Musculoskeletal Problems-Chapter 16-Dunphy
A common cause of in-toeing in childhood is A. internal tibial torsion B. femoral retroversion C. external tibial torsion D. flat feet
A
Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest with her elbow flexed. Based on the specific location of her pain, you suspect a radial head fracture. The best initial strategy to assess for radial head fracture would be A. to palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle B. to palpate for tenderness, swelling, and crepitus along the radial wrist C. to palpate for tenderness in the "anatomical snuffbox" D. to order an x-ray of the wrist
A
Bone mineral density (BMD) testing is recommended by the National Osteoporosis Foundation for which of the following client populations to assess whether they are at high risk for osteoporosis? A. All women age 65 and older regardless of risk factors B. All men age 65 and older regardless of risk factors C. All women in their 30s for a baseline D. All women of menopausal age
A
Colchicine may be used to terminate an acute attack of gouty arthritis, as well as to prevent recurrent episodes. the mechanism of action is to: a. interrupt the cycle of urate crystal deposition and inflammatory response b. increase serum uric acid levels c. potentiate the excretion of uric acid d. inhibit the tubular reabsorption of urate, promoting the excretion of uric acid
A
Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct? A. Integumentary effects include swelling, erythema, and warmth at the involved site B. There is a low-grade fever with intermittent chills C. Musculoskeletal effects include tenderness of the entire leg D. CV effects include bradycardia
A
During a sports preparticipation physical examination, when the client is instructed to rise up on his toes and raise his heels, the NP is 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
During assessment of a client's foot, the NP notes that the foot is in alignment with the long axis of the lower leg and that weight-bearing falls on the middle of the foot, from the heel, along the midfoot, to between the second and third toes. These findings best describe A. a normal foot B. Hallux valgus C. Talipes equinovarus D. hammertoes
A
First-line drug therapy for acute low back pain includes the use of A. NSAIDs B. muscle relaxants C. opioids D. antidepressants
A
Gout is caused by urate crystals being deposited in certain joints leading to acute pain, erythema and edema. Gout typically occurs most often in the joint of the A. foot B. wrist C. elbow D. finger
A
In assessing the skeletal muscles, the NP turns the patient's forearm so that the palm is up. This is called A. supination B. pronation C. abduction D. eversion
A
James, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given the diagnosis of Osgood-Schlatter disease and ask you about his treatment options. You tell him the initial treatment is? A. relative rest; he could benefit from hamstring, heel cord, and quadricep stretching exercises B. immobilization; a long-leg knee immobilizer is recommended C. surgical intervention; removal of the bony fragments is necessary D. bedrest for 1 week
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 fx of her radius. When she asks what that means, you tell her that in a comminuted fx the: A. bony fragments are in many pieces B. broken ends of the bone protrude through the soft tissue and skin C. bone breaks cleanly but does not penetrate the skin D. bone is crushed
A
Jill, age 49, has recently begun a rigorous weight-lifting regimen. She presents to the primary care office with a shoulder dislocation. Which of the following clinical manifestations lead the NP to suspect an anterior shoulder dislocation over a posterior dislocation? A. Inability to shrug the shoulder B. Absence of pain C. Inability to rotate the shoulder externally D. Shortening of the arm
A
John, age 16, 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
Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis A. develops when loss of bone occurs more rapidly than new bone growth B. is a degenerative joint disease characterized by loss of cartilage in certain joints C. is a chronic inflammatory disorder that affects multiple joints D. is a bone disorder that has to do with inadequate mineralization of the bones
A
Management of fibromyalgia would include A. giving psychotropic drugs, such as amytriptyline (Elavil), in a low dose at bedtime B. instructing clients to keep as busy as possible to keep their minds off the symptoms C. using high doses of NSAIDs D. avoiding exercise
A
Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? A. Musculoskeletal pain B. Difficulty sleeping C. Depression D. Fatigue
A
Shane, age 26, has a cast on his right arm because of an in-line skating accident. Twelve hours after the cast was applied, he complains of severe pain even though he recently took his pain medication. His fingers are pink, yet he states that they are tingling and feel slightly numb. What should the NP suspect? A. Compartment syndrome B. Phlebitis C. Osteomyelitis D. Muscle contraction
