder. c. ankle. d. knee.

c. ankle.

A 72-year-old man presents at an early stage of OA in his left knee. He mentions that he heard about the benefits of using glucosamine and chondroitin for treating joint problems. In consulting the patient, you mention all of the following except: a. any benefit can take at least 3 months of consistent use before observed. b. glucosamine is not associated with any drug interactions. c. clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA of the knee. d. chondroitin should be used with caution because of its antiplatelet effect.

c. clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA of the knee.

RA disease progression is typically evaluated using all of the following approaches except: a. X-ray b. MRI c. echosonography d. ultrasound

c. echosonography

A short leg cast is often needed for what type of ankle sprain? a. grade I b. grade II c. grade III d. grade IV

c. grade III

Pharmacologic treatment of Sjogren syndrome can include all of the following except: a. NSAIDs. b. methotrexate. c. infliximab. d. hydroxychloroquine.

c. infliximab.

Patients with subscapular bursitis typically present with: a. limited shoulder ROM. b. heat over affected area. c. localized tenderness under the superomedial angle of the scapula. d. cervical nerve root irritation.

c. localized tenderness under the superomedial angle of the scapula.

Cyclooxygenase-1 (COX-1) contributes to: a. inflammatory response. b. pain transmission. c. maintenance of gastric protective mucosal layer. d. renal arteriole function.

c. maintenance of gastric protective mucosal layer.

A Grade II ankle sprain is best described as: a. minor swelling and minimal joint instability. b. moderate joint instability without swelling or ecchymosis. c. moderate swelling, mild to moderate ecchymosis, and moderate joint instability. d. complete ankle instability, significant swelling, and moderate to severe ecchymosis.

c. moderate swelling, mild to moderate ecchymosis, and moderate joint instability.

Most episodes of low back pain are caused by: a. an acute precipitating event b. disk herniation c. muscle or ligamentous strain d. nerve impingement

c. muscle or ligamentous strain

All of the following diagnostic findings are expected in a patient with SLE except: a. elevated ESR. b. anemia. c. negative ANA test. d. proteinuria.

c. negative ANA test.

As part of the evaluation of patients with OA, the NP anticipates finding: a. anemia of chronic disease. b. elevated CRP level. c. no disease-specific laboratory abnormalities. d. elevated antinuclear antibody (ANA) titer.

c. no disease-specific laboratory abnormalities.

Radiographic findings of OA of the knee often reveal: a. microfractures. b. decreased density of subchondral bone. c. osteophytes. d. no apparent changes to the joint structure.

c. osteophytes.

Which of the following is not characteristic of rheumatoid arthritis (RA)? a. it is more common in women than in men at a 3:1 ratio. b. family history of autoimmune conditions often is reported. c. peak age for disease onset in individuals is age 50 to 70 years. d. wrists, ankles, and toes often are involved.

c. peak age for disease onset in individuals is age 50 to 70 years.

In caring for a patient with OA of the knee, you advise that: a. straight-leg raising should be avoided. b. heat should be applied to painful joints after exercise. c. quadriceps-strengthening exercises should be performed. d. physical therapy should be avoided.

c. quadriceps-strengthening exercises should be performed.

A 46-year-old woman is diagnosed with SLE with reports of edema, severe headaches, and seizures, as well as anemia (Hgb=9.8 g/dL) and renal dysfunction (CrCl=62 mL/min). All of the following can be considered for treatment except: a. leflunomide. b. azathioprine. c. rituximab. d. belimumab.

c. rituximab.

A patient with sciatica will typically report: a. loss of bladder control. b. stiffness, spasm, and reduced ROM. c. shooting pain that starts at the hip and radiates to the foot. d. pain at its worst when lying down.

c. shooting pain that starts at the hip and radiates to the foot.

NSAIDS cause gastric injury primarily by: a. direct irritative effect b. slowing gastrointestinal motility c. thinning of the protective gastrointestinal mucosa d. enhancing prostaglandin synthesis

c. thinning of the protective gastrointestinal mucosa

Clinical findings of the knee in a patient with OA include all of the following except: a. coarse crepitus. b. joint effusion. c. warm joint. d. knee often locks or a pop is heard.

c. warm joint.

Which of the following non-pharmacologic methods is least helpful in preventing low back pain recurrence? a. low-impact aerobic exercises. b. toning exercises. c. weekly ice baths. d. massage therapy.

c. weekly ice baths.

Approximately what percentage of patients experiencing low back pain will have the symptoms resolve within 1 month without specific therapy? a. 33%. b. 57%. c. 78%. d. 90%.

d. 90%.

