Musculoskeletal – FNP Certification Exam 4th ed. Winland-Brown and Dunphy – Flashcards
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d. a goniometer
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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
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a. de-bride and irrigate the wound thoroughly
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J., age 16, comes into the office with a human bit on his fist. what is the first course of action? a. de-bride and irrigate the wound thoroughly b. initiate broad-spectrum antibiotics c. leave the wound open for drainage d. administer a tetanus injection
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d. refer to a neurosurgeon
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S. age 49 presents with loss of anal spincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. you suspect cauda equina syndrome. what is your next action? a. order physical therapy b. order a lumbar/sacral x-ray c. order extensive lab work d. refer to a neurosurgeon
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a. supination
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in assessing the skeletal muscles, you turn the forearm so that the palm is up. this is called: a. supination b. pronation c. abduction d. eversion
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b. Salter-Harris III
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E. a 10 y/o boy, jumps off a 2 foot wall, twisting his foot and ankle upon landing. his ankle xpray demonstrates a fx 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. Salter-Harris II b. Salter-Harris III c. Salter-Harris IV d. Salter-Harris V
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c. vitamin D increases intestinal absorption of the dietary calcium and mobilizes calcium from the bone
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K. who is postmenopausal, is taking 1,500mg of calcium 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 the dietary calcium and mobilizes calcium from the bone d. vitamin D binds with calcium to allow active transport into the cells
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a. women should try to exercise moderately for at least 30 min on most, if not all, days of the week
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the American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy and after delivery include which of the following? a. women should try to exercise moderately for at least 30 min on most, if not all, days of the week b. exercise in the supine position is the position of choice c. anaerobic exercise during pregnancy is preferred over aerobic exercise d. exercise should be discontinued upon discovery of pregnancy and be resumed after delivery
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a. interrupt the cycle of urate crystal deposition and inflammatory response
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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
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begin a course of glucocorticoids
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L., age 52, who has just been given a dx of sarcoidoxis, has joint sxs including arthralgias and arthritis. your next plan of action would be to: a. order a bone scan b. obtain a tissue biopsy c. begin a course of glucocorticoids d. obtain an electrocardiogram
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b. hyponatremia
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G., age 26, runs marathons and frequently c/o painful contractions of his calf muscles after running. you attribute this to: a. hypercalcemia b. hyponatremia c. heat exhaustion d. dehydration
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c. as long as you can protect the remaining testicle, go for it
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S., age 15, has only one testicle. when he asks you if he can play on the soccer team at school, how do you respond? a. no, you'd be taking too much of a chance of injuring your remaining testicle b. you can play any noncontact sport; however, soccer is too strenuous c. as long as you can protect the remaining testicle, go for it d. it should have no bearing on any activity
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a. high estrogen states, such as with oral contraceptive
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there are many precursors of deep venous thrombosis (DVT), such as decreased blood flow, injury to the blood vessel wall, and altered blood coagulation. which clinical risk factor for DVT is the result of hypercoagulability? a. high estrogen states, such as with oral contraceptive b. trauma that results in orthopedic surgery c. an indwelling intravenous catheter of a lower extremity d. prolonged sedentary position related to immobility
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c. let pain be your guide and continue activities
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H., 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. let pain be your guide and continue activities d. back-strengthening exercises
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c. Dupuytren's contracture
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D. who is 45 and of norther european ancestry, has a dysfunctional disfiguring condition affecting the palmar tissue between the skin and the distal palm and fourth and fifth fingers. what do you suspect? a. Hallux valgus b. DeQuervain's tenosynovitis c. Dupuytren's contracture d. Hallux rigidus
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d. if you have additional pain, an occasional acetaminophen is permitted in between the usual doses of the NSAID
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for your clt with a knee injury, you order an NSAID to be taken on a routine basis for the next 2 wks. your teaching should include which of the following? a. you may take this medication on an empty stomach as long as you eat within 2-3 hrs 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 in between the usual doses of the NSAID
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b. change the position of J.'s arm every hr
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J., age 87, broke her wrist after falling ff a curb.she just had a plaster cast applied to her wrist. in instructing her family on allowing the cast to dry properly, tell them to: a. continuously elevate J.'s arm on a pillow b. change the position of J.'s arm every hr c. position a fan near J.'s during the night to ensure even drying of the cast d. put a blanket over the cast to absorb the dampness
