PC2-Exam 3 Quiz Questions
The physical exam should be conducted in all children until age ___ to assess for hip dysplasia
2
"Nonsteroidal anti-inflammatory drugs, opioids, and topiramate (Topamax) are more effective than placebo in the short-term treatment of nonspecific chronic low back pain." A B C
A The correct answer is A. First line therapy should be NSAIDS (if not contraindicated). Radicular symptoms seem to be unaffected by NSAID use and evidence shows that there is no difference in reducing radicular pain with NSAIDS vs Placebo. Take a few moments and read the section on Pharmacologic Treatment in the AAF article.
When conducting the initial assessment after an injury, which of the following are you concerned about in the adult patient? A. Mechanism of injury B. Loss of sensation C. Previous injury to the area D. Developmental stage
A, B, C It is always important to ascertain the mechanison of injury and include this in the request for imaging. A neurovascular assessment is important in musckuloskeletal injuries so make sure you ask about lack of sensation, movement, and/or numbness or tingling. Documenting a previous injury and known impairment in the exam is essential. You would not be concerned about the developmental stage of the bones in an adult.
With any extremity injury it is important to assess which of the following? Select all that apply? A. Neurovascular status B. Skin integrity C. Mechanism of injury D. Need for referral
A, B, C, D
In a patient with a neck strain, which of the following interventions would you recommend? A. Alternating cold and heat application B. Stretching after heat application C. Norco 5/325 every 4-6 hours as needed D. Naproxen 250 mg twice a day
A, B, D All of the above strategies would be helpful in a patient with a neck strain except the use of opioid medications.
Which of the following medications can cause muscle spasms? SATA A. Lasix B. Hydrochlorithiazide C. Amoxicillin D. Simvastatin
A, B, D Diuretics and statins are known to cause muscle spasms. Antibiotics are rarely the culprit.
Which of the following are the correct test descriptions? Select all that apply. A. Tinel test is described as an abnormal tingling when the median nerve is tapped. B. Tinel test is described as pain with internal rotation C. Phalen test is described as a reproduction of symptoms with forced flexion D. Phalen test is described as pain with supination
A, C Tinel test is described as an abnormal tingling when the median nerve is tapped. Phalen test is described as a reproduction of symptoms with forced flexion
A 3-year-old presents with a limp that has been present for the past 2 days. Which of the following labs would be important to obtain? Select all that apply A. CDC with diff B. TSH C. ESR D. CRP
A, C, D TSH would be the only lab that you would not obtain in a child with a limp. Review the lab selection here against the differentials for a limp. Inflammation, infection, and JRA are causes you would want to rule out.
Check all the correct statements that apply to the ESR/Sed Rate. a. A low hematocrit can cause an increased ESR b. Can distinguish between infection and other causes of acute and chronic inflammation c. Use as diagnostic criterion only for temporal arteritis and polymyalgia rheumatica d. Is useful in monitoring the response to treatment in some autoimmune disorders e. Rises and falls slowly f. Narrow range of results
A, C, D, E
Check all that are correct statements about the CRP a. High reproducibility b. Wide range of results c. High sensitivity and specificity d. Indirect marker of inflammation e. Not affected by age, gender, or anemia f. Rises and falls slowly
A, C, E
Parents bring in a 26 month old to the urgent care because he refuses to move his right arm. You exam the arm and find no redness, bruising or swelling. He has been well at home and playful. What other differential would you consider in addition to a nursemaids elbow? A. Clavicle fracture B. Septic joint
A. Clavicle fracture You should consider a clavicle or elbow fracture. It is unlikely that he has a septic joint based on his exam (no redness, swelling).
A patient presents with a grade 3 sprain. Which of the following defines a grade 3 sprain? A. Complete tear of the ligament B. Partial team of the ligament C. Microscopic tear of the ligament
A. Complete tear of the ligament A grade 3 sprain is a complete tear.
Patients with olecranon bursitis usually present with: A. Edema, possible tenderness and erythema over the affected area B. Limited elbow range of motion (ROM) C. Nerve impingement D. Destruction of the joint space
A. Edema, possible tenderness and erythema over the affected area Bursitis is secondary to over use of a joint where the bursa sac, the membrane overlying the bony prominence, becomes thickened and develops fluid thus leading to swelling, pain and erythema. It can limit ROM but is not a presenting factor like swelling. ROM is usually not limited because swelling is focal not diffuse within the joint. The olecranon is the most common site. FEEDBACK: The Spurling test is a medical maneuver used to assess nerve root pain or radicular pain. A positive Spurling's sign produces pain arising in the neck radiating in the direction of the corresponding ipsilateral dermatome.
