NURSING 633 Week 14 – Musculoskeletal (MSK) (Q /A LATEST 2022

Week 14 – Musculoskeletal (MSK) A school-age child falls off a swing and fractures the humerus close to the elbow joint. What is the most important assessment for this patient to evaluate possible complications of this injury? Salter-Harris classification Palpation for joint laxity Evaluation of pain with extension The presence of a spiral fracture A patient has symptoms of carpal tunnel syndrome. Which diagnostic tests will help confirm this disorder? (Select all that apply.) Erythrocyte sedimentation rate Plain radiographs Anti-nuclear antibody Electromyography Nerve conduction studies A 62-year-old female presents with atraumatic right knee pain. On exam, she has mildly swollen right knee that is not warm or tender to touch. She has negative McMurray test. Her x-ray demonstrates tibial femoral joint space narrowing and visualization of osteophytes. How should the nurse practitioner interpret the results of this x-ray? Age-related changes in the knee A Baker's cyst Gouty arthritis Osteoarthritis In the knee, joint space narrowing indicates a loss of articular cartilage and usually worsening osteoarthritis. Osteophytes formed in response to degeneration of cartilage and joints. The McMurray test is commonly used to assess joint motion and meniscal injury. A patient presents with right shoulder pain after an acute shoulder injury yesterday. He fell against a brick wall while working at his home. He reports pain that radiates into his upper arm. How should this be managed? Prescribe physical therapy for the patient Ordered x-ray of the right shoulder Rest, ice, and naproxen for one week Immobilize the right shoulder for 3 days And x-rays generally the initial test used to evaluate trauma that results in acute pain. An x-ray could demonstrate fracture. It would not be helpful for evaluation of most soft tissue injuries. No other intervention is appropriate until fracture and dislocation have been ruled out. An adolescent athlete has injured his ankle playing basketball. He has right ankle pain, ecchymosis, and significant edema, and he is unable to bear weight at the time of the clinical exam. Which diagnosis is least likely? Grade 3 sprain Grade 2 sprain Grade 1 sprain An avulsion fracture A grade 1 sprain results from minimal stretching or small tears in the ligament. There is mild tenderness and edema, and the patient is able to bear weight. A grade 2 sprain is more significant, the clinical signs are more severe stretching and tearing of ligament with moderate pain, edema, tenderness and ecchymosis. Weightbearing is painful but the patient is able to walk. A grade 3 sprain is the most severe, and involves complete tear of the ligament, there is joint instability, severe pain, edema, tenderness, ecchymosis, patients are unable to bear weight due to pain. An adult patient who has been taking high-dose corticosteroids reports a dull, aching pain in the groin and presents with a limp. What condition does the provider suspect, based on this history? Avascular necrosis of the femoral head What are included in the initial management of bursitis of the heel? (Select all that apply.) Nonsteroidal anti-inflammatory medications Rest, ice, compression, and elevation Activity modification and bracing A patient comes to a provider with reports of unilateral arm pain and weakness with mild neck pain. The provider notes that the patient prefers holding the affected arm crossed in front of the throat. A history reveals a recent onset of sexual dysfunction. What does the provider suspect based on this history? Cervical myelopathy A patient takes HCTZ daily for hypertension. He developed severe pain in his great toe yesterday. He was diagnosed with gout today and started on the medication. Which medication listed below would be contraindicated at this time? Prednisone Colchicine Indomethacin Allopurinol Allopurinol has no role in treatment of acute gout because it has no role in inflammation. A 75-year-old female who Knits daily has a positive Finkelstein test. What is her likely diagnosis? Gamekeeper's thumb DeQuervain's tenosynovitis Trigger thumb Osteoarthritis of the thumb DeQuervain's tenosynovitis were present inflammation of the exterior and flexor tendon in the thumb. The classic finding includes a positive Finkelstein test. Pain can radiate up to the forearm. The probable precipitant is this patient's daily knitting. A long distance runner is diagnosed with a tibial stress fracture. Which stayed in the street about the injury? Rest and an alternative activity are recommended Plain x-ray will confirm the diagnosis The patient should be casted for 6 weeks The pain worsens with rest Stress factors are an example of an overuse injury. X-ray usually do not demonstrate stress fractures, so history and exam are important. Engaging in an alternative exercise that does not stress the fractured area is recommended. Casting and crutches are reserved for use when conservative treatment are not affected. A 45-year-old patient who is in good health presents with complaints of pain in his left heel. He states that the first few steps out of the bed