MSK Practice Questions Flashcards
1
Q
The most common cause of acute bursitis is: A. inactivity. B. joint overuse. C. fibromyalgia. D. bacterial infection.
A
B. joint overuse.
2
Q
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).
A
D. nonsteroidal anti-inflammatory drugs (NSAIDs).
3
Q
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
A. swelling and redness over the affected area.
4
Q
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.
A
C. localized tenderness under the superomedial angle of the scapula.
5
Q
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
A. increased pain from resisted hip abduction.
6
Q
Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy. B. infection. C. inflammatory reaction. D. soreness at the site of injection.
A
D. soreness at the site of injection.
7
Q
First-line therapy for prepatellar bursitis should include: A. bursal aspiration. B. intrabursal corticosteroid injection. C. acetaminophen. D. knee splinting.
A
A. bursal aspiration.
8
Q
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.
A
All of them
9
Q
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.
A
D. decreased hand grip strength.
10
Q
Risk factors for lateral epicondylitis include all of the following except: A. repetitive lifting. B. playing tennis. C. hammering. D. gout.
A
D. gout.
11
Q
Up to what percent of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95%
A
D. 95%
12
Q
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.
A
B. corticosteroid injections.
13
Q
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.
A
C. promote the natural healing process.
14
Q
Patients with medial epicondylitis typically present with: A. forearm numbness. B. reduction in ROM. C. pain on elbow flexion. D. decreased grip strength.
A
D. decreased grip strength.
15
Q
Risk factors for medial epicondylitis include playing: A. tennis. B. golf. C. baseball. D. volleyball.
A
B. golf.
16
Q
Risk factors for acute gouty arthritis include: A. obesity. B. female gender. C. rheumatoid arthritis. D. joint trauma.
A
A. obesity.
17
Q
The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.
A
B. statins.
18
Q
Secondary gout can be caused by all of the following conditions except: A. psoriasis. B. hemolytic anemia. C. bacterial cellulitis. D. renal failure.
A
C. bacterial cellulitis.
19
Q
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.
A
B. greatest swelling and pain along the median aspect of the joint.
20
Q
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.
A
C. analysis of aspirate from the affected joint.
21
Q
First-line therapy for treating patients with acute gouty arthritis usually includes: A. aspirin. B. naproxen sodium. C. allopurinol. D. probenecid.
A
B. naproxen sodium.
22
Q
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.
A
D. nontender, firm nodules located in soft tissue.
23
Q
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. a 66-year-old patient with a gastric ulcer
24
Q
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.
A
D. the shoulders.
25
```
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.
26
```
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
27
```
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
28
```
Pseudogout has been linked with abnormal activity of the:
A. liver.
B. kidneys.
C. parathyroid.
D. adrenal gland.
```
C. parathyroid.
29
```
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.
30
```
Treatment of pseudogout can include all of the following except:
A. NSAIDs.
B. colchicine.
C. allopurinol.
D. oral corticosteroids.
```
C. allopurinol.
31
```
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
32
```
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.
33
```
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.
34
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.
35
```
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%
36
```
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.
37
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
38
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.
39
First-line pharmacological intervention for milder OA should be a trial of:
A. acetaminophen.
B. tramadol.
C. celecoxib.
D. intraarticular corticosteroid injection.
A. acetaminophen.
40
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.
41
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.
42
```
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.
43
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.
44
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.
45
```
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.
46
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
47
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.
48
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.
49
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.
50
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.
51
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.
52
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
53
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.
54
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
55
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)
56
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.
57
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.
58
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%).
59
```
X-rays will fail to show changes in affected joints in approximately what percent of patients with RA at disease onset?
A. 30%
B. 50%
C. 75%
D. 95%
```
A. 30%
60
```
RA disease progression is typically evaluated using all of the following approaches except:
A. x-ray.
B. MRI.
C. echosonography.
D. ultrasound.
```
C. echosonography.
61
```
Mrs. Sanchez is a 42-year-old mother of three who reports pain and stiffness in multiple joints that have lasted for more than 6 months. She is diagnosed with rheumatoid arthritis. She has no other clinical conditions of significance. You recommend which of the following treatments for first-line therapy?
