Np Test 5: Musculoskeletal

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| By Ctichy84

Ctichy84

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Quizzes Created: 5 | Total Attempts: 24,334

Questions: 63 | Attempts: 5,735 | Updated: Mar 22, 2023

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Questions and Answers

1.

The most common cause of acute bursitis is:
- A.
  
  Inactivity
- B.
  
  Joint overuse
- C.
  
  Fibromyalgia
- D.
  
  Bacterial infection
Correct Answer
B. Joint overuse

Explanation
Joint overuse is the most common cause of acute bursitis. Bursitis occurs when the bursae, which are small fluid-filled sacs that cushion the joints, become inflamed. This inflammation is often a result of repetitive motions or excessive stress on the joints. Joint overuse can lead to irritation and inflammation of the bursae, causing acute bursitis. Inactivity, fibromyalgia, and bacterial infection are not typically associated with the development of acute bursitis.

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2.

First-line treatment options for bursitis usually include:
- A.
  
  Corticosteroid bursal injection
- B.
  
  Heat to area
- C.
  
  Weight-bearing exercises
- D.
  
  NSAIDS
Correct Answer
D. NSAIDS

Explanation
The first-line treatment options for bursitis usually include NSAIDs. NSAIDs are nonsteroidal anti-inflammatory drugs that help reduce inflammation and relieve pain. They work by inhibiting the production of prostaglandins, which are responsible for causing inflammation and pain. By reducing inflammation, NSAIDs can help alleviate the symptoms of bursitis and promote healing. They are often recommended as an initial treatment because they are easily accessible, have a low risk of side effects, and can provide effective relief for many individuals with bursitis.

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3.

Patients with olecranon bursitis typically present with:
- A.
  
  Swelling and redness over the affected area
- B.
  
  Limited elbow ROM
- C.
  
  Nerve impingement
- D.
  
  Destruction of the joint space
Correct Answer
A. Swelling and redness over the affected area

Explanation
Patients with olecranon bursitis typically present with swelling and redness over the affected area. This is because olecranon bursitis is inflammation of the bursa, a small fluid-filled sac located at the tip of the elbow. Inflammation causes fluid to accumulate in the bursa, leading to swelling and redness. Other symptoms may include limited range of motion (ROM) of the elbow, but nerve impingement and destruction of the joint space are not typically associated with olecranon bursitis.

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4.

Patients with subscapular bursitis typically present with:
- A.
  
  Limited shoulder ROM
- B.
  
  Heat over affected area
- C.
  
  Localized tenderness under the superomedial angle of the scapula
- D.
  
  Cervical nerve root involvement
Correct Answer
C. Localized tenderness under the superomedial angle of the scapula

Explanation
Patients with subscapular bursitis typically present with localized tenderness under the superomedial angle of the scapula. This is a characteristic symptom of subscapular bursitis, which is inflammation of the bursa located between the subscapularis muscle and the scapula. Limited shoulder range of motion may also be present due to pain and inflammation. Heat over the affected area is another common symptom, as inflammation often leads to increased blood flow and warmth in the affected area. However, cervical nerve root involvement is not typically associated with subscapular bursitis.

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5.

Patients with gluteus medius or deep trochanteric bursitis typically present with:
- A.
  
  Increased pain from resisted hip abduction
- B.
  
  Limited hip ROM
- C.
  
  Sciatic nerve pain
- D.
  
  Heat over the affected area
Correct Answer
A. Increased pain from resisted hip abduction

Explanation
Patients with gluteus medius or deep trochanteric bursitis typically present with increased pain from resisted hip abduction. This is because the gluteus medius muscle is responsible for hip abduction, and when it is inflamed or irritated, resisted abduction can exacerbate the pain. Limited hip range of motion may also be present due to the pain and inflammation. Sciatic nerve pain and heat over the affected area are not typically associated with gluteus medius or deep trochanteric bursitis.

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6.

Likely sequelae of intrabursal corticosteroid injection include:
- A.
  
  Irreversible skin atrophy
- B.
  
  Infection
- C.
  
  Inflammatory reaction
- D.
  
  Soreness at the site of injection
Correct Answer
D. Soreness at the site of injection

Explanation
The likely sequelae of intrabursal corticosteroid injection include soreness at the site of injection. This is because the injection can cause localized irritation and inflammation, leading to discomfort and soreness in the area where the injection was administered. However, the other options such as irreversible skin atrophy, infection, and inflammatory reaction are less likely to occur as sequelae of this specific type of injection.

