Chap 15 Musculoskeletal 1 Flashcards
70yo female has fallen 2wks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. ROM is uncomfortable and severely diminished due to pain. No crepitus is heard or felt. Her fingers are warm, pulse is strong, and cap refill is less than 2sec. What should you do?
a. Make an immediate referral for an orthopedic eval without further assessment
b. Tell her that it takes time for these bruises to improve, so she should be patient
c. Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint
d. Send her to the ER for reduction of this obvious wrist fracture
Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint
- The clinician has instructed Sam, a 25yo pt with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
a. “You should start with the lowest dose that is effective in managing your pain, because long- term use of NSAIDs can result in GI disorders such as ulcers and hemorrhage.”
b. “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.”
c. “You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.”
d. “It is important to take NSAIDs on an empty stomach in order to increase absorption.”
. “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in GI disorders such as ulcers and hemorrhage.”
- The clinician is caring for Diane, a 22yo woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s exam or history would alert the clinician to the need for obtaining radiographs?
a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury c. Crepitation with palpation or movement of the ankle
d. All of the above
D. All of the above
- The clinician suspects that a client has a patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30 degrees. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
Apprehension sign
- Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the ER with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks
Paresthesia of the perineum and buttocks
- John is a 16yo boy who presents to the ER after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
McMurray circumduction test
Jennifer is an 18yo who comes to the ER after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
a. Posterior dislocations are more common than anterior dislocations
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses
c. Recurrent dislocations are uncommon and would require great force to result in injury.
d. Surgery is most commonly the treatment of choice
There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses
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
- a. all women age 65 and older regardless of risk factors
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
. develops when loss of bone matrix (resorption) occurs more rapidly than new bone growth (deposition)
. 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
- b. a high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly
