1. 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?
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 ANS: A
Immediate referral is indicated for patients who present with symptoms
consistent with septic bursitis, such as with the symptoms above. Lidocaine is
injected into a painful joint to evaluate for improvement to determine whether
bursitis or tendonitis is present as a result of impingement. This exam is not
consistent with fracture. An ultrasound is not indicated.REF: Shoulder
Bursitis/Management
2. 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 ANS: C
Initial therapy includes conservative measures for comfort. Until infection is
suspected, based on the white blood count and inflammatory markers, and
without localized signs of infection, aspiration of the bursal sac is not indicated.
Corticosteroids should not be injected into the bursal sac until infection has been
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excluded. Physical and occupational therapy should not precede comfort
measures.REF: Elbow Bursitis/Management
3. What are included in the initial management of bursitis of the heel?
Select all that apply.
a. Activity modification and bracing
b. Closed heel shoes to prevent further injury
c. Corticosteroid injections
d. Nonsteroidal anti-inflammatory medications
e. Rest, ice, compression, and elevation ANS: A, D, E
Activity modification and bracing, NSAIDs, and RICE are all used initially to treat
heel bursitis. Patients should wear open-heeled shoes. Corticosteroid injections
should be used cautiously to prevent rupture of the Achilles tendon.REF: Heel
Bursitis/Management
1. A patient has chronic elbow pain associated with arthritis. What is included in
management of this condition?
Select all that apply.
a. Avoidance of certain activities
b. Balanced rest and exercise
c. Long-term NSAIDs
d. Occupational therapy
e. Splinting of the elbow ANS: A a. Avoidance of certain activities
B Balanced rest and exercise
D. Occupational therapy
Patients with arthritis may be managed by avoiding pain-causing activities, a
program of balanced rest and exercise, and occupational therapy to improve
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function. NSAIDs are used for short periods. Splinting is not recommended.REF:
Management
2. 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?
a. Lateral epicondylitis
b. Medial collateral ligament instability
c. Medial epicondylitis
d. Ulnar neuritis ANS: C
Medial epicondylitis will produce pain as described above. Lateral epicondylitis
may result in pain with passive wrist flexion and active wrist extension.REF:
Physical Examination
1. When counseling a patient about the long-term effects of fibromyalgia
syndrome, what is important to include in teaching?
a. A multidisciplinary approach to treatment is most effective.
b. Eventual damage to muscles and joints will occur.
c. Exercise may cause discomfort and damage to muscles.
d. Medications are useful for controlling and preventing symptoms. ANS: A
A multidisciplinary approach to FMS management can help with pain
management, stress, and exercise. Although patients experience pain, damage to
tissues does not occur. Exercise may be painful, but does not cause damage.
Medications help alleviate some, but not all symptoms.REF: Multidisciplinary
Approach/Complications
2. Which are symptoms associated with fibromyalgia?
Select all that apply.
a. Gastrointestinal complaints
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