MSK Practice Questions Flashcards
The most common cause of acute bursitis is: A. inactivity. B. joint overuse. C. fibromyalgia. D. bacterial infection.
B. joint overuse.
First-line treatment options for bursitis usually include:
A. corticosteroid bursal injection.
B. heat to area.
C. weight-bearing exercises.
D. nonsteroidal anti-inflammatory drugs (NSAIDs).
D. nonsteroidal anti-inflammatory drugs (NSAIDs).
Patients with olecranon bursitis typically present with:
A. swelling and redness over the affected area.
B. limited elbow range of motion (ROM).
C. nerve impingement.
D. destruction of the joint space.
A. swelling and redness over the affected area.
Patients with subscapular bursitis typically present with:
A. limited shoulder ROM.
B. heat over affected area.
C. localized tenderness under the superomedial angle of the scapula.
D. cervical nerve root irritation.
C. localized tenderness under the superomedial angle of the scapula.
Patients with gluteus medius or deep trochanteric bursitis typically present with:
A. increased pain from resisted hip abduction.
B. limited hip ROM.
C. sciatic nerve pain.
D. heat over the affected area.
A. increased pain from resisted hip abduction.
Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy. B. infection. C. inflammatory reaction. D. soreness at the site of injection.
D. soreness at the site of injection.
First-line therapy for prepatellar bursitis should include: A. bursal aspiration. B. intrabursal corticosteroid injection. C. acetaminophen. D. knee splinting.
A. bursal aspiration.
Clinical conditions with a presentation similar to acute bursitis include: (More than one option can apply.) A. rheumatoid arthritis. B. septic arthritis. C. joint trauma. D. pseudogout.
All of them
Patients with lateral epicondylitis typically present with:
A. electric-like pain elicited by tapping over the median nerve.
B. reduced joint ROM.
C. pain that is worst with elbow flexion.
D. decreased hand grip strength.
D. decreased hand grip strength.
Risk factors for lateral epicondylitis include all of the following except: A. repetitive lifting. B. playing tennis. C. hammering. D. gout.
D. gout.
Up to what percent of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95%
D. 95%
Initial treatment of lateral epicondylitis includes all of the following except: A. rest and activity modifications. B. corticosteroid injections. C. topical or oral NSAIDs, D. counterforce bracing.
B. corticosteroid injections.
Extracorporeal shock-wave therapy can be used in the treatment of epicondylitis as a means to: A. improve ROM. B. build forearm strength. C. promote the natural healing process. D. stretch the extensor tendon.
C. promote the natural healing process.
Patients with medial epicondylitis typically present with: A. forearm numbness. B. reduction in ROM. C. pain on elbow flexion. D. decreased grip strength.
D. decreased grip strength.
Risk factors for medial epicondylitis include playing: A. tennis. B. golf. C. baseball. D. volleyball.
B. golf.
Risk factors for acute gouty arthritis include: A. obesity. B. female gender. C. rheumatoid arthritis. D. joint trauma.
A. obesity.
The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.
B. statins.
Secondary gout can be caused by all of the following conditions except: A. psoriasis. B. hemolytic anemia. C. bacterial cellulitis. D. renal failure.
C. bacterial cellulitis.
The clinical presentation of acute gouty arthritis affecting the base of the great toe includes:
A. slow onset of discomfort over many days.
B. greatest swelling and pain along the median aspect of the joint.
C. improvement of symptoms with joint rest.
D. fever.
B. greatest swelling and pain along the median aspect of the joint.
The most helpful diagnostic test to perform during acute gouty arthritis is:
A. measurement of erythrocyte sedimentation rate (ESR).
B. measurement of serum uric acid.
C. analysis of aspirate from the affected joint.
D. joint radiography.
C. analysis of aspirate from the affected joint.
First-line therapy for treating patients with acute gouty arthritis usually includes: A. aspirin. B. naproxen sodium. C. allopurinol. D. probenecid.
B. naproxen sodium.
Tophi are best described as:
A. ulcerations originating on swollen joints.
B. swollen lymph nodes.
C. abscesses with one or more openings draining pus onto the skin.
D. nontender, firm nodules located in soft tissue.
D. nontender, firm nodules located in soft tissue.
Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection?
A. a 66-year-old patient with a gastric ulcer
B. a 44-year-old patient taking a thiazide diuretic
C. a 68-year-old patient with type 2 diabetes mellitus
D. a 32-year-old patient who is a binge drinker
A. a 66-year-old patient with a gastric ulcer
The most common locations for tophi include all of the following except: A. the auricles. B. the elbows. C. the extensor surfaces of the hands. D. the shoulders.
D. the shoulders.
Dietary recommendations for a person with gouty arthritis include avoiding foods high in: A. artificial flavors and colors. B. purine. C. vitamin C. D. protein.
