Musculoskeletal #2 (Fitzgerald)
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
For a patient with a suspected meniscal tear that is not revealed on a knee radiograph, the preferred next step is: A. an MRI. B. a computed tomography (CT) scan. C. arthroscopy. D. to consider an alternative diagnosis as meniscal tear is unlikely.
A
In counseling a postmenopausal woman, you advise her that systemic estrogen therapy users can possibly experience: A. an increase in breast cancer rates with long-term use. B. reduction in high-density lipoprotein cholesterol. C. a 10% increase in bone mass. D. no change in the occurrence of osteoporosis.
A
Long-term bisphosphonate treatment (i.e., >5 years) has been associated with: A. atypical fractures. B. hyperprolactinemia. C. osteoarthritis. D. bone marrow suppression.
A
The Phalen test is described as: A. reproduction of symptoms with forced flexion of the wrists. B. abnormal tingling when the median nerve is tapped. C. pain on internal rotation. D. palmar atrophy.
A
The most common type of injury causing a sport-related meniscal tear involves: A. twisting of the knee. B. hyperextension of the knee. C. repetitive hard impact on the knee (i.e., running on hard surface). D. an unknown origin in most cases.
A
Which of the following is least likely to be reported by patients with CTS? A. worst symptoms during the day B. burning sensation in the affected hand C. tingling pain that radiates to the forearm D. nocturnal numbness
A
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
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
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 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 or both legs. D. pain at its worst when in sitting position.
B
Initial therapy for patients with CTS includes: A. intra-articular injection. B. joint splinting. C. systemic corticosteroids. D. referral for surgery.
B
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
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
The Tinel test is best described as: A. reproduction of symptoms with forced flexion of the wrists. B. abnormal tingling when the median nerve is tapped. C. pain on internal rotation. D. palmar atrophy.
B
The bisphosphonate therapy given as an annual infusion is: A. risedronate. B. zoledronic acid. C. ibandronate. D. denosumab.
B
The preferred screening test for osteoporosis is: A. quantitative ultrasound measurement. B. dual-energy x-ray absorptiometry. C. qualitative CT. D. wrist, spine, and hip radiographs.
B
To help prevent meniscal tear, you advise: A. limiting participation in sports. B. quadriceps-strengthening exercises. C. using a knee brace. D. applying ice to the knee before exercise.
B
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
Which of the following patients would be an appropriate candidate for treatment with teriparatide (Forteo®)? A. a 54-year-old woman with osteopenia B. a 64-year-old woman with bone mineral density (BMD) T-score of -2.5 and prior hip fracture C. a 67-year-old man with a BMD T-score of -1 D. a 72-year-old woman who has a stable BMD T-score of -1.5 with bisphosphonate treatment for the past 3 years
B
You see a 54-year-old man complaining of low back pain and who 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
A 32-year-old male with a meniscal tear shows no improvement after 4 weeks of non-pharmacologic approaches. He also complains of joint locking and effusion. An appropriate next course of action for this patient is: A. corticosteroid injection. B. fentanyl patch. C. arthroscopy with débridement and repair. D. to watch and wait an additional 4 weeks.
C
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
Acroparesthesia, frequently reported in patients with CTS, is best described as: A. constant pain radiating from the elbow. B. a transient inability to move the fingers. C. waking up at night with numbness and burning pain in the fingers. D. muscle spasms that cause fist clenching.
C
All of the following are common signs of osteoporosis except: A. gradual loss of height with stooped posture. B. hip or wrist fracture. C. increase in waist circumference. D. patient report of back pain.
C
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
Loss of posterior tibial reflex often indicates a lesion at: A. L3. B. L4. C. L5. D. S1.
C
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
Nondairy sources of calcium include all of the following except: A. tofu. B. spinach. C. brown rice. D. sardines.
C
Osteoporosis is defined as having a bone density more than standard deviation(s) below the average bone mass for a healthy young adult. A.1 B. 1.5 C. 2.5 D.4
C
Osteoporosis prevention measures include all of the following except: A. calcium supplementation. B. selective estrogen receptor modulator use. C. vitamin B6 supplementation. D. weight-bearing and muscle-strengthening exercises.
C
Patients whose CTS fails to respond to conservative treatment measures should be considered for: A. systemic corticosteroid use. B. low-dose opioids. C. surgery. D. vitamin B6 injections in the carpal tunnel.
C
Primary prevention of CTS includes: A. screening of thyroid dysfunction. B. treatment of concomitant arthritis forms. C. stretching and toning exercises. D. wrist splinting.
C
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 S1 and S1 to S2.
C
The use of calcitonin to treat osteoporosis has been associated with an increased risk of: A. type 2 diabetes. B. rheumatoid arthritis. C. malignancy. D. systemic lupus erythematosus.
C
What is the recommended daily calcium intake for women older than 50 years of age? A. 800 mg B. 1000 mg C. 1200 mg D. 1500 mg
C
Which of the following best describes the presentation of a patient with complete medial meniscus tear? A. joint effusion B. heat over the knee C. inability to kneel D. loss of smooth joint movement
C
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
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
With the straight-leg-raising 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
All of the following statements about electromyography (EMG) are true except: A. EMG measures electrical impulses caused by muscles. B. diagnosis of carpal tunnel syndrome involves com- paring EMG results of the muscles at rest versus contraction. C. EMG can detect muscle damage. D. EMG involves sending a small electrical impulse through the muscle tissue.
D
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
Common causes of sciatica include all of the following except: A. herniated disk. B. spinal stenosis. C. compression fracture. D. soft tissue abnormality.
D
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 neurological deficits. C. presence of risk factors for cancer. D. presence of moderate pain lasting at least 2 weeks.
D
Initial treatment for meniscal tear includes all of the following except: A. NSAID use. B. applying ice to the affected area. C. elevation of the affected limb. D. joint aspiration of the affected knee.
D
Results of a nerve conduction study in a person with carpal tunnel syndrome (CTS) would reveal: A. erratic nerve impulses during forearm muscle contraction. B. a lack of nerve impulses in the carpal tunnel. C. continued firing of the median nerve while the forearm muscles are at rest. D. a slowing of nerve impulses in the carpal tunnel.
D
Risk factors for CTS include all of the following except: A. pregnancy. B. untreated hypothyroidism. C. repetitive motion. D. multiple sclerosis.
D
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
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
When counseling a patient taking a bisphosphonate such as alendronate (Fosamax®), you advise that the medication should be taken with: A. a bedtime snack. B. a meal. C. other medications. D. a large glass of water.
D
You see a 37-year-old man complaining of low back pain consisting of stiffness and spasms but without any sign of neurological 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. bedrest for at least 5 days.
D
Osteoporosis is more common in individuals: A. with type 2 diabetes mellitus. B. on long-term systemic corticosteroid therapy. C. who are obese. D. of African ancestry.
b
Clinical disorders that increase the risk for osteoporosis include all of the following except: A. rheumatoid arthritis. B. celiac disease. C. hyperlipidemia. D. hyperprolactinemia.
c
All of the following are common sites of fracture in patients with osteoporosis except: A. the proximal femur. B. the distal forearm. C. the vertebrae. D. the clavicle.
d