ortho Flashcards
A 66-year-old male patient presents to the clinic with increasing lower back pain that does not radiate. Which of the following assessments was specifically developed to evaluate lumbar back pain?
Waddells sign
The Waddell signs (D) are a grouping of eight clinical observations that can be assessed during examination. Their presence suggests psychogenic manifestations rather than an orthopedic source of lower back pain.
A 55-year-old nurse presents to the clinic with reports of increasing right shoulder pain over the last 6 months. The nurse practitioner suspects a possible rotator cuff tendinopathy or tear. Which of the following assessment tests can be performed to further evaluate the patient’s right rotator cuff?
Jobe Test
The Jobe test (B), commonly referred to as the empty can test, is a test that can be used to further evaluate the patient’s rotator cuff. This test assesses supraspinatus function, which is the most superior tendon of the rotator cuff. To perform the Jobe test, the patient first places a straight arm in 90 degrees of abduction position with 30 degrees of forward flexion. The patient next internally rotates their arm (thumb toward the floor), and the nurse practitioner applies downward pressure against the patient’s resistance. A supraspinatus tear is suspected if the patient experiences pain and weakness. Pain without weakness suggests supraspinatus tendinopathy.
The nurse practitioner is evaluating an adult patient who sustained a knee injury while playing soccer. Which of the following assessment findings would suggest a torn meniscus rather than a torn anterior cruciate ligament?
Meniscal tears rarely present with immediate swelling, as is seen with fractures or ligament tears. Swelling usually occurs over the 24 hours following the injury and is accompanied by pain (C), especially when squatting.
A 30-year-old man presents to the clinic for a follow-up on his back pain and recently underwent an X-ray. The patient reports that his pain is the worst in the morning and improves throughout the day. The nurse practitioner suspects ankylosing spondylitis. Which of the following findings on X-ray is consistent with this diagnosis?
Continuous spine lesions, vertebral squaring, joint space stenosis, and sacroiliitis (B) are all common findings in ankylosing spondylitis. Sacroiliitis is typically the first finding and will be symmetrical and bilateral. Calcifications of the spine may be seen in end stages of ankylosing spondylitis.
Ankylosing spondylitis is a type of seronegative spondyloarthropathy that causes sacroiliitis, inflammation of the bone insertions of ligaments and tendons, inflammatory back pain, peripheral joint inflammation, skin disease, and eye inflammation. This condition causes bone destruction and new bone formation. Patients will often initially report chronic pain and stiffness of the lower back and pelvis. Spondylitis typically begins in the lumbosacral spine, but upper portions of the spine become involved as the disease progresses. Patients may also report pain in the buttock or hip pain that suggests sacroiliac joint involvement. The pain associated with ankylosing spondylitis is often described as nagging or a deep ache. It often improves with movement and exercise and worsens with rest or inactivity. Physical examination of the spine may reveal loss of the normal lumbar lordosis, and there may also be a palpable muscle spasm of the paraspinal muscles. Spinal mobility may be decreased. Some patients have peripheral joint involvement and extra-articular manifestations, including a heart murmur of aortic valve insufficiency and a red, inflamed eye due to acute iritis.
Eges test does what
tests knee instability
Watson test
scaphoid shift test - instability of the writs
A 22-year-old man presents to urgent care with knee pain and swelling. Upon assessment, the nurse practitioner elicits a positive Lachman test. Given the likely diagnosis, which of the following is the priority intervention for this patient?
Refer to ortho
Patients with an isolated anterior cruciate ligament (ACL) injury should be referred to an orthopedic surgeon (C), as definitive management may involve surgery.
ACL injuries are most often related to sports activities. Female patients are much more likely than male patients to experience an ACL injury. Injury is often associated with a popping sound and immediate effusion development. All patients with knee injuries should undergo an extensive history and physical to determine the most likely etiology of injury and a thorough musculoskeletal assessment. If the Lachman test is positive, the patient should be referred to an orthopedic clinician for surgical consideration to improve functional outcomes. An MRI will confirm the diagnosis of ACL disruption and may be indicated for operative planning.
Which test offers the highest sensitivity for the evaluation of an anterior cruciate ligament tear?
lachman test
hen a patient presents with an acute knee injury it is important to assess the stability of the four major ligaments of the knee (anterior cruciate ligament [ACL], posterior cruciate ligament [PCL], medial collateral ligament [MCL], and lateral collateral ligament [LCL]). The ACL is the most frequently injured knee ligament, and the Lachman test (B) is the most sensitive test to assess for ACL damage.
The Hawkins-Kennedy test (B) and the Neer test (C), also known as the passive painful arc maneuver, are both used to assess for
shoulder impingement
A 39-year-old woman presents to the clinic due to increasing left foot pain. She reports no injury to the site and states that this pain has worsened over time. During the physical exam, it is noted that the first metatarsophalangeal joint is deviated inward, causing a deformity of the foot. What is the most likely diagnosis for this patient?
Hallux valgus - Hallux valgus (B), also known as a bunion, occurs when there is a lateral deviation of the great toe, causing pain and deformity of the foot. The deformity can clearly be seen on X-ray. The etiology of this condition is unclear. It is often treated with footwear modifications, orthotics, splinting, ice, and analgesics such as acetaminophen. In severe cases, surgery may be considered.
A 43-year-old woman presents to the office with reports of joint pain for the last several months. The pain is mainly in her wrists and knees. She also reports that she feels “sore all over.” The pain is always worse in the morning but persists throughout the day. Which laboratory test is most specific for the suspected diagnosis?
Anti-CCP antibodies (A) are up to 98% specific to RA. Anti-CCP antibodies correlate with erosive disease.
A 39-year-old woman presents to the clinic with increasing left foot pain. She reports no injury to the area but states the pain has been worsening over time. Upon physical exam, the first metatarsophalangeal joint is observed to deviate inward, causing a clear deformity of the foot. Which of the following angles observed on X-ray is regarded as the cutoff for a diagnosis of hallux valgus?
The hallux abductus angle is the angle found between the hallux and the first metatarsal. Angles > 20° (C) measured on X-ray are abnormal and indicative of hallux valgus. Hallux valgus (also known as a bunion) is a common cause of foot deformities. It can be caused by arthritis, biomechanical abnormalities, neuromuscular diseases, genetic conditions, or trauma.
olecranon bursitis affects the
elbow
A 25-year-old woman presents to the clinic with concerns of intense nail pain on her right fourth finger. She states that it began swelling approximately 3 days ago and has become increasingly painful ever since. She reports having a habit of chewing on her fingernails. The nurse practitioner diagnoses the patient with paronychia without abscess. Which of the following is the most appropriate treatment at this time?
The first-line treatment for paronychia without abscess is a chlorhexidine or a povidone-iodine soak several times per day, followed by the application of a topical antibiotic such as mupirocin (C).
Paronychia is characterized by inflammation of the proximal nail folds. This can occur as a result of overmanicuring, nail-biting, picking at hangnails, or occupations where hands are frequently immersed in water.
Ankle sprains are the most common cause of ankle injury. There are three locations of ankle sprains: lateral, medial, and syndesmotic. Ankle sprains are graded based on the degree of ligament disruption. G
Grade 1 mild sprains involve stretching of a ligament with potential microscopic ligamentous tears. Grade 2 moderate sprains involve an incomplete tear of a ligament. Grade 3 severe sprains involve the complete ligament tear of a ligament. Inability to bear weight on the affected extremity is a sign of a grade 3 injury. Patients with grade 3 tears should be referred to an orthopedic specialist (C) for consideration of conservative versus surgical management.