A
Stan, age 34, fractured his femur when his horse tripped over a jump. With this type of injury, you know that Stan is at risk for fat emboli. Early assessment findings for this complication include A. fever, tachycardia, rapid respirations, and neurological manifestations B. neurological manifestations, temperature elevation, bradycardia, and pallor C. hostility; combativeness; substernal pain; and a weak, thready pulse D. lethargy, hypothermia, paresthesia, and absent peripheral pulses
A
The NP is considering a diagnosis of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout in a 72 year old man who presents with complaints of pain and stiffness in his wrists and knees. The most useful diagnostic test to assist in confirming this diagnosis would be A. synovial-fluid analysis and x-ray B. bacterial culture C. bone scan and MRI D. anticitrullinated protein antibody (ACPA) test and RA factor
A
The straight leg-raising maneuver can be used to diagnose A. nerve root compression B. a fractured hip C. an ACL tear D. tendinitis
A
To diagnose fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender point sites, which would include the A. occiput, low cervical, trapezius, and supraspinatus B. proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints of the hands, and the metatarsophalangeal (MTP) and PIP joints of the foot C. facet joints of the cervical, thoracic, and lumbar spine D. radial and ulnar styloids and the medial and lateral malleoli
A
Trevor, age 4, has an apparent hypertrophy of the calf muscles, which seem doughy on palpation. His mother is concerned because Trevor is unable to raise himself from the floor without bracing his knees with his hands. The NP should suspect A. Duchenne muscular dystrophy B. cerebral palsy C. Legg-Calve-Perthes disease D. multiple sclerosis
A
What part of the body is affected by Dupuytren's contracture? A. The fourth and fifth fingers B. The great toe C. The tibia D. The penis
A
What pathophysiology associated with transient pain after exercising usually begins a few hours after exercise with soreness and may last up to a week? A. Increased lactic acid production, muscle breakdown, and minor inflammation B. Mild musculotendinous inflammation C. Major musculotendinous inflammation, periostitis, and bone microtrauma D. Breakdown in soft tissue and stress fracture
A
When Maxwell, age 12 slid into home plate while playing baseball he injured his ankle, you are trying to differentiate between a sprain and a strain. You know that a sprain: A. is an injury to the ligaments that attach to bones in a joint B. is an injury to the tendons that attach to the muscles in a joint C. is an injury resulting in extensive tears of the muscles D. is an injury that does not result in joint instability
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. deQuervain's disease d. intersection syndrome
A
Which diagnostic tests are nonspecific indicators of inflammation and may be elevated in rheumatic disease and polymyalgia rheumatic? A. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) B. Rheumatoid factor (RF) and uric acid C. C-reactive protein (CRP) and fluorescent ANA test D. Fluorescent ANA test and uric acid
A
Which of the following can assist in diagnosis of myasthenia gravis? A. Repetitive nerve stimulation B. The presence of cogwheel rigidity C. Chvostek's sign D. Trousseau's sign
A
Which of the following is true regarding scoliosis? A. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending B. Functional scoliosis is fixed; the curvature shows both on standing and bending forward C. Structural scoliosis is fixed; the curvature shows both on standing and bending forward D. Functional scoliosis is permanent, whereas structural scoliosis can result from outside influences such as leg length discrepancy or muscle spasms
A
Which of the following statements concerning development dysplasia of the hip (DDH) is correct? A. It is often associated with being the firstborn female child B. It results from an orthopedic malformation in utero C. It has no genetic predisposition D. It is more common in males
A
Which of the following tests assesses the patency of the radial and ulnar arteries? A. Allen test B. Finkelstein's test C. Phalen's test D. Tinel's sign
A
Which of the following tests for hand and wrist problems assesses the patency of the radial and ulnar arteries and the arterial arch? A. Allen's test B. Phalen's test C. Tinel's sign D. Finkelstein's test
A
A NP correctly performs the obturator test when the client's leg is raised with knee flexed and the leg is internally rotated. A positive obturator test is indicative of A. avascular necrosis (AVN) of the femoral head B. cholecystitis C. hip bursitis D. appendicitis
D
A clinical manifestation of symmetric neurogenic pain may indicate A. radiculopathy B. reflex sympathetic dystrophy C. entrapment neuropathy D. peripheral neuropathy
D