B. purine.
Which of the following dietary supplements is associated with increased risk for gout? A. vitamin A B. gingko biloba C. brewer’s yeast D. glucosamine
C. brewer’s yeast
Pseudogout is caused by the formation of what type of crystals in joints? A. uric acid B. calcium oxalate C. struvite D. calcium pyrophosphate dihydrate
D. calcium pyrophosphate dihydrate
Pseudogout has been linked with abnormal activity of the: A. liver. B. kidneys. C. parathyroid. D. adrenal gland.
C. parathyroid.
Differentiation between gout and pseudogout can involve all of the following diagnostic approaches except: A. analysis of minerals in the blood. B. analysis of joint fluid. C. x-ray of the affected joint. D. measuring thyroid function.
C. x-ray of the affected joint.
Treatment of pseudogout can include all of the following except: A. NSAIDs. B. colchicine. C. allopurinol. D. oral corticosteroids.
C. allopurinol.
Which of the following joints is most likely to be affected by osteoarthritis (OA)? A. wrists B. elbows C. metacarpophalangeal joint D. distal interphalangeal joint
D. distal interphalangeal joint
Changes to the joint during osteoarthritis can typically include all of the following except: A. widening of the joint space. B. articular cartilage wears away. C. formation of bone spurs. D. synovial membrane thickens.
A. widening of the joint space.
Clinical findings of the knee in a patient with OA include all of the following except: A. coarse crepitus. B. joint effusion. C. warm joint. D. knee often locks or a pop is heard.
C. warm joint.
Radiographic findings of osteoarthritis of the knee often reveal:
A. microfractures.
B. decreased density of subchondral bone.
C. osteophytes.
D. no apparent changes to the joint structure.
C. osteophytes.
Approximately what percent of patients with radiological findings of osteoarthritis of the knee will report having symptoms? A. 25% B. 50% C. 70% D. 95%
B. 50%
Deformity of the proximal interphalangeal joints found in an elderly patient with OA is known as: A. Heberden nodes. B. Bouchard nodes. C. hallus valgus. D. Dupuytren contracture.
B. Bouchard nodes.
Which of the following best describes the presentation of a patient with OA?
A. worst symptoms in weight-bearing joints later in the day
B. symmetrical early morning stiffness
C. sausage-shaped digits with associated skin lesions
D. back pain with rest and anterior uveitis
A. worst symptoms in weight-bearing joints later in the day
As part of the evaluation of patients with OA, the NP anticipates finding:
A. anemia of chronic disease.
B. elevated CRP level.
C. no disease-specific laboratory abnormalities.
D. elevated antinuclear antibody (ANA) titer.
C. no disease-specific laboratory abnormalities.
First-line pharmacological intervention for milder OA should be a trial of:
A. acetaminophen.
B. tramadol.
C. celecoxib.
D. intraarticular corticosteroid injection.
A. acetaminophen.
In caring for a patient with OA of the knee, you advise that:
A. straight-leg raising should be avoided.
B. heat should be applied to painful joints after exercise.
C. quadriceps-strengthening exercises should be performed.
D. physical activity should be avoided.
C. quadriceps-strengthening exercises should be performed.
The mechanism of action of glucosamine and chondroitin is:
A. via increased production of synovial fluid.
B. through improved cartilage repair.
C. via inhibition of the inflammatory response in the joint.
D. largely unknown.
D. largely unknown.
An adverse effect associated with the use of glucosamine is: A. elevated ALT and AST. B. bronchospasm. C. increased bleeding risk. D. QT prolongation.
B. bronchospasm.
A 72-year-old man presents at an early stage of osteoarthritis in his left knee. He mentions that he heard about the benefits of using glucosamine and chondroitin for treating joint problems. In consulting the patient, you mention all of the following except:
A. any benefit can take at least 3 months of consistent use before observed.
B. glucosamine is not associated with any drug interactions.
C. clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA of the knee.
D. chondroitin should be used with caution because of its antiplatelet effect.
C. clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA of the knee.
The American Academy of Orthopaedic Surgeons (AAOS) favors all of the following in the management of symptomatic OA of the knee except:
A. low-impact aerobic exercises.
B. weight loss for those with a BMI ≥25 kg/m2.
C. acupuncture.
D. strengthening exercises.
C. acupuncture.
AAOS strongly recommends all of the following therapeutic agents for the management of symptomatic OA of the knee except: A. oral NSAIDs. B. topical NSAIDs. C. tramadol. D. opioids.
D. opioids.
Among surgical and procedural interventions, AAOS strongly recommends the use of which of the following for the management of symptomatic OA of the knee?
