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NURS 524 Final Exam Questions And Correct Answers
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NURS 524 Final Exam Questions And Correct AnswersStraight leg test - Answer tests for presence of disk herniation
Calcium/Vitamin D dose for adults - Answer Calcium: 1000-1200mg/day; Vitamin D: 400
IU daily
Back pain "red flags" - Answer Unrelenting night pain
Pain at rest
History or suspicion of CA
Fever >38 degrees X 48 hours
Osteoporosis
Other systemic disease
Neuromotor or sensory deficit
Chronic oral steroids
Immunosuppresssion
Serious accident or injury
Clinical suspicion of ankylosing spondylitis
>50 years old or <20 at onset of pain
Drug/ETOH abuse
Failure to respond to 4-6 weeks of therapy
Back Pain imaging - Answer DO NOT perform unless positive red flags
Order AP/Lateral Spinal Xray
DO NOT order oblique view (adds minimal information, doubles radiation)
MRI only if pt. is potential candidate for surgery or epidural steroid injection (suspected
radiculopathy)
,Differential diagnosis for back pain - Answer Reactive Arthritis
Osteomyelitis (fevers, pain at rest)
Malignancy/Metastasis/Multiple myeloma (unexplained weight loss)
postural backaches [obese, pregnancy] [dull, persistent, stiffness that worsens as day
progresses] Herniated disk [sudden onset, pain radiates to buttock/down leg/possibly to
foot; sharp pain; may have paresthesias or muscle weakness; may increase pain with
coughing/sneezing, sitting, and lateral bending] Degenerative disk disease [aggravated
by flexion and sitting] Facet Joint [mechanism of injury extension, rotation,
compression; aggravated by extension and rotation] lumbosacral arthritis [gradual
onset, morning stiffness, radiation less common]
Spinal stenosis Pain worsens with walking and prolonged standing, spinal extension;
may report relief when leaning forward on shopping cart May not complain of back pain
but of aching and cramping in thighs and calves Ankylosing spondylitis Intervertebral
Sprain Sudden onset often related to lifting, turning, twisting Aggravated by flexion
Compression fracture/osteoporosis Spondylolithesis (displacement of vertebrae)
Sacroiliac joint Mechanism of injury: fall onto buttocks Aggravated by walking and
sitting
Nerve Root Irritation (mechanism of injury flexion and compression; aggravated by
flexion and sitting)
Depression
Renal colic
AAA
GU problem (prostatitis, PID)
IBS
(INFLAMMATORY BACK PAIN OFTEN IMPROVES WITH EXERCISE, MECHANICAL PAIN
WORSENS WITH EXERCISE)
( Administer RECTAL AND PELVIC EXAMS, especially in pts over 40)
Reiter's syndrome / Reactive arthritis -Answer an autoimmune acute arthritis in
response to an enteric or urogenital infection; more common in MEN ages 18-35;
present with low-grade fever, asymmetric arthralgia and stiffness, low back pain that
increases with rest, and urethritis
,Ankylosing Spondylitis - Answer chronic multisystem inflammatory disorder involving SI
joint and axial skeleton; chronic inflammation leads to granulation tissue that invades
the joints and is gradually replaced by cartilage and then ossification; usual onset
before age 40; insidious onset of low back pain; more common in men; hereditary;
present with presence of symptoms > 3 months; symptoms worse in morning or with
inactivity; improvement of symptoms with exercise; fatigue, uveitis,
renal/pulmonary/neurologic/CV/GI diseases
Pelvic girdle pain-differential diagnosis - Answer Degenerative disk disease with facet
impingement (pain in the buttock/ posterior thigh worse with pelvic extension)
Degenerative disk disease with nuclear prolapse dysfunction
Sacroiliitis (pain in the buttock or posterior thigh that is worse with rest and relieved
with activity)
OA of hip Pain in groin, buttock, knee worse with activity, relieved by rest
Meralgia paresthetica anterosuperior (injury to lateral cutaneous nerve of thigh - obesity
or pregnancy; tenderness over iliac spine)
Trochanteric bursitis (pain in lateral thigh, worse at night with activity; tenderness over
greater trochanter)
Cauda equina syndrome - Answer Caused by pressure on unmyelinated fibers - surgical
emergency; SX= central back pain, leg weakness, impotence, urinary
frequency/retention/incontinence, saddle anesthesia, and loss of sphincter tone.
Herniated disk treatment - Answer About 90% of pts with back pain respond w/
conservative treatment; May take up to 2 months; NSAID X 2 weeks (Naproxen or
Ibuprofen - no more than 600mg TID) and muscle relaxant (Flexoril) X 3 days; Teach
don't drive; bedrest not encouraged (48 hours max); No lifting > 5 lbs; No twisting or
bending; Follow up frequently (2 weeks); Weight loss if needed; When pain decreases,
start stretching and strengthening exercises; Teach dont sit for longer than 20 minutes;
Sleep on side in knee-chest position w/ pillow between legs; apply moist heat to back of
legs 3-4 times daily;
Anterior/Posterior Drawer Test - Answer To perform: Hips flexed 45 degrees, knees
flexed 90 degrees, feet flat on table; examiner sits on pts feet and holds leg above calf
with both hands; pull forward (anterior) and push back (posterior); normal = 6-8 mm of
laxity; If (+), may indicate ACL or PCL rupture
, Lachman Test - Answer Flex knee 20-30 degrees; grasp femur with one hand, and grasp
calf with other hand; firmly pull to displace tibia on femur; assess laxity; may indicate
ACL tear
McMurray's Test - Checking for a tear in either the medial or lateral meniscus; Flex knee
and hip, and have pt. relax. With one hand palpate joint space. Hold heel of pts foot with
the other; externally rotate tibia and slowly extend leg, feeling for click in the knee joint,
then repeat with tibia internally rotated
Valgus/Varus stress - Answer Valgus = "knock knees"
Varus = "bow-legged"
Test MCL and LCL integrity
Apley's Test Answer Pt. lies prone; Leg flexed 90 degrees; Compression test = lean on
pts foot and apply pressure to heel; internally and externally rotate tibia; popping and
crepitus w/ pain is a positive sign and indicates a meniscus tear
Differential Diagnosis of Knee Pain Answer ACL tear
MCL tear (often injured when ACL torn)
Meniscus tear (more often medial; sometimes causes "locking of joint due to flap of
cartilage; often occurs w/ACL tear)
PCL tear (can also be seen when the tibial tuberosity "sags" posteriorly)
Ligamentous laxity
Patellar Subluxation (the patella may sublux laterally, causing chronic recurrent knee
pain; usu. in adolescent females)
Osgood-Schlatter's disease (periostitis of tibial tuberosity; repetitive strain at
developing epiphysis causes tenderness at tibial tuberosity; common cause of anterior
knee pain in children and adolescents
Septic arthritis
Iliotibial band syndrome (common in runners)
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