NS 832 EXAM 3 PRACTICE QUESTIONS & ANSWERS
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
A. Likely ankle sprain with a possible fracture
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?
A. Cessation of all sports activities and exercise
B. Crutches and partial weight bearing
C. Physical therapy for ultrasound therapy
D. Referral to an orthopedist for MRI and evaluation
A. Cessation of all sports activities and exercise
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?
A. A series of steroid injections
B. Avoiding all high-impact activities
C. Night splints
D. Wearing flat shoes only
B. Avoiding all high-impact activities
,A postmenopausal female patient has a blood test that reveals hyperuricemia, although
the patient has no symptoms of gout. What will the provider do initially?
A. Ask the patient about medications and medical history.
B. Begin therapy with colchicine and an NSAID
C. Recommend a low-purine, alcohol-restricted diet
D. Treat for gout prophylactically to prevent a flare.
A. Ask the patient about medications and medical history.
A patient with gout and impaired renal function who uses urate-lowering therapy (ULT)
is experiencing an acute gout flare involving one joint. What is the recommended
treatment?
A. Administration of intraarticular corticosteroid
B. Discontinuing ULT while treating the flare
C. Oral colchicine for 5 days
D. Therapy with NSAIDs begun within 24 hours.
A. Administration of intraarticular corticosteroid
A patient experiences a second gouty flare and the provider decides to begin urate-
lowering therapy (ULT). How should this be prescribed?
A. Begin with a high-loading dose and gradually decrease.
B. Start ULT during the current flare for best results.
C. Start ULT in 5 weeks along with an anti-inflammatory drug.
D. ULT should be suspended during future gouty flares.
C. Start ULT in 5 weeks along with an anti-inflammatory drug.
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?
A. Asking the patient to perform the Valsalva maneuver
B. Assessing reflexes and asking about tingling or numbness
C. Determining whether the pain is present with prolonged sitting
D. Noting whether pain is mitigated with frequent position shifts
A. Asking the patient to perform the Valsalva maneuver
,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?
A. Magnetic resonance imaging (MRI) to evaluate soft tissue involvement
B. Plain radiographs to evaluate the extent of the injury
C. Traction therapy to minimize complications
D. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
D. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
A patient has recurrent lumbar pain which is sometimes severe. The patient reports that
prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is no longer effective for
pain relief. What will the provider recommend?
A. Adjunctive treatment with physical therapy
B. Beginning treatment with opioid analgesics
C. Complementary and alternative therapies
D. Referral to an interventional spine physician
D. Referral to an interventional spine physician
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?
A. Avascular necrosis of the femoral head
B. Infectious arthritis of the hip
C. Osteoarthritis of the hip
D. Slipped capital femoral epiphysis (SCFE)
A. Avascular necrosis of the femoral head
A patient with chronic hip pain cannot take nonsteroidal anti-inflammatory drugs
(NSAIDs) and tells the provider that acetaminophen is minimally helpful. What might the
provider recommend initially to improve pain relief?
A. A fentanyl patch
B. Capsaicin
C. Glucosamine
D. Lidocaine patches
B. Capsaicin
, 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?
A. Instruct about RICE management and follow-up in 1 week
B. Refer for a same-day orthopedic consultation
C. Schedule a magnetic resonance imaging (MRI) exam
D. Splint the knee and refer for orthopedic consultation in 1 to 2 weeks
B. Refer for a same-day orthopedic consultation
A patient experiencing 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?
A. Admit to the hospital for intravenous antibiotics
B. Inject lidocaine into the joint and reassess in 5 to 10 minutes
C. Order a plain radiograph of the shoulder to identify possible fracture
D. Perform a shoulder ultrasound to further evaluate the cause.
A. Admit to the hospital for intravenous antibiotics
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?
A. Aspiration of the bursal sac for culture
B. Corticosteroid injection into the bursal sac
C. Elbow pads, NSAIDs, rest, and ice
D. Physical and occupational therapy
C. Elbow pads, NSAIDs, rest, and ice
Which cause is implicated in patients with fibromyalgia syndrome (FMS)?