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a. relative rest; he could benefit from hamstring stretching, heel cord stretching, and quadriceps stretching exercises
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J., age 17 has been c/o a painful knob below his rt knee that has prevented him from actively participating in sports. he has recently been given a dx of Osgood-Schlatter disease and asks you about his tx options. you tell him that the initial tx is: a. relative rest; he could benefit from hamstring stretching, heel cord stretching, and quadriceps stretching exercises b. immobilization; a long-leg knee immobilizer is recommended c. surgical intervention; removal of the bony fragments is necessary d. bedrest for one week
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a. Allen test
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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
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d. lysosomal degradation
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Mrs. M has rheumatoid arthritis. 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
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d. herniated nucleus pulposus
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B., age 49, comes in with low back pain. an x-ray fo the lumbar/sacral spine is within normal limits. which of the following dx do you explore further? a. scoliosis b. osteoarthritis c. spinal stenosis d. herniated nucleus pulposus
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d. Ortolani maneuver
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in assessing an infant for developmental dysplasia of the hip (DDH), the NP places the infant supine, flexes the knees by holding the thumbs on the inner midthighs, 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. Ortolani maneuver
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a. internal tibial torsion
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a common cause of in-toeing in childhood is: a. internal tibial torsion b. femoral retroversion c. external tibial torsion d. flat feet
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d. peripheral neuropathy
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a clinical manifestation of symmetric neurogenic pain may indicate: a. radiculopathy b. reflex sympathetic dystrophy c. entrapment neuropathy d. peripheral neuropathy
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c. how do you feel this surgery will affect you?
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Mr. M. is a 72 y/o African American with type I diabetes mellitus. he has been a chronic smoker for 50 yrs. he has been told recently that he must have an above-the-knee amputation because of a gangrenous foot. he has lost the will to live and states, "they shoot horses don't they? "how do you respond? a. you should be thankful they can save your life, if not your leg b. your wife needs you; you must think of her at this time c. how do you feel this surgery will affect you? d. Iwill stay with you before, during, and after the surgery because I know that this is a difficult time for you
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c. Bulge test
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Mr. MK was recently given a dx of degernative joint disease. which assessment test would you use to check for effusion on his knee? a. Thomas test b. Tinel's sign c. Bulge test d. Phalen's test
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d. appendicitis
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you correctly perform the obturator test when you raise the cl't leg with knee flexed and internally rotate the leg. a positive obturator test is indicative of: a. avascular necrosis of the femoral head b. cholecystitis c. hip bursitis d. appendicitis
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d. straight-leg-raising test
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you suspect a herniated disk on S., age 72. you elevate her affected leg when she is in the supine position and it elicits back pain 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 c. doorbell sign d. straight-leg-raising test
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b. musculoskeletal strain
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J., a 59 y/o cashier, present 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 your initial dx? a. ankylosing spondylitis b. musculoskeletal strain c. spondylolisthesis d. herniated disk
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b. hypertrophic cardiomyopathy
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which of the following would be considered a common cause of sudden death in athletes young than age 30? a. bronchospasm from exercise-induced asthma b. hypertrophic cardiomyopathy c. compartment syndrome d. meningitis
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b. gout
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C, age 67, tells you that she has been dx 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 dx but she knows that it is caused by urate crystal that get stuck in the joint and cause pain. J. is on hydrochlorothiazide (HCTZ) for management of her HTN. you suspect a dx of: a. septic arthritis b. gout c. rheumatoid arthritis d. Charcot neuro-osteoarthropathy
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a. calf symmetry and leg strength
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during a sports pre-participation physical exam, when you ask the clt to rise up on his toes and raise his heels, you are observing for: a. calf symmetry and leg strength b. hip, knee, and ankle symmetry c. hip, knee, and ankle motion d. scoliosis, hip motin, and hamstring tightness
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a. the 4th and 5th fingers
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what part of the body is affected by Dupuytren's contracture? a. the 4th and 5th fingers b. the great toe c. the tibia d. the penis
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b. the collagen fibers that connect muscle to bone
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C. a 22 y/o carpenter who is rt hand dominant, comes to you for f/u from the ED where he was seen for rt forearm pain. he states he was dx with rt forearm tendinitis and wants you to explain this dx to him. you explain that he has inflammation of one or more tendons, which are: a. the rope-like 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
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c. diarthrosis joint
