AGNP BOARD EXAM QUESTIONS Orthopedics Assessment.docx

AGNP BOARD EXAM QUESTIONS Orthopedics Assessment (317 Questions). Question: The axioscapular group of muscles include which one of the following? Supraspinatus Trapezius Correct Subscapularis Pectoralis major Explanation: The axioscapular group attaches the trunk to the scapula and includes the trapezius, rhomboids, serratus anterior, and levator scapulae. The scapulohumeral group of muscles extends from the scapula to the humerus and includes the muscles inserting directly on the humerus. This group includes the supraspinatus, infraspinatus, teres minor, and subscapularis. The axiohumeral muscle group attaches the trunk to the humerus and includes the pectoralis major and minor, and the latissimus dorsi. Question: An example of a cartilaginous joint would be the: vertebral bodies of the spine. Correct skull. shoulder. knee. Explanation: Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. The skull is an example of the fibrous joint. Question: The part of the ulna that forms the outer prominence of the elbow is referred to as the: olecranon bursa. olecranon fossa. olecranon process. Correct olecranon. Explanation: The part of the ulna that forms the outer prominence of the elbow is referred to as the olecranon process. This process fits into the fossa of the humerus when the arm is extended. Question: To assess muscle tone in the legs, support the patient's thigh with one hand, grasp the foot with the other, and: extend the patient's feet. flex and extend the patient's knee and ankle on each side. Correct have the patient try to lift the foot. AGNP BOARD EXAM QUESTIONS Orthopedics A feel for jerkiness in the calf. Explanation: To assess muscle tone in the legs, support the patient's thigh with one hand, grasp the foot with the other, and flex and extend the patient's knee and ankle on each side noting for any resistance to the movements. Question: When grading muscle strength, a grade of three would indicate: no muscular contraction detected. barely detectable trace of contraction. active movement of the body part with gravity eliminated. active movement against gravity. Correct Explanation: A grade of three would indicate active movement against gravity. Zero muscular strength would indicate no muscular contraction was noted on exam. A grade of one indicates a barely detectable trace of contraction noted on exam. For active movement of the body part with gravity eliminated, a grade of two would be noted. Question: Joints in which bones have intervening layers of fibrous tissue or cartilage holding the bones together are referred to as: cartilaginous joints. synovial joints. fibrous joints. Correct extra-articular joints. Explanation: Fibrous joints, such as the sutures of the skull, have intervening layers of fibrous tissue or cartilage holding the bones together. The bones are almost in direct contact and do not allow movement. Cartilaginous joints, such as those between vertebrae and the symphysis pubis, are slightly movable. In these joints, fibrocartilaginous discs separate the bony surfaces. Joints in which bones do not touch each other, and the joint articulations are freely moveable (within the limits surrounding ligaments) are called synovial joints. Extra-articular refers to the structures of selected regions of the joint and types of movement. Question: Passive flexion, varus stress, and external rotation of the lower leg evaluates the: medial meniscus. Correct lateral meniscus. lateral collateral ligament (LCL). posterior cruciate ligament (PCL). Explanation: Passive flexion, varus stress, and external rotation of the lower leg evaluates the medial meniscus. Question: When examining the knee, the presence of a palpable fluid wave with the returning fluid wave into the suprapatellar pouch is noted. This positive sign for effusion of the knee is known as the: balloon sign. Correct bulge sign. balloting sign. McMurray's sign. Explanation: A positive balloon sign for effusion in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. Balloting of the patella is tested by compressing the suprapatellar pouch and pushing the patella sharply against the femur. If fluid returns to the suprapatellar pouch, then an effusion of the knee is diagnosed. McMurray's test checks for tears in the medial meniscus. Question: The Abduction (or Valgus) Stress Test is a maneuver used to assess the function of the: Achilles tendon. medial meniscus. medial collateral ligament (MCL). Correct lateral collateral ligament (LCL). Explanation: The Abduction (or Valgus) Stress Test is a maneuver that evaluates the function of the medial collateral ligament. To perform this test, place the knee in thirty degrees of flexion. While stabilizing the