01 Oct What does a positive posterior drawer sign in a 10-year-old soccer player signify?
What does a positive posterior drawer sign in a 10-year-old soccer player signify?
a) Normalknee
b) Instability of theknee
c) Swelling on theknee
d) Injury to themeniscus
1. A patient injures an ankle while playing soccer and reports rolling the foot inward while falling with immediate pain and swelling of the lateral part of the joint. The patient is able to bear weight and denies hearing an audible sound at the time of injury. What does this historyindicate?
a. Likely ankle sprain with a possiblefracture
b. Mild ankle injury without fracture
c. Mild soft tissue injuryonly
d. Serious ankle injury with certain fracture
2. A patient who is a distance runner reports pain in one heel that is worse in the morning and seems to improve with exercise. The provider notes localized swelling and a bony prominence at the heel. What is the initial treatment for thiscondition?
a. Cessation of all sports activities andexercise
b. Crutches and partial weightbearing
c. Physical therapy for ultrasoundtherapy
d. Referral to an orthopedist for MRI andevaluation
3. A patient reports elbow pain and the examiner elicits pain with resisted wrist flexion, forearmpronation, and passive wrist extension on the affected side. What is a likely cause of thispain?
a. Lateralepicondylitis
b. Medial collateral ligamentinstability
c. Medialepicondylitis
d. Ulnar neuritis
2. A 19-year-old male athlete complains of acute knee pain after a football game. The nurse practitioner elicits McMurray’s sign, which is positive on the patient’sinjured knee. This is a testfor:
a) Meniscalinjury
b) Inflammation of the kneejoint
c) Osteophytes of the knee joint
d) Tenosynovitis
With an acute knee injury, the knee should be assessed using McMurray’s sign. A positive
McMurray’s sign indicates a meniscal injury. Inflammation of the knee, osteophytes, and tenosynovitis would not elicit a positive McMurray’s sign.
3. The complications of untreated goutinclude:
a) Impaired joint mobility and renaldamage
b) Impaired joint mobility and liverdamage
c) An increased risk of urinary tractinfections
d) Bladdercancer
4. All of the following factors are associated with a higher risk of osteopeniaand osteoporosisexcept:
a) Excessive alcohol intake and cigarettesmoking
b) Asian or Caucasianancestry
c) Obesity
d) Older age
5. A 36-year-old man presents to the nurse practitioner complaining of a history of cervical and upper back pain for many months. On examination, the range of motion of the patient’s spine is limited, especially with lateral flexion. The other joints inthe patient’s body are normal. Only the spine seems to be affected. The patient reports that a laboratory test from a previous doctor showed increased ESR(erythrocyte sedimentation rate), negative antinuclear antigen (ANA), and negative rheumatoid factor. Which of the following is bestdescribed?
a) Rheumatoid arthritis
b) Lupuserythematosus
c) Degenerative joint disease of thespine
d) Ankylosing spondylitis
1. A 55-year-old woman brings her mother, who is 82 years of age, to the emergency department of a local hospital. She reports she found her mother on the floor whenshe checked on her that morning. Her mother was awake and oriented, but needed help getting up. Her mother states that she thinks she passed out. She is being evaluated by a physician who orders an EKG and x-rays of both hips. Regarding laboratory testing, which of the following tests is important to performinitially?
a) Urinalysis
b) Serumelectrolytes
c) Blood glucose
d) Hemoglobin and hematocrit
2. Thiazide diuretics have been shown to have a beneficial effect on the bones,making them a desirable treatment option in hypertensive women with osteopenia or osteoporosis. What is the mechanism of action for their effect on thebones?
a) Thiazide diuretics decrease calcium excretion by the kidneys and stimulateosteoblast production
b) Thiazide diuretics increase both calcium and magnesium retention by thekidneys
c) Thiazide diuretics increase bone mineral density(BMD)
d) Thiazide diuretics influence electrolyte excretion by the kidneys
3. A 36-year-old woman complains of fatigue and headaches accompanied by widespread muscle and joint pain that started 6 months ago. She reports insomnia and feeling tired even with adequate sleep. She was diagnosed with major depression 1 year ago and is currently on escitalopram (Lexapro) 20 mg PO daily. She is also taking B-complex vitamins and melatonin at bedtime for sleep. During the physical exam,the nurse practitioner notes bilateral areas of tender points on the neck, jaw, shoulders, chest, upper back, and greater trochanter. The symptoms and physical exam findings are highly suggestive of whichcondition?