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7.

First-line therapy for prepatellar bursitis should include:
- A.
  
  Bursal aspiration
- B.
  
  Intrabursal corticosteroid injection
- C.
  
  Acetaminophen
- D.
  
  Knee splinting
Correct Answer
A. Bursal aspiration

Explanation
The first-line therapy for prepatellar bursitis should include bursal aspiration. This involves using a needle and syringe to remove fluid from the bursa, which can help relieve pain and swelling. Bursal aspiration allows for the examination of the fluid for any signs of infection or other underlying conditions. It also helps to reduce the pressure within the bursa and promote healing. Intrabursal corticosteroid injection may be considered as a second-line therapy if the symptoms persist after bursal aspiration. Acetaminophen may help with pain management, but it is not a primary treatment for bursitis. Knee splinting may be used to immobilize the knee joint and reduce stress on the bursa, but it is not typically the first-line therapy.

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8.

Patients with lateral epicondylitis typically present with:
- A.
  
  Electric-like pain elicited by tapping over the median nerve
- B.
  
  Reduced joint ROM
- C.
  
  Pain that is worst with elbow flexion
- D.
  
  Decreased hand grip strength
Correct Answer
D. Decreased hand grip strength

Explanation
Patients with lateral epicondylitis typically present with decreased hand grip strength. Lateral epicondylitis, also known as tennis elbow, is a condition characterized by inflammation and pain in the tendons that attach to the lateral epicondyle of the humerus. This inflammation can lead to weakness in the muscles responsible for gripping objects, resulting in decreased hand grip strength. Other common symptoms of lateral epicondylitis include pain that is worsened with elbow flexion, reduced joint range of motion, and tenderness over the lateral epicondyle. However, the most specific and characteristic finding is the decreased hand grip strength.

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9.

Risk factors for lateral epicondylitis include all of the following except:
- A.
  
  Repetitive lifting
- B.
  
  Playing tennis
- C.
  
  Hammering
- D.
  
  Gout
Correct Answer
D. Gout

Explanation
Lateral epicondylitis, also known as tennis elbow, is a condition characterized by inflammation and pain on the outside of the elbow. Risk factors for this condition typically include activities that involve repetitive movements and strain on the tendons in the forearm. Playing tennis and hammering are both examples of activities that can contribute to the development of lateral epicondylitis. However, gout is a type of arthritis caused by the buildup of uric acid crystals in the joints and is not directly associated with the development of tennis elbow. Therefore, gout is the exception among the given options.

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10.

Initial therapy for treatment of lateral epicondylitis includes:
- A.
  
  A long arm cast
- B.
  
  A short arm cast with thumb spica
- C.
  
  A wrist splint with metal stays
- D.
  
  A shoulder sling
Correct Answer
C. A wrist splint with metal stays

Explanation
The initial therapy for treatment of lateral epicondylitis includes a wrist splint with metal stays. This is because a wrist splint helps to immobilize the wrist joint and reduce strain on the tendons in the elbow. The metal stays provide additional support and stability to the wrist, allowing for proper healing and reducing pain. A long arm cast or a short arm cast with thumb spica may be too restrictive and unnecessary for this condition. A shoulder sling is not appropriate for lateral epicondylitis as it does not provide support or immobilization to the affected area.

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11.

Patients with medial epicondylitis typically present with:
- A.
  
  Forearm numbness
- B.
  
  Reduction in ROM
- C.
  
  Pain on elbow flexion
- D.
  
  Decreased grip strength
Correct Answer
D. Decreased grip strength

Explanation
Patients with medial epicondylitis typically present with decreased grip strength. Medial epicondylitis, also known as golfer's elbow, is a condition characterized by inflammation and pain in the tendons that attach to the medial epicondyle of the elbow. This inflammation can lead to weakness in the muscles responsible for grip strength, making it difficult for patients to maintain a strong grip. Other symptoms of medial epicondylitis may include pain on elbow flexion, reduction in range of motion, and forearm numbness. However, decreased grip strength is a common and characteristic finding in this condition.

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12.

Risk factors for medial epicondylitis include playing:
- A.
  
  Tennis
- B.
  
  Golf
- C.
  
  Baseball
- D.
  
  Volleyball
Correct Answer
B. Golf

Explanation
Medial epicondylitis, also known as golfer's elbow, is a condition characterized by pain and inflammation on the inner side of the elbow. The answer "Golf" is correct because golf involves repetitive swinging motions, which can put stress on the tendons and muscles in the forearm. The forceful impact between the golf club and the ball can strain the tendons, leading to the development of golfer's elbow. Playing other sports like tennis, baseball, or volleyball may also involve repetitive arm movements, but golf is specifically associated with this condition.