An 86 year old female reports a sudden onset of hip pain. A few moments later her daughter reports that her leg gave out and she fell to the ground. She has had pain with standing on this leg. Her daughter borrowed a wheelchair at the independent living facility to bring her mother in. What is the likely cause of her sudden pain? A. Femoral neck fracture B. Bursitis C. Osteoarthritis D. Labral tear
A. Femoral neck fracture Based on this patients age and risk factors, a femoral neck fracture should be considered. This can occur prior to or as a result of a fall. Her inability to walk is concerning. Bursitis, osteoarthritis, and labral tears would not cause a sudden onset of pain.
A 12 year old presents with a limp that has been progressively worsening over the past few days. Which of the following assessment findings will rule out SCFE? A. Fever of 38.8 B. Posterior displacement of the femoral epiphysis C. Limited internal rotation
A. Fever of 38.8 In SCFE the onset is usually after a minor trauma but can even come after months of ill-defined hip symptoms. The imaging will show a posterior displacement of the femoral epiphysis with limited internal rotation on exam. A fever of 38.8 is more indicative of septic arthritis.
A patient presents to the clinic with a complaint of progressive weakness in the great toe, numbness on the top of his foot and between the web space of 1-2. On exam he has has a decrease in sensation over the posterolateral thigh. Which nerve root is likely affected? A. L4-L5 B. L3-L4 C. L5-S1
A. L4-L5 This best describes L4-L5 innervation. "L3-4 would cause weakness in the anterior tibialis, numbness in the shin, thigh pain, and asymmetrical knee reflex. L5-S1 would cause weakness in the great toe flexor and gastrocsoleus, numbness in the lateral foot, posterior calf pain and ache, and an asymmetrical ankle reflex" (Dunphy, 2019)
What symptom(s) would describe a "red flag" for a person with back pain? A. Loss of bowel or bladder function B. Pain immediately following a lifting injury C. Weight gain after steroid burst used to treat back pain D. Pain radiating down buttock and posterior thigh
A. Loss of bowel or bladder function Red flags would include: Age > 50 or < 20 years (neoplastic); history of cancer (recurrence or metastatic), night sweats or weight loss (neoplastic, rheumatologic); urinary or bowel incontinence or saddle anesthesia (neurologic compromise/cauda equine syndrome); recent bacterial infection (disc infection); pain worse when supine (rheumatologic, neurologic, neoplastic); history of trauma.
Which imaging study would provide the best information for evaluation of a person with rapidly progressive back pain and radicular symptoms? A. MRI B.CT C. Plain X-ray D. Discogram
A. MRI An MRI would be the preferred study for a patient with red flags for serious or rapidly progressive disease and radicular symptoms that do not resolve after six weeks. For most patients imaging is not indicated for nonspecific pain without red flags of serious disease.
Select the correct description of lateral and medial epicondylitis. A. Medial epicondylitis pain worsens with wrist flexion and lateral epicondylitis presents with wrist extension B. Medial epicondylitis pain worsens with wrist extension and lateral epicondylitis presents with wrist flexion
A. Medial epicondylitis pain worsens with wrist flexion and lateral epicondylitis presents with wrist extension Medial epicondylitis pain worsens with wrist flexion and lateral epicondylitis presents with wrist extension. Medial also presents with pain over the inner aspect of the lower humerus and lateral presents with pain over the outer aspect of the lower humerus. Both present with decreased grip strength and have full ROM.
A 34 year old woman presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome. Which of the following is more characteristic of fibromyalgia? A. Musculoskeletal pain B. Difficulty sleeping C. Depression D. Fatigue
A. Musculoskeletal pain Musculoskeletal pain is not characteristic of chronic fatigue syndrome; rather it is often seen with fibromyalgia. The achy muscle pain may be localized or involve the entire body, is usually gradual in onset, although the onset may be sudden, occasionally after a viral illness. Fatigue is a more significant feature with chronic fatigue syndrome. With both disorders difficulty sleeping and depression occur.