a) Rheumatoid arthritis
b) Osteoarthritis
c) Fatiguesyndrome
d) Fibromyalgia
4. What is the significance of a positive Lachman sign?
a) Instability of the knee caused by damage to the anterior cruciate ligament of theknee
b) Posterior cruciate ligament laxity which may cause locking of theknee
c) Achilles tendonrupture
d) Patellar tendonrupture
5. Which of the following individuals is most likely to be at higher risk forosteoporosis?
a) 70-year-old woman of African ancestry who walks daily forexercise
b) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg dailyfor the past 12 years to control her severeasthma
c) 55-year-old Caucasian woman who is an aerobicsinstructor
d) 45-year-old Asian woman who has been on high-dose steroids for 1week
6. Carpal tunnel syndrome is due to inflammation of the:
a) Ulnar nerve
b) Radialnerve
c) Brachialnerve
d) Median nerve
7. All of the following measures have been found to help lower the risk ofosteoporosis except:
a) Drinking organic orangejuice
b) Eating low-fat dairyfoods
c) Performing weight-bearingexercises
d) Vitamin D supplementation
8. Which of the following conditions is considered aradiculopathy?
a) Polymyalgiarheumatica
b) Sciatica
c) Stroke
d) Dementia
9. Amenopausalwomanwithosteopeniaisattendingadietaryeducationclass.Whichof the following foods arerecommended?
a) Yogurt andsardines
b) Spinach and redmeat
c) Cheese and redmeat
d) Low-fat cheese and wholegrain
10. Glucosamine sulfate is a natural supplement that is used for which of thefollowing conditions?
a) Rheumatoid arthritis
b) Osteoarthritis
c) Osteoporosis
d) Metabolic syndrome .
11. The gold-standard test for visualizing a torn meniscus or joint abnormalities isthe:
a) Computed tomography (CT)scan
b) Magnetic resonance imaging (MRI)scan
c) X-ray with special views of the affectedknee
d) Lachman’smaneuver
12. The best form of aerobic exercise for a patient with severe rheumatoid arthritisis:
a) Yoga
b) Swimming
c) Riding abicycle
d) Passive range ofmotion
13. The Phalen test is used to evaluate:
a) Inflammation of the mediannerve
b) Rheumatoid arthritis
c) Degenerative joint changes
d) Chronic tenosynovitis
14. The Lachman maneuver is used to detect which of thefollowing?
a) Instability of theknee
b) Nerve damage of the knee due to past kneeinjuries
c) Integrity of the patellartendon
d) Tears on the meniscus of the knee
15. A positive straight leg raising test is indicative of which of thefollowing?
a) Myasthenia gravis
b) Inflammation of the sciatic nerve/herniateddisk
c) Multiple sclerosis
d) Parkinson’s disease
16. Bouchard’s nodes are associated with which of the followingconditions?
a) Osteoarthritis and rheumatoidarthritis
b) Osteoporosis andosteopenia
c) Degenerative joint disease
d) Autoimmune disorders
17. All of the following signs and/or symptoms are seen in patients withrhabdomyolysis except:
a) Myalgias and generalizedweakness
b) Bonepain
c) Muscles that are tender onpalpation
d) Dark-colored urine
18. A 76-year-old woman reports that 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 herbra. 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(RA)
b) Degenerative jointdisease
c) Polymyalgia rheumatica(PMR)
d) Fibromyalgia .
19. Kyphosis is a late signof:
a) Rheumatoid arthritis
b) Osteopenia
c) Osteoporosis
d) Osteoarthritis
20. A 60-year-old female truck driver presents to the outpatient urgent care clinic of a hospital complaining of the worsening of her low-back pain the past few days. Pain is accompanied by numbness in the perineal area. 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 physical exam, the ankle jerk and the knee jerk reflex are 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 shouldthe nurse practitioner consider for this patient?
a) Order an MRI scan of the lumbosacral spine as soon aspossible
b) Write a prescription for ibuprofen 800 mg PO QID with a muscle relaxant and advise the patient to follow up with her primary care provider within 3days
c) Refer the patient to an orthopedicsurgeon
d) Ordering an imaging study of the spine is premature because the majority of lowback pain cases resolve within 10 to 12weeks
21. Hypovolemic shock would most likely occur with fractures ofthe:
a) Spine
b) Pelvis
c) Femur
d) Humerus .
22. A 45-year-old woman is complaining of generalized morning stiffness, especiallyin both her wrist and hands. It is much worse in the morning and lasts for a few hours. She also complains of fatigue and generalized body aches that have been presentfor the past few months. Which of the following is mostlikely?
a) Osteoporosis
b) Rheumatoid arthritis
c) Osteoarthritis
d) Gout . Correctb
When rheumatoid arthritis is active, symptoms can include fatigue, loss of energy,
depression, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. During flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining of the tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovitis).