A. topical analgesics and oral NSAIDs
B. methotrexate plus oral NSAIDs
C. acetaminophen plus leflunomide
D. anakinra and systemic corticosteroids
```
B. methotrexate plus oral NSAIDs
62
You see a 37-year-old man with rheumatoid arthritis who has been treated with hydroxychloroquine and oral NSAIDs for the past 3 months with little improvement in symptoms. Radiography indicates slight progression of RA in several major joints. You recommend:
A. maintaining the current regimen.
B. increasing the dose of NSAIDs.
C. adding methotrexate to his regimen.
D. switching from hydroxychloroquine to a biologic agent.
C. adding methotrexate to his regimen.
63
```
A significant adverse effect of biologic therapy for treating RA is:
A. myopathy.
B. infections.
C. renal impairment.
D. elevated liver enzymes.
```
B. infections.
64
```
Which of the following tests is most specific to the diagnosis of RA?
A. elevated levels of rheumatoid factor
B. abnormally high ESR
C. leukopenia
D. positive ANA titer
```
A. elevated levels of rheumatoid factor
65
```
A positive ANA test is a sensitive marker for the presence of:
A. hyperparathyroidism.
B. systemic lupus erythematosus (SLE).
C. Kawasaki disease.
D. leukocytosis.
```
B. systemic lupus erythematosus (SLE).
66
```
A 52-year-old woman has RA. She now presents with decreased tearing, “gritty”-feeling eyes, and a dry mouth. You consider a diagnosis of:
A. systemic lupus erythematosus.
B. vasculitis.
C. Sjögren syndrome.
D. scleroderma.
```
C. Sjögren syndrome.
67
```
Cyclooxygenase-1 (COX-1) contributes to:
A. inflammatory response.
B. pain transmission.
C. maintenance of gastric protective mucosal layer.
D. renal arteriole function.
```
C. maintenance of gastric protective mucosal layer.
68
Cyclooxygenase-2 (COX-2) contributes to all of the following except:
A. inflammatory response.
B. pain transmission.
C. maintenance of gastric protective mucosal layer.
D. renal arteriole constriction.
C. maintenance of gastric protective mucosal layer.
69
```
Which of the following special examinations should be periodically obtained during hydroxychloroquine sulfate use?
A. dilated eye retinal examination
B. bone marrow biopsy
C. pulmonary function tests
D. exercise tolerance test
```
A. dilated eye retinal examination
70
```
Common physical findings of SLE include all of the following except:
A. weight gain.
B. joint pain and swelling.
C. fatigue.
D. facial rash.
```
A. weight gain.
71
```
All of the following diagnostic findings are expected in a patient with SLE except:
A. elevated ESR.
B. anemia.
C. negative ANA test.
D. proteinuria.
```
C. negative ANA test.
72
```
First-line treatment of SLE in a patient with mild symptoms is:
A. systemic corticosteroids.
B. hydroxychloroquine plus NSAIDs.
C. anakinra.
D. methotrexate.
```
B. hydroxychloroquine plus NSAIDs.
73
```
All of the following agents can be considered for the treatment of severe cases of SLE except:
A. leflunomide.
B. azathioprine.
C. rituximab.
D. belimumab.
```
C. rituximab.
74
You see a 26-year-old woman who has been recently diagnosed with SLE and has initiated therapy to control moderate symptoms of the disease, including fatigue and joint pain. She mentions that she and her husband are hoping to start a family soon. In counseling her about pregnancy, you consider that:
A. there is a low probability of conception during symptomatic flares of SLE.
B. most treatments for SLE must be discontinued once a woman becomes pregnant.
C. SLE is associated with a high risk of pregnancy loss.
D. there is a higher risk of gestational diabetes in women with SLE.
C. SLE is associated with a high risk of pregnancy loss.
75
```
To confirm the results of a McMurray test, you ask the patient to:
A. squat.
B. walk.
C. flex the knee.
D. rotate the ankle.
```
A. squat.
76
The most common type of injury causing a sport-related meniscal tear involves:
A. twisting of the knee.
B. hyperextension of the knee.
C. repetitive hard impact on the knee (i.e., running on hard surface).
D. an unknown origin in most cases.
A. twisting of the knee.
77
```
Which of the following best describes the presentation of a patient with complete medial meniscus tear?