A patient presents to the emergency room with reproducible chest pain over the anterior chest that has been present for 3-4 days. The patient reports increasing physical activity recently. On exam you note localized pain over the costosternal junction on the right. Pain is worse with coughing and lifting. You diagnose the patient with costochondritis. What is an appropriate first line treatment regimen? A. Naproxen B. Tramadol C. Norco D. Tylenol
A. Naproxen The best option for this patient would be an NSAID. In addition, you should recommend rest and ice. You could add tylenol if the patient is not able to tolerate NSAIDS or needs additional pain relief.
A father and her 3 year old daughter present to your clinic for upper extremity injury. The dad describes that he was holding his daughters hand when she pulled away from him and he felt a pop. She started crying right away and holding her arm she has not wanted to use the arm since the injury -2 hrs prior to arrival. You suspect what injury and what management? A. Nursemaid's elbow-correct with supination-flexion technique B. Nursemaid's elbow-obtain elbow and forearm x-rays. C. Golfer's elbow-recommend RICE therapy. D. Shoulder dislocation-place in sling
A. Nursemaid's elbow-correct with supination-flexion technique
A 66-year-old patient presents with acute hip pain with no known trauma. She is afebrile. Exam shows mild posterior hip pain. What is the most appropriate first step? A. Obtain an X-ray to rule out a fracture B. Refer to PT for evaluation C. Obtain and MRI D. Recommend heat
A. Obtain an X-ray to rule out a fracture The most appropriate first step would be to obtain an x-ray to rule out a fracture.
A common finding on exam in a patient with LCPD is which of the following? A. Pain with rolling the leg internally B. Pain with adduction of the leg C. Pain with rolling the leg externally D. Pain with abduction of the leg
A. Pain with rolling the leg internally It is common to find pain when rolling the leg internally as well as an antalgic gaint and limited hip movement and a hx of muscle spasm. You can also find atrophy of the gluteus, queadricepts, and hamstring muscles.
The reason treatment of giant cell arteritis (temporal arteritis) should be started immediately is to: A. Prevent blindness B. Prevent osteoporosis C. Prevent polymyalgia rheumatica D. Prevent cardiovascular disease
A. Prevent blindness
A male patient presents with the following symptoms: urethritis, conjunctivitis, and asymmetric joint stiffness in his knees and ankles. Which condition do you suspect? A. Reactive arthritis B. Gonorrhea C. Syphilis D. Systemic Lupus erythematosus (SLE)
A. Reactive arthritis Reactive arthritis (Reiter's syndrome) is arthritis of the lower extremities and is more common in white men. Associated symptoms include the classic triad of conjunctivitis, nongonococccal urethritis, and arthritis. (Can't see, can't pee, can't climb a tree)
A 10-year-old female presents after a fall on the school playground while playing tag with an outstretched right hand (FOOSH). She is able to tell you that most of the pain originates in the anatomic snuff box region that worsens when she tried to grasp her pencil. Physical exam reveals tenderness in the anatomic snuff box (base of proximal thumb palmar side) with minimal swelling without additional deformities, dislocations or areas of tenderness. She has ice in place.You obtain an x-ray image of right hand and wrist that reveals no fractures and/or abnormalities. What is the next BEST action? A. Thumb spica splint and refer to orthopedics B. Volar splint and follow up with PCP in 2 weeks C. OTC Analgesics/RICE therapy D. Place right arm in sling and advise follow-up for repeat imaging
A. Thumb spica splint and refer to orthopedics
Which of the following is the most appropriate first step in assessing a traumatic shoulder injury? A. X-ray B. MRI C. Ultrasound
A. X-ray The first step in assessing a traumatic injury would be an X-ray. An MRI would be ordered if the X-ray was inconclusive.
"Intensive patient education that includes advice to stay active, avoid aggravating movements, and return to normal activity as soon as possible, and a discussion of the often benign nature of acute low back pain is effective in patients with nonspecific pain." A B C
B Patient education has been shown to be an effective method to treat low back pain.
