NURS 671 DUNPHY FINAL CLINICAL EXAM
QUESTIONS & ANSWERS
One of the initial steps in assessing pt's w/musculoskeletal complaints is to determine
whether the complaint is articular or nonarticular in origin. Which of the following is an
example of an articular structure?
a. Bone
b. Synovium
c. Tendons
d. Fascia - Answer -b. Synovium
You have detected the presence of crepitus on exam of a pt with a musculskeletal
complaint. Additionally, there is limited ROM w/both active and passive movement.
These findings suggest that the origin of the musculoskeletal complaint is: - Answer -
Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain?
a. Decreased CRP
b. Hyperalbuminemia
c. Morning stiffness
d. Weight gain - Answer -c. Morning stiffness
Which of the following statements concerning the musculoskeletal exam is true?
a. The uninvolved side should be examined initially and then compared to the involved
side.
b. The part of the body that is causing the pain should be examined first.
c. When possible, the pt should not be asked to perform active ROM exercises to avoid
causing pain.
d. Radiographs should always be obtained prior to examination so as not to cause
further injury to the pt. - Answer -a. The uninvolved side should be examined initially
and then compared to the involved side.
You are performing muscle strength testing on a pt presenting w/musculoskeletal pain
and find that the pt has complete ROM w/gravity eliminated. Which numeric grade of
muscle strength would you give this pt, 1-5? - Answer -2
Mrs. Gray is a 55yo woman who presents with tightness, pain, and limited movement in
her right shoulder. She denies any h/o trauma. Her exam reveals a 75% reduction in
both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing
,tenderness with motion and pain at the deltoid insertion. Her medical hx is significant for
type 1 diabetes mellitus and HTN. Her social hx reveals that she is a secretary and that
she is right-handed. Based on her examination and medical hx, you suspect adhesive
capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's hx supports this dx? - Answer
-Her h/o diabetes
Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of
L5-S1. She is currently in the ER with suspicion of cauda equina compression. Which of
the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks - Answer -d. Paresthesia of the perineum
and buttocks
Which of the following statements is true concerning the management of the client with
a herniated disc?
a. Muscle relaxants and narcotics can be used to control moderate pain but should be
discontinued after 3 weeks of use.
b. An epidural injection is helpful in reducing leg pain that has persisted for at least 3
weeks after the herniation occurred.
c. Intolerable pain for more than a 3mo period is an indication for surgical intervention.
d. All of the above. - Answer -c. Intolerable pain for more than a 3mo period is an
indication for surgical intervention.
John is a 16yo boy who presents to the ER after hurting his knee in a football game. He
described twisting his knee and then being unable to extend it completely. John tells the
clinician that he heard a pop when the injury occurred and has been experiencing
localized pain. The clinician suspects a meniscal tear. Which test would be most
appropriate to assess for the presence of a meniscal tear? - Answer -McMurray
circumduction test
The clinician suspects that a client has a patellar instability. In order to test for this, the
client is seated with the quadriceps relaxed, and the knee is placed in extension. Next
the patella is displaced laterally, and the knee flexed to 30 degrees. If instability is
present, this maneuver displaces the patella to an abnormal position on the lateral
femoral condyle, and the client will perceive pain. Testing for patellar instability in this
way is known as: - Answer -Apprehension sign
The clinician is caring for Diane, a 22yo woman who presents with an injured ankle.
Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an
x-ray is not always necessary for an injured ankle and that the decision to obtain
radiographs is dependent on the examination and Diane's description of her injury.
,Which of the following clues in Diane's exam or history would alert the clinician to the
need for obtaining radiographs?
a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above - Answer -d. All of the above
Mr. Jackson is a 65yo man recently diagnosed with osteoarthritis. The clinician has
explained to Mr. Jackson that the goals for managing osteoarthritis include controlling
pain, maximizing functional independence and mobility, minimizing disability, and
preserving quality of life. Mr. Jackson explains to the clinician that his first choice would
be to use complementary therapies to control his condition and asks what therapies are
most effective in treating osteoarthritis. What would be the appropriate response from
the clinician?
a. "Complementary therapies should be considered only if surgical interventions are not
successful."
b. "I am unfamiliar with the available complementary therapies for osteoarthritis and
prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy,
to manage your condition."
c. "I would be happy to discuss all the treatment options with you. Complementary
therapies, su - Answer -c. "I would be happy to discuss all the treatment options with
you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are
being studied for use in the treatment of osteoarthritis and have shown promise when
used with standard medical therapy."