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
A. Likely ankle sprain with a possible fracture
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?
A. Cessation of all sports activities and exercise
B. Crutches and partial weight bearing
C. Physical therapy for ultrasound therapy
D. Referral to an orthopedist for MRI and evaluation
A. Cessation of all sports activities and exercise
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?
A. A series of steroid injections
B. Avoiding all high-impact activities
C. Night splints
D. Wearing flat shoes only
B. Avoiding all high-impact activities
,A postmenopausal female patient has a blood test that reveals hyperuricemia, although
the patient has no symptoms of gout. What will the provider do initially?
A. Ask the patient about medications and medical history.
B. Begin therapy with colchicine and an NSAID
C. Recommend a low-purine, alcohol-restricted diet
D. Treat for gout prophylactically to prevent a flare.
A. Ask the patient about medications and medical history.
A patient with gout and impaired renal function who uses urate-lowering therapy (ULT)
is experiencing an acute gout flare involving one joint. What is the recommended
treatment?
A. Administration of intraarticular corticosteroid
B. Discontinuing ULT while treating the flare
C. Oral colchicine for 5 days
D. Therapy with NSAIDs begun within 24 hours.
A. Administration of intraarticular corticosteroid
A patient experiences a second gouty flare and the provider decides to begin urate-
lowering therapy (ULT). How should this be prescribed?
A. Begin with a high-loading dose and gradually decrease.
B. Start ULT during the current flare for best results.
C. Start ULT in 5 weeks along with an anti-inflammatory drug.
D. ULT should be suspended during future gouty flares.
C. Start ULT in 5 weeks along with an anti-inflammatory drug.
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?
A. Asking the patient to perform the Valsalva maneuver
B. Assessing reflexes and asking about tingling or numbness
C. Determining whether the pain is present with prolonged sitting
D. Noting whether pain is mitigated with frequent position shifts
A. Asking the patient to perform the Valsalva maneuver
,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?
A. Magnetic resonance imaging (MRI) to evaluate soft tissue involvement
B. Plain radiographs to evaluate the extent of the injury
C. Traction therapy to minimize complications
D. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
D. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
A patient has recurrent lumbar pain which is sometimes severe. The patient reports that
prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is no longer effective for
pain relief. What will the provider recommend?
A. Adjunctive treatment with physical therapy
B. Beginning treatment with opioid analgesics
C. Complementary and alternative therapies
D. Referral to an interventional spine physician
D. Referral to an interventional spine physician
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?
A. Avascular necrosis of the femoral head
B. Infectious arthritis of the hip
C. Osteoarthritis of the hip
D. Slipped capital femoral epiphysis (SCFE)
A. Avascular necrosis of the femoral head
A patient with chronic hip pain cannot take nonsteroidal anti-inflammatory drugs
(NSAIDs) and tells the provider that acetaminophen is minimally helpful. What might the
provider recommend initially to improve pain relief?
A. A fentanyl patch
B. Capsaicin
C. Glucosamine
D. Lidocaine patches
B. Capsaicin
, 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?
A. Instruct about RICE management and follow-up in 1 week
B. Refer for a same-day orthopedic consultation
C. Schedule a magnetic resonance imaging (MRI) exam
D. Splint the knee and refer for orthopedic consultation in 1 to 2 weeks
B. Refer for a same-day orthopedic consultation
A patient experiencing 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?
A. Admit to the hospital for intravenous antibiotics
B. Inject lidocaine into the joint and reassess in 5 to 10 minutes
C. Order a plain radiograph of the shoulder to identify possible fracture
D. Perform a shoulder ultrasound to further evaluate the cause.
A. Admit to the hospital for intravenous antibiotics
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?
A. Aspiration of the bursal sac for culture
B. Corticosteroid injection into the bursal sac
C. Elbow pads, NSAIDs, rest, and ice
D. Physical and occupational therapy
C. Elbow pads, NSAIDs, rest, and ice
Which cause is implicated in patients with fibromyalgia syndrome (FMS)?