"Consider referral to physical therapy for McKenzie method techniques to reduce the risk of recurrence and need for health care services." A B C
B The McKenzie method has shown moderate evidence of effectiveness in reducing pain and improving function in patients with low back pain.
Identify the Evidence rating for the following Sort: Key Recommendation for low back pain: "Do not order initial imaging studies unless there is concern for cauda equina syndrome, malignancy, fracture, or infection." A B C
B The correct answer is B. In the absence of red flags, imaging is not recommended for nonspecific mechanical low back pain. Imaging would only be appropriate if there was no change in symptoms after six weeks of conservative therapy. Radiculopathy in itself, is not an indication to image.
"Acetaminophen, antidepressants (except duloxetine [Cymbalta]), lidocaine patches, and transcutaneous electrical nerve stimulation are not consistently more effective than placebo in the treatment of chronic low back pain." A B C
B Tylenol, Tens units, lidocaine patches and anti-depressants (except Cymbalta) have not been shown to be more beneficial than placebo. Systemic corticosteroids or cyclobenzaprine have not been shown to improve back pain. Strategies that do work in addition to short term use of NSAIDS include yoga and cognitive behavioral therapy,
Check all that apply to the immune response in an autoimmune disorder. A. antibodies remove invading antigens b. immune system forms antibodies to self antigens c. antibodies remain and protect d. Antibodies attack self-antigens
B&D
Initial treatment of epicondylitis includes all of the following except? A. Corticosteroid injections B. Topical NSAID's C. Bracing D. Rest and reducing repetitive movements
B, C, D Conservative treatment would be the first step. Corticosteroid injections would not be necessary as an initial treatment. Repetitive movements are the most likely cause such as tennis and golf (things DNP students do not have time for), or repetitive lifting/movements (which all DNP students do with their laptops, coffee cups, poor body mechanics with the mouse while trying to cook dinner and type a paper).
Check all the statements that are correct as it relates to ANA testing. A. The presence of a positive ANA is necessary to diagnose a rheumatologic illness B. ANA titers correlate poorly with disease activity C. Serial ANA measurements are recommended D. Some medications can stimulate the production of ANA E. About 5% of the normal population without disease will have a positive ANA F. The incidence of a false positive ANA increases with age
B, D, E, F
A newborn infant presents to your clinic for a well child exam. You are performing a Ortolani and Barlow hip tests. What is the proper way to perform this exam? A. 2nd- 5ths fingers on the buttocks B. 2nd-5th fingers on the medial aseptct of the knee C. grasping mid thigh D. 2nd-5th fingers on the greater trochanter
B. 2nd-5th fingers on the medial aseptct of the knee
A 63 y/o female patient presents to the clinic c/o left hip pain for approximately 2-3 weeks that is getting progressively worse. She reports having difficulty lying on her left side at night. Upon exam you note point tenderness at the greater trochanter. What is your diagnosis? A. Fracture B. Bursitis of the greater trochanter C. Sciatica D. Referred pain from sacroiliac joint
B. Bursitis of the greater trochanter Great trochanter bursitis often presents with point tenderness over the great trochanter and patients will often c/o increased pain when lying on the affected side.
Which of the following is characteristic of rheumatoid arthritis (RA)? A. It is more common in men at a 3:1 ratio B. Family history of autoimmune conditions is often reported C. Peak age for the disease onset in individuals is 60-80 years D. Cervical and lumbar spine are usually involved
B. Family history of autoimmune conditions is often reported Persons with RA often have a family history of autoimmune disorders. Peak age for onset is usually 20-40 years but older adults can have new onset symptoms as well. RA is more common in women by a 3:1 ratio. Symmetrical joints such as shoulder, wrists, fingers, knees, ankles are involved.