23. A 40-year-old nurse complains of new-onset back pain secondary to her job on the medical-surgical 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 buttocksarea and radiating down the back of her thigh. It becomes worse when she sits down for long periods. You wouldsuspect:
a) Sciatica
b) Acute musclespasm
c) Cauda equinasyndrome
d) Acute muscle strain . Correct a
Sciatica is defined as pain that begins in the buttock area and radiates down one leg. Other
symptoms include weakness and tingling sensation. Acute muscle spasm and strain do not cause tingling down the leg. Cauda equina syndrome is an emergent issue, in which there is
neurological involvement and the patient complains of weakness and loss of bladder and bowel control.
24. The result of a postmenopausal woman’s dual-energy x-ray absorption (DXA)scan shows osteopenia. Which of the following T-scores is indicative ofosteopenia?
a) T-score of -1.0 orhigher
b) T-score between -1. 0 to-2.5
c) T-score of less than-2.5
d) T-score of -2.50 to-3.50
e) Normal results . Correctb
Osteopenia is defined as a T-score between -1. 0 and -2.5. Osteoporosis is defined as a T-
score of -2.5 or below.
25. What type of cast is used to stabilize a fracture of the scaphoidbone?
a) Long armcast
b) Thumb spicacast
c) Short legcast
d) Leg cylinder cast . Correctb
The scaphoid bone is located on the radial aspect of the wrist (same side as the thumb).
Another term for scaphoid fracture is navicular space fracture of the wrist. In patients with this injury, palpating in the anatomic snuffbox area reveals local tenderness. Athumb spica cast is used to stabilize fractures of the wrist. It is applied below the elbow (forearm in neutral position) and extends to the hand (wrist and thumb are immobilized). Sometimes, this type of fracture is stabilized with a screw (surgery) because it has a higher rate of nonunion.
26. Podagra is associated with which of thefollowing?
a) Rheumatoid arthritis
b) Gout
c) Osteoarthritis
d) Septic arthritis . Correctb
Gout (also known as podagra when it involves the big toe) is characterized by recurrent
attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal- phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases). Pain occurs due to the accumulation of uric acid and salts in the joint.
27. A 53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitionerdiagnoses a grade II sprain. The initial treatment plan includes which of thefollowing?
a) Intermittent application of cold packs the first 24 hours followed by applicationsof low heat at bedtime
b) Elevation of the affected limb and intermittent applications of cold packs for thenext 48 hours
c) Rechecking the knee in 24 hours and encouraging isometricexercises
d) Application of an elastic bandage wrap to the affectedknee . Correctb
Elevation of the injured knee above the heart will reduce the amount of swelling that can
occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 to 20 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30 to 45 minutes between icing of the limb is recommended.
28. Which of the following T-scores is indicative ofosteoporosis?
a) T-score of 0 to-1.0
b) T-score of -1.0 to-2.0
c) T-score of -2.5 orless
d) Diagnosis is based on an x-ray series of thespine
Osteoporosis is defined as having a T-score of -2.5 or less. Risk factors should also be
considered when interpreting T-scores for diagnosis.
29. Heberden’s nodes are commonly found in which of the followingdiseases?
a) Rheumatoid arthritis
b) Degenerative joint disease
c) Psoriaticarthritis
d) Septic arthritis correctb
Heberden’s nodes are bony nodules on the distal interphalangeal joints, commonly seen in
degenerative joint disease.
30. 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 mostlikely?
a) Bouchard’snodes
b) Heberden’snodes
c) Osteoarthriticnodules
d) Tophi deposits
31. A middle-aged man with a body mass index (BMI) of 28 is complaining of sharp burning pain that starts at the middle of the right buttock and radiates down the posterior aspect of the thigh and lower leg. He is complaining of weakness of theankle and foot that is interfering with walking. The pain started 3 months ago and is becoming more frequent and severe. It is aggravated by prolonged sitting, which is interfering with his job as a truck driver. His past medical history is positive for hypertension and metabolic syndrome. The patient is taking lisinopril- hydrochlorothiazide (Zestoretic) 10 mg/12.5 mg once a day. Which of the following tests is appropriate to further evaluate the patient’ssymptoms?
a) Straight leg raisingtest
b) McMurraytest
c) Lachmantest
d) Markle test
32. A 65-year-old carpenter complains of stiffness and pain in both his hands and right knee shortly after waking and worsens in the afternoon. He feels some relief withrest. On exam, the nurse practitioner notices the presence of Heberden’s nodes. Which of the following is most likely?