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what is the type of joint that is freely movable, such as the shoulder joint, called? a. synarthrosis joint b. amphiarthrosis joint c. diarthrosis joint d. juxtarthrosis joint
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b. doxorubicin (adriamycin)
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M. 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)
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b. acetaminophen
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J. age 64, has rheumatoid arthritis. which of the following drugs would be of the least benefit? a. disease modifying antirheumatic drugs (DMARDs) b. acetaminophen c. NSAIDs d. glucocorticoids
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a. NSAIDs
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first-line drug tx for acute low back pain includes the use of: a. NSAIDs b. muscle relaxants c. opioids d. antidepressants
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d. adequate to perform only few or none of the duties of usual occupation or self-care
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J., age 69, has a class III case of rheumatoid arthritis. 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 few or none of the duties of usual occupation or self-care
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c. analgesia and by the use of a "donut" cushion when sitting
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a coccygeal fx is tx with: a. traction b. surgical repair c. analgesia and by the use of a "donut" cushion when sitting d. prolonged bedrest for 6 wks
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a. musculoskeletal pain
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M. age 34 presents with sxs 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
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b. recommend physical therapy for quadriceps strengthening exercises
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you have just completed a work-on M., age 13, and confirmed Osgood-Schlatter disease. you should: a. refer to orthopedics for early surgical correction b. recommend physical therapy for quadriceps strengthening exercises c. advise him to temporarily d/c all sports activities until his growth plates have completely fused d. tell M. that he can resume his usual activities immediately without concern and should begin aggressive exercises to increase muscle bulk and strength
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a. bend your knees and face the object straight on
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J., age 17 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
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b. gelling
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G., age 48, has rheumatoid arthritis 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
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b. due to differences in race or gender, select grps may have 23 or 25 (cervical, thoracic, lumbar)
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which of the following statement is true regarding vertebra? a. all people have only 24 vertebra, (cervical, thoracic, lumbar) b. due to differences in race or gender, select grps may have 23 or 25 (cervical, thoracic, lumbar) c. it is common to have few than 23 vertebrae (cervical, thoracic, lumbar) d. it is common to have few than 25 vertebrae (cervical, thoracic, lumbar)
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c. creatine kinase
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which muscle enzyme is elevated in polymyositis? a. aldolase A b. aspartate aminotransferase c. creatine kinase d. lactate dehydrogenase
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c. apply cold for 20 min, then take it off for 30-45 min, repeat for the first 24-48 hrs while awake
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a., age 18 sprained his ankle playing ice hockey. he is confused as to whether to apply heat or cold. what do you tell him? a. use continuous heat for the first 12 hrs, then use heat or cold to your won preference b. use continuous cold for the first 12 hrs, the use heat or cold to your own preference c. apply cold for 20 min, then take it off for 30-45 min, repeat for the first 24-48 hrs while awake d. alternate between cold and heat for 20 min each for the first 24-48 hrs
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d. Roos test
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which test assesses for thoracic outlet syndrome by having the clt abduct his/her arms 90 degrees externally rotated with the elbows flexed 90 degrees, and then having the clt open and close his /her hands for 3 minutes? a. Neer test b. Speeds test c. Hawkins test d. Roos test
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a. tennis elbow
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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
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a. to palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle
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A., a 67 y.o female who sustained a fall on an outstretched hand, presents holding her arm against her chest with her elbow flexed. based on the specific location of her pain, you suspect a radial head fx. your best initial assessment strategy to assess for radial head fx 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
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c. slipped capital femoral epiphysis (SCFE)
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a 13 y/o obese (BMI > than 90%) boy reports low-grade lft 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 wt at all on his left leg. his current c/o include left groin, thigh, and medial knee pain and tenderness. his exam 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, you suspect? a. left meniscal tear b. left anterior cruciate ligament (ACL tear) c. slipped capital femoral epiphysis (SCFE) d. Osgood-Schlatter disease
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c. hematuria
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S. age 32, fell off a roof while shingling it. he is c/o pain in his left hip and leg area. other than an x-ray, whould would make you suspect a fx pelvis? a. a clicking sensation when moving the hips b. a positive pelvic tilt test c. hematuria d. absence of distal reflexes
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b. cruciate ligament
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you are assessing M., age 16 after a football injuryt to his rt knee. you elicit a positive anterior/posterior drawer sign. this test indicates an injury to the: a. lateral meniscus b. cruciate ligament c. medial meniscus d. collateral ligament