in the morning are extremely painful. He has no history of trauma. What is the likely etiology of his pain? Calcaneal spur Arthritis of the foot Plantar fasciitis Achilles tendinitis Symptoms are classic for plantar fasciitis A 12-year-old with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated? Perform Trendelenburg's test in the office There are several diagnoses in the differential. The assessment of this child's pain should begin in the office. Asking the child to stand on the affected leg to perform the Trendelenburg test. If there are weak adductor muscles in the affected hip, a pelvic tilt will be visible in the affected hip. After assessment of the hip, knee, and gait in the office, a hip x-ray to include AP and lateral should be ordered. A 8-year-old boy with type 1 diabetes is being seen for 3 day history of urinary frequency and nocturia. He denies flank pain and is afebrile. The urinalysis results is negative for blood and nitrates but is positive for large amount of leukocytes and ketones. He has a trace amount of protein. Which is the following is best test to order initially? A urine culture and sensitivity In 8-year-old male patient with diagnosis of diabetes has a high risk of UTIs. Urinalysis is showing possible UTI. The urine culture would be ordered because he has high risk of infection. A mother brings her 4-year-old daughter, we just started attending preschool, to the health clinic. She tells the nurse practitioner that her child is complaining of burning and itching that started in the left eye. Within 2 days involved both eyes, and the child developed a runny nose and a sore throat. During the physical exam, the child's eyes appear injected bilaterally with no purulent discharge. The throat is red, the inferior nasal turbinates are swollen, and shotty nodes are palpated in front of each year. Which of the following is most likely: Viral conjunctivitis Vital conjunctivitis is often present with or without cold symptoms. Patient's complaint of itchy red eyes and may have clear discharge accompanied by periocular lymphadenopathy. A 4-week-old boy seen in the clinic for a complaint of forceful vomiting that occurs immediately after feeding. The vomitus is composed of infant formula and is not bilious. The infant is bottle-fed with infant formula that was recommended by the pediatrician. The mother reports that the infant seems hungry and sucks on the bottle without any problems. His birth weight is 3.4 kg and his current weight is 3.2 kg. Which with the following clinical findings is an important clue regarding the possible cause of the infant's vomiting? Round olive like mass located in the right upper quadrant of the abdomen The stem is asking about the possible cause of the infant's vomiting, it is not asking about the symptoms. Projectile of forceful vomiting after feeding is a classic symptom of infantile hyperrtrophic pyloric stenosis. The other signs and symptoms are dehydration, irritabillity, crying. Positive rooting reflex is normal finding in a 4-week-old. A 8-year-old child is seen as a walk-in appointment by nurse practitioner. The mother reports that the child is febrile for 2 days and is not eating well due to painful sores inside the mouth. During the physical exam, the nurse practitioner notices several small blisters and shallow ulcers on the child's pharynx and oral mucosa. The child has small round red rashes on both palms and soles. Which are the following conditions is most likely? Hand-foot-and-mouth disease Hand foot and mouth disease is caused by coxsackie virus. Symptoms in the question align with this disease. A 50-year-old patient reports acute pain in his lower back that started 2 weeks ago after working in his yard. The pain radiates into his right leg intermittently. He has been managing his pain with ibuprofen. There are no red flags in history or on exam. When should consideration be given to imaging studies? There is no need Now At 4 weeks At 8 weeks Imaging studies are usually not indicated for uncomplicated acute low back pain. The probable precipitant, physical labor, like yard work, is a common cause of low back pain. As long this pain is of less than 4 weeks duration and there are no red flags in history or exam, radiological tests can be delayed. Imaging should be considered initially in patients who have a history of cancer, age greater than 50, significant trauma or neurological deficits, or pain in consistent with history. A 40-year-old woman reports pain at the thumb base in one hand radiating to the distal radius. The provider learns that the woman knits for a hobby and is able to elicit the pain by asking the patient to pour water from a pitcher. Which condition is suspected in this patient? Trigger finger Palmar fibrosis Tenosynovitis Carpal tunnel syndrome A patient has pain at the base of one thumb and reports frequently dropping things because of pain and weakness in that joint. During physical examination, what will the examiner do to help diagnose this condition? Adduct the first metacarpal and hyperextend the metacarpal phalanx Flex the thumb while placing a finger on the metacarpophalangeal joint Place the