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13.

Risk factors for acute gouty arthritis include:
- A.
  
  Thiazide diuretic use
- B.
  
  Female gender
- C.
  
  Rheumatoid arthritis
- D.
  
  Joint trauma
Correct Answer
A. Thiazide diuretic use

Explanation
Thiazide diuretic use is a risk factor for acute gouty arthritis. Thiazide diuretics are commonly prescribed medications for hypertension and can increase the levels of uric acid in the blood, leading to the development of gout. Uric acid is a waste product that is normally excreted by the kidneys, but thiazide diuretics can interfere with this process, causing uric acid to accumulate in the joints and form crystals, triggering an inflammatory response and resulting in gouty arthritis. Therefore, individuals who are taking thiazide diuretics are at an increased risk of developing acute gouty arthritis.

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14.

The clinical presentation of acute gouty arthritis affecting the base of the great toe includes:
- A.
  
  Slow onset of discomfort over many days
- B.
  
  Greatest swelling and pain along the median border of the joint.
- C.
  
  Improvement of symptoms with joint rest
- D.
  
  Fever
Correct Answer
B. Greatest swelling and pain along the median border of the joint.

Explanation
The correct answer is "Greatest swelling and pain along the median border of the joint." In acute gouty arthritis, the affected joint, in this case, the base of the great toe, shows characteristic symptoms. The swelling and pain are most prominent along the median border of the joint. This is a distinguishing feature of gouty arthritis and helps differentiate it from other causes of joint pain. The slow onset of discomfort over many days and improvement of symptoms with joint rest are also common features of gouty arthritis. However, the presence of fever is not typically associated with gouty arthritis.

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15.

The most helpful diagnostic test to perform during acute gouty arthritis is:
- A.
  
  Measurement of erythrocyte sedimentation rate (ESR)
- B.
  
  Measurement of serum uric acid
- C.
  
  Analysis of aspirate from affected joint
- D.
  
  Joint radiography
Correct Answer
C. Analysis of aspirate from affected joint

Explanation
The most helpful diagnostic test to perform during acute gouty arthritis is the analysis of aspirate from the affected joint. This is because gout is characterized by the deposition of urate crystals in the joints, leading to inflammation and pain. Analyzing the aspirate allows for the identification of these crystals, confirming the diagnosis of gout. Measurement of erythrocyte sedimentation rate (ESR) and serum uric acid levels can be elevated in gout, but they are not specific to the condition and can be influenced by other factors. Joint radiography may show characteristic changes in chronic gout, but it is not useful in the acute phase.

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16.

First-line therapy for treating patients with acute gouty arthritis includes:
- A.
  
  Aspirin
- B.
  
  Naproxen sodium
- C.
  
  Allopurinol
- D.
  
  Probenecid
Correct Answer
B. Naproxen sodium

Explanation
Naproxen sodium is the correct answer for first-line therapy in treating patients with acute gouty arthritis. This medication is a nonsteroidal anti-inflammatory drug (NSAID) that helps reduce pain, inflammation, and swelling associated with gout attacks. It works by inhibiting the production of certain chemicals in the body that cause inflammation. Naproxen sodium is commonly prescribed for acute gouty arthritis due to its effectiveness in relieving symptoms and its relatively low risk of side effects compared to other NSAIDs. Aspirin, allopurinol, and probenecid are not recommended as first-line therapies for acute gouty arthritis.

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17.

Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection?
- A.
  
  A 66-year-old patient with a gastric ulcer
- B.
  
  A 44-year-old patient taking a thiazide diuretic
- C.
  
  A 68-year-old patient with type 2 diabetes
- D.
  
  A 32-year-old patient who is a binge drinker
Correct Answer
A. A 66-year-old patient with a gastric ulcer

Explanation
A 66-year-old patient with a gastric ulcer is the best candidate for local corticosteroid injection because systemic corticosteroids, which are commonly used to treat acute gouty arthritis, can worsen gastric ulcers. Local corticosteroid injections target the affected joint directly, providing relief without affecting the gastric ulcer. This treatment option minimizes the risk of exacerbating the gastric ulcer and ensures effective management of the gouty arthritis symptoms.

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18.

The most common locations for tophi include all of the following except:
- A.
  