Beth, age 49, comes in with low back pain. An x-ray of the lumbar/sacral spine is within normal limits. Which of the following diagnoses do you explore further? A. Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus
D
Which of the following statements is true regarding ROM of a joint? A. The normal active ROM of a joint is greater than the passive ROM of the same joint B. If there is a limitation of active ROM, you should not attempt passive ROM to avoid further injury to the joint C. Active and passive ROM of a joint should be equal, full, and cause only mild discomfort D. Active and passive ROM of a joint should be equal, full, and pain-free
D
Which test assesses for thoracic outlet syndrome by having the client abduct his or her arms 90 degrees externally rotated with the elbows flexed 90 degrees and then having the client open and close his or her hands for 3 minutes? A. The Neer test B. Speed's test C. Hawkins test D. The Roos test
D
Which test is routinely recommended for a preparticipation sport physical? A. A complete blood count B. A chest x-ray C. An electrocardiogram D. A Snellen test
D
Christian, age 22, is a carpenter who is right-hand dominant. He comes to the clinic for follow-up from the ER where he was seen for right forearm pain. He states he was diagnosed with right forearm tendinitis and wants the provider to explain this diagnosis to him. Patient teaching should explain that he has inflammation of one or more tendons, which are A. the ropelike bundles of collagen fibrils that connect bone to bone B. the collagen fibers that connect muscle to bone C. the pouches of synovial fluid that cushion bone and other joint structures D. the fibrocartilaginous disks that separate bony surfaces
B
Ethan, age 10, jumps off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray demonstrates a fracture of the distal tibia over the articular surface into the epiphysis and physis. Based on the Salter-Harris classification for growth plate injuries, you know this is a A. II B. III C. IV D. V
B
Ginny, age 48, has RA and gets achy and stiff after sitting through a long movie. This is referred to as: A. longevity stiffness B. gelling C. intermittent arthritis D. molding
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
How can you differentiate between a ganglion cyst and a neoplasm? A. A neoplasm is more painful B. Ganglia transilluminate C. Ganglia cause more swelling D. A neoplasm may fluctuate in size
B
In a client with osteomalacia, you would expect levels of A. serum calcium to be elevated B. alkaline phosphatase to be elevated C. creatinine excretion to be elevated D. serum phosphatase to be elevated
B
Jeffrey, age 16, was involved in a motor vehicle accident. He walks into the office with an obvious facial fracture and then collapses. What should the first action of the NP be? A. Call his parents for permission to treat B. Assess for an adequate airway C. Obtain head and maxillofacial CT D. Assess for a septal hematoma
B
Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond? A. "Caffeine has no effect on osteoporosis." B. "A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly." C. "Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix." D. "Caffeine increases bone resorption."
B
Jessie, age 49, states that she thinks she has RA. Before any diagnostic tests are ordered, the NP completes a physical exam and makes a differential diagnosis of osteoarthritis rather than RA. Which clinical manifestation ruled out RA? A. Fatigue B. Affected joints are swollen, cool, and bony hard on palpation C. Decreased ROM D. Stiffness
B
Jim, age 64, has RA. Which of the following drugs would be of the least benefit? A. DMARDs B. Acetaminophen C. NSAIDs D. Glucocorticoids
B
Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In instructing Joyce and her family on allowing the cast to dry properly, tell them to A. continuously elevate Joyce's arm on a pillow B. change the position of Joyce's arm every hour C. position a fan near Joyce during the night to ensure even drying of the cast D. put a blanket over the cast to absorb the dampness
B
June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back and muscles without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely differential diagnosis? A. Ankylosing spondylitis B. Musculoskeletal strain C. Spondylolisthesis D. Herniated disk
B
A 50 year old patient has been diagnosed with adhesive capulitis often referred to as "frozen shoulder." The medical management often includes all of the following except A. application of moist heat B. aspiration with concurrent corticosteroid injection C. gentle stretching exercises D. NSAIDs and nonnarcotic analgesics
B
A 55 year old patient is able to complete ROM against gravity with some resistance. The NP would assign which of the following numerical grades to this manual muscle testing description? A. 5 B. 4 C. 3 D. 2
B