A. intraarticular corticosteroid use
B. hyaluronic acid injections
C. arthroscopy with lavage and/or débridement
D. none of the above
D. none of the above
Regarding the current scientific evidence on the use of glucosamine and chondroitin for the management of symptomatic OA of the knee, AAOS:
A. strongly favors their use.
B. provides a moderate-strength recommendation for their use.
C. cannot recommend for or against the use of these supplements (limited evidence).
D. cannot recommend the use of these supplements.
D. cannot recommend the use of these supplements.
You see a 67-year-old woman who has been treated for pain due to OA of the hip for the past 6 months and who asks about hip replacement surgery. She complains of pain even at night when sleeping and avoids walking even moderate distances unless absolutely necessary. In counseling the patient, you mention all of the following except:
A. arthroplasty can be considered when pain is not adequately controlled.
B. arthroplasty is not needed if the patient can walk even short distances.
C. arthroplasty candidates must be able to tolerate a long surgical procedure.
D. rehabilitation following surgery is essential to achieve maximal function of the joint.
B. arthroplasty is not needed if the patient can walk even short distances.
Recommended exercises for patients with OA of the knee include all of the following except:
A. squatting with light weights.
B. straight-leg raises without weights.
C. quadriceps sets.
D. limited weight-bearing aerobic exercises.
A. squatting with light weights.
Recommended exercises for patients with OA of the hip include all of the following except:
A. stretching exercises of the gluteus muscles.
B. straight-leg raises without weights.
C. isometric exercises of the iliopsoas and gluteus muscles.
D. weight-bearing aerobic exercises.
D. weight-bearing aerobic exercises.
Which of the following is not characteristic of rheumatoid arthritis (RA)?
A. It is more common in women at a 3:1 ratio.
B. Family history of autoimmune conditions often is reported.
C. Peak age for disease onset in individuals is age 50 to 70 years.
D. Wrists, ankles, and toes often are involved.
C. Peak age for disease onset in individuals is age 50 to 70 years.
Which of the following best describes the presentation of a person with RA?
A. worst symptoms in weight-bearing joints later in the day
B. symmetrical early-morning stiffness
C. sausage-shaped digits with characteristic skin lesions
D. back pain with rest and anterior uveitis
B. symmetrical early-morning stiffness
NSAIDs cause gastric injury primarily by:
A. direct irritative effect.
B. slowing gastrointestinal motility.
C. thinning of the protective gastrointestinal mucosa.
D. enhancing prostaglandin synthesis.
C. thinning of the protective gastrointestinal mucosa.
Of the following individuals, who is at highest risk for NSAID-induced gastropathy?
A. a 28-year-old man with an ankle sprain who has taken ibuprofen for the past week and who drinks four to six beers every weekend
B. a 40-year-old woman who smokes and takes about six doses of naproxen sodium per month to control dysmenorrhea
C. a 43-year-old man with dilated cardiomyopathy who uses ketoprofen one to two times per week for low back pain
D. a 72-year-old man who takes aspirin four times a day for pain control of osteoarthritis
D. a 72-year-old man who takes aspirin four times a day for pain control of osteoarthritis
Which of the following is the preferred method of preventing NSAID-induced gastric ulcer?
A. a high-dose histamine 2 receptor antagonist
B. timed antacid use
C. sucralfate (Carafate)
D. misoprostol (Cytotec)
D. misoprostol (Cytotec)
Taking a high dose of aspirin or ibuprofen causes:
A. an increase in the drug’s half-life.
B. enhanced renal excretion of the drug.
C. a change in the drug’s mechanism of action.
D. a reduction of antiprostaglandin effect.
A. an increase in the drug’s half-life.
Which of the following statements is most accurate concerning RA?
A. Joint erosions are often evident on radiographs or MRI.
B. RA is seldom associated with other autoimmune diseases.
C. A butterfly-shaped facial rash is common.
D. Parvovirus B19 infection can contribute to its development.
A. Joint erosions are often evident on radiographs or MRI.
Which of the following hemograms would be expected for a 46-year-old woman with poorly controlled RA?
A. Hg = 11.1 g/dL (12–14 g/dL); MCV = 66 fL (80–96 fL); reticulocytes = 0.8% (1%–2%).
B. Hg = 10.1 g/dL (12–14 g/dL); MCV = 103 fL (80–96 fL); reticulocytes = 1.2% (1%–2%).
C. Hg = 9.7 g/dL (12–14 g/dL); MCV = 87 fL (80–96 fL); reticulocytes = 0.8% (1%–2%).
D. Hg = 11.4 g/dL (12–14 g/dL); MCV = 84 fL (80–96 fL); reticulocytes = 2.3% (1%–2%).
C. Hg = 9.7 g/dL (12–14 g/dL); MCV = 87 fL (80–96 fL); reticulocytes = 0.8% (1%–2%).