A. joint effusion
B. heat over the knee
C. inability to kneel
D. loss of smooth joint movement
```
C. inability to kneel
78
To help prevent meniscal tear, you advise:
A. limiting participation in sports.
B. quadriceps-strengthening exercises.
C. using a knee brace.
D. applying ice to the knee before exercise.
B. quadriceps-strengthening exercises.
79
Initial treatment for meniscal tear includes all of the following except:
A. NSAID use.
B. applying ice to the affected area.
C. elevation of the affected limb.
D. joint aspiration of the affected knee.
D. joint aspiration of the affected knee.
80
The Phalen test is described as:
A. reproduction of symptoms with forced flexion of the wrists.
B. abnormal tingling when the median nerve is tapped.
C. pain on internal rotation.
D. palmar atrophy.
A. reproduction of symptoms with forced flexion of the wrists.
81
The Tinel test is best described as:
A. reproduction of symptoms with forced flexion of the wrists.
B. abnormal tingling when the median nerve is tapped.
C. pain on internal rotation.
D. palmar atrophy.
B. abnormal tingling when the median nerve is tapped.
82
All of the following statements about electromyography (EMG) are true except:
A. EMG measures electrical impulses caused by muscles.
B. diagnosis of carpal tunnel syndrome involves comparing EMG results of the muscles at rest versus contraction.
C. EMG can detect muscle damage.
D. EMG involves sending a small electrical impulse through the muscle tissue.
D. EMG involves sending a small electrical impulse through the muscle tissue.
83
Results of a nerve conduction study in a person with carpal tunnel syndrome (CTS) would reveal:
A. erratic nerve impulses during forearm muscle contraction.
B. a lack of nerve impulses in the carpal tunnel.
C. continued firing of the median nerve while the forearm muscles are at rest.
D. a slowing of nerve impulses in the carpal tunnel.
D. a slowing of nerve impulses in the carpal tunnel.
84
```
Risk factors for CTS include all of the following except:
A. pregnancy.
B. untreated hypothyroidism.
C. repetitive motion.
D. multiple sclerosis.
```
D. multiple sclerosis.
85
Which of the following is least likely to be reported by patients with CTS?
A. worst symptoms during the day
B. burning sensation in the affected hand
C. tingling pain that radiates to the forearm
D. nocturnal numbness
C. tingling pain that radiates to the forearm
86
Acroparesthesia, frequently reported in patients with CTS, is best described as:
A. constant pain radiating from the elbow.
B. a transient inability to move the fingers.
C. waking up at night with numbness and burning pain in the fingers.
D. muscle spasms that cause fist clenching.
C. waking up at night with numbness and burning pain in the fingers.
87
```
Initial therapy for patients with CTS includes:
A. intra-articular injection.
B. joint splinting.
C. systemic corticosteroids.
D. referral for surgery.
```
B. joint splinting.
88
Patients whose CTS fails to respond to conservative treatment measures should be considered for:
A. systemic corticosteroid use.
B. low-dose opioids.
C. surgery.
D. vitamin B6 injections in the carpal tunnel.
C. surgery.
89
```
Primary prevention of CTS includes:
A. screening for thyroid dysfunction.
B. treatment of concomitant arthritis forms.
C. stretching and toning exercises.
D. wrist splinting.
```
C. stretching and toning exercises.
90
```
Approximately what percent of patients experiencing low back pain will have the symptoms resolve within 1 month without specific therapy?
A. 33%
B. 57%
C. 78%
D. 90%
```
D. 90%
91
```
Risk factors for the development of low back pain include all of the following except:
A. older age.
B. carpal tunnel syndrome.
C. scoliosis.
D. spinal stenosis.
```
B. carpal tunnel syndrome.
92
```
Most episodes of low back pain are caused by:
A. an acute precipitating event.
B. disk herniation.
C. muscle or ligamentous strain.
D. nerve impingement.
```
C. muscle or ligamentous strain.
93
```
With the straight-leg–raising test, the NP is evaluating tension on which of the following nerve roots?
A. L1 and L2
B. L3 and L4
C. L5 and S1
D. S2 and S3
```
C. L5 and S1
94
A patient with a lumbosacral strain will typically report:
A. numbness in the extremities.
B. stiffness, spasm, and reduced ROM.
C. “electric” sensation running down one or both legs.
D. pain at its worst when in sitting position.
B. stiffness, spasm, and reduced ROM.
95
You see a 54-year-old man complaining of low back pain and is diagnosed with acute lumbosacral strain. Which of the following is the best advice to give about exercising?
