Orthopedics
A patient who frequently has episodes of gout should avoid which groups of food? Beans, rice, and tea Scrambled eggs, milk, and toast Roast beef with gravy, rice Fish and steamed vegetables
Roast beef with gravy, rice
An adolescent athlete has sprained his ankle. What instruction should be given to him regarding activity? He can resume regular activities in about one week. He should be able to walk pain-free before he starts to run. His ankle should be taped prior to competition. He can resume activity when the edema has resolved.
He should be able to walk pain-free before he starts to run.
An elderly patient had a total knee replacement (TKR) 10 months ago. He is doing well. What information should he be given regarding the knee replacement? He should take an aspirin daily for the first year. He should receive an antibiotic prior to dental procedures. He should take the flu shot annually. There are no recommendations 6 months after his surgery.
He should receive an antibiotic prior to dental
A 4 year-old was brought into the clinic by her mother who reports that she pulled her arms upward to pick her up and now the child won't use her right arm. A nursemaid's elbow is suspected. Which statement below is correct? The child is crying because her arm hurts. She will need to be admitted to the hospital for fracture reduction. Her arm is slightly flexed and held close to her body. Her elbow is held straight at her side and her fingers are in a fist.
Her arm is slightly flexed and held close to her body
Which of the following is NOT true regarding cervical whiplash injury? This occurs after a traumatic event. It may be accompanied by severe pain, spasm. Is identifiable on MRI or CT, but not x-ray. Occipital pain and headache can occur.
Is identifiable on MRI or CT, but not x-ray.
What should the nurse practitioner assess in a patient who reports a fall but does not have serious physical injury? Blood pressure while the patient is seated Medications taken a few hours before the fall Visual acuity and ability to distinguish colors The ability to get out of a chair easily
Medications taken a few hours before the fall
A 45 year-old male who is in good health presents with complaints of pain in his left heel. He states that the first few steps out of bed in the morning are extremely painful. He has no history of trauma. What is the likely etiology of his pain? Achilles tendinitis Plantar fasciitis Calcaneal spur Arthritis of the foot
Plantar fasciitis
A 60 year-old female presents with history of low back pain of recent origin. Her gait is antalgic and she reports loss of bladder function since the onset of back pain this morning. What should be done? Order physical therapy Refer to the emergency department Refer to a neurologist Keep non-weight bearing until x-rays are completed
Refer to the emergency department
When should functional rehabilitation occur once a patient has had an ankle or knee sprain? The day of the injury About 5 days post-injury 2-3 weeks after injury When the patient's pain level allows
The day of the injury
Which statement below best characterizes scoliosis in an adolescent? It is more common in males and is idiopathic. There can be unequal rib prominences or shoulder heights. The diagnosis can be made when the curvature is 8? or more. There is a strong familial component to this condition.
There can be unequal rib prominences or shoulder heights.
Which statement below is true regarding NSAIDs for low back pain? They are as equally efficacious as acetaminophen for pain. They are associated with more side effects than acetaminophen. They provide superior relief of symptoms at one week post injury. They should not be used to treat acute low back pain.
They are associated with more side effects than acetaminophen.
Women are commonly screened for osteoporosis at age 65 years. How should screening for osteoporosis be managed in a male this age? They should be screened starting at age 65 if they have risk factors. They should be screened routinely at age 65. They do not need screening since this is not prevalent in males. They should be screened if they have prostate disease.
They should be screened starting at age 65 if they have risk factors.
A 60 year-old adult with an antalgic gait and complaints of hip pain is examined. He has trochanteric tenderness. What is the most common cause of this? Bone cancer Trochanteric strain Trochanteric bursitis Osteoarthritis
Trochanteric bursitis
A patient has suspected plantar fasciitis. The plantar fascia is best examined: with the great toe dorsiflexed. with the foot in neutral position. while the patient stands. with the ankle at a 90 degree angle.
with the great toe dorsiflexed.
The Ottawa ankle rules help the examiner determine when: an inversion ankle injury has occurred. an anterior talofibular fracture has occurred. x-rays are needed with a suspected ankle sprain. referral to orthopedics should occur.
x-rays are needed with a suspected ankle sprain.
The age at which a child can first walk backwards is: 12 months. 15 months. 18 months. 24 months.
18 months.