A 10 year old female presents to your clinic limping after she slid into a base while playing softball 1 hr PTA. She reports she is unable to bear weight on her right leg. Physical exam reveals: mild to moderate R ankle joint instability with decreased ROM-pt able to bear weight but very painful. You suspect what grade ankle sprain? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4
B. Grade 2
A 20 year old college student presents to the student health center with a complaint of progressive neck pain over the last 2 days. To narrow down a diagnosis it is important to rule out serious issues first. Which of the following symptoms would alert you to a more serious illness? A. Headache and tingling in the triceps B. Headache and fever with light sensitivity C. Headache over occipital area in the morning D. Headache and tenderness over the forehead
B. Headache and fever with light sensitivity A headache with fever in the patient with neck pain would be considered a red flag. The other symptoms are common occurences with MS neck issues and are not alarming in nature.
A clinical finding of femoral anteversion is? A. Out-toeing gait B. In-toeing gait
B. In-toeing gait Femoral anteversion will cause an in-toeing gait because of the increased internal rotation.
The reverse straight leg raise places tension on which of the following nerve roots? A. L5 - S1 B. L1- L4
B. L1- L4 The reverse straight leg raise places tension on L1-L4 nerve roots. The straight leg test places tension on L5 - S1
Treatment of choice for polymyalgia rheumatica (PMR) is: A. NSAIDs B. Low dose steroids C. Tricyclic antidepressants D. Antibiotics
B. Low dose steroids Low dose prednisone 10-15 mg daily is used for 2-4 weeks to achieve improvement in symptoms. Taper dose by 10-20% every 2 weeks to attain the lowest dose that will control symptoms and CRP/ESR.
Dexter is a 13-year-old basketball player who presents with anterior knee pain that has occurred intermittently over the past 3 months. The pain worsens with squatting and walking up or down stairs, and is better with rest. He denies fever, weight loss, joint redness, or skin rash. Physical examination reveals a Tanner 3 male in no acute distress with a tender, swollen tibial tuberosity in the affected knee. Pain can be reproduced with resisted active extension and passive hyperflexion of the knee. No effusion is present. Gait stability is normal. Dexter's presentation is most consistent with: A. Reactive arthritis B. Osgood Schlatter's disease C. Prepatellear bursitis D. Meniscal tear
B. Osgood Schlatter's disease
he posterior drawer tests which of the following ligaments? A. ACL B. PCL C. MCL
B. PCL The posterior drawer test the PCL. The anterior drawer tests teh ACL. The valgus stress test measures the MCL.
The Apley scratch test evaluates which of the following? A. Strength B. ROM C. Sensation
B. ROM The Apley scratch test evaluates ROM.
Which of the following describes a sprain? A. Overstretching/overuse of muscles and/or tendons B. Stretching and/or tearing of the ligaments
B. Stretching and/or tearing of the ligaments A sprain is a stretching and or tearing of the ligaments. Many patients will compalint of local pain, swelling, pain with ROM, a "pop" sound and bruising.
All of the following are typical complaints of a person suffering from PMR except: A. Aching and weakness of the muscles of the shoulder and hip girdles B. Swollen, tender, stiff wrist joints C. Progressive, fatigue, malaise, depression and dependence D. Stiffness and soreness, worse in the morning and evening
B. Swollen, tender, stiff wrist joints
Which of the following describes genu valgum? A. The distance between the knees is > 4-5 " B. The distance between the intermalleolar is > 4-5 "
B. The distance between the intermalleolar is > 4-5 "
When performing a straight leg raise (SLR), which of the following definitons would be considered a postive test? A. pain is elicited below the knee when the leg is raised less than 30 degrees B. pain is elicited below the knee when the leg is raised less than 60 degrees. C. pain is elicited below the knee when the leg is raised greater than 60 degrees D. pain is elicited below the knee when the leg is raised greater than 90 degrees
B. pain is elicited below the knee when the leg is raised less than 60 degrees. "It is considered positive when the pain is elicited below the level of the knee when the leg is raised less than 60 degrees." (Dunphy, 2019).
Which of the following is a true statement about the rheumatoid factor? A. The prevalence of RF decreases with age. B. RA is very specific for rheumatoid arthritis. C. A high titer for RF almost always reflects more severe disease and poor prognosis D. Positive RF titers are only seed in autoimmune disorders.