Normal estrogen function is important for preventing osteoporosis in both men and
Jennifer is an 18yo who comes to the ER after a fall during a soccer game. Jennifer
explains that she fell on her left side and kept her arm out straight to break her fall. She
has been experiencing severe pain and limited ROM in her left shoulder. The clinician
has diagnosed Jennifer with a dislocated shoulder. Which of the following statements
are true concerning shoulder dislocation?
a. Posterior dislocations are more common than anterior dislocations
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should
check for distal pulses
c. Recurrent dislocations are uncommon and would require great force to result in
injury.
d. Surgery is most commonly the treatment of choice - Answer -b. There is a risk of
neurovascular and neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35yo woman who has been recently diagnosed with carpal tunnel
syndrome. She has 2 young children and asks the clinician what the chances are that
they also will develop carpal tunnel syndrome. Which of the following responses would
be correct regarding the risk of developing carpal tunnel syndrome?
, a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to
account for about one-half the risk of developing carpal tunnel.
b. Only people w/occupations that require repeated flexion extension of the wrist, use of
hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for
developing carpal tunnel.
c. An underlying musculoskeletal disorder must be present for a person to develop
carpal tunnel.
d. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. -
Answer -a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are
thought to account for about one-half the risk of developing carpal tunnel.
Which of the following statements is true regarding the treatment of carpal tunnel
syndrome?
a. The goal of treatment is to prevent flexion and extension movements of the wrist.
b. Splints are used in carpal tunnel syndrome, because they allow for free movement of
the fingers and thumb while maintaining the wrist in a neutral position.
c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome
because of the risks for median nerve damage, scarring, and infection.
d. All of the above - Answer -d. All of the above
Sam is a 25yo who has been diagnosed with low back strain based on his h/o localized
low back pain and muscle spasm along with a normal neurological examination. As the
clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the
following symptoms would alert the clinician to the more serious finding of a herniated
nucleus pulposus or ruptured disc?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain.
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue - Answer -b.
Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
The clinician has instructed Sam, a 25yo pt with low back strain, to use NSAIDs to
manage his symptoms of pain and discomfort. Which of the following statements would
be most appropriate when teaching Sam about the use of NSAIDs?
a. "You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage."
b. "You should start with the lowest dose that is effective in managing your pain to avoid
developing tolerance to the medication."
QUESTIONS & ANSWERS
One of the initial steps in assessing pt's w/musculoskeletal complaints is to determine
whether the complaint is articular or nonarticular in origin. Which of the following is an
example of an articular structure?
a. Bone
b. Synovium
c. Tendons
d. Fascia - Answer -b. Synovium
You have detected the presence of crepitus on exam of a pt with a musculskeletal
complaint. Additionally, there is limited ROM w/both active and passive movement.
These findings suggest that the origin of the musculoskeletal complaint is: - Answer -
Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain?
a. Decreased CRP
b. Hyperalbuminemia
c. Morning stiffness
d. Weight gain - Answer -c. Morning stiffness
Which of the following statements concerning the musculoskeletal exam is true?
a. The uninvolved side should be examined initially and then compared to the involved
side.
b. The part of the body that is causing the pain should be examined first.
c. When possible, the pt should not be asked to perform active ROM exercises to avoid
causing pain.
d. Radiographs should always be obtained prior to examination so as not to cause
further injury to the pt. - Answer -a. The uninvolved side should be examined initially
and then compared to the involved side.
You are performing muscle strength testing on a pt presenting w/musculoskeletal pain
and find that the pt has complete ROM w/gravity eliminated. Which numeric grade of
muscle strength would you give this pt, 1-5? - Answer -2
Mrs. Gray is a 55yo woman who presents with tightness, pain, and limited movement in
her right shoulder. She denies any h/o trauma. Her exam reveals a 75% reduction in
both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing
,tenderness with motion and pain at the deltoid insertion. Her medical hx is significant for
type 1 diabetes mellitus and HTN. Her social hx reveals that she is a secretary and that
she is right-handed. Based on her examination and medical hx, you suspect adhesive
capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's hx supports this dx? - Answer
-Her h/o diabetes
Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of
L5-S1. She is currently in the ER with suspicion of cauda equina compression. Which of
the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks - Answer -d. Paresthesia of the perineum
and buttocks
Which of the following statements is true concerning the management of the client with
a herniated disc?
a. Muscle relaxants and narcotics can be used to control moderate pain but should be
discontinued after 3 weeks of use.
b. An epidural injection is helpful in reducing leg pain that has persisted for at least 3
weeks after the herniation occurred.
c. Intolerable pain for more than a 3mo period is an indication for surgical intervention.
d. All of the above. - Answer -c. Intolerable pain for more than a 3mo period is an
indication for surgical intervention.