knee, abduct the ankle. If the knee joint abducts greater than the uninjured knee, the test is positive. This is suggestive of a medical collateral ligament tear. Question: The dorsiflexors muscles in the foot include the: posterior tibial muscle. gastrocnemius. toe flexors. toe extensors. Correct Explanation: The dorsiflexors in the foot include the anterior tibial muscles and the toe extensors. Question: Thenar atrophy suggests: an ulnar nerve disorder. a median nerve disorder. Correct a radial nerve disorder. a superficial branch of the radial nerve. Explanation: Thenar atrophy suggests a median nerve disorder such as carpal tunnel syndrome. This is evidenced by muscle wasting in the palm of the hand. Question: Pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures are referred to as: synovial joints. bursae. Correct joint capsule. synovial membrane. Explanation: Pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures are referred to as bursae. (Bursae is plural. Bursa is singular). Question: A patient experienced a neck injury yesterday and presents to the nurse practitioner with aching paracervical pain and stiffness. Other complaints include dizziness, malaise, and fatigue. These findings may be associated with: mechanical neck pain. mechanical neck pain with whiplash. Correct cervical radiculopathy. cervical myelopathy. Explanation: In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder, lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. Question: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except: hallux valgus. metatarsalgia. Achilles tendinitis. Correct Morton's neuroma. Explanation: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux valgus, metatarsalgia, and Morton's neuroma. Achilles tendinitis more commonly occurs in runners and affects the posterior foot as opposed to the forefoot. Question: Anserine bursitis arises from: excessive running. Correct excessive kneeling. arthritis. trauma Explanation: Anserine bursitis arises from excessive running, valgus knee deformity, fibromyalgias, and osteoarthritis. Prepatellar bursitis (“housemaid’s knee”) arises from excessive kneeling. A popliteal or “baker’s” cyst arises from distention of the gastrocnemius semimembranous bursa from underlying arthritis or trauma. Question: A 64-year-old man complains of worsening pain that radiates from the right buttock to the posterior upper thigh. This is a common complaint associated with: osteoporosis. degenerative disc disease (DDD). sciatica. Correct cauda equina. Explanation: Sciatica is characterized as a constant pain in one side of the buttock that radiates to the leg. The pain worsens while sitting. Patients with osteoporosis have no symptoms until bone fracture occurs. Degenerative disc disease (DDD) involves chronic lower back or neck pain and spasms. Cauda equina involves lower back pain, weakness, numbness of lower extremities, and possible loss of bladder control. Question: The ankle is a hinge formed by the tibia, fibula, and the: Achilles tendon. talus. Correct deltoid ligament. calcaneus. Explanation: The ankle is a hinge formed by the tibia, fibula, and the talus. The tibia and fibula act as a mortise, stabilizing the joint while bracing the talus like an inverted cup. Question: The group of muscles that lies medial and swings the thigh toward the body is known as the: abductor group. extensor group. flexor group. adductor group. Correct Explanation: The group of muscles that lies medial and swings the thigh toward the body is known as the adductor group. The group of muscles that lies laterally and swings the thigh away from the body is known as the abductor group. The group of muscles that lies posteriorly and extends the thigh is known as the extensor group. The group of muscles that lies anteriorly and flexes the thigh is known as the flexor group. Question: When examining the elbow for range of motion, the nurse practitioner instructs the patient to turn his palm upward. This motion is an example of: extension. flexion. supination. Correct pronation. Explanation: Instructing the patient to turn his palm upward is supination. Extension occurs with straightening the elbow. Flexion occurs with bending the elbow. Turning the palms downward demonstrates pronation. Question: The adductor tubbercle of the knee is located: lateral surface. medial surface. Correct anterior surface. posterior surface. Explanation: The adductor tubercle of the knee is located on the medial surface of the knee. Question: A patient complains of low back pain when he walks, but improvement with rest or lumbar flexion. This type of low back pain is referred to as: radicular low back pain. mechanical low back pain. sciatica. pseudoclaudication. Correct Explanation: Lumbar spinal