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b. scaphoid fx
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M., a 55 y.o female, presents to you for evaluation of left hand and wrist pain a d swelling after a slip and fall on the ice yesterday. on exam, you note tenderness at her anatomical snuffbox. you know this probably indicates: a. ulnar styloid fx b. scaphoid fx c. hamate fx d. radial head fx
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b. begin a planned exercise program to strengthen back muscles
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M. a golf pro, has had chronic back pain for many yrs. his work-up reveals that is is not the result of a degenerative disk problem. his back goes out about twice per yr, and he is out of work for about a week each time. which of the following should you 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 appt with a neurosurgeon for a surgical consultation d. start on a daily low dose narcotic to take away the pain
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d. rheumatoid arthritis
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in analyzing synovial fluid, a yellow-green color may indicate which of the following? a. trauma b. gout c. bacterial infection d. rheumatoid arthritis
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a. bony fragments are in many pieces
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J. age 64 comes in for a visit. she has a cast on her rt 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 tissues and skin c. bone breaks cleanly but does not penetrate the skin d. bone is crushed
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b. assess for an adequate airway
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J., age 16 was involved in a motor vehicle accident. he walks into the office with an obvious facial fx, then collapses. what should your first action be? a. call his parents for permission to tx b. assess for an adequate airway c. obtain head and maxillofacial Ct d. assess for a septal hematoma
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c. deQuervain's tenosynovitis
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when you elicit a painful Finkelstein's sign, you are testing for: a. carpal tunnel syndrome b. bursitis of the shoulder c. deQuervain's tenosynovitis d. tennis elbow
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b. alkaline phosphatase to be elevated
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in a clt 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 phosphorus to be elevated
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a. nerve root compression
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the straight leg raising maneuver can be used to dx: a. nerve root compression b. a fx hip c. an anterior cruciate ligament tear d. tendinitis
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a. the occiput, low cervical, trapezius, and supraspinatus
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to dx fibromyalgia, there must be tenderness on digital palpation in at least 11 of 18 (nine pairs) tender-point sites, which would include: a. the occiput, low cervical, trapezius, and supraspinatus b. the proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints of thehands, and the metatarsophalangeal (MTP) and PIP joints of the footthe face joints of the cervical, thoracic, and lumbar spine d. the radial and ulnar styloids and the medial and lalteral malleoli
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c. try neutral position wrist splinting and order an oral NSAID
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S. a computer programmer, has just been given a new dx of carpal tunnel syndrome. your next step is to: a. refer her to a hand surgeon b. take a more complete hx c. try neutral position wrist splinting and order an oral NSAID d. order a nerve conduction study such as an electromyography (EMG)
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c. computer programmers
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to plan for a community education program, the NP needs to know that persons at highest risk for developing thoracic outlet syndrome (TOS) are: a. bicycle riders b. dancers c. computer programmers d. swimming instructors
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b. Bouchard's nodes
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C., age 62, has swollen, bony proximal interphalangeal joints. you describe these as: a. Heberden's nodes b. Bouchard's nodes c. Osler's nodes d. Murphy's nodes
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d. active and passive ROM of a joint should be equal, full, and pain free
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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 to avoid further injury to the 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
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a. Duchenne muscular dystrophy
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T., age 4, has an apparent hypertrophy of the calf muscles, which seem doughy on palpation. his mother is concerned because T. is unable to raise himself from the floor without bracing his knees with his hands. what do you suspect? a. Duchenne muscular dystrophy b. cerebral palsy c. Legg-Calve-Perthes disease d. multiple sclerosis
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c. temporomandibular joint syndrome
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in assessing your clt, you place the tips of your first two fingers in front of each ear and ask him to open and close his mouth. then you drop your fingers into the depressed area over the joint and note for smooth motion of the mandible. with this action, you are assessing for: a. maxillomandibular integrity b. well-positioned permanent teeth or well-fitting dentures c. temporomandibular joint syndrome d. mastoid inflammation
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c. osteosarcoma
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your clt has just been told that he has a primary bone tumor. he was so upset when he heard this that he focused only on the word tumor and not on the prognosis or type of tumor. which of the following tumors is malignant? a. osteochondroma b. chondroma c. osteosarcoma d. giant-cell tumor
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b. a high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly
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J. says that she has heard that caffeine can cause osteoporosis and ask 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