John is a 16yo boy who presents to the ER after hurting his knee in a football game. He
described twisting his knee and then being unable to extend it completely. John tells the
clinician that he heard a pop when the injury occurred and has been experiencing
localized pain. The clinician suspects a meniscal tear. Which test would be most
appropriate to assess for the presence of a meniscal tear? - Answer -McMurray
circumduction test
The clinician suspects that a client has a patellar instability. In order to test for this, the
client is seated with the quadriceps relaxed, and the knee is placed in extension. Next
the patella is displaced laterally, and the knee flexed to 30 degrees. If instability is
present, this maneuver displaces the patella to an abnormal position on the lateral
femoral condyle, and the client will perceive pain. Testing for patellar instability in this
way is known as: - Answer -Apprehension sign
The clinician is caring for Diane, a 22yo woman who presents with an injured ankle.
Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an
x-ray is not always necessary for an injured ankle and that the decision to obtain
radiographs is dependent on the examination and Diane's description of her injury.
,Which of the following clues in Diane's exam or history would alert the clinician to the
need for obtaining radiographs?
a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above - Answer -d. All of the above
Mr. Jackson is a 65yo man recently diagnosed with osteoarthritis. The clinician has
explained to Mr. Jackson that the goals for managing osteoarthritis include controlling
pain, maximizing functional independence and mobility, minimizing disability, and
preserving quality of life. Mr. Jackson explains to the clinician that his first choice would
be to use complementary therapies to control his condition and asks what therapies are
most effective in treating osteoarthritis. What would be the appropriate response from
the clinician?
a. "Complementary therapies should be considered only if surgical interventions are not
successful."
b. "I am unfamiliar with the available complementary therapies for osteoarthritis and
prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy,
to manage your condition."
c. "I would be happy to discuss all the treatment options with you. Complementary
therapies, su - Answer -c. "I would be happy to discuss all the treatment options with
you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are
being studied for use in the treatment of osteoarthritis and have shown promise when
used with standard medical therapy."
Normal estrogen function is important for preventing osteoporosis in both men and
Jennifer is an 18yo who comes to the ER after a fall during a soccer game. Jennifer
explains that she fell on her left side and kept her arm out straight to break her fall. She
has been experiencing severe pain and limited ROM in her left shoulder. The clinician
has diagnosed Jennifer with a dislocated shoulder. Which of the following statements
are true concerning shoulder dislocation?
a. Posterior dislocations are more common than anterior dislocations
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should
check for distal pulses
c. Recurrent dislocations are uncommon and would require great force to result in
injury.
d. Surgery is most commonly the treatment of choice - Answer -b. There is a risk of
neurovascular and neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35yo woman who has been recently diagnosed with carpal tunnel
syndrome. She has 2 young children and asks the clinician what the chances are that
they also will develop carpal tunnel syndrome. Which of the following responses would
be correct regarding the risk of developing carpal tunnel syndrome?
, a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to
account for about one-half the risk of developing carpal tunnel.
b. Only people w/occupations that require repeated flexion extension of the wrist, use of
hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for
developing carpal tunnel.
c. An underlying musculoskeletal disorder must be present for a person to develop
carpal tunnel.
d. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. -
Answer -a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are
thought to account for about one-half the risk of developing carpal tunnel.
Which of the following statements is true regarding the treatment of carpal tunnel
syndrome?
a. The goal of treatment is to prevent flexion and extension movements of the wrist.
b. Splints are used in carpal tunnel syndrome, because they allow for free movement of
the fingers and thumb while maintaining the wrist in a neutral position.
c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome
because of the risks for median nerve damage, scarring, and infection.
d. All of the above - Answer -d. All of the above
Sam is a 25yo who has been diagnosed with low back strain based on his h/o localized
low back pain and muscle spasm along with a normal neurological examination. As the
clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the
following symptoms would alert the clinician to the more serious finding of a herniated
nucleus pulposus or ruptured disc?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain.
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue - Answer -b.
Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
The clinician has instructed Sam, a 25yo pt with low back strain, to use NSAIDs to
manage his symptoms of pain and discomfort. Which of the following statements would
be most appropriate when teaching Sam about the use of NSAIDs?
a. "You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage."
b. "You should start with the lowest dose that is effective in managing your pain to avoid
developing tolerance to the medication."