A. You should not exercise until you are free of pain.
B. Back-strengthening exercises can cause mild muscle soreness.
C. Electric-like pain in response to exercise is to be expected.
D. Conditioning exercises should be started immediately.
B. Back-strengthening exercises can cause mild muscle soreness.
96
```
Risk factors for lumbar radiculopathy include all of the following except:
A. male gender.
B. age <50 years.
C. overweight.
D. cigarette smoking.
```
B. age <50 years.
97
A patient with sciatica will typically report:
A. loss of bladder control.
B. stiffness, spasm, and reduced ROM.
C. shooting pain that starts at the hip and radiates to the foot.
D. pain at its worst when lying down.
C. shooting pain that starts at the hip and radiates to the foot.
98
```
Early neurological changes in patients with lumbar radiculopathy include:
A. loss of deep tendon reflexes.
B. poor two-point discrimination.
C. reduced muscle strength.
D. footdrop.
```
A. loss of deep tendon reflexes.
99
```
Common causes of sciatica include all of the following except:
A. herniated disk.
B. spinal stenosis.
C. compression fracture.
D. soft tissue abnormality.
```
D. soft tissue abnormality.
100
```
You see a 48-year-old woman who reports low back pain. During the evaluation, she mentions new-onset loss of bowel and bladder control. This most likely indicates:
A. cauda equina syndrome.
B. muscular spasm.
C. vertebral fracture.
D. sciatic nerve entrapment.
```
A. cauda equina syndrome.
101
```
Loss of posterior tibial reflex often indicates a lesion at:
A. L3.
B. L4.
C. L5.
D. S1.
```
C. L5.
102
```
Loss of Achilles tendon reflex most likely indicates a lesion at:
A. L1 to L2.
B. L3 to L4.
C. L5 to S1.
D. S2 to S3.
```
C. L5 to S1.
103
```
Which test is demonstrated when the examiner applies pressure to the top of the head with the neck bending forward, producing pain or numbness in the upper extremities?
A. Spurling
B. McMurray
C. Lachman
D. Newman
```
A. Spurling
104
Immediate diagnostic imaging for low back pain should be reserved for all of the following except:
A. presence of signs of the cauda equina syndrome.
B. presence of severe neurologic deficits.
C. presence of risk factors for cancer.
D. presence of moderate pain lasting at least 2 weeks.
D. presence of moderate pain lasting at least 2 weeks.
105
```
Which of the following tests yields the greatest amount of clinical information in a patient with acute lumbar radiculopathy?
A. lumbosacral radiograph series
B. ESR measurement
C. MRI
D. bone scan
```
C. MRI
106
```
The most common site for cervical radiculopathy is:
A. C3 to C4.
B. C4 to C5.
C. C5 to C6.
D. C6 to C7
```
D. C6 to C7
107
```
The most common sites for lumbar disk herniation are:
A. L1 to L2 and L2 to L3.
B. L2 to L3 and L4 to L5.
C. L4 to L5 and L5 to S1.
D. L5 to S1 and S1 to S2.
```
C. L4 to L5 and L5 to S1.
108
You see a 37-year-old man complaining of low back pain consisting of stiffness and spasms but without any sign of neurologic involvement. You recommend all of the following interventions except:
A. application of cold packs for 20 minutes 3–4 times a day.
B. use of NSAIDs or acetaminophen for pain control.
C. initiation of aerobic and toning exercises.
D. bed rest for at least 5 days.
D. bed rest for at least 5 days.
109
```
A 22-year-old man presents with new onset of pain and swelling in his feet and ankles, conjunctivitis, oral lesions, and dysuria. To help confirm a diagnosis of reactive arthritis, the most important test to obtain is:
A. ANA analysis.
B. ESR measurement.
C. rubella titer measurement.
D. urethral cultures.
```
D. urethral cultures.
110
```
Symptoms commonly associated with reactive arthritis include all of the following except:
A. dactylitis.
B. bursitis.
C. enthesitis.
D. cervicitis.
```
B. bursitis.
111
```
Treatment for reactive arthritis (also known as Reiter syndrome) in a sexually active man usually includes:
A. antimicrobial therapy.
B. corticosteroid therapy.
C. antirheumatic medications.
D. immunosuppressive drugs.
```
A. antimicrobial therapy.
112
In reference to reactive arthritis (also known as Reiter syndrome), which of the following statements is false?