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d. pack the fingers in a saline-soaked dressing and seal in a plastic bag
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M. 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 ED 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
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b. rt thoracic curvature
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you suspect adolescent idiopathic scoliosis in V., age 15 who is in her growth spurt. you perform the Adams forward-bending test and note a right-sided rib hump. what is this indicative of? a. rt lumbar shifting b. rt thoracic curvature c. rt truncal shift d. spondylolysis
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d. a posterior rounding at the thoracic level
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you are assessing M., a 69 y.o Asian woman, for the first time. you are trying to differential between scoliosis and kyphosis. 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
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a. develops when loss of bone matrix (resorption) occurs more rapidly than new bone growth (deposition)
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L. 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 matrix (resorption) occurs more rapidly than new bone growth (deposition) b. is a degenerative joint disease characterized by degeneration and loss of articular cartilage in synovial joints c. is a chronic, systemic inflammatory disorder characterized by persistent synovitis of multiple joints d. is a metabolic bone disorder characterized by inadequate mineralization of bone matrix
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d. raloxifene
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J. age 76 has been given dxes of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. you have educated her about the importance of increasing calcium and vitamin D in her diet and starting a low impact wt bearing exercise program. you are also going to start her on medial management. J. ask you about a drug called a "SERM" that she has heard has been shown in studies to prevent vertebral fx. which of the following pharmacological tx for osteoporosis is classified as a selective estrogen receptor modulator (SERM)? a. aldendronate b. risedronate c. salmon calcitonin d. raloxifene
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c. establish an airway
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you are driving home from work and stop at the scene of a motorcycle accident that must have just occurred because there are no rescue vehicles at the scene the drive is lying at the side of the road unconscious with an obvious open fx of his femur. which of the following actions should take priority? a. stop the bleeding b. determine if there has been a cervical fx c. establish an airway d. palpate the peripheral pulses
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c. the knee
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what is the largest join in the body? a. the hip b. the shoulder c. the knee d. the elbow
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d. a Snellen test
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which test is routinely recommended for a preparticpation sport physical? a. complete blood count b. a chest x-ray c. EKG d. a Snellen test
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c. shoulder abduction and elbow flexion
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the C5 myotome innervates: a. wrist extension b. elbow extension c. shoulder abduction and elbow flexion d. ulnar deviation at the wrist along with finger flexion and abduction
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c. the buildup of synovial fluid behind the knee
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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
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b. advance the cane with the ipsilateral leg
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when teaching A., age 67 yo use of a cane because of osteoarthritis of her left knee, an important point to stress is to tell her to: a. carry the cane int he ipsilateral hand b. advance the cane with the ipsilateral leg c. make sure that the cane length equals the ht of the iliac crest d. use the cane to aid in joint protection and safety
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b. MRI scan
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P. has a malignant fibrosarcoma of the femur. he recently had surgery and is now on radiation tx. you want to order a test to determine the extend 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 scan c. CT scan d. a needle biopsy
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a. toe walking is consider normal until age 3
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T. the mother of a 2 y/o is concerned because her daughter walks on her toes all the time. what do you tell her? a. toe walking is consider normal until age 3 b. don't worry, she will outgrow it c. toe walking is normal until she starts kindergarten d. we should do further testing now
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a. compartment syndrome
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S., age 26 has a cast on his rt arm because of an in-line skating accident. twelve hrs after the cast was applied, he c/o severe pain ever though he recently took his pain meds. his fingers are pink, yet he states that they are tingling and feel slightly numb. what do you suspect? a. compartment syndrome b. phlebitis c. osteomyelitis d. muscle contraction
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a. functional scoliosis is flexible; it is apparent with standing and disappears with forward bending
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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
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c. condylar joint
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the knee is an example of a: a. spheroidal joint b. hinge joint c. condylar joint d. fibrous joint
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b. affected joints are swollen, cool, and bony hard on palpation
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J. age 49 states that she thinks she has rheumatoid arthritis. before any dxnostic test are ordered, you complete a PE and make a tentative dx of osteroarthritis rather than rheumatoid arthritis. which clinical manifestation r/o rheumatoid arthritis? a. fatigue b. affected joints are swollen, cool, and bony hard on palpation c. decreased ROM d. stiffness
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a. integumentary effects include swelling, erythema, and warmth at the involved site
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D. 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 thenderness of the entire leg d. cardiovascular effects include bradycardia
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c. basketball
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RM has a 15 y/o son who wants to play sports; however, she is very leery because she has heard of so many accidents. which one of the following sports does the American Academy of Pediatrics list as a limited contact/impact sport? a. field hockey b. soccer c. basketball d. lacross
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b. dietary counseling
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S. age 48 has asymptomatic hyperuricemia. what is your inital tx? a. NSAIDs b. dietary counseling c. colchicine d. allopurinol
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c. lumbar intervertebrak disk herniation
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the most common cause of cauda equina syndrome is: a. fx b. hematoma c. lumbar intervertebrak disk herniation d. space-occupying lesion
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b. NSAIDs
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you are caring for a pt that has a hx of psoriasis and now is showing signs of musculoskeletal s/s with joint involvement. seropositivity provides a definitive dx of psoriatic arthritis (PsA). your initial tx choice for management of the pt is: a. disease modifying antirheumtic drugs (DMARDs) b. NSAIDs c. tumor necrosis factor-alpha inhibitors (TNF-alphal inhibitor) d. uricosuric
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c. polymyalgia rheumatica
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what do 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, wt loss, sweats, and low-grade fever? a. fibromyalgia syndrome b. myofascial somatic dysfunction c. polymyalgia rheumatica d. Reiter's syndrome
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b. L4/L5 (L5 root involvement)
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M. age 52 is a postal worker who drive a truck every day. he presents with lower back pain and has decreased sensation to a pinprick int he lateral leg and web of the great toe. this indicates discogenic disease int he dermatomal pattern of which area? a. L3/L4 (L4 root involvement) b. L4/L5 (L5 root involvement) c. L5/S1 (S1 root involvement) d. none of the above
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c. bisphosphonates
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S. age 50, presents with Paget's disease that has been stable for several yrs. recently, his serum alkaline phosphatase level has been steadily rising. you determine that it is time to start him on: a. NSAIDs b. corticosteroids c. bisphosphonates d. calcitonin
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c. begin lower back strengthening exercises depending on pain tolerance
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J. age 22, a stock boy, has an acute episode of low back pain. you order an NSAID and tell him which of the following? a. maintain moderate bedrest for 3-4 days b. call the office for narcotic meds if there is no relief with the NSAID after 24-48 hrs c. begin lower back strengthening exercises depending on pain tolerance d. wear a Boston brace at night
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a. normal foot
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during your assessment of your clt's foot, you note that the foot is in alignment with the long axis of the lower leg and that wt-bearing falls on the middle of the foot, from the hell, along the midfoot, to between the second and third toes. what do you dx? a. normal foot b. Hallux valgus c. talipes equinovarus d. hammertoes
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c.Thompson test
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which test is used to dx an Archilles tendon rupture? a. boutonniere test b. Lachman test c.Thompson test d. Drawer test
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a. synovial-fluid analysis and x-ray
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you are considering a dx of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease or pseudogout in a 72 y/o man who presents with c/o pain and stiffness in his wrists and knees. the most useful dx test to assist you in making this dx 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
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a. increased lactic acid production, muscle breakdown, and minor inflammation
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what pathophysiology associated with transient pain after exercising usually begins a few hrs 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 fx
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c. smoking
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which of the following is a modifiable risk factor for osteoporosis? a. low alcohol intake b. low caffeine intake c. smoking d. excessive exercise
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b. low-dose steroids
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treatment of choice for polymyalgia rheumatica (PMR) is. a. acetaminophen or NSAIDs b. low-dose steroids c. tricyclic antidepressants d. antibiotics
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d. apley's compression test
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to aid in the dx of meniscus damage, which test should you perform? a. bulge test b. lachman test c. drawer sign d. apley's compression test
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a. all women age 65 and older regardless of risk factors
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bone mineral density (BMD) testing is recommended by the National Osteoporosis foundation for which fo the following clt 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 baseline d. all women of menopausal age
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b. CASPAR (Classification of Psoriatic Arthritis) criteria
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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
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a. inability to shrug the shoulder
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J. age 49 has recently begun a rigorous wt-lifting regimen. she presents in your office with a shoulder dislocation. which of the following clinical manifestations make you 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
