test4

Question 1

Kyphosis is a late sign of

a. old age
b. osteopenia
c. osteoporosis
d. osteoarthritis

Answer 1

c. osteoporosis

Question 2

The Lachman maneuver is used to detect which of the following?

a. knee instability
b. nerve damage of the knee to past knee injuries
c. the integrity of the patellar tendon
d. tears on the meniscus of the knee

Answer 2

a. knee instability

Question 3

Mr. Brown is a 65 year old carpenter c/o morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam. the nurse notices the presence of Heberden’s nodes. Which of the following is most likely?

a. osteoporosis
b. rheumatoid arthritis
c. degenerative joint disease
d. reiter’s syndrome

Answer 3

c. degenerative joint disease

Question 4

What does a positive posterior drawer test in a 10 year old soccer player signify?

a. an abnormal knee
b. instability of the knee
c. a large amount of swelling on the knee
d. an injury of the meniscus

Answer 4

b. instability of the knee

Question 5

A 53 year old crossing guard c/o twisting his right knee while working that morning. The knee is swollen and tender to palpation. the NP diagnosis a grade II sprain. The initial treatment plan includes which of the following

a. application of cold packs the first 24 hours followed by applications of low heat at bedtime.
b. elevation of the affected limb and intermittent applications of cold packs for the next 48 hours
c. rechecking the knee in 24 hours and isometric exercises.
d. the application of an ace bandage to the affected knee

Answer 5

b. elevation of the affected limb and intermittent applications of cold packs for the next 48 hours

Question 6

The phalen test is used to evaluate for

a. inflammation of the median nerve
b. rheumatoid arthritis
c. degenerative joint changes
d. chronic tenosynovitis

Answer 6

a. inflammation of the median nerve

Question 7

A 62 year old female c/o chronic severe low back pain. She also reports mild episodes of fecal incontinence and numbness to her lower legs over the past week. You suspect which of the following

a. fracture of the lower spine
b. a herniated disc
c. cauda equine syndrome
d. ankylosing spondylitis

Answer 7

c. cauda equine syndrome

Question 8

A positive straight leg test is indicative of which of the following

a. myasthenia gravis
b. inflammation of the sciatic nerve/ herniated disc
c. multiple sclerosis
d. Parkinson’s disease

Answer 8

b. inflammation of the sciatic nerve/ herniated disc

Question 9

Heberden’s nodes are commonly found in which of the following diseases

a. rheumatoid arthritis
b. degenerative joint disease
c. psoriatic arthritis
d. septic arthritis

Answer 9

b. degenerative joint disease

Question 10

Mrs. Green, age 45, is c/o generalized morning stiffness, especially in both her wrists and hands. It is much worse in the morning and lasts for a few hours. She also c/o fatigue and generalized body aches that have been present for the past few months. Which of the following is most likely

a. osteoporosis
b. rheumatoid arthritis
c. osteoarthritis
d. gout

Answer 10

b. rheumatoid arthritis

Question 11

You note bony nodules located at the proximal interphalangeal joints on both the hands of your 65 year old female patient. Which of the following is most likely

a. bouchard’s node
b. heberden’s node
c. osteoarthritic nodules
d. tophi deposits

Answer 11

a. bouchard’s node

Question 12

A fracture on the navicular area of the wrist is usually caused by falling forward and landing on the hands. The affected wrist is hyperextended to break the fall. The NP is aware that all of the following statements are true except

a. it has higher rate of non union compared with the other bones of the wrist when it is fractured
b. the fracture frequently doesn’t show up on x ray film when it is taken immediately after the injury
c. the x ray film will show the fracture if the film is repeated in 2 weeks
d. these fractures always require surgical intervention to stabilize the joint

Answer 12

d. these fractures always require surgical intervention to stabilize the joint

Question 13

A neighbors 14 year old son, who is active in basketball, c/o pain and swelling of both knees. On PE, there is tenderness over the tibial tuberosities of both knees. Which of the following is most likely

a. chondromalacia patella
b. left knee sprain
c. Osgood schlatter disease
d. tear of the medial ligament

Answer 13

c. Osgood schlatter disease

Question 14

Joe, a 20 year old Asian male, reports pain in his right knee after twisting it playing soccer. The injured knee locks up when he attempts to straighten his leg. Which of the following is most likely

a. injury to the meniscus of the right knee
b. injury to the patella of the right knee
c. injury to the ligaments of the right knee
d. rupture of the quadriceps tendon

Answer 14

a. injury to the meniscus of the right knee

Question 15

Which of the following is the best course of treatment for this patient

a. refer him to an orthopedist specialist.
b. refer him to a chiropractor
c. advise him that the clicking noise will resolve within 2-4 weeks
d. advise him to use an ace wrap during the first 2 weeks for knee support and to see you again for reevaluation

Answer 15

a. refer him to an orthopedist specialist.

