Musculoskeletal-Certification practice questions by Amelie Hollier – Flashcards
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what joints are least commonly involved in osteoarthritis? a. fingers b. wrists c. hips d. knees
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b. wrists
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an x-ray report of a pt's painful right knee indicates "joint space narrowing". what does this mean? a. the pt is aging b. gout is present c. this is a normal finding d. loss of cartilage has occurred
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d. loss of cartilage has occurred
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which sx can be used to r/o out a fx? a. degree of pain b. extent of mobility c. degree of swelling d. no sxs can r/o a fx
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d. no sxs can r/o a fx
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a long distance runner is dx with a tibial stress fx. which statement is true about the injury? a. the pain worsens with rest b. the pt should be casted for six weeks c. plain x-rays will confirm the dx d. rest and an alternative activity are recommended
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d. rest and an alternative activity are recommended
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what is the most prevalent skeletal problem in the US? a. osteoarthritis b. stress fx c. osteoporosis d. gouty arthritis
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a. osteoarthritis
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which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus? a. antinuclear antibody (ANA) b. rheumatoid factor c. elevated liver function studies d. erythrocyte sedimentation rate (ESR)
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a. antinuclear antibody (ANA)
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a 75 y/o pt has osteoarthritis and pain. which of the following medications increases the risk of a GI related ulceration? a. celecoxib b. warfarin c. tramadol d. amitriptyline
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a. celecoxib
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a 16 y/o male plays trumpet in the school marching band. he has had marching practice every day for the last week. today he c/o of pain in his left midfoot. the foot is neither swollen nor red. what is the most likely dx in the differential? a. strain b. bursitis c. stress fx d. tendonitis
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c. stress fx
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a pt presents with rt shoulder pain (7/10 on the side 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? a. immobilize the rt shoulder for 3 days b. rest, ice, and naproxen for one wk c. order an x-ray of the rt shoulder d. prescribe physical therapy for the pt
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c. order an x-ray of the rt shoulder
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a 50 y/o pt reports acute pain in his lower back that started 2 wks ago after working in his yard. the pain radiates into his rt leg intermittently. he has been managing his pain with over the counter NSAIDs. there are no red flags in his hx or exam. when should consideration be given to imaging studies? a. now b. at 4 wks c. at 8 wks d. there is no need
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b. at 4 wks
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a 65 y/o female c/o of left medial knee pain. she has been told that she has arthritis in this knee. where would the pain be located? a. medially, radiating into the upper thigh b. medially, along the joint line c. about an inch above the medial knee joint line d. about an inch below the medial knee joint line
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b. medially, along the joint line
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a 60 y/o pt who is otherwise healthy, presents with acute onset of rt knee pain. she denies injury but reports that she walked up alot of steps yesterday. she is dx with prepatellar bursitis. what is a common finding? a. limping and erythema about the anterior knee b. swelling and pain to touch of the anterior knee c. posterior knee pain, anterior knee edema, and redness d. tenderness to touch of the tibial tubercle
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b. swelling and pain to touch of the anterior knee
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a 55 y/o male pt describes severe pain at the base of his lft first toe. he is limping and says he can't remember hurting his toe. which sx below suggests something other than gout? a. pain b. elevated sedimentation rate c. erythema d. fever
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d. fever
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an 80 y/o pt 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 dx? a. osteoarthritis b. sacroiliac joint disease c. lumbar radiculopathy d. herpes zoster
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a. osteoarthritis
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a 75 y/o female, who knits daily, has a positive Finkelstein test. what is her likely dx? a. Gamekeeper's thumb b. DeQuervain's tenosynovitis c. osteoarthritis of the thumb d. trigger thumb
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b. DeQuervain's tenosynovitis
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which sxs are most commonly found in a pt with rheumatoid arthritis? a. morning stiffness, positive rheumatoid antigen and antinuclear antibody b. fever, symmetrical joint involvement, normal sedimentation rate c. asymmetrical joint involvement, male gender, pain d. nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody
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a. morning stiffness, positive rheumatoid antigen and antinuclear antibody