A 55 year old patient presents with complaints of paresthesias into the lower lateral arm, thumb, and middle finger. The most commonly involved nerve roots that cause the related symptoms are C6 and C7. The most likely differential diagnosis would be A. brachial plexis neuritis B. cervical radiculopathy C. peripheral polyneuropathy D. thoracic outlet syndrome
B
Alan, age 46, presents with a tender, red, swollen knee. You rule out septic arthritis and diagnose gout by confirming A. an elevated WBC B. hyperuricemia C. a significant response to a dose of ceftriaxone (Rocephin) D. a positive antinuclear antibody test
B
Ankylosis is defined as A. muscle shortening B. joint stiffness C. malposition of a joint D. dislocation of a joint
B
Manny age 52 is a postal worker who drives all day. He presents with LBP and has decreased sensation to pinprick in the lateral leg and web of the great toe. This indicates discogenic disease in the dermatomal pattern of which area? A. L3/L4 (L4 root involvement) B. L4/L5 (L5 root involvement) C. L5/S2 (S1 root involvement) D. None of the above
B
Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her "anatomical snuffbox." You know this probably indicates a(n) A. ulnar styloid fracture B. scaphoid fracture C. hamate fracture D. radial head fracture
B
Mickey, age 18, is on a chemotherapeutic antibiotic for a musculoskeletal neoplasm. Which drug do you think he is taking? A. Cyclophosphamide (Cytoxan) B. Doxorubicin (Adriamycin) C. Methotrexate (Rheumatrex) D. Cisplatin (Platinol)
B
Mike, age 42, 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 per year, and he is out of work for about a week each time. Which of the following should the NP 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 on a daily low-dose narcotic to take away the pain
B
Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis
B
Paul has a malignant fibrosarcoma of the femur. He recently had surgery and is now on radiation therapy. You want to order a test to determine the extent of the tumor invasion of the surrounding tissues and the response of the bone tumor to the radiation. Which of the following tests should you order? A. X-ray B. MRI C. CT D. needle biopsy
B
Anna, age 42, is pregnant and was just given a diagnosis of carpal tunnel syndrome. She is worried that this will affect her in caring for the baby. What do you tell her? A. "Don't worry; we'll find a brace that is very malleable." B. "After childbirth, your carpal tunnel syndrome may resolve." C. "If we do surgery now, you'll be recovered by the time the baby arrives." D. "You should prepare yourself for the probability of being unable to care for your baby."
B
Black men have a relatively low incidence of osteoporosis because they have A. increased bone resorption B. a higher bone mass C. wide and thick long bones D. decreased bone deposition
B
Carol, age 62, has swollen, bony proximal interphalangeal joints. The NP describes these as A. Heberden's nodes B. Bouchard's nodes C. Osler's nodes D. Murphy's nodes
B
Cass, age 67, tells the NP 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." Joan is on HCTZ for management of her HTN. The NP should suspect a diagnosis of A. septic arthritis B. gout C. RA D. Charcot neuro-osteoarthropathy
B
The NP has just completed a work-up on Michael, age 13, and confirmed Osgood-Schlatter disease. The initial management would be to A. refer to orthopedics for early surgical correction B. recommend physical therapy for quadricep-strengthening exercises C. advise him to temporarily discontinue all sports activities until his growth plates have completely fused D. tell Michael that he can resume his usual activities immediately without concern and should begin aggressive exercises to increase muscle bulk and strength
B
The NP suspects adolescent idiopathic scoliosis in Victoria, age 15, who is in her "growth spurt." An Adams forward-bending test is performed, and it is noted that the patient has a right-sided rib hump. What is this indicative of? A. Right lumbar shifting B. Right thoracic curvature C. Right truncal shift D. Spondylolysis
B
The most widely accepted screening tool for psoriatic arthritis (PsA) is the A. ACR (American College of Rheumatology) Criteria B. CASPAR (Classification of Psoriatic Arthritis) Criteria C. Psoriasis Area and Severity Index D. Rome Criteria
B
Treatment of choice for polymyalgia rheumatica (PMR) is A. acetaminophen or NSAIDs B. low-dose steroids C. tricyclic antidepressants D. antibiotics
B
Upon assessment, the NP notes unilateral back pain that had an acute onset and increases when standing and bending. A straight-leg test is negative. The most likely differential diagnosis is A. herniated nucleus pulposus B. muscle strain C. osteoarthritis D. spondylolisthesis
B
When grading muscle strength on a scale of 1 to 5, a grade of 4 indicates A. full range of motion against gravity with full resistance B. full ROM against gravity with some resistance C. full ROM with gravity D. full ROM with gravity eliminated (passive motion)
B
When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important point to stress is to tell her to A. carry the cane in the ipsilateral hand B. advance the cane with the ipsilateral leg C. make sure that the cane length equals the height of the iliac crest D. use the cane to aid in joint protection and safety
B
Which of the following statements is true regarding vertebrae? A. All people have only 24 vertebrae (cervical, thoracic, and lumbar) B. Due to differences in race or gender, select groups may have 23 or 25 vertebrae C. It is common to have fewer than 23 vertebrae D. It is common to have more than 25 vertebrae
B
You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This tests indicates an injury to the A. lateral meniscus B. cruciate ligament C. medial meniscus D. collateral ligament
B
You are caring for a patient who has a history of psoriasis and now is showing signs of joint involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PsA). The initial treatment choice for management of the patient is A. disease-modifying antirheumatic drugs (DMARDs) B. NSAIDs C. tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors) D. uricosuric
B
The Valgus stress test, Varus stress test, Lachman test, and Thumb test are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the NP choose to assess the ACL, which is the most commonly involved structure in severe knee injury? A. Valgus stress test B. Varus stress test C. Lachman test D. Thumb sign
C
The four cardinal signs of inflammation related to musculoskeletal disorders include which of the following A. Erythema, warmth, fever, or morning stiffness B. Fatigue, morning stiffness, fever, or effusion C. Erythema, warmth, pain, or swelling D. Effusion, pain, fever, or swelling
C
The knee is an example of a A. spheroidal joint B. hinge joint C. condylar joint D. fibrous joint
C
The most common cause of cauda equina syndrome is A. fracture B. hematoma C. lumbar intervertebral disk herniation D. space-occupying lesion
C
To plan for a community education program, the NP needs to know that persons at highest risk for developing thoracic outlet syndrome are A. bicycle riders B. dancers C. computer programmers D. swimming instructors
C
What disorder affects older individuals, particularly women, and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, weight loss, sweats, and low-grade fever? A. Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica D. Reiter's syndrome
C
What is the largest joint in the body? A. The hip B. The shoulder C. The knee D. The elbow
C
What is the type of joint that is freely movable, such as the shoulder joint, called? A. The synarthrosis joint B. The amphiarthrosis joint C. The diarthrosis joint D. The juxtarthrosis joint
C
When a provider elicits a painful Finkelstein's sign, he or she is testing for A. carpal tunnel syndrome B. bursitis of the shoulder C. de Quervan's tenosynovitis D. tennis elbow
C
Which of the following is NOT a management principal for an acute musculoskeletal injury that does not require emergent treatment? A. RICE B. NSAIDs or acetaminophen C. Imaging studies D. Skeletal muscle relaxants
C
Which of the following is a modifiable risk factor for osteoporosis? A. Low alcohol intake B. Low caffeine intake C. Smoking D. Excessive exercise
C
Which test is used to diagnose an Achilles' tendon rupture? A. The Boutonniere test B. The Lachman test C. The Thompson test D. The drawer test
C
A 13 year old obese (BMI > 95%) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent "horseplay" with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative Drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and knee flexion causing external hip rotation. Based on the above scenario, the NP should suspect A. a left meniscal tear B. a left anterior cruciate ligament (ACL) tear C. a slipped capital femoral epiphysis (SCFE) D. Osgood-Schlatter disease
C
A Baker's cyst is A. an inflammation of the bursa B. a form of tendinitis C. the buildup of synovial fluid behind the knee D. the result of a "swollen" ligament
C
A NP is driving home from work and stopes at the scene of a motorcycle accident that must have just occurred because there are no rescue vehicles at the scene. The driver is lying at the side of the road unconscious with an obvious open fracture of his femur. Which of the following actions should take priority? A. Stop the bleeding from the wound B. Determine if there has been a cervical fracture C. Establish an airway D. Palpate the peripheral pulses
C
A coccygeal fracture is treated with A. traction B. surgical repair C. analgesia and by use of a "donut" cushion when sitting D. prolonged bedrest for 6 weeks
C
Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What should the NP tell him? A. "Use continuous heat for the first 12 hours and then use heat or cold to your own preference." B. "Use continuous cold for the first 12 hours and then use heat or cold to your own preference." C. "Apply cold for 20 minutes, then take it off for 30 to 45 minutes; repeat this for the first 24 to 48 hours while awake." D. "Alternate between cold and heat for 20 minutes each for the first 24 to 48 hours."