Which patient below should be screened for osteoporosis? 60 year-old male with rheumatoid arthritis 50 year-old Caucasian female A 65 year-old male who is otherwise healthy A 62 year-old post menopausal female
60 year-old male with rheumatoid arthritis
A patient has cut himself on a fence post while working outside. He has not had a tetanus shot in more than 10 years. How long can he wait before getting the immunization and still prevent tetanus? 24 hours 48 hours 72 hours 5 days
72 hours
A 6 year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from "playing outside too much". When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? Osgood-Schlatter disease Growing pains Acute lymphocytic leukemia (ALL) Psychogenic pain
Acute lymphocytic leukemia (ALL)
A 70 year old patient has had intermittent back pain for more than 3 years. In the last year, it is constant (pain scale is 2-3/10) and at times is sharp. She is not a surgical candidate. What class of medication would be a good choice for improvement of chronic pain in this patient? Naproxen Codeine Amitriptyline Sertraline
Amitriptyline
What medication is recommended by American College of Rheumatology as a first line agent for a patient who has been unsuccessful with non-pharmacologic interventions for osteoarthritis pain? Naproxen Acetaminophen Ibuprofen Tramadol
Acetaminophen
A 49 year-old patient has osteoarthritis in the lumbar spine and hip. His hip x-ray demonstrates bone on bone. What can be done to resolve his complaints of pain in his hip? Acetaminophen onlyAn NSAID onlyAcetaminophen and physical therapy IncorrectAcetaminophen and a referral to orthopedics
Acetaminophen and a referral to orthopedics E
Which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus (SLE)? Antinuclear antibody (ANA) Rheumatoid factor Elevated liver function studies Erythrocyte sedimentation rate (ESR)
Antinuclear antibody (ANA)
A 50 year-old patient reports acute pain in his lower back that started 2 weeks ago after working in his yard. The pain radiates into his right leg intermittently. He has been managing his pain with over the counter NSAIDs. There are no red flags in his history or exam. When should consideration be given to imaging studies? Now At 4 weeks At 8 weeks There is no need
At 4 weeks
A 79 year-old frail adult reports that she had a fall last week. She had no broken bones but is very sore. In evaluating this adult, what question is most important to ask? Do you have gait problems? Have you had other falls this year? Are you on any new medications? Does your family know that you fell?
Have you had other falls this year?
A 16 year-old male plays trumpet in the school marching band. He has had marching practice every day for the last week. Today he complains of pain in his left midfoot. The foot is neither swollen nor red. What is the most likely diagnosis in the differential? Strain Bursitis Stress fracture Tendonitis
Stress fracture
A young athlete is found to have a depression of the longitudinal arch of both feet. He complains of heel pain bilaterally. The rest of his foot is normal and he has continued with his activities. What could be recommended for his heel pain? An x-ray of the foot is needed first. He needs some heel support in his shoes. NSAIDs should be used initially. Rigid orthotics could be ordered for his shoes.
He needs some heel support in his shoes.
A 66 year-old African American female has multiple risk factors for osteoporosis. Which choice listed below is NOT a risk factor for osteoporosis? Her age Her race Glucocorticoid intake Excessive alcohol intake
Her race
Which symptom can be used to rule out a fracture? Degree of pain Extent of mobility Degree of swelling No symptom can rule out a fracture
No symptom can rule out a fracture
A college age basketball player landed awkwardly on his foot and ankle after jumping during a game yesterday. He states that he sprained his ankle. He complains of ankle pain and foot pain but is able to limp into the exam room. How should he be managed? Rest, ice, compression, elevation Non-weight bearing until fracture is ruled out C Short leg splint NSAIDs and rest with partial non-weight bearing
Non-weight bearing until fracture is ruled out
Which beverage below does not increase the risk of gout in a male who is prone to this condition? Vodka Beer Wine Bourbon
Wine
What joints are least commonly involved in osteoarthritis? Fingers Wrists Hips Knees
Wrists
Clubfoot: always requires an urgent neurosurgical referral. involves the foot and lower extremity. involves the foot only. can be corrected with casting and exercises.
involves the foot and lower extremity.
Ankle inversion is a common complaint from a patient with a: medial ankle sprain. lateral ankle sprain. severely torn ligament. fracture of the medial malleolus.
lateral ankle sprain
A 70 year-old African American male complains of pain in his back and trunk. Cardiovascular disease is ruled out. He has a normocytic normochromic anemia with hypercalcemia. A likely diagnosis is: multiple myeloma. lymphoma. leukemia. prostate cancer.
multiple myeloma. E
Management of a sprained ankle includes: x-rays. rest, ice, compression, elevation. anti-inflammatory medications. activity as tolerated.
rest, ice, compression, elevation
The "get up and go" test in an elderly patient is used to evaluate: risk for falls. lower extremity strength. mental acuity. driving safety.
risk for falls. E
The drop arm test is used to assess patients with suspected: cervical injury. rotator cuff injury. impingement syndrome. malingering.
rotator cuff injury
Bone mineral density screening in women over age 65 years is an example of: primary prevention. secondary prevention. tertiary prevention. quaternary prevention.
secondary prevention.