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the "get up and go" test in an elderly pt is used to evaluate: a. risk for falls b. lower extremity strength c. mental acuity d. driving safety
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a. risk for falls
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a 75 y/o has pain from osteoarthritis in her rt knee. what intervention is considered first line to tx her pain? a. exercise b. acetaminophen c. ibuprofen d. tramadol
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a. exercise
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what medication is recommended by American College of Rheumatology as a first line agent for a pt who has been unsuccessful with non-pharmacologic interventions for osteoarthritis pain? a. naproxen b. acetaminophen c. ibuprofen d. tramadol
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b. acetaminophen
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an adolescent athlete has injured his ankle playing basketball. he has rt ankle pain, ecchymosis, significant edema, and he is unable to bear wt at the time of the clinical exam. which dx is least likely? a. an avulsion fx b. grade I sprain c. grande II sprain d. grade III sprain
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b. grade I sprain
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the Ottawa ankle rules help the examiner determine when: a. an inversion ankle injury has occurred b. an anterior talofibular fx has occurred c. x-rays are needed with a suspected ankle sprain d. referral to orthopedics should occur
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c. x-rays are needed with a suspected ankle sprain
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when should functional rehab occur once a pt has had an ankle or knee sprain? a. the day of the injury b. about 5 days post-injury c. 2-3 wks after injury d. when the pt's pain level allows
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a. the day of the injury
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management of a sprained ankle includes: a. x-rays b. rest, ice, compression, elevation c. anti-inflammatory medications d. activity as tolerated
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b. rest, ice, compression, elevation
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what does a positive anterior drawer test demonstrate with an injured knee? a. injury to the lateral meniscus b. instability of the anterior cruciate ligament c. stability of the posterior cruciate ligament d. stability of the lateral knee
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b. instability of the anterior cruciate ligament
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which dx is the least likely cause of extrinsic shoulder pain? a. angina b. hepatobiliary disease c. pneumonia d. gout
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d. gout
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the drop arm test is used to assess pts with suspected: a. cervical injury b. rotator cuff injury c. impingement syndrome d. malingering
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b. rotator cuff injury
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which of the following is NOT true regarding cervical whiplash injury? a. this occurs after a traumatic event b. it may be accompanied by severe pain, spasm c. is identifiable on MRI or Ct, but not on X-ray d. occipital pain and headache can occur
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c. is identifiable on MRI or Ct, but not on X-ray
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a 66 y/o African American female has multiple risk factors for osteoporosis. which choice listed below is NOT a risk factor for osteoporosis? a. her age b. her race c. glucocorticoid intake d. excessive alcohol intake
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b. her race
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a pt who is 60 y/o c/o of low back pain for the last 5-6 weeks. she states that the severity is about 4/`0 and that she gets no relief from sitting, standing, or lying. the NP should consider: a. sciatica b. ankylosing spondylitis c. disc disease d. systemic illness
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d. systemic illness
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a 45 y/o male who is in good health presents with c/o pain in his left heel. he states that the first few steps out of bed in the morning are extremely painful. he has no hx of trauma. what is the likely etiology of his pain? a. archilles tendinitis b. plantar fasciitis c. calcaneal spur d. arthritis of the foot
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b. plantar fasciitis
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an elderly hypertensive pt has osteoporosis. which antihypertensive agent would have the secondary effect of improving her osteoporosis? a. thiazide diuretic b. calcium channel blocker c. an ACE inhibitor d. a beta-blocker
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a. thiazide diuretic
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a 70 y/o African American male c/o pain in his back and trun. Cardiovascular disease is ruled out. he has a normocytic normochromic anemia with hypercalcemia. a likely dx is: a. multiple myeloma b. lymphoma c. leukemia d. prostate cancer
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a. multiple myeloma
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a 49 y/o pt has osteoarthritis in the lumbar spine and hip. his hip x-ray demonstrates bone on bone. what can be done to resolve his c/o pain in his hip? a. acetaminophen only b. an NSAID only c. acetaminophen and physical therapy d. acetaminophen and a referral to ortho
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d. acetaminophen and a referral to ortho