C
A 77-year-old man is taking multiple medications for chronic conditions. Deprescribing or finding an alternative for which of the following medications would have the greatest impact in decreasing the risk of falling? A. Sitagliptin B. Atorvastatin C. Amitriptyline D. Furosemide
C. Amitriptyline Amitriptyline has strong anticholinergic properties which can cause postural hypotension, sedation and contribute to the additive effects of anticholinergic burden. For these reasons it is on the Beer's list of inappropriate meds for older adults. Furosemide could contribute to hypotension or to urinary urgency but would in this cause would not be the first medication to address.
Which one of the following symptoms is consistent with the clinical history of fibromyalgia? A. localized body aching B. Unilateral joint swelling C. Fatigue unrelieved with sleep D. Cognitive changes
C. Fatigue unrelieved with sleep Frequently reported symptoms of fibromyalgia include widespread body aching, fatigue and nonrefreshing sleep, migratory pain, headaches.
A 43 y/o male patient presents to the clinic c/o left medial pain of the knee that occurred after playing basketball last weekend. He states that he made a sudden stop and pivoted to make a basket. On exam you note pain upon palpation of the medial aspect of the knee with a mild joint effusion. The patient has a positive Thessaly and McMurray test. What is your working diagnosis? A. ACL tear B. PCL tear C. Medial meniscus tear D. Knee strain
C. Medial meniscus tear Based on the patient's mechanism of injury (sudden stop and pivoting) and positive Thessaly and McMurray tests a medial meniscus tear is the likely diagnosis.
A 42 year-old female reports pain and stiffness in multiple joints that has lasted for more than 6 months. She has been diagnosed with Rheumatoid arthritis. She has no other clinical conditions. Which of the following treatments would be used first? A. Prednisone B. NSAIDs C. Methotrexate D. Adalimumab (Humira®)
C. Methotrexate The first line treatment is with a disease-modifying antirheumatic drug (DMARD) such as methotrexate. NSAIDs are helpful for pain but do not alter the underlying disease process of joint destruction. Prednisone can help with pain and inflammation but is not a long term treatment option due to side effect profile. A DMARD such as Humira would be the next step if methotrexate is not successful in achieving disease remission.
What is the next best step in management of Dexter today? A. Intraarticular corticosteroid injection in affected knee B. Provider note excusing his dissmal from all sports, PE, gym activities until healed C. NSAIDs and physical therapy for quadricep strengthening exercises D. Referal to pediatric orthopedic surgery for correction
C. NSAIDs and physical therapy for quadricep strengthening exercises
A patient presents with pain over the lateral malleolus after falling while playing VB and eversion of the ankle. What is the most appropriate next step? A. Immobilizing in a boot B. Wrapping with an ACE wrap C. Obtaining an X-ray D. Splinting with orthoglass
C. Obtaining an X-ray With an ankle injury with pain over the lateral malleolus obtaining an X-ray would be the most appropriate first step.
Lateral epicondylitis typically presents with? A. Redness over the lateral epicondyle B. Decreased ROM of the elbow C. Pain over the lateral epicondyle that increases with wrist extension D. Normal grip strength
C. Pain over the lateral epicondyle that increases with wrist extension Pain increases in the elbow with wrist extension, Grip strength is usually weak. ROM is not affected. The redness would indicate possible infected bursa.
What is your intervention for this patient? A. Air cast or splint B. Surgical intervention C. RICE therapy D. Crutch training and months of non-weight bearing
C. RICE therapy
A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What is the best management of this patient? A. Obtain a chest radiograph to evaluate possible causes for these symptoms B. Order an electrocardiogram to rule out potential cardiovascular disease. C. Recommend NSAIDs, stretching exercises, and ice packs to the area. D. Refer the child to a pediatric orthopedist for evaluation and treatment.
C. Recommend NSAIDs, stretching exercises, and ice packs to the area.
A 68-year-old male presents to the clinic with left hip pain. He reports that the pain started 2 days ago with no known trauma. He thought it was just his arthritis, but he is starting to have more pain than usual and his normal dose of Tylenol only helps him to feel better for a few hours. He is diabetic. He checked his blood sugar today and it was 258. On exam you note that his temperature is 100.9, he has pain over the posterior aspect of the left hip. He is able to bear weight, with some hesitation, to bear weight. Which of the following differentials would you want to rule out first? A. Labral tear B. Trochanteric bursitis C. Septic joint D. Lyme Disease
C. Septic joint Although all of the above could be considered, a septic joint would be the most important to rule out first. It is reasonable to obtain labs on this patient (CBC, CRP, ESR), but he would also need arthrocentesis which would require transfer to the ED.
