Chapter 12: Musculoskeletal Disorders

Question 1

Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following except:

Answer 1

Crystal deposition

Question 2

In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be:

Answer 2

Synovial fluid analysis

Question 3

Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as:

Answer 3

Steppage

Question 4

Which of the following best describes the pain associated with osteoarthritis?

Answer 4

Begins upon arising and after prolonged weight bearing and/or use of the joint

Question 5

Joint effusions typically occur later in the course of OA, especially in the:

Answer 5

Knee

Question 6

You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which two clinical findings are common in patients with PMR?

Answer 6

Normochromic, normocytic anemia and thrombocytosis

Question 7

You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative of GCA and PMR?

Answer 7

Scalp tenderness and aching in shoulder and pelvic girdle

Question 8

Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include:

Answer 8

Dual-energy x-ray (DEXA) scan and updating immunizations

Question 9

Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica (PMR) can be ruled out with a muscle biopsy?

Answer 9

Polymyositis

Question 10

In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results you would expect to see include:

Answer 10

Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour

Question 11

Which of the following is the most appropriate laboratory test for monitoring gout therapy over the long-term?

Answer 11

Serum urate level

Question 12

In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items:

Answer 12

Beer, sausage, fried seafood

Question 13

The best method of verifying a diagnosis of gout in a joint is which of the following:

Answer 13

Joint aspiration and polarized-light microscopy

Question 14

The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk):

Answer 14

Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days

Question 15

The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset rheumatoid arthritis would be:

Answer 15

Soft tissue swelling

Question 16

The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as:

Answer 16

Haygarth’s nodes

Question 17

A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic congestive heart failure. The most likely contributing factor to the development of gout in this older female is:

Answer 17

Thiazide diuretics

Question 18

Which of the following statements about osteoarthritis is true?

Answer 18

It affects primarily weight-bearing joints

Question 19

In considering the specificity of laboratory data, the most reliable diagnostic test listed below would be:

Answer 19

Synovial fluid analysis to differentiate between an infectious versus an inflammatory infusion

Question 20

When examining the spine of an older adult you notice a curvature with a sharp angle. This is referred to as a:

Answer 20

Gibbus