Musculoskeletal Disorders Flashcards
Fitzgerald
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. non steroidal anti-inflammatory drugs (NSAIDS).
D. 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 medium 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 intramural corticosteroid injection include: A. irreversible skin atrophy B. infection C. inflammatory reaction D. soreness at the injection site.
D. soreness at the injection site
First-line therapy for prepateller bursitis should include: A. bursal aspiration B. intramural corticosteroid injection C. acetaminophen D. knee splinting.
A. bursal aspiration
Clinical conditions with a presentation similar to acute bursitis include with of the following? (more than one can apply.) A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout
ALL apply: A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout
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 worse 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 percentage 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 ora 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 factor for acute gouty arthritis include: A. obesity B. female gender C. rheumatoid arthritis D. joint trauma
A. obesity
The use of all 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 form 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 thiazide diuretic
C. a 68-year-old patient with type 2 diabetes mellitus
D. a 32-year-old patient with 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
Which of the following foods is least likely to trigger acute gouty arthritis? A. mussels B. beef liver C. hard cheese D. spinach.
C. hard cheese
Indicate whether each medication is used for prevention (P) or treatment (T) of gout.
- febuxostat (Uloric)
- colchicine
- allopurinol (Aloprim)
- febuxostat (Uloric) = Prevention
- colchicine = Treatment
- allopurinol = Prevention
Pegloticase (Krystexxa) reduces serum uric acid levels by:
A. reducing the production of urea
B. converting uric acid to allantoin
C. blocking conversion of urea to uric acid
D. binding to uric acid and facilitating elimination through the GI system.
B. converting uric acid to allantion
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 formations 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 OA can typically include all o the following except: A. widening of the joint space B. wearing away of articular cartilage 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 OA of the knee often reveal:
A. microfractures
B. decreased density of subchondral bone
C. osteophytes
D. no apparent changes to joint structure
C. osteophytes
Approximately what percentage of patients with radiological findings of OA 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 (proximally located)
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 lab abnormalities
D. elevated antinuclear antibody (ANA) titer.
C. no disease-specific lab abnormalities
First-line pharmacologic intervention for milder OA should be a trial of:
A. acetaminophen
B. tramadol
C. celecoxib
D. intra-articular 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. quadricep-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 associate with the use of glucosamine is:
A. elevated alanine aminostransferase (ALT) and aspartate aminotransferase (AST)
B. bronchospasm
C. increased bleeding risk
D. QT prolongation.
B. bronchospasm
A 72-year-old man presents at an early stage of OA 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 the knee
D. chondroitin should be used with caution because of its antiplatlet 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 body mass index (BMI) >25kg/m
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. intra-articular corticosteroid use
B. hyaluronic acid injections
C. arthroscopy with lavage and/or debridement
D. none of these.
D. none of these
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 last 6 months and who asks about hip replacement surgery. She complains of pain even at night when she is 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 in 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
D. weight-bearing aerobic exercises.
D. weight-bearing aerobic exercises
Criteria favoring knee replacement surgery for a patient with OA should include all of the following except:
A. pain control requires daily use of NSAID therapy
B. >80% of articular cartilage is worn away
C. physical functioning is severely compromised
D. patient can tolerate the surgical procedure and rehabilitation.
A. pain control requires daily use of NSAID therapy
Criteria favoring hip replacement surgery for a patient with OA should include all of the following except:
A. pain control requires daily use of NSAID therapy
B. > 80% of articular cartilage is worn away
C. physical functioning is severely compromised
D. patient can tolerate the surgical procedure and rehabilitation.
A. pain control requires daily use of NSAID
Which of the following is NOT characteristic of rheumatoid arthritis (RA)?
A. it is more common in women than in men 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.
Rationale: RA is a disease that causes chronic systemic inflammation. RA is more common in women then men 3:1, RA is often seen in people with other autoimmune diseases, a family history of RA and other autoimmune disease is often noted, peak age at onset is 20-40 years.
The leading cause of death among individuals with RA is: A. infection B. cardiovascular events C. cancer D. renal failure.