stenosis or "pseudoclaudication" refers to pain in the back or legs where the patient walks but improves with rest, lumbar flexion, or both. Radicular pain, or sciatica, presents with shooting pains below the knee, into the lateral leg or posterior calf. It may be accompanied by paresthesias and/or weakness in the affected leg. Mechanical low back pain often arises from muscle and ligament injuries (~70%) or agerelated intervertebral disc or facet disease. Common symptoms include aching pain in the lumbosacral area that radiates to the upper leg. Common risk factors include heavy lifting, poor conditioning, and obesity. Question: When examining the foot of a patient, the nurse practitioner notes tenderness of the posterior medial malleolus. This could be suggestive of: a bone spur. plantar fasciitis. a ligamentous injury. tibial tendinitis. Correct Explanation: Tenderness along the posterior medial malleolus suggests posterior tibial tendinitis. Bone spurs may be present on the calcaneus as bony projections and may cause numbness, tenderness, or pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. Question: The posterior drawer sign is used to assess instability of the: anterior cruciate ligament (ACL). posterior cruciate ligament (PCL). Correct lateral collateral ligament (LCL). medial collateral ligament (MCL). Explanation: The posterior drawer sign is used to test instability of the posterior cruciate ligament. A positive posterior drawer sign occurs when the proximal tibia falls backward when force is applies to the PCL. This suggests PCL injury. Question: The nurse practitioner instructs the patient to place one hand behind his back and touch his shoulder blade. This shoulder movement elicits: extension. flexion. internal rotation. Correct external rotation. Explanation: The nurse practitioner instructs the patient to place one hand behind his back and touch his shoulder blade. This shoulder movement elicits internal rotation. Extension is tested by asking the patient to move his arm behind himself. Flexion is tested by asking the patient to move his arm in front of his body. External rotation is tested by asking the patient to raise his arm to his shoulder, bend his elbow, and rotate his forearm toward the ceiling. Question: The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses: cervical flexion. cervical extension. rotation. lateral bending. Correct Explanation: Looking over one shoulder and then the other would be assessing rotation of the neck and having the patient bring his ear to his shoulder would be assessing lateral bending of the neck. Assessing neck extension would be having the patient look upward at the ceiling. Bringing the chin to the chest would be assessing flexion of the neck. Question: The lateral end of the clavicle that articulates with the acromion process of the scapula is referred to as the: glenohumeral joint. sternoclavicular joint. acromioclavicular joint. Correct manubrium joint. Explanation: The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. There is no manubrium joint; it is the broad upper part of the sternum. Question: The synovial cavity occupies the: prepatellar bursa. negative infrapatellar space. Correct anserine bursa. suprapatellar pouch. Explanation: The concavities noted on each side and above the patella are known as the negative infrapatellar space. The synovial cavity of the knee occupies these areas. Question: When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of himself and overhead. This motion of the shoulder girdle would be an example of: adduction. abduction. flexion. Correct extension. Explanation: When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front and overhead. This motion of the shoulder girdle would be an example of flexion. Extension occurs when the patient moves his arm behind himself. Abduction occurs when the patient moves his arms away from the body laterally and overhead. Adduction occurs when the patient crosses his arm in front of his body. Question: The structure that projects from the spinal column posteriorly in the midline is referred to as the: articular process. spinous process. Correct articular facets. vertebral foramen. Explanation: The structure that projects from the spinal column posteriorly in the midline is referred to as the spinous process. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets. The vertebral foramen encloses the spinal cord. Question: The nerve that provides sensation to the palm and palmar surface of most of the thumb, second and third fingers, and half of the fourth digit is the: ulnar nerve. radial nerve. median nerve. Correct flexor retinaculum. Explanation: The nerve that provides sensation to the palm and palmar surface of most of the thumb, second and third fingers, and half of the fourth digit is the median nerve. The ulnar nerve innervates half of the fourth digit and the fifth digit. The radial nerve innervates the dorsal web space of thumb and index finger. The flexor retinaculum is a ligament. Question: Tenderness over the sacroiliac joint is commonly noted in patients with: arthritis. spondylolisthesis. ankylosing spondylitis. Correct thoracic kyphosis. Explanation: Tenderness over the sacroiliac joint is commonly noted in patients with sacroiliitis or ankylosing spondylitis. Question: Which one of the following ligaments of the foot is most at risk for injury from inversion? Anterior talofibular ligament Correct Deltoid ligament Calcaneofibular ligament Posterior talofibular ligament Explanation: The three ligaments of the foot with higher risk for injury are the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament. The anterior talofibular ligament is most at risk in injury from inversion (heel bows inward) injuries. Question: A patient complains of a sharp burning pain in the neck and right arm with associated paresthesias and weakness. These symptoms may be associated with: mechanical neck pain. mechanical neck pain with whiplash. cervical radiculopathy. Correct cervical myelopathy. Explanation: With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm and stiffness and tightness in the upper back and shoulder, lasting up to 6 weeks. In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. Question: When examining the patient for wrist flexion, the nurse practitioner instructs the patient with his palms down to: point his fingers toward the ceiling. move his fingers toward the midline. move his fingers away from the midline. point his fingers toward the floor. Correct Explanation: When examining the patient for wrist flexion, the nurse practitioner instructs the patient to place his palms down and to point his fingers toward the floor. Extension occurs with pointing fingers toward the ceiling. Adduction occurs with bringing the fingers toward the midline. Abduction occurs with having the patient move his fingers away from his midline. Question: Which of the following substances is essential for bone health and muscle function? Vitamin B12 Calcium Correct Magnesium Phosphorus Explanation: Calcium is the most abundant mineral in the body and is essential for bone health, muscle function, nerve transmission, vascular function, intracellular signaling, and hormonal secretion. Vitamin B12 is responsible for normal cognitive function and peripheral nerve health. Vitamin B12 is essential for absorption of dietary calcium. Magnesium contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant, glutathione. The main function of phosphorus is in the formation of bones and teeth. Question: When examining the ankle and foot, the nurse practitioner instructs the patient to dorsiflex and plantar flex the foot at the ankle. This maneuver assesses the: talocalcaneal joint. tibiotalar joint. Correct transverse tarsal joint. metatarsophalangeal joint. Explanation: Dorsiflexion and plantar flexion of the foot at the ankle assesses the ankle joint, also known as the tibiotalar joint. Question: The longest part of the sternum extending from the end of the manubrium to the beginning of the xiphoid process is referred to as the: body of the sternum. Correct manubrium. xiphoid process. acromion process. Explanation: The body of the sternum is the longest part and extends from the end of the manubrium to the beginning of the xiphoid process. The manubrium, (Latin for handle), or manubrium sterni, is the broad upper part of the sternum. It has a quadrangular shape, narrowing from the top, which gives it four borders. The xiphoid process is the pointed end of the sternum located at the inferior end. The acromion process is an extension of the spine of the scapula and located at the highest point of the shoulder. Question: Physical signs associated with cervical radiculopathy from nerve root compression include: weakness in the triceps and finger flexors and extensors. Correct decreased cervical range of motion. neck flexion with resulting sensation of electrical shock radiating down the spine. local neck muscle tenderness. Explanation: Weakness in the triceps and finger flexors and extensors is associated with cervical radiculopathy from nerve root compression. Mechanical neck pain with whiplash results in decreased neck range of motion, perceived weakness of the upper extremities, and paracervical tenderness. Physical signs associated with cervical myelopathy from cervical cord compression may include hyperreflexia, clonus at the wrists, knee or ankle, gait disturbances and positive Lhermitte's sign: neck flexion with resulting