Musculoskeletal

Question 1

Balloting the patella assesses for what

Answer 1

Major effusion

Question 2

A patient reports knee pain when walking up stairs. What would be a finding in a positive patellofemoral grinding test?

Answer 2

Crepitus

Question 3

A forward jerk showing the contours of the upper tibia is a positive test, or anterior drawer sign and suggests which diagnosis?

Answer 3

ACL injury/tear

Question 4

The FNP should be suspicious for which diagnosis in an obese child with an acute onset of a limp without know trauma?

Answer 4

Slipped capital femoral epiphysis (SCFE)

Question 5

Upon examination of the newborn, pigmented spots, hairy patches, or deep pits within 1cm of midline may indicate abnormalities of what structure?

Answer 5

The spinal cord

Question 6

Pushing the tibia posteriorly and observing the degree of backward movement

Answer 6

Posterior drawer sign

Question 7

If the proximal tibia falls back while performing the posterior draw sign test, what injury is expected?

Answer 7

Posterior cruciate ligament (PCL) injury

Question 8

A positive Lachman test indicates what?

Answer 8

significant forward excursion of the knee is a positive test for an ACL (anterior cruciate ligament) tear

Question 9

Inversion of the foot

Answer 9

Varus

Question 10

Flat feet from laxity of the soft tissue structures of the foot

Answer 10

Pes planus

Question 11

The most serious cause of lower back pain, due to risk of limb paralysis or bladder/bowel dysfunction.

Answer 11

Cauda Equina Compression - spinal compression of S2 to S4 - also know as saddle anesthesia

Question 12

Tests for carpel tunnel syndrome

Answer 12

Thumb abduction
Tinel sign
Phalen sign

Question 13

This test checks for a supraspinatus rotator cuff tear by asking the patient to hold arms out at 90 degress with arms internally rotated and thumbs facing down - then asking the patient to resist as you place downward pressure.
Inability of the patient to hold the arm fully abducted @ shoulder level or control lowering the arm is a positive result

Answer 13

Empty Can Test (shoulder composite test)

Question 14

This test checks for glenohumeral disease or adhesive capsulitis by asking the patient to adduct and flex the arm to 90 degrees with thumbs turned up then applying pressure proximal to the wrist while asking the pt to press outward to external rotation - pain or weakness is a positive result

Answer 14

External rotation resistance test (shoulder composite test)

Question 15

This test for supraspinatus rotator cuff tear or bicipital tendinitis is done by asking the patient to fully abduct the arm to shoulder level up to 90 degrees and lowering it slowly. Weakness during this maneuver is a positive result.

Answer 15

Drop arm test (rotator cuff strength test)

Question 16

This test checks for s subscapularis disorder by having the patient place the dorsum of the hand on the low back with elbow flexed to 90 degrees, then lifting the hand off the back and asking the patient to hold it there. Inability of the patient to hold the hand in this position is a positive result.

Answer 16

Internal rotation lag test (rotator cuff strength test)

Question 17

This test checks for a supraspinatus or infraspinatus disorder by having the patient bend his arm to 90 degrees with palm up & rotating the arm from 20 degrees abduction to 90 degrees flexsion

Answer 17

External rotation lag test (rotator cuff strength test)

Question 18

This test checks for a subacromial impingement/rotator cuff tendonitis disorder by pressin gon the scapula to prevent scapular movement with one hand and raising the patients arm with the other - compresses the greater tuberosity of the humerus against the acromion

Answer 18

Neers Impingement Sign (rotator cuff provication test)

Question 19

Maneuvers/tests for checking for rotator cuff/impingement issues

Answer 19

Pain provication tests: painful arc test
Strength tests: internal rotation lag test; external rotation lag test; drop arm test
Composite tests: external rotation resistance test; empty can test

Question 20

Articular joint pain characteristics

Answer 20

is there pain or stiffness, decreased AROM & PROM; am stiffness, “gelling”

Question 21

Extra-articular pain characteristics

Answer 21

Involves bones, muscles, and tissues around the joint periarticular tenderness- only PROM remains intact

Question 22

Mono articular

Answer 22

pain in a single joint - suggests injury, monoarticular arthritis or tendonitis or bursitis (extra-articular)

Question 23

4 Key Features of MSK disorders

Answer 23

• Is this articular or extra-articular?
• Is this an acute symptom (<6wks) or chronic (>12wks)?
• Is this inflammatory or non-inflammatory?
• Is this localized (monoarticular) or diffuse (polyarticular)?

Question 24

4 Cardinal signs of inflammatory joint disease

Answer 24

• swelling
• warmth
• redness
• pain

Question 25

Causes of inflammatory joint disease

Answer 25

infectious, crystal-induced, immune-related, reactive, ideopathic
gonorrhea, gout, RA/Lupus

Question 26

S/S of inflammatory joint disease

Answer 26

Fever & chills (septic arthritis) - morning stiffness that gradually improves with activity (RA)

Question 27

Causes of non-inflammatory joint disease

Answer 27

trauma (rotator cuff tear), repetitive use (bursitis, tendinitis), degernarative changes or fibromyalgia

Question 28

S/S of non-inflammatory joint disease

Answer 28

intermittent stiffness and “gelling” (consistent with OA)

Question 29

Determining acute or chronic

Answer 29

-onset is very important
-duration
-quality
-severity
Gradual onset over days, weeks, or months, or rapid onset?
Has pain progressed or fluctuated?
How long has pain lasted?
What is the pattern?

Question 30

Acute joint disease

Answer 30

lasts up to 6 weeks

Question 31

Chronic joint disease

Answer 31

lasts longer that 12 weeks

Question 32

Sarcopenia

Answer 32

Loss of muscle mass, strength , and function as we age

Question 33

Determining localized or diffuse

Answer 33

Which joints are painful (monoarticular or polyarticular)?
Asymmetric or symmetric involvement?
Monoarticular: trauma, crystalline, or septic
Oliguarticular arthritis: infection from gonorrhea or rheumatic fever
Polyarthicular: viral, inflammatory