. Barkley FNP Review – Family Nurse
Practitioner Board Certification
(Orthopaedics)Q&A with Rationale
EXAM
Prepare for your Family Nurse Practitioner certification with this focused
orthopaedic review featuring the latest Q&A for 2026/2027. This resource
covers key clinical assessments like the Lachman maneuver, drawer tests, and
identification of osteoarthritis vs. rheumatoid arthritis. Each question is
accompanied by detailed rationales to deepen your understanding of diagnosis
and treatment, including pharmacological considerations for conditions like
osteoporosis. Ideal for FNP students and practitioners seeking to strengthen
their orthopaedic knowledge for board exams and clinical practice
Lower Extremity Assessment (Knee & Ankle)
Question 1
What does a positive posterior drawer sign in a 10-year-old soccer player signify?
A) Normal knee
B) Instability of the knee
C) Swelling on the knee
D) Injury to the meniscus
Answer: B) Instability of the knee
Rationale: The drawer test is used to identify mediolateral or anteroposterior plane
instability of the knee. The anterior drawer test evaluates the anterior cruciate
ligament (ACL), while the posterior drawer test evaluates the posterior cruciate
,ligament (PCL). A positive posterior drawer indicates posterior tibial translation,
which signifies PCL injury and overall knee instability .
Technique Note: To perform the drawer test, the patient lies supine with knee at
90-degree flexion. Grasp the posterior aspect of the tibia over the upper calf
muscle; then, with steady force, push the lower leg forward and backward. Anterior
or posterior movement beyond normal range is positive for ligamentous laxity .
Question 2
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 history indicate?
A) Likely ankle sprain with a possible fracture
B) Mild ankle injury without fracture
C) Mild soft tissue injury only
D) Serious ankle injury with certain fracture
Answer: A) Likely ankle sprain with a possible fracture
Rationale: Immediate swelling of the joint raises the index of suspicion for a
possible fracture. The mechanism described (inversion injury) typically causes
lateral ankle sprain affecting the anterior talofibular ligament (ATFL). However,
immediate swelling can also indicate an avulsion fracture (e.g., of the fibula). The
ability to bear weight does not rule out fracture. Ottawa Ankle Rules should be
applied to determine need for X-ray .
Question 3
A 16-year-old basketball player comes to the clinic with anterior knee pain that
worsens with jumping, squatting, and climbing stairs. Physical exam reveals
tenderness at the inferior pole of the patella. What is the most likely diagnosis?
,A) Osgood-Schlatter disease
B) Patellofemoral pain syndrome
C) Jumper's knee (patellar tendinopathy)
D) Sinding-Larsen-Johansson syndrome
Answer: D) Sinding-Larsen-Johansson syndrome
Rationale: Sinding-Larsen-Johansson syndrome is an overuse injury causing
inflammation at the inferior pole of the patella where the patellar tendon inserts. It
is common in adolescent athletes involved in jumping sports. Key distinguishing
feature: tenderness is at the inferior pole of the patella (vs. Osgood-Schlatter
where tenderness is at the tibial tuberosity). Patellofemoral pain syndrome
typically presents with retropatellar pain without focal tenderness at the inferior
pole.
Question 4
A 45-year-old patient reports knee pain that started gradually without trauma. The
pain is worse after sitting for long periods ("theater sign") and improves with
walking. On exam, crepitus is noted with patellar compression. What is the most
likely diagnosis?
A) Medial meniscus tear
B) Patellofemoral pain syndrome
C) Osteoarthritis of the knee
D) Iliotibial band syndrome
Answer: B) Patellofemoral pain syndrome
Rationale: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee
pain worsened by prolonged sitting, squatting, kneeling, and stair climbing. The
"theater sign" (pain after sitting with knees bent) is classic. Crepitus with patellar
compression is common. PFPS is often due to patellar malalignment or quadriceps
muscle imbalance. Unlike osteoarthritis, PFPS typically affects younger adults and
pain improves with activity rather than worsening.
, Question 5
During a knee examination, the nurse practitioner performs the Lachman test. A
positive Lachman test indicates injury to which structure?
A) Posterior cruciate ligament (PCL)
B) Medial collateral ligament (MCL)
C) Anterior cruciate ligament (ACL)
D) Lateral meniscus
Answer: C) Anterior cruciate ligament (ACL)
Rationale: The Lachman test is the most sensitive test for ACL injury. With the
patient supine and knee flexed 20-30 degrees, the examiner stabilizes the femur
with one hand and pulls the tibia forward with the other. Excessive anterior
translation (lack of a firm endpoint) indicates ACL tear. The Lachman test is
preferred over the anterior drawer test for acute ACL injuries because it causes less
pain and is more sensitive.
Question 6
A patient presents with knee swelling that developed approximately 24 hours after
a twisting injury during soccer. The patient reports hearing a "pop" at the time of
injury. What is the most likely diagnosis?
A) Anterior cruciate ligament (ACL) tear
B) Patellar dislocation
C) Medial collateral ligament (MCL) sprain
D) Osteochondritis dissecans
Answer: A) Anterior cruciate ligament (ACL) tear
Rationale: ACL tears typically present with an audible "pop" at the time of injury,
hemarthrosis (swelling developing within hours, often delayed 4-12 hours), and
instability. The mechanism is often non-contact with deceleration, pivoting, or
landing from a jump. MCL sprains cause medial knee pain and swelling but typically
no pop. Patellar dislocation presents with visible deformity and immediate
swelling.