C
Anne Marie states that she has a maternal history of rheumatoid disease but that she has never been affected. Today she presents with complaints of dryness of the eyes and mouth. What is the most likely differential diagnosis? A. Rheumatoid arthritis B. Systemic lupus erythematosus C. Sjogren's syndrome D. Rosacea
C
Bursitis is an inflammatory process that may be caused by infection, trauma, repetitive movement disorders, gout, or neoplastic disease. The most common cause of septic bursitis due to infection is from which of the following? A. Mycobacterium tuberculosis B. Candida C. Staphylococcus aureus D. Streptococcus
C
Daniel, age 45, is of northern European ancestry and has a dysfunctional and disfiguring condition affecting the palmar tissue between the skin of the distal palm and fourth and fifth fingers. What do you suspect? A. Hallux valgus B. de Quervain's tenosynovitis C. Dupuytren's contracture D. Hallux rigidus
C
Grating of the bones or entrance of air into an open fracture is manifested by A. swelling B. ecchymosis C. crepitus D. pain and tenderness
C
Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple "mechanical" backache and order A. bedrest for 2 days B. muscle relaxants C. her to continue activities as the pain permits D. back-strengthening exercises
C
In assessing a patient, the NP places the tips of their first 2 fingers in front of each ear and asks the patient to open and close his/her mouth. Then the NP drops his or her fingers into the depressed area over the joint and assesses for smooth motion of the mandible. With this action, the NP is checking for A. maxillomandibular integrity B. well-positioned permanent teeth or well-fitting dentures C. temporomandibular joint syndrome D. mastoid inflammation
C
Jim, age 22, a stock boy, has an acute episode of low back pain. The NP orders an NSAID and should educate him in which of the following? A. Maintain moderate bedrest for 3 to 4 days B. Call the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours C. Begin lower back strengthening exercises depending on pain tolerance D. Wear a Boston brace at night
C
Karen, who is postmenopausal, is taking 1,200 mg of calcium daily but does not understand why she also needs to take vitamin D. You tell her that A. a deficiency of vitamin D results in an inadequate mineralization of bone matrix B. all vitamins need to be supplemented C. vitamin D increases intestinal absorption of dietary calcium and mobilizes calcium from the bone D. vitamin D binds with calcium to allow active transport into the cells
C
Lois, age 52 who has been given a dx of sarcoidosis, has joint symptoms including arthralgias and arthritis, your next plan of action would be to: A. order a bone scan B. obtain a tissue bx C. begin a course of glucocorticoids D. obtain an EKG
C
Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment test should the NP use to check for effusion of the patient's knee? A. The Thomas test B. Tinel's sign C. The bulge test D. Phalen's test
C
Sam age 50 presents with Paget's disease, that has been stable for several years. Recently his serum alkaline phosphatase level has been steadily rising. You determine that it is time to start him on: A. NSAID's B. corticosteriods C. bisphosphonates D. calcitonin
C
Sandra, a computer programmer has just been given a new diagnosis of carpel tunnel syndrome, your next step is to A. refer her to a hand surgeon B. take a complete hx C. try neutral position wrist splinting and order an oral NSAID D. order an EMG
C
Steve age 32 fell off a roof while shingling it. He is complaining of pain in his left hip and leg area. Other than an xray what would make you suspect a fractured hip? A. clicking sensation when moving the hips B. a positive pelvic tilt test C. Hematuria D. absence of distal reflexes
C
The NP is trying to distinguish between an articular and nonarticular musculoskeletal complaint of a 26 year old patient complaining of pain in the elbow area. Which of the following would characterize nonarticular bursitis? A. Deep or diffuse pain B. Limited ROM on active and passive movement C. Point or focal tenderness D. Swelling and instability
C
Emily, age 12, presents to the clinic with another muscle strain from one of her many sports activities. The NP thinks that the patient was probably never taught about health promotion and maintenance regarding physical activity. What information should be included in patient teaching? A. "After an activity, if any part hurts, apply ice for 20 minutes." B. "You must first get in shape with a rigorous schedule of weight training, and then you can participate in any activity once you are physically fit." C. "After strenuous activity, you must completely rest your muscles before beginning your next activity." D. "Stretching and warm-up exercises are an important part of any exercise routine."
D
For an adult patient with a knee injury, the NP orders an NSAID to be taken on a routine basis for the next 2 weeks. Patient 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 is permitted between the usual doses of NSAID."
D
Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological compromise D. Spinal fracture
D
If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured by using: A. Phalen's test B. skeletometry C. the Thomas test D. a goniometer
D
In analyzing synovial fluid, a yellow-green color may indicate which of the following? A. Trauma B. Gout C. A bacterial infection D. RA
D
In assessing an infant for developmental dysplasia of the hip (DDH), the practitioner places the infant supine, flexes the knees by holding the thumbs on the inner mid-thighs, with fingers outside on the hips touching the greater trochanters, stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this external rotation feels smooth with no sound present, there is no hip dislocation. This is A. the Allis test B. Lasegue's sign C. the McMurray test D. the Ortolani maneuver
D
Janine, age 69, has a class III case of RA. According to the American Rheumatism Association, her function would be A. adequate for normal activities despite a handicap of discomfort or limited motion of one or more joints B. largely or wholly incapacitated, bedridden, or confined to a wheelchair, permitting little or no self-care C. completely able to carry on all usual duties without handicaps D. adequate to perform only a few or none of the duties of usual occupation or self-care
D
Joan, age 76, has been given a diagnosis of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. The NP has educated her about the importance of increasing calcium and vitamin D in her diet and starting a low-impact, weight-bearing exercise program. The NP is also going to start the patient on medial management. Joan asks about a drug called a "SERM" that she has heard has been shown in studies to prevent vertebral fractures. Which of the following pharmacological therapies for osteoporosis is classified as a selective estrogen receptor modulator (SERM)? A. Alendronate (Fosamax) B. Risedronate (Actonel) C. Salmon calcitonin D. Raloxifene (Evista)
D
Martin, age 58, presents with urethritis, conjunctivitis, asymmetric joint stiffness, primarily in the knee, ankles, and feet. You suspect what? A. syphilis B. gonorrhea C. HIV D. reactive arthritis
D
Matthew, age 52, is a chef who just severed two of his fingers with a meat cutter. You would recommend that he A. wrap the severed fingers tightly in a dry towel for transport to the ER with him B. leave the severed fingers at the scene because fingers cannot be reattached C. immediately freeze the severed fingers for reattachment in the near future D. pack the fingers in a saline-soaked dressing and seal in a plastic bag
D
Mrs. Matthews, age 71, has RA. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? A. Antigen-antibody formation B. Lymphocyte response C. Immune complex formation D. Lysosomal degradation
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 PT B. Order lumbar/sacral x-ray C. Order extensive lab work D. Refer to a neurosurgeon
D
Sean, a factory line worker, has osteoarthritis of the right hand. According to the American College of Rheumatology (ACR), the guidelines for pharmacological treatment include A. acetaminophen, tramadol, and intra-articular corticosteroid injections B. oral NSAIDs, tramadol, and articular corticosteroid injections C. acetaminophen, topical capsaicin, and topical NSAIDs D. topical capsaicin, topical NSAIDs, and oral NSAIDs
D
The NP is assessing Maya, a 69 year old Asian woman, for the first time. When trying to differentiate between scoliosis and kyphosis, the NP recalls that 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
The NP suspects a herniated disk in a 72 year old patient. The NP elevates the patient's affected leg when she is in the supine position, and it elicits back 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
To aid in the diagnosis of meniscus damage, which test should a NP perform? A. The bulge test B. The Lachman test C. The drawer test D. Apley's compression test
D
What is the name of the test used to assess for nerve-root compression? A. The Apley scratch test B. The drop arm test C. Finkelstein's test D. Spurling's maneuver
D