thumb on the palm while deviating the hand toward the ulna Passively extend the thumb and observe for puckering of the skin A patient with shoulder pain is seen by an orthopedic specialist who notes erythema, warmth, and fluctuance of the shoulder joint. What is the next step in treatment for this patient? Admit to the hospital for intravenous antibiotics Perform a shoulder ultrasound to further evaluate the cause Order a plain radiograph of the shoulder to identify possible fracture Inject lidocaine into the joint and reassess in 5 to 10 minutes An examiner is evaluating a patient who reports unilateral shoulder pain and notes limited active and passive range of motion in the affected shoulder along with erythema and bulging on the anterior shoulder. What diagnosis is likely with this presentation? Adhesive capsulitis Acromioclavicular joint disease Inflammatory bursitis Rotator cuff tear A 60-year-old patient is otherwise healthy presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. Was a common finding? Posterior knee pain, anterior knee edema, and redness Tenderness to touch of the tibial tubercle Swelling and pain to touch in the anterior knee Limping and erythema above the anterior knee Prepatellar bursitis is often precipitated by an increase in activity involving the knees. If it's more infectious in origin, erythema would be present, but based and patient history and absence of risk factors that is less likely. Prepatellar bursitis is characterized by swelling and inflammatory changes anterior to the patella, with no symptoms posteriorly. What does a positive anterior drawer test demonstrated in a patient who has an injured knee? Instability of the anterior cruciate ligament Injury to the lateral meniscus Stability of the anterior cruciate ligament Stability of the lateral knee A patient has chronic elbow pain associated with arthritis. What is included in management of this condition? (Select all that apply.) Splinting of the elbow Avoidance of certain activities Long-term NSAIDs Occupational therapy Balanced rest and exercise A patient with elbow pain without localized erythema or warmth is diagnosed with bursitis of the elbow and serum laboratory results are pending. What is the initial treatment while waiting for these results? Physical and occupational therapy Corticosteroid injection into the bursal sac Aspiration of the bursal sac for culture Elbow pads, NSAIDs, rest, and ice A soccer player is brought to the emergency department after twisting an ankle during a game. An examination of the affected joint reveals ecchymosis and edema of the ankle and limited joint laxity along with pain on weight-bearing, although movement with pain is intact. Which grade sprain is likely? Grade II Grade IV Grade III Grade I A male patient who injured his back lifting a heavy object report that he has low back pain. He is diagnosed with a lumbar strain. He is afraid to continue activities of daily living, especially walking, because he has pain with these activities. What statement below is true? Stop performing all activities of daily living for 3 days Gradually increase activities of daily living and walking as tolerated Bedrest will help your back pain Continue your activities of daily living, but stopped walking, except to go to the bathroom Pain associated with a lumbar strain does produce pain with activity and walking. patient should be educated that some pain as expected and that it will not produce permanent injury. He should be encouraged to gradually increase activities of daily living and normal walking as tolerated. A high school soccer player sustains a knee injury when kicked on the lateral side of the knee by another player. The provider notes significant swelling of the knee, with pain at the joint line on the medial aspect of the knee. What will the provider do to treat this injury? Refer for a same-day orthopedic consultation Instruct about RICE management and follow up in 1 week Splint the knee and refer for orthopedic consultation in 1 to 2 weeks Schedule a magnetic resonance imaging (MRI) exam A 40-year-old nurse complains of new onset back pain secondary to her job. 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 per thigh. It becomes worse when she sits down for long periods. You would suspect: Acute muscle spasm Sciatica Acute muscle strain Cauda equina syndrome Sciatica is defined as pain that begins in the buttocks area and radiates down one leg. Other symptoms include weakness and tingling. A long distance runner is diagnosed with a tibial stress fracture. What is the best conservative treatment recommendation? The patient should be casted for 6 weeks The pain worsens with rest Plain x-ray will confirm the diagnosis Rest and an alternative activity are recommended Stress factors are an example of an overuse injury. X-ray usually do not demonstrate stress fractures, so history and exam are important. Engaging in an alternative exercise that does not stress the fractured area is recommended. Casting and crutches are reserved for use when conservative treatment are not affected. 