A 42 year-old female presents with symptoms of dry eyes and very dry mouth. She reports these symptoms came on over the last 2 months. She does have a family history of autoimmune disease including mother with rheumatoid arthritis and sister with thyroiditis. What do you suspect? A. Rheumatoid arthritis B. Systemic lupus erythematosus C. Sjögren's syndrome D. Rosacea
C. Sjögren's syndrome Sjögren's syndrome (SJS) affects the salivary and lacrimal glands and causes individuals to have dry eyes and mouths. It can be an isolated entity or associated with other rheumatic disease such as RA or systemic lupus erythematosus.
A 54 year old male who is a construction worker presents with posterior neck stiffness and a tingling sensation in his right deltoid. Which of the following tests would you perform to test for cervical nerve root compression? A. Lift-off B. Hawkin's- Kennedy C. Spurling
C. Spurling The Spurling test will assess for nerve root compression. The Hawkin's-Kennedy tests for shoulder impingement and the lift off test will assess for a subscapularis tendon tear.
During your hip exam you note unequal gluteal folds (positive finding) What is your next step in management? A. AP x-ray B. This is a normal finding C. Ultrasound of hips/pelvis D. MRI of hip/pelvis
C. Ultrasound of hips/pelvis
How long should prednisone be used to treat PMR and GCA? A. 1 month B. 1 year C. Until symptom remission D. 10 days
C. Until symptom remission
Bursitis typically presents with which of the following symptoms? A. inability to raise arm over head B. nerve impingement that radiates into the forearm C. swelling and tenderness over the affected area D. elevated temperature, redness over the area
C. swelling and tenderness over the affected area In bursitis, the synovial fluid becomes thickened with resultant increased fluid production which leads to swelling and pain. Unlike arthritis, bursitis presents acutely wlith focal tenderness. ROM is normally not limited, but may be uncomfortable with abduction over the bursa. Risk factors for development include overuse, trauma, RA and OA. Recommend minimizing activity, but not restricting use, ice 3-4 times per day, NSAIDS. And expect that sx will resolve in 4-8 weeks. Occasionally, the bursa will become infected and will become extremely tender, warm, with redness over the area.
A patient presents for sports physical exam for school sports and activities beginning in the fall. Which scoliosis patient should cause the greatest concern for the NP? A. An 18-year old male with 5 degree curve B. A 13 year old female with 10 degree curve C. A 12 year old male with 5 degree curve D. A 17 year old female with 10 degree curve
D. A 17 year old female with 10 degree curve
Patients with medial epicondylitis present with: A. Forearm numbness B. Reduction of ROM C. Pain on elbow flexion D. Decreased grip strength
D. Decreased grip strength?
What test during the physical examination would be most useful in identifying which nerve roots were involved in a patient describing radicular back pain? A. Monofilament test, vibratory exam and muscle strength B. Deep tendon reflexes, pulses, and muscle strength C. Anal sphincter strength, extremity strength and sensation D. Deep tendon reflexes, strength and sensation
D. Deep tendon reflexes, strength and sensation Testing deep tendon reflexes, strength and sensation can help identify which nerve roots are involved.
When testing the tendons of the shoulder, specific tests isolate different tendons. Below select the correct combination of test and specific tendon that is isolated. A. Lag test will isolate the infraspinatous B. Empty can test will isolate the teres minor C. External rotation test will isolate the subscapularis D. Empty can test will isolate the supraspinatus
D. Empty can test will isolate the supraspinatus Lag test = subscapularis. External rotation = infraspinatous and teres minor. Empty can = supraspinatus
Systemic Lupus Erythematosus (SLE) is characterized by all of the following except: A. Fatigue and malaise B. Malar rash and photosensitivity C. Persistent proteinuria D. Erosive arthritis of multiple joints
D. Erosive arthritis of multiple joints SLE can affect multiple systems. Early symptoms of SLE are nonspecific and can include joint pain, fatigue to profound fatigue and malaise. Malar and discoid facial rashes can occur. Lupus nephritis develops in 25-50% of patient and proteinuria is present. The joint pain of SLE is milder than RA and is nonerosive.