a) Osteoporosis
b) Rheumatoid arthritis
c) Osteoarthritis
d) Reiter’s syndrome
33. Which treatment would you recommend to a 65-year-old arthritic patient who complains of a new onset of a painful, swollen left knee caused by overworking inthe garden for 2days?
a) Quadriceps-strengthening exercises of the left knee followed by the applicationof cold packs for 20 minutes four times aday
b) Rest the joint and apply cold packs intermittently for the next 48hours
c) Passive range of motion and coldpacks
d) A cool tub bath with warm packs on the knee to avoid stiffening of thejoint . Correctb
New onset of a painful, swollen left knee (inflammation) should be treated using RICE: Rest
the knee/joint, use alternating ice packs for the first 24 to 48 hours, use compression if knee feels unstable, and elevate the limb to decrease swelling.
34. A 62-year-old woman complains of chronic severe low-back pain. She alsoreports mild episodes of fecal incontinence and numbness to her lower legs over the past week. You would suspect which of the following?
a) Fracture of the lowerspine
b) A herniateddisk
c) Cauda equinasyndrome
d) Ankylosing spondylitis
35. A middle-aged woman has been experiencing low-back pain that recently started to radiate to both buttocks and down her legs. She complains of leg weakness and problems with walking. Along with these symptoms she reports new onset of urinary incontinence, in which she leaks a small amount of urine at random. She also reports numbness on her perineal area, which is new. She denies trauma but reports that she recently moved to a new apartment and has been lifting and moving furniture.Which of the following is bestdescribed?
a) Sciatica
b) Acute musclespasm
c) Cauda equinasyndrome
d) Acute muscle strain
36. Which of the following tests would be the initial choice for evaluating forpossible fractures on the right lowerleg?
Plain radiographs of the right lower leg, ankle, and foot
Ultrasound of the right lower leg MRI of the right ankle
Radiograph of the right ankle and knee with special view of the hip
Plain radiographs or x-rays are the first exam ordered for suspected or obvious bony
37. An elderly woman with a history of rheumatoid arthritis reports to the nurse practitioner that she had been taking ibuprofen twice daily for many years. All ofthe following organ systems are at risk of damage from chronic nonsteroidal anti- inflammatory drug (NSAID) useexcept:
a) Cardiovascularsystem
b) Pulmonarysystem
c) Gastrointestinalsystem
d) Renal system
38. A 65-year-old woman’s bone density result shows severe demineralization of cortical bone. All of the following pharmacological agents are useful in treating thiscondition except:
a) Raloxifene (Evista)
b) Calcitonin (Miacalcin)
c) Medroxyprogesterone (Depo-Provera)
d) Calcium with vitamin D . CORRECTC
20. The Lachman maneuver is used to detect which of the following?
A) Kneeinstability
B) Nerve damage of the knee due to past kneeinjuries
C) The integrity of the patellar tendon
D) Tears on the meniscus of theknee
20. A) Knee instability The Lachman maneuver is a test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament.
24. Mr. Brown is a 65-year-old carpenter complaining of 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 fol- lowing is mostlikely?
A) Osteoporosis
B) Rheumatoidarthritis
C) Degenerative joint disease
D) Reiter’ssyndrome
24. C) Degenerative joint disease Heberden’s nodes are commonly seen in degen- erative joint disease. Heberden’s nodes are bony nodules located on the distal interphalangeal joints (DIPs).
25. What does a positive posterior drawer sign in a 10-year-old soccer playersignify?
A) An abnormalknee
B) Instability of theknee
C) A large amount of swelling on theknee
D) An injury of themeniscus
25. B) Instability of the knee The drawer sign is performed on the knee or ankle to assess for knee instability. The affected knee will have more laxity when compared to the unaffected knee.
54. A53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitioner diagnoses 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 heatat bedtime
B) Elevation of the affected limb and intermittent applications of cold packs for the next48 hours
C) Rechecking the knee in 24 hours and isometricexercises
D) The application of an Ace bandage to the affectedknee
54. B) Elevation of the affected limb and intermittent applications of cold packs for thenext 48 hours Elevation of the injured knee above the heart will reduce the amout of swelling that can occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30-45 minutes between icings of the limb isrecommended.
39. Phalen test is used to evaluate:
A) Inflammation of the mediannerve
B) Rheumatoidarthritis
C) Degenerative joint changes
D) Chronictenosynovitis