The most common site for cervical radiculopathy is: a. C3 to C4. b. C4 to C5. c. C5 to C6. d. C6 to C7.

d. C6 to C7.

First-line treatment options for bursitis usually include: a. corticosteroid bursal injection. b. heat to area. c. weight-bearing exercises. d. NSAIDs.

d. NSAIDs.

Of the following individuals, who is at highest risk for NSAID-induced gastropathy? a. a 28-year-old man with an ankle sprain who has taken ibuprofen for the past week and who drinks four to six beers every weekend. b. a 40-year-old woman who smokes and takes about six doses of naproxen sodium per month to control dysmenorrhea. c. a 43-year-old man with dilated cardiomyopathy who uses ketoprofen one to two times per week for low back pain. d. a 72-year-old man who takes aspirin four times a day for pain control of OA.

d. a 72-year-old man who takes aspirin four times a day for pain control of OA.

You see a 37-year-old man complaining of low back pain consisting of stiffness and spasms but without an sign of neurologic involvement. You recommend all of the following interventions except: a. application of cold packs for 20 minutes 3-4 times a day b. use of NSAIDS or acetaminophen for pain control c. initiation of aerobic and toning exercises d. bed rest for at least 5 days

d. bed rest for at least 5 days

Regarding the current scientific evidence on the use of glucosamine and chondroitin for the management of symptomatic OA of the knee, AAOS: a. strongly favors their use b. provides a moderate-strength recommendation for their use c. cannot recommend for or against the use of these supplements (limited evidence) d. cannot recommend the use of these supplements

d. cannot recommend the use of these supplements

A person with a Grade III ankle sprain presents with: a. minor swelling and minimal joint instability. b. moderate joint instability without swelling or ecchymosis. c. moderate swelling, mild to moderate ecchymosis, and moderate joint instability. d. complete ankle instability, significant swelling, and moderate to severe ecchymosis.

d. complete ankle instability, significant swelling, and moderate to severe ecchymosis.

Which of the following joints is most likely to be affected by OA? a. wrists. b. elbow. c. metacarpophalangeal joint. d. distal interphalangeal joint.

d. distal interphalangeal joint.

The mechanism of action of glucosamine and chondroitin is: a. via increased production of synovial fluid. b. through improved cartilage repair. c. via inhibition of the inflammatory response in the joint. d. largely unknown.

d. largely unknown.

Which of the following is usually not part of treatment of a sprain? a. immobilization. b. applying ice to the area. c. joint rest. d. local corticosteroid injection.

d. local corticosteroid injection.

Patients with a Grade III ankle sprain should be advised that full recovery is likely to take: a. a few days. b. 2 to 3 weeks. c. 4 to 6 weeks. d. many months.

d. many months.

Among surgical and procedural interventions, AAOS strongly recommends the use of which of the following for the management of symptomatic OA of the knee? a. intra-articular corticosteroid use b. hyaluronic acid injections c. arthroscopy with lavage and/or debridement d. none of the above

d. none of the above

Which of the following is the preferred method of preventing NSAID-induced gastric ulcer? a. a high-dose histamine 2 receptor antagonist. b. timed antacid use. c. sucralfate. d. omeprazole.

d. omeprazole.

When considering the use of opioids for low back pain, the NP considers all of the following except that: a. patients should be evaluated for abuse potential. b. common adverse effects include sedation and constipation. c. use should be limited to patients with severe pain or pain refractory to other medications. d. opioids should be combined with an NSAID for greatest effect.

d. opioids should be combined with an NSAID for greatest effect.

AAOS strongly recommends all of the following therapeutic agents for the management of symptomatic OA of the knee except: a. oral NSAIDS. b. topical NSAIDS. c. tramadol. d. opioids.

d. opioids.

Immediate diagnostic imaging for low back pain should be reserved for all of the following except: a. presence of signs of the cauda equina syndrome b. presence of severe neurologic deficits c. presence of risk factors for cancer d. presence of moderate pain lasting at least 2 weeks

d. presence of moderate pain lasting at least 2 weeks

Common causes of sciatica include all of the following except: a. herniated disk. b. spinal stenosis. c. compression fracture. d. soft tissue abnormality.

d. soft tissue abnormality.

Likely sequelae of intrabursal corticosteroid injection include: a. irreversible skins atrophy b. infection c. inflammatory reaction d. soreness at the site of injection

d. soreness at the site of injection

Recommended exercises for patients with OA of the hip include all of the following except: a. stretching exercises of the gluteus muscles. b. straight-leg raises without weights. c. isometric exercises of the iliopsoas and gluteus muscles. d. weight-bearing aerobic exercises.

d. weight-bearing aerobic exercises.