Connie is a 63-year-old seamstress who presents with pain at the base of her right thumb on abduction and extension of her right thumb. She also complains of pain on the radial side of her right wrist with lifting. Which of these diagnostic tests will help to determine if she has de Quervain's tenosynovitis? A. Allen's test B. Phalen maneuver C. Tinel's sign D. Finkelstein's test
D. Finkelstein's test
A 42 adult patient presents with a complaint of back pain that has been present for the past 3-4 weeks. She is unaware of a specific event that elicited the pain and no known trauma. Her pain is dull and aching, without radiculopathy. She does report some mild burning in her buttocks when sitting. She has been treating her pain at home with ibuprofen. Otherwise, she feels well. In reviewing her chart, you see that she was treated for breast cancer several years ago. Which of the following pieces from her history raises a red flag? A. Burning pain into the buttocks B. Three to four weeks of symptoms C. Lack of radiculopathy D. History of breast cancer
D. History of breast cancer Her history of breast cancer raises a red flag. It is normal to have a buring sensation into the buttocks. Pain without radiculopathy is benign.
Risk factors for falls in the older adult would include all of the following except: A. History of Parkinson disease B. Taking more than 9 medications C. Impaired vision D. Living alone in the community
D. Living alone in the community Risk factors for falling include visual impairment (decreased vision, cataracts, macular degeneration); neurodegenerative conditions (Parkinson disease, dementia, and stroke related gait/balance changes); taking multiple medications which may contribute to orthostatic hypotension; and environmental hazards. Living alone in the community is not an independent risk factor although 1/3 of older adults who live in the community fall in a given year. They may or may not live alone.
A patient presents with pain over the 4th digit after trying to catch a baseball. He reports that his finger bent backwards and looks a little crooked. What is the most appropriate first step? A. Buddy tape the 3rd and 4th digits B. Create a splint using orthoglass C. Perform ROM to assess function D. Obtain an X-ray
D. Obtain an X-ray The most appropriate first step is to obtain an X-ray. Because of the mechanism of injury, the patient might have sustained a fracture as well as a dislocation. Perform ROM after X-rays have been obtained to prevent worsening of fracture displacement if present.
Which 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 B. Myofascial somatic dysfunction C. Reiter's syndrome D. Polymyalgia rheumatica (PMR)
D. Polymyalgia rheumatica (PMR) Myalgia in the cervical spine, shoulder and hip girdle are seen with PMR and are commonly accompanied by systemic symptoms. Arthralgias may also occur which are similar to those found in persons with rheumatoid arthritis. Reiter's syndrome or reactive arthritis is a classic triad of non-gonococcal urethritis, conjunctivitis and arthritis that follows certain infections of the GI or GU tract.
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. Neurologic compromise D. Spinal fracture
D. Spinal fracture Cancer may be suspected if the low back pain is accompanied by unexplained weight loss and immunosuppression in a person over age 50. Low back pain accompanied by acute onset of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, loss of sensation in the buttocks and perineum, and motor weakness in the lower extremities is a red flag for cauda equina syndrome or severe neurologic compromise.
Which of the following best describes the presentation of a person with rheumatoid arthritis? A. Symptoms in weight bearing joints which increase after a day of walking and activity B. Early morning stiffness lasting < 30 minutes C. Back pain which increases with rest D. Symmetrical joint stiffness lasting > 1 hour
D. Symmetrical joint stiffness lasting > 1 hour Joint stiffness is symmetrical and typically worse in the morning. It lasts greater than 1 hour and can recur after a period of inactivity or exercise.
Match the correct description with the Type of Salter Harris Fracture Classification. A complete physeal fracture with subtle widening.
Type I
Match the correct description with the Type of Salter Harris Fracture Classification. Physeal Fracture that extends through the metaphysis and produces a chip fracture of the metaphysis
Type II
Match the correct description with the Type of Salter Harris Fracture Classification. Physeal fracture that extends through but. below the epipihysis
Type III
Match the correct description with the Type of Salter Harris Fracture Classification. A physeal fracture plus epiphyseal and metaphyseal fractures
Type IV