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a. giving psychotropic drugs, such as amitriptyline in a low dose at bedtime
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management of fibromyalgia would include: a. giving psychotropic drugs, such as amitriptyline in a low dose at bedtime b. instructing clts to keep as busy as possible to keep their minds off the sxs c. using high doses of NSAIDs d. avoiding exercise
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a. fever, tachycardia, rapid respirations, and neurological manifestation
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S. age 34, fx his femur when his horse tripped over a jump. with this type of injury you know that S. is at risk for fat emboli. early assessment findings for this complication include: a. fever, tachycardia, rapid respirations, and neurological manifestation b. neurological manifestations, temperature elevation, bradycardia and pallor c. hostility; combativeness; substernal pain; and weak thready pulse d. lethargy, hypothermia, paresthesia, and absent peripheral pulses
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a. is an injury to the ligaments that attach to bone in a joint
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when M., 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 bone 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. does not result in joint instability
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a. osteosarcoma
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H., age 59 has Paget's disease of the bone. it was dx as a result of routine blood work during his annual physical, which showed an increased serum alkaline phosphate level. you know that the most serious complication of Paget's disease is: a. osteosarcoma b. nerve compression c. fx d. bone pain
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d. reactive arthritis
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M. age 58 presents with urethritis, conjunctivitis, and asymmetric joint stiffness, primarily in the knees, ankles, and feet. which condition do you suspect? a. syphilis b. gonorrhea c. HIV d. reactive arthritis
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b. full ROM against gravity with some resistance
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when grading muscle strength on a scale of 1-5, a grade of 4 indicates: a. full ROM 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)
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a. repetitive nerve stimulation
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which of the following can assist in the dx of myasthenia gravis? a. repetitive nerve stimulation b. the presence of cogwheel rigidity c. Chvostek's sign d. Trousseaus' sign
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c. Sjogren's syndrome
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AM sttes that she has a maternal hx of rheumatoid disease but that she has never been affected. today she presents with c/o dryness of the eyes and mouth. what do you suspect? a. rheumatoid arthritis b. systemic lupus erythematosus c. Sjogren's syndrome d. rosacea
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b. hyperuricemia
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A., age 46 presents with a tender, red, swollen knee. you r/o septic arthritis and dx 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
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d. spinal fx
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H. age 73, presents with a c/o low back pain. red flags inher hx of a minor fall, having 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 fx
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b. dorsal kyphosis
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Mr.s K. 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
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c. no more than 3-4 times a yr int he same joint
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M. age 72, has severe osteoarthritis of her rt knee. she obtains much relief from corticosteroid injection. when she asks you how often she can have them, how do you respond? a. only once a yr in the same joint b. no more than twice a yr in the same joint c. no more than 3-4 times a yr int he same joint d. no more than 5-6 times a yr in the same joint
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a. it is often associated with being the first born female child
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which of the following statements concerning developmental dysplasia of the hip (DDH) is correct? a. it is often associated with being the first born female child b. it results from an orthopedic malformation in utero c. it has no genetic predisposition d. it is more common in males
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b. ganglia transilluminate
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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
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b. higher bone mass
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black men have a relatively low incidence of osteoporosis because they have: a. increased bone resorption b. higher bone mass c. wide and thick long bones d. decreased bone deposition
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b. ankylosis
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what is stiffness or fixation of a joint called? a. contracture b. ankylosis c. dislocation d. subluxation
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b. after childbirth, your carpal tunnel syndrome may resolve
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A. age 42 is pregnant and was just given a dx 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 or the probability of being unable to care for your baby
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c. crepitus
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grating of the bones or entrance of air into an open fx is manifested as: a. swelling b. ecchymosis c. crepitus d. pain and tenderness
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d. stretching and warm-up exercises are an important part of any exercise routitne
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E., age 21 presents today with another muscle strain from one of her many sports activities. you think that she was probably never taught about health promotion and maintenance regarding physical activity. what information do you include in your 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 wt training and then you can participate in any activity once you are physically fit c. after any 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 routitne