Question 16

A 16 yo basketball player who is 6 feet tall is seen for c/o painful lumps on his knees. upon inspection, the NP notes a bony like growth on the upper tibia midline below the kneecap on both knees. The patient has full ROM with no joint tenderness, redness or swelling. which of the following conditions is best described here

a. osteosarcoma of the tibia
b. juvenile rheumatoid arthritis
c. Osgood schlatter disease
d. paget’s disease of the bone

Answer 16

c. Osgood schlatter disease

Question 17

The best form of exercise for a patient with severe rheumatoid arthritis is

a. yoga
b. swimming
c. riding a bicycle
d. passive ROM

Answer 17

b. swimming

Question 18

A 19 yo male athlete c/o acute knee pain after a football game. The NP elicitis McMurray’s sign, which is positive on the patients injured knee. this is a test for

a. meniscal injury
b. inflammation of the knee joint
c. osteophytes of the knee joint
d. tenosynovitis

Answer 18

a. meniscal injury

Question 19

Which of the following exercises would you recommend to a 65 yo arthritic patient who c/o new onset painful, swollen left knee caused by gardening for 2 days

a. quadriceps strengthening exerecises of the left knee followed by the application of cold packs for 20 minues 4 times a day
b. rest the joint and apply cold packs intermittently for the next 48 hours
c. passive ROM and cold packs
d. a cool tub bath with warm packs on the knee to avoid stiffening of the joint

Answer 19

b. rest the joint and apply cold packs intermittently for the next 48 hours

Question 20

A 40 yo nurse c/o a new onset of back pain secondary to her job on the med surg floor of a hospital. She reports lifting some obese patients while working the previous night shift. She reports to the worker’s compensation clinic where she was referred. She describes the pain as starting in her right buttocks area and radiating down the back of her thigh. It becomes worse when she sits down for long periods. You would suspect

a. sciatica
b. acute muscle spasm
c. cauda equine syndrome
d. acute muscle strain

Answer 20

a. sciatica

Question 21

Carpal tunnel syndrome is due to inflammation of the

a. ulnar nerve
b. radial nerve
c. brachial nerve
d. median nerve

Answer 21

d. median nerve

Question 22

A 25 yo male who was involved in a car accident is brought into the local ED. He reports wearing a seat belt and was the driver of the vehicle. The patient is c/o pain on his right leg. The skin is intact, but the right foot is abducted slightly. The right knee is tender and swollen. Which of the following test is/are the best choice for evaluating for possible fractures and joint damage

a. plain radiographs of the right hip and knee
b. ultrasound with a CT scan of the right leg
c. plain radiograph of the right hip and leg with an MRI of the knee joint
d. radiograph of the right hip and knee with special view of the hip

Answer 22

c. plain radiograph of the right hip and leg with an MRI of the knee joint

Question 23

a yo female truck driver presents to the outpatient urgent care clinic of a hospital c/o worsening of her low back pain the past few days. She describes the pain as “sharp and burning” and points to the left buttock. She reports that the pain started on the mid buttock of the left leg and recently started to go down the lateral aspect of the leg toward the top of the foot. during the PE, the ankle jerk and knee jerk reflex is +1 on the affected leg and 2+ on the other leg. The pedal, posterior tibialis and popliteal pulses are the same on both legs. Which of the following tests should the NP consider for this patient

a. order both a plain radiograph and CT scan of the spine as soon as possible
b. write a RX for motrin 800mg PO QID with a muscle relaxant and advise the patient to follow up with her PCP within 3 days
c. refer the patient ot an orthopedic surgeon
d. ordering an imaging study of the spine is premature because the majority low back pain cases resolve within 10-12 weeks

Answer 23

a. order both a plain radiograph and CT scan of the spine as soon as possible

Question 24

What is the significance of a positive Lachman sign?

a. instability of the affect knee caused by damage (ie rupture) to the ACL of the knee
b. PCL laxity which may cause locking of the affected knee
c. Achilles tendon rupture
d. patellar tendon rupture

Answer 24

a. instability of the affect knee caused by damage (ie rupture) to the ACL of the knee

Question 25

A 76 yo female reports for the previous 4 months, she has noticed severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having a difficult time getting out of bed because of the severe stiffness and pain. It is difficult for her to put on a jacket or blouse or to fasten her bra. Along with these symptoms, she also has a low grade fever, fatigue, loss of appetite and weight loss. Starting yesterday, the vision in her right eye has progressively worsened. She has annual eye exams and denies that she has glaucoma. Which of the following conditions is most likely

a. rheumatoid arthritis
b. degenerative joint disease
c. polymyalgia rheumatic
d. fibromyalgia

Answer 25

c. polymyalgia rheumatic

Question 26

The gold standard test for visualizing a torn meniscus or joint abnormalities is the

a. CT scan
b. MRI
c. X ray with special views of the affected knee
d. Lachman’s maneuver

Answer 26

b. MRI

Question 27

Glucosamine sulfate is a natural supplement that is used for which of the following conditions

a. rheumatoid arthritis
b. osteoarthritis
c. osteoporosis
d. metabolic syndrome

Answer 27

b. osteoarthritis