A. When the disease is associated with urethritis, the male:female ratio is about 9:1.
B. When the disease is associated with infectious diarrhea, the male and female incidences are approximately equal.
C. ANA analysis reveals a speckled pattern.
D. Results of joint aspirate culture are usually unremarkable.
C. ANA analysis reveals a speckled pattern.
113
```
In men with reactive arthritis and associated urethritis, a common finding is:
A. ANA positive.
B. HLA-B27 positive.
C. RF positive.
D. ACPA positive.
```
B. HLA-B27 positive.
114
```
You see a 33-year-old man diagnosed with reactive arthritis and urethritis. You recommend antimicrobial treatment with:
A. amoxicillin.
B. doxycycline.
C. TMP-SMX.
D. nitrofurantoin.
```
B. doxycycline.
115
```
All of the following are common sites of fracture in patients with osteoporosis except:
A. the proximal femur.
B. the distal forearm.
C. the vertebrae.
D. the clavicle.
```
D. the clavicle.
116
Osteoporosis is more common in individuals:
A. with type 2 diabetes mellitus.
B. on long-term systemic corticosteroid therapy.
C. who are obese.
D. of African ancestry.
B. on long-term systemic corticosteroid therapy.
117
```
Clinical disorders that increase the risk for osteoporosis include all of the following except:
A. rheumatoid arthritis.
B. celiac disease.
C. hyperlipidemia.
D. hyperprolactinemia.
```
C. hyperlipidemia.
118
```
Osteoporosis is defined as having a bone density more than _____ standard deviation(s) below the average bone mass for women younger than 35 years old.
A. 1
B. 1.5
C. 2.5
D. 4
```
C. 2.5
119
```
The preferred screening test for osteoporosis is:
A. quantitative ultrasound measurement.
B. dual-energy x-ray absorptiometry.
C. qualitative CT.
D. wrist, spine, and hip radiographs.
```
B. dual-energy x-ray absorptiometry.
120
Osteoporosis prevention measures include all of the following except:
A. calcium supplementation.
B. selective estrogen receptor modulator use.
C. vitamin B6 supplementation.
D. weight-bearing and muscle-strengthening exercises.
C. vitamin B6 supplementation.
121
All of the following are common signs of osteoporosis except:
A. gradual loss of height with stooped posture.
B. hip or wrist fracture.
C. increase in waist circumference.
D. patient report of back pain.
C. increase in waist circumference.
122
```
How much daily calcium is recommended for women older than 50 years of age?
A. 800 mg
B. 1000 mg
C. 1200 mg
D. 1500 mg
```
C. 1200 mg
123
```
Nondairy sources of calcium include all of the following except:
A. tofu.
B. spinach.
C. brown rice.
D. sardines.
```
C. brown rice.
124
```
Long-term bisphosphonate treatment (i.e., >5 years) has been associated with:
A. atypical fractures.
B. hyperprolactinemia.
C. osteoarthritis.
D. bone marrow suppression.
```
A. atypical fractures.
125
```
The use of calcitonin to treat osteoporosis has been associated with an increased risk of:
A. type 2 diabetes.
B. rheumatoid arthritis.
C. malignancy.
D. systemic lupus erythematosus.
```
C. malignancy.
126
Which of the following patients would be an appropriate candidate for treatment with teriparatide (Forteo)?
A. a 54-year-old woman with osteopenia
B. a 64-year-old woman with BMD T-score of -2.5 and prior hip fracture
C. a 67-year-old man with a BMD T-score of –1
D. a 72-year-old woman who has a stable BMD T-score of –1.5 with bisphosphonate treatment for the past 3 years
B. a 64-year-old woman with BMD T-score of -2.5 and prior hip fracture
127
```
The bisphosphonate therapy given as an annual infusion is:
A. risedronate.
B. zoledronic acid.
C. ibandronate.
D. denosumab.
```
B. zoledronic acid.
128
In counseling a postmenopausal woman, you advise her that systemic estrogen therapy users can possibly experience:
A. an increase in breast cancer rates with long-term use.
B. reduction in high-density lipoprotein cholesterol.
C. a 10% increase in bone mass.
D. no change in the occurrence of osteoporosis.
A. an increase in breast cancer rates with long-term use.
129
```
When counseling a patient taking a bisphosphonate such as alendronate (Fosamax), you advise that the medication should be taken with:
A. a bedtime snack.
B. a meal.
C. other medications.
D. a large glass of water.
```
D. a large glass of water.
130
```
The most common site of sprain is the:
A. wrist.
B. shoulder.
C. ankle.
D. knee.
```
C. ankle.
131
Risk factors for ankle sprain include all of the following except:
A. poor conditioning.
B. running on paved surfaces.
C. inappropriate footwear.
D. lack of a warm-up period prior to exercising.
B. running on paved surfaces.
132
A Grade II ankle sprain is best described as:
A. minor swelling and minimal joint instability.
B. moderate joint instability without swelling or ecchymosis.
C. moderate swelling, mild to moderate ecchymosis, and moderate joint instability.
D. complete ankle instability, significant swelling, and moderate to severe ecchymosis.
C. moderate swelling, mild to moderate ecchymosis, and moderate joint instability.
133
A person with a Grade III ankle sprain presents with:
A. minor swelling and minimal joint instability.
B. moderate joint instability without swelling or ecchymosis.
C. moderate swelling, mild to moderate ecchymosis, and moderate joint instability.
D. complete ankle instability, significant swelling, and moderate to severe ecchymosis.
D. complete ankle instability, significant swelling, and moderate to severe ecchymosis.
134
```
Patients with a Grade III ankle sprain should be advised that full recovery is likely to take:
A. a few days.
B. 2 to 3 weeks.
C. 4 to 6 weeks.
D. many months.
```
D. many months.
135
```
Which of the following is usually not part of treatment of a sprain?
A. immobilization
B. applying ice to the area
C. joint rest
D. local corticosteroid injection
```
D. local corticosteroid injection
136
```
For a Grade I ankle sprain, weight-bearing should be avoided for at least:
A. 24 hours.
B. 72 hours.
C. 1 week.
D. until full ROM is restored.
```
A. 24 hours.
137
```
A short leg cast is often needed for what type of ankle sprain?
A. grade I
B. grade II
C. grade III
D. grade IV
```
C. grade III
138
Which of the following statements about tendonitis is false?
A. Tendonitis is typically the result of overuse.
B. Tendonitis is the result of a macroscopic or partial tear of the tendon.
C. Acute pain results when firm pressure is applied to the tendon.
D. Signs of tendonitis include reduced ROM caused by stiffness and discomfort.
B. Tendonitis is the result of a macroscopic or partial tear of the tendon.
139
```
Activities that commonly contribute to the development of rotator cuff tendonitis include all of the following except:
A. swimming.
B. throwing a football.
C. bowling.
D. pitching a baseball.
```
C. bowling.
140
```
All of the following are common symptoms of wrist tendonitis except:
A. muscle cramping.
B. reduced ROM.
C. swelling of the wrist.
D. muscle weakness.
```
A. muscle cramping.
141
```
With initial presentation, the diagnosis of tendonitis is usually made from:
A. clinical presentation.
B. plain radiographic films.
C. CT scan of the area.
D. laboratory diagnosis.
```
A. clinical presentation.
142
```
Complications of Achilles tendonitis include:
A. tendon rupture.
B. neurological sequelae.
C. stress fracture.
D. bursitis.
```
A. tendon rupture.
143
```
Which of the following is often found with rotator cuff tendonitis?
A. osteoarthritis
B. tendon rupture
C. bursitis
D. joint effusion
```
C. bursitis
144
```
First-line therapy for biceps tendonitis usually includes:
A. applying ice to the area.
B. local corticosteroid injection.
C. orthopedic referral.
D. nerve block.
```
A. applying ice to the area.
145
```
A 36-year-old man has experienced shoulder pain associated with tendonitis for the past 4 weeks despite the use of ice and analgesics (NSAIDs) and undergoing physical therapy. An appropriate next step would include:
A. systemic corticosteroid use.
B. x-ray of the shoulder.
C. MRI of the shoulder.
D. use of an upper arm sling.
```
C. MRI of the shoulder.