Practitioner Board Certification
(Orthopaedics)Q&A with Rationale
EXAM
Prepare for your Family Nurse Practitioner certification with this focused
orthopaedic review featuring the latest Q&A for 2026/2027. This resource
covers key clinical assessments like the Lachman maneuver, drawer tests, and
identification of osteoarthritis vs. rheumatoid arthritis. Each question is
accompanied by detailed rationales to deepen your understanding of diagnosis
and treatment, including pharmacological considerations for conditions like
osteoporosis. Ideal for FNP students and practitioners seeking to strengthen
their orthopaedic knowledge for board exams and clinical practice
Lower Extremity Assessment (Knee & Ankle)
Question 1
What does a positive posterior drawer sign in a 10-year-old soccer player signify?
A) Normal knee
B) Instability of the knee
C) Swelling on the knee
D) Injury to the meniscus
Answer: B) Instability of the knee
Rationale: The drawer test is used to identify mediolateral or anteroposterior plane
instability of the knee. The anterior drawer test evaluates the anterior cruciate
ligament (ACL), while the posterior drawer test evaluates the posterior cruciate
,ligament (PCL). A positive posterior drawer indicates posterior tibial translation,
which signifies PCL injury and overall knee instability .
Technique Note: To perform the drawer test, the patient lies supine with knee at
90-degree flexion. Grasp the posterior aspect of the tibia over the upper calf
muscle; then, with steady force, push the lower leg forward and backward. Anterior
or posterior movement beyond normal range is positive for ligamentous laxity .
Question 2
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 history indicate?
A) Likely ankle sprain with a possible fracture
B) Mild ankle injury without fracture
C) Mild soft tissue injury only
D) Serious ankle injury with certain fracture
Answer: A) Likely ankle sprain with a possible fracture
Rationale: Immediate swelling of the joint raises the index of suspicion for a
possible fracture. The mechanism described (inversion injury) typically causes
lateral ankle sprain affecting the anterior talofibular ligament (ATFL). However,
immediate swelling can also indicate an avulsion fracture (e.g., of the fibula). The
ability to bear weight does not rule out fracture. Ottawa Ankle Rules should be
applied to determine need for X-ray .
Question 3
A 16-year-old basketball player comes to the clinic with anterior knee pain that
worsens with jumping, squatting, and climbing stairs. Physical exam reveals
tenderness at the inferior pole of the patella. What is the most likely diagnosis?
,A) Osgood-Schlatter disease
B) Patellofemoral pain syndrome
C) Jumper's knee (patellar tendinopathy)
D) Sinding-Larsen-Johansson syndrome
Answer: D) Sinding-Larsen-Johansson syndrome
Rationale: Sinding-Larsen-Johansson syndrome is an overuse injury causing
inflammation at the inferior pole of the patella where the patellar tendon inserts. It
is common in adolescent athletes involved in jumping sports. Key distinguishing
feature: tenderness is at the inferior pole of the patella (vs. Osgood-Schlatter
where tenderness is at the tibial tuberosity). Patellofemoral pain syndrome
typically presents with retropatellar pain without focal tenderness at the inferior
pole.
Question 4
A 45-year-old patient reports knee pain that started gradually without trauma. The
pain is worse after sitting for long periods ("theater sign") and improves with
walking. On exam, crepitus is noted with patellar compression. What is the most
likely diagnosis?
A) Medial meniscus tear
B) Patellofemoral pain syndrome
C) Osteoarthritis of the knee
D) Iliotibial band syndrome
Answer: B) Patellofemoral pain syndrome
Rationale: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee
pain worsened by prolonged sitting, squatting, kneeling, and stair climbing. The
"theater sign" (pain after sitting with knees bent) is classic. Crepitus with patellar
compression is common. PFPS is often due to patellar malalignment or quadriceps
muscle imbalance. Unlike osteoarthritis, PFPS typically affects younger adults and
pain improves with activity rather than worsening.
, Question 5
During a knee examination, the nurse practitioner performs the Lachman test. A
positive Lachman test indicates injury to which structure?
A) Posterior cruciate ligament (PCL)
B) Medial collateral ligament (MCL)
C) Anterior cruciate ligament (ACL)
D) Lateral meniscus
Answer: C) Anterior cruciate ligament (ACL)
Rationale: The Lachman test is the most sensitive test for ACL injury. With the
patient supine and knee flexed 20-30 degrees, the examiner stabilizes the femur
with one hand and pulls the tibia forward with the other. Excessive anterior
translation (lack of a firm endpoint) indicates ACL tear. The Lachman test is
preferred over the anterior drawer test for acute ACL injuries because it causes less
pain and is more sensitive.
Question 6
A patient presents with knee swelling that developed approximately 24 hours after
a twisting injury during soccer. The patient reports hearing a "pop" at the time of
injury. What is the most likely diagnosis?
A) Anterior cruciate ligament (ACL) tear
B) Patellar dislocation
C) Medial collateral ligament (MCL) sprain
D) Osteochondritis dissecans
Answer: A) Anterior cruciate ligament (ACL) tear
Rationale: ACL tears typically present with an audible "pop" at the time of injury,
hemarthrosis (swelling developing within hours, often delayed 4-12 hours), and
instability. The mechanism is often non-contact with deceleration, pivoting, or
landing from a jump. MCL sprains cause medial knee pain and swelling but typically
no pop. Patellar dislocation presents with visible deformity and immediate
swelling.