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a 75 y/o female who is otherwise healthy has osteoarthritis in her rt knee. she c/o pain not relieved by acetaminophen 2000mg daily. what should be done? a. increase her acetaminophen to 4gm daily b. consider an NSAID c. continue acetaminophen and order physical therapy d. continue acetaminophen and refer to orthopedics
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c. continue acetaminophen and order physical therapy
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the incidence of osteoporosis in the elderly is high. which characteristics below would increase the risk of osteoporosis in an elderly male pt? a. low body wt, age 60 yrs b. smoker, age 65 yrs c. chronic glucocorticoid therapy, age 70 yrs d. family hx of hypothyroidism, age 65
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c. chronic glucocorticoid therapy, age 70 yrs
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a typical description of sciatica is: a. deep and aching b. worse at nighttime c. burning and sharp d. worse with coughing
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c. burning and sharp
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if plantar fasciitis is suspected in a pt, how is this dx? a. x-ray of the foot b. CT scan c. physical exam d. bone scan
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c. physical exam
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besides inadequate intake of vitamin D in elder adults, what other factor contributes to deficiencies? a. impaired synthesis of previtamin D b. decreased physical activity c. diminished hepatic function d. decreased body mass
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a. impaired synthesis of previtamin D
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a pt c/o "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? a. driving a vehicle long distances b. walking in new tennis shoes c. riding a bicycle d. pes planus
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d. pes planus
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a pt who has diabetes presents with pain when he walks and pain resolution with rest. when specifically asked about the pain in his lower leg, he likely will report pain: a. in and around the ankle joint b. in the calf muscle c. radiating down his leg from the thigh d. pain in his lower leg which waxes and wanes
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b. in the calf muscle
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bone mineral density screening in women over age 65 yrs is an example of: a. primary prevention b. secondary prevention c. teritiary prevention d. quaternary prevention
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b. secondary prevention
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a male pt who injured his back lifting a heavy object reports that he has low back pain. he is dx 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 is true? a. stop doing any activities that produce pain in your lower back b. continue your ADL, but stop walking, except to go to the bathroom c. bedrest will help your back pain d. continue your ADL and walking
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d. continue your ADL and walking
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an elderly pt had a total knee replacement (TKR) 10 months ago. he is doing well. what info should he be given regarding the knee replacement? a. he should taken an aspirin daily for the first year b. he should receive an antibiotic prior to dental procedures c. he should take the flu shot annually d. there are no recommendations 6 months after his surgery
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b. he should receive an antibiotic prior to dental procedures
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which statement is true regarding NSAIDs for low back pain? a. they are as equally efficacious as acetaminophen for pain b. they are associated with more side effects than acetaminophen c. they provide superior relief of sxs at one wk post injury d. they should not be used to tx acute low back pain
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b. they are associated with more side effects than acetaminophen
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a man fell off a 3 foot stepladder while working at home. he presents to your offic ewith c/o foot pain. he has point tenderness over the lateral malleolus, swelling, but he is able to ambulate. how should this be managed? a. ACE wrap and rest b. rest, ice, compression, and elevation c. x-ray of foot and ankle d. non-wt bearing for 3-7 days
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c. x-ray of foot and ankle
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a pt c/o of rt leg numbness and tingling following a back injury. he has a diminished rt patellar reflex and his sxs are progressing to both legs. what test should be performed? a. lumbar x-rays b. lumbar CT scan c. lumbar MRI d. lumbar MRI with contrast
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c. lumbar MRI
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an adolescent athlete has sprained his ankle. what instruction should be given to him regarding activity? a. he can resume regular activities in about one wk b. he should be able to walk pain-free before he starts to run c. his ankle should be taped prior to competition d. he can resume activity when the edema has resolved
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b. he should be able to walk pain-free before he starts to run
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a positive Tinel's test can be used to assess carpal tunnel syndrome. what other test can be used to assess for this? a. Patrick's test b. Finkelstein's test c. Phalen's test d. Allen's test
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c. Phalen's test
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what is another term Phalen's test called?