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 this condition? Crutches and partial weight bearing Cessation of all sports activities and exercise Physical therapy for ultrasound therapy Referral to an orthopedist for MRI and evaluation A 16-year-old complains that his knee hurts. his mother states that he has complained of knee pain for the past 2 weeks. He has a prominent tibial tubercle. Which should be part of the differential diagnosis? Psychogenic pain Acute lymphocytic leukemia Growing pains Osgood-Schlatter disease Osgood Slater disease is in osteochondritis of the tibial tubercle that can produce pain in the knees of adolescence. pain gradually increases over time and can become severe. The diagnosis can be made on clinical presentation without the need for imaging studies. A patient has pain on the plantar aspect of the heel with weight bearing after rest. The pain is worsened with dorsiflexion of the foot. What is the initial treatment for this patient? Avoiding all high-impact activities A series of steroid injections Night splints Wearing flat shoes only A patient who has osteoarthritis in the carpometacarpal joints of both thumbs asks about corticosteroid injections to treat symptoms. What will the provider tell this patient about this therapy? Corticosteroid therapy reduces inflammation and improves joint mobility Intra-articular injections provide significant pain relief for 3 to 4 months This treatment may cause a temporary increase in pain, warmth, and redness Injections may be administered as needed up to 6 times per year A patient has an acute onset of lower back pain associated with lifting heavy objects at work. A physical examination reveals no loss of lower extremity function or neurological symptoms. What is the initial intervention for this patient? Treatment with a nonsteroidal anti-inflammatory drug An older adult with complaint of shoulder pain has positive "drop arm" test. What is his likely diagnosis? Torn rotator cuf A positive drop arm test should give the examiner good idea of the diagnosis of torn rotator cuff. An MRI confirms the diagnosis. A patient reports severe back pain located in the lumbar spine. To evaluate whether the patient has axial pain or radicular pain, which assessment is necessary? Assessing reflexes and asking about tingling or numbness Noting whether pain is mitigated with frequent position shifts Asking the patient to perform the Valsalva maneuver Determining whether the pain is present with prolonged sitting Patient reports that his knee "locks" sometimes and feels like it will "give out." She denies injury. She has no complaints about her other knee. What is her likely problem? Meniscal tear A 50-year-old woman reports pain in one knee upon awakening each morning that goes away later in the morning. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the provider tell this patient? To take acetaminophen 1 gram three times daily for pain Which maneuver during a physical examination is used to assess the anterior cruciate ligament? Anterior drawer test An emergency department provider is giving instructions for rest, ice, compression, and elevation (RICE) treatment in a patient with a sprain. What is included in teaching about this home care? (Select all that apply.) Place a cloth between the ice pack and the skin Apply ice packs for 20 minutes three times daily ! Moist heat therapy may be applied if muscle spasm occurs Proximal joints should be elevated higher than distal joints An elastic bandage is sufficient for compression 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? Mild soft tissue injury only Likely ankle sprain with a possible fracture Serious ankle injury with certain fracture Mild ankle injury without fracture A patient reports a deep ache in one shoulder and the provider suspects tendonitis secondary to repetitive activity. To determine whether the pain is caused by impingement on the acromion, the provider will ask the patient to abduct the arm. adduct the arm. internally rotate the shoulder. shrug the shoulders. A 45-year-old patient reports a recent onset of unilateral shoulder pain which is described as diffuse and is associated with weakness of the shoulder but no loss of passive range of motion. What does the provider suspect as the cause of these symptoms? Cervical radicular pain Acromioclavicular joint disease Glenohumeral arthritis Rotator cuff injury A previously healthy patient reports a sensation of one knee locking or feeling like it will give way when descending stairs. The patient has no recollection of injury to the knee and denies pain. What is the most likely treatment for this disorder? Conservative management with RICE and activity modification A patient reports elbow pain and the examiner elicits pain with resisted wrist flexion, forearm pronation, and passive wrist extension on the affected side. What is a likely cause of this pain? Medial epicondylitis A 60-year-old patient is otherwise healthy presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding on physical exam? Tenderness to touch of the tibial tubercle Posterior knee pain, anterior knee edema, and redness Swelling and pain to touch in the anterior knee Limping and erythema above the anterior knee