Which symptoms are most commonly found in a patient with rheumatoid arthritis? Morning stiffness, positive rheumatoid antigen and antinuclear antibody Fever, symmetrical joint involvement, normal sedimentation rate Asymmetrical joint involvement, male gender, pain Nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody
Morning stiffness, positive rheumatoid antigen and antinuclear antibody
A positive Tinel's test can be used to assess carpal tunnel syndrome. What other test can be used to assess for this? Patrick's test Finkelstein's test Phalen's test Allen's test
Phalen's test
A long distance runner is diagnosed with a tibial stress fracture. Which statement is true about the injury? The pain worsens with rest. The patient should be casted for 6 weeks. Plain x-rays will confirm the diagnosis. Rest and an alternative activity are recommended.
Rest and an alternative activity are recommended.
A male patient takes HCTZ daily for hypertension. He developed severe pain in his great toe yesterday. He was diagnosed with gout today and started on a medication. Which medication listed below would be contraindicated at this time? Allopurinol Prednisone Colchicine Indomethacin
Allopurinol
75 year-old patient has osteoarthritis and pain. Which of the following medications increases the risk of a GI related ulceration? Celecoxib Warfarin Tramadol Amitriptyline
Celecoxib
A nurse practitioner has successfully reduced a nursemaid's elbow. How can the NP know that it was successful? X-rays Child moves the affected arm at the elbow A click is heard The deformity has resolved
Child moves the affected arm at the elbow
A nurse practitioner has successfully reduced a nursemaid's elbow. How can the NP know that it was successful? X-rays Child moves the affected arm at the elbow A click is heard The deformity has resolved
Child moves the affected arm at the elbow
A 75 year-old female who is otherwise healthy has osteoarthritis in her right knee. She complains of pain not relieved by acetaminophen 2000 mg daily. What should be done? Increase her acetaminophen to 4 grams daily Consider an NSAID Continue acetaminophen and order physical therapy Continue acetaminophen and refer to orthopedics
Continue acetaminophen and order physical therapy
A 55 year-old male patient describes severe pain at the base of his left first toe. He is limping and says he can't remember hurting his toe. Which symptom below suggests something other than gout? Pain Elevated sedimentation rate Erythema Fever
Fever
Which diagnosis is the least likely cause of extrinsic shoulder pain? Angina Hepatobiliary disease Pneumonia Gout
Gout
An adolescent athlete has injured his ankle playing basketball. He has right ankle pain, ecchymosis, significant edema, and he is unable to bear weight at the time of the clinical exam. Which diagnosis is least likely? An avulsion fracture Grade I sprain Correct Grade II sprain Grade III sprain
Grade I sprain Correct
Besides inadequate intake of Vitamin D in elder adults, what other factor contributes to deficiencies? Impaired synthesis of previtamin D Decreased physical activity Diminished hepatic function Decreased body mass
Impaired synthesis of previtamin D
A patient is at increased risk of osteopenia if she uses which form of birth control? Injectable progestin Intrauterine device Oral contraceptives Natural family planning
Injectable progestin
Which factor listed below is NOT considered a risk factor for development of osteoporosis? Asian race Infrequent physical activity Alcoholism Late menopause
Late menopause
An x-ray report of a patient's painful right knee indicates "joint space narrowing". What does this mean? The patient is agingGout is presentThis is a normal findingLoss of cartilage has occurred
Loss of cartilage has occurred
Which of the following is true regarding metatarsus adductus? This is another term for clubfoot Mild flexible metatarsus usually spontaneously corrects X-rays are usually necessary to diagnose this Infants frequently require casting to correct
Mild flexible metatarsus usually spontaneously corrects
A patient presents with right shoulder pain (7/10 on the pain scale) after an acute shoulder injury yesterday. He fell against a brick wall while working at his home. He reports pain that radiates into his upper arm. How should this be managed? Immobilize the right shoulder for 3 days Rest, ice, and naproxen for one week Order an x-ray of the right shoulder Prescribe physical therapy for the patient
Order an x-ray of the right shoulder
A 14 year-old male client reports dull anterior knee pain, exacerbated by kneeling. What is the likely etiology? Patellar fasciitis Osgood-Schlatter disease Osteosarcoma of the tibia Over developed quadriceps
Osgood-Schlatter disease
A 16 year-old complains that his knees hurt. His mother states that he has complained of knee pain for the past 2 weeks. He has a prominent tibial tubercle. What should be part of the differential diagnosis? Osgood-Schlatter disease Growing pains Acute lymphocytic leukemia (ALL) Psychogenic pain
Osgood-Schlatter disease Explanation:
An 80 year-old patient is very active but presents today with posterior hip pain for the past week. Which of the following is least likely part of the differential diagnosis? Osteoarthritis Sacroiliac joint disease Lumbar radiculopathy Herpes zoster
Osteoarthritis .
What is the most prevalent skeletal problem in the United States? Osteoarthritis Correct Stress fractures Osteoporosis Gouty arthritis
Osteoarthritis Correct
An adolescent complains of knee pain. He is diagnosed with Osgood-Schlatter disease. What assessment finding is typical? The pain is always bilateral. Pain worsens with quadriceps contraction. There will be an avulsion of the quadriceps tendon. Assessments vary. An x-ray can be used for diagnosis.
Pain worsens with quadriceps contraction
A patient complains of "first step in the morning" pain in his heel. He states that it has progressed to "end of the day" heel pain. What probably has contributed to this most? Driving a vehicle long distances Walking in new tennis shoes Riding a bicycle Pes planus
Pes planus
A 60 year-old patient who is otherwise healthy, presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding? Limping and erythema about the anterior knee Swelling and pain to touch of the anterior knee Posterior knee pain, anterior knee edema, and redness Tenderness to touch of the tibial tubercle
Swelling and pain to touch of the anterior knee
An 8 year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? He should be immediately referred to orthopedics. The NP should order a hip x-ray, CBC and ESR. The NP should order a hip and knee x-ray. He should be referred for synovial fluid aspiration.
The NP should order a hip x-ray, CBC and ESR.
The average age of pubertal growth spurt in North American boys is: 9.5 - 11.5 years. 10 - 12 years. 12 - 14 years. 14 - 16 years.
12 - 14 years.
What does a positive anterior drawer test demonstrate with an injured knee? Injury to the lateral meniscus Instability of the anterior cruciate ligament Stability of the posterior cruciate ligament Stability of the lateral knee
Instability of the anterior cruciate ligament
A male patient who injured his back lifting a heavy object reports that he has low back pain. He is diagnosed with a lumbar strain. He is afraid to continue activities of daily living and especially walking because he has pain with these activities. What statement below is true? Stop doing any activities that produce pain in your lower back. Continue your activities of daily living, but stop walking, except to go to the bathroom. Bedrest will help your back pain. Continue your activities of daily living and walking.
Continue your activities of daily living and walking.
A 75 year-old female, who knits daily, has a positive Finkelstein test. What is her likely diagnosis? Gamekeeper's thumb De Quervain's tenosynovitis Osteoarthritis of the thumb Trigger thumb
De Quervain's tenosynovitis
A 75 year-old has pain from osteoarthritis in her right knee. What intervention is considered first line to treat her pain? Exercise Acetaminophen Ibuprofen Tramadol
Exercise
A 60 year-old has been on NSAIDs for the past week for shoulder pain. He has complaints of blood on toilet tissue when wiping after a bowel movement. What should be suspected? He has a GI bleed from NSAIDs. He could have hemorrhoids. He does not have a GI bleed. The bleeding is from tissue friability from NSAIDs. This is unrelated to the NSAIDs.
He could have hemorrhoids
What is the value of Vitamin D supplementation in the diet of older adults? It decreases the risk of falls. It decreases the severity of hip fractures. There is no clear value unless a Vitamin D deficiency is identified. It helps to prevent fractures.
It decreases the risk of falls.
A 12 year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks but his pain is worse and now involves the knee. There is no history of trauma. How should the work-up be initiated? Order a hip and knee x-ray Order a hip x-ray and a sed rate Perform Trendelenburg's test in the office Have the child squat in the office to assess the hips
Perform Trendelenburg's test in the office
A man fell off a 3-foot stepladder while working at home. He presents to your office with complaints of foot pain. He has point tenderness over the lateral malleolus, swelling, but he is able to ambulate. How should this be managed? ACE wrap and rest Rest, ice, compression, and elevation X-ray of the foot and ankle Non-weight bearing for 3-7 days
X-ray of the foot and ankle
A patient with sciatica is most likely to describe relief of symptoms with: sitting. standing. side lying or standing. walking.
side lying or standing.
A positive Trendelenburg's test could be used to identify a child with: scoliosis. Osgood-Schlatter disease. nursemaid's elbow. slipped capital femoral epiphysis.
slipped capital femoral epiphysis. Explanation:
A characteristic of rheumatoid arthritis not typical in osteoarthritis is: weight loss. morning stiffness. symmetrical joint involvement. the presence of Bouchard's nodes.
symmetrical joint involvement.