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backward praying test
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a young male pt with a herniated disc reports bilateral sciatica and leg weakness. if he calls the NP with c/o urinary incontinence, what should be suspected? a. opioid overuse b. medial or lateral herniation c. rupture of the disc d. cauda equina syndrome
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d. cauda equina syndrome
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a 16 y/o c/o that his knees hurt. his mother states that he has c/o knee pain for the past 2 wks. he has a prominent tibial tubercle. what should be part of the differential dx? a. Osgood-Schlatter disease b. growing pains c. acute lymphocytic leukemia (ALL) d. psychogenic pain
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a. Osgood-Schlatter disease
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a pt has suspected plantar fasciitis. the plantar fascia is best examined: a. with the great toe dorsiflexed b. with the foot in neutral position c. while the pt stands d. with the ankle at a 90 degree angle
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a. with the great toe dorsiflexed
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a 60 y/o adult with an antalgic gait and c/o hip pain is examined. he has trochanteric tenderness. what is the most common cause of this? a. bone cancer b. trochanteric strain c. trochanteric bursitis d. osteoarthritis
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c. trochanteric bursitis
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a young athlete is found to have a depression of the longitudinal arch of both feet. he c/o 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? a. an x-ray of the foot is needed first b. he needs some heel support in his shoes c. NSAIDs should be used initially d. rigid orthotics could be ordered for his shoes
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b. he needs some heel support in his shoes
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an older adult has osteopenia. her healthcare provider has recommended calicum 500mg TID. what is the most common side effect of calcium supplementation? a. stomach upset b. diarrhea c. constipation d. mild nausea intially
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c. constipation
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a 40 y/o c/o back pain after heavy lifting. this began 2 wks ago. he has had little improvement in his pain. which statement is true regarding plain x-rays in this pt? a. they should be gotten since 2 wks have passed without improvement b. x-rays will be of benefit in dx c. x-rays usually detect findings unrelated to sxs d. x-rays can detect herniated discs
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c. x-rays usually detect findings unrelated to sxs
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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 c/o ankle pain and foot pain but is able to limp into the exam room. how should he be managed? a. rest, ice, compression, elevation b. non-wt bearing until fx is ruled out c. short leg splint d. NSAIDs and rest with partial non-wt bearing
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b. non-wt bearing until fx is ruled out
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a pt is at increased risk of osteopenia if she uses which form of birth control? a. injectable progestin b. intrauterine device c. oral contraceptives d. natural family planning
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a. injectable progestin
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a pt presents to the NP clinical with a c/o nocturnal paresthesias. what is the likely underlying etiology? a. DeQuervain's tenosynovitis b. carpal tunnel syndrome c. ulnar radiculopathy d. medial epicondylitis
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b. carpal tunnel syndrome
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ankle inversion is a common c/o from a pt with a: a. medial ankle sprain b. lateral ankle sprain c. severely torn ligament d. fx of the medial malleolus
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b. lateral ankle sprain
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a characteristic of rheumatoid arthritis not typical in osteoarthritis is: a. wt loss b. morning stiffness c. symmetrical joint involvement d. the presence of Bouchard's nodes
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c. symmetrical joint involvement
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a pt reports that her knee "locks" sometimes and feels like it will "give out". she denies injury. she has no c/o about her other knee. what is her likely problem? a. torn anterior cruciate ligament b. knee effusion c. premature osteoarthritis d. meniscal tear
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d. meniscal tear