B. cardiovascular events
Rationale: Approximately 40% of all deaths in individuals with RA are attributed to cardiovascular causes, including ischemic heart disease and stroke.
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
Rationale: A clinical picture of slowly progressive malaise, weight loss, and stiffness is more common, however. The stiffness is symmetrical, is typically worst on arising , lasts about 1 hour, involves at least three joint groups, and can recur after a period of inactivity or exercise.
NSAIDs cause gastric injury primarily by: A. direct irritative effect B. slowing gastrointestinal motility C. thinning of the protective GI mucosa D. enhancing prostaglandin synthesis.
C. thinning of the protective GI mucosa
Rationale: NSAIDs inhibit synthesis of prostaglandins from arachidonic acid, yielding an anti-inflammatory effect yet they also thin the protective GI 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 for 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 OA.
D. a 72-year-old man who takes aspirin four times a day for pain control of OA
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. Omeprazole (Prilosec).
D. Omeprazole (Prilosec)
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 antiprostiglandin effect.
A. an increase in the drug’s half-life
Rationale: With many of the NSAIDs, the half-life of the drug is increased as the dose is increased.
Which of the following statements is most accurate concerning RA?
A. joint erosions are often evident on radiographs or MRIs
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 x-rays and MRIs
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 (80-96fL); reticulocytes = 0.8% (1%-2%)
B. Hg = 10.1 g/dL (12-14 g/dL); MCV = 103 fL (80-96fL); reticulocytes = 1.2% (1%-2%)
C. Hg = 9.7 g/dL (12-14 g/dL); MCV = 87 fL (80-96fL); reticulocytes = 0.8% (1%-2%)
D. 11.4 g/dL (12-14 g/dL); MCV = 84 fL (80-96fL); reticulocytes = 2.3% (1%-2%)
C. Hg = 9.7 g/dL (12-14 g/dL); MCV = 87 fL (80-96fL); reticulocytes = 0.8% (1%-2%)
X-rays will fail to show changes in affected joints in approximately what percentage of patients with RA at disease onset? A. 30% B. 50% C. 75% D. 95%
A. 30%
RA disease progression is typically evaluated using all of the following approaches except: A. x-ray B. MRI C. echosonography D. ultrasound
C. echosonography
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 RA. She has no other clinical conditions of significance. You recommend which of the following treatment for the 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
You see a 37-year-old man with RA 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
A significant adverse effect of biologic therapy (e.g., abatacept) for treating RA is: A. myopathy B. infections C. renal impairment D. elevated liver enzymes
B. infections
Prior to initiating biologic therapy for a 50-year-old woman with RA, vaccination against all of the following is recommended except: A. pneumococcal disease B. hepatitis B C. Haemophilus influenza type B D. influenza
C. Haemophilus influenza type B
Which of the following test is most specific to the diagnosis of RA? A. elevated levels of rheumatoid factor B. abnormally high ESR C. leukopnenia D. positive ANA titer.
A. elevated rheumatoid factor
Rationale: Rheumatoid factor, an immunoglobulin M antibody, is present in approximately 50%-90% of patients with RA and the level of the titer often corresponds to the severity of the disease.
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
Rationale: ANAs are antibodies against cellular nuclear components that act as antigens. ANA is occasionally present in health adults, but it is usually found in individuals with SLE and detected in 95% of these patients; only 30%-50% of patients with ANA have RA.
Long-term effects of SLE can include all of the following except:
A. birth defects when occurring in a pregnant female
B. kidney failure
C. avascular necrosis
D. pericarditis
A. birth defects when occurring in a pregnant female
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 erythematous B. vasculitis C. Sjögren syndrome D. scleroderma
C. Sjögren syndrome
Rationale: Common complaints with Sjögren usually concern problems related to decreased oral and ocular secretions. Treating the underlying disease is critical, and can include NSAIDs or medications that suppress the immune system (e.g., methotrexate).
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
Rationale: COX-1 is an enzyme found in gastric mucosa, small and large intestine mucosa, kidneys, platelets, and vascular epithelium.
