NR 511 Final Exam
One of the initial steps in assessing patients with musculoskeletal complaints is to determine
whether the complain is articular or nonarticular in origin. Which of the following in an example of
an articular structure?
A. Bone
B. Synovium
C. Tendons
D. Fascia - ANS Synovium
You have detected the presence of crepitus on examination of a patient with a musculoskeletal
complaint. Additionally, there is limited range of motion (ROM) with both active and passive
movement. These findings suggest that the origin of the musculoskeletal complaint is:
A. Articular
B. Inflammatory
C. Nonarticular
D. A and B - ANS 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 - ANS 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 patient pain should be examined first
C. When possible, the patient 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 patient. - ANS When possible, the patient should not be asked to perform active ROM exercises
to avoid causing pain
,You are performing muscle strength testing on a patient presenting with musculoskeletal pain and
find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle
strength would you give this patient?
A. 1
B. 2
C. 3
D. 4
E. 5 - ANS B
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her
right shoulder. She denies any history of trauma. Her exam reveals a 75% reduction in both active
and passive range of motion of the right shoulder. Mrs. Gray is also experiencing tenderness with
motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes
mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-
handed. Based on her exam and medical history, you suspect adhesive capulitis or "frozen shoulder."
Which clue in Mrs. Gray's history supports this diagnosis?
A. HX HTN
B. Her affected shoulder is her dominant arm
C. Her HX of DM
D. Her work as a secretary predisposes her to repetitive motions - ANS HX of DM
Jennifer is an 18-year-old girl who comes to the emergency room 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 range of motion 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 the most common treatment of choice - ANS There is a risk of neurovascular and
neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel
syndrome. She has two young children and asks the clinician what the chances are that they will also
,develop carpal tunnel syndrome. Which of the following responses would be correct regarding the
risk of developing carpal tunnel syndrome?
- Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for
about half the risk of developing carpal tunnel.
- Only people with occupations that require repeated flexion extension of the wrist, use of hand
tools that require forceful gripping, or hand tools that vibrate are at risk for developing carpal
tunnel.
- An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel.
- Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. - ANS Carpal tunnel
syndrome commonly occurs in families. Genetic factors are thought to account for about 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 TX is to prevent flexion and extension movements of the wrist
B. Splints are used in carpal tunnel syndrome, because they allow for free movement the fingers and
thumb while maintaining the wrist in a neutral position
C Corticosterioid injections are discouraged in the treatment of CTS because of the risks for median
nerve damage, scarring, and infection
D. All of the above - ANS All of the above
Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of
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 L 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 ESR
D. Pathologic fractures, severe night pain, weight loss, and fatigue - ANS 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 25 year old patient 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 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
C. You should take the max recommended dose of NSAIDs so that you will not need to take narcotics
to control your pain
D. It is important to take NSAIDs on an empty stomach in order to increase absorption - ANS 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.
Janet is 30y/o woman who has been diagnosed with a herniated disc at the L5-S1. She is currently in
the emergency room with suspicion of cauda equina compression. Which of the following is a sign or
symptom of cauda equina compression?
A. Paresthesia of the perineum & buttock
B. A reduced or absent ankle reflex
C. Numbness in the lateral foot
D. Gastrocnemius weakness - ANS Paresthesia of the perineum & buttock
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 d/c 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 3 month period is an indication for surgical intervention
D All of the above - ANS Intolerable pain for more than a 3 month period is an indication for surgical
intervention
John is a 16 y/o boy presents to your office after hurting his knee in a football game. He described
twisting his knee & then being able to extend it completely. John tells you he heard a pop when the
injury occurred & has been experiencing localized pain. You suspect a meniscal tear. Which test
would be most appropriate to assess for the presence of a meniscal tear?
A. Lachman test
B. Vulgus stress test
C. McMurray circumduction test
D. Varus stress test - ANS McMurray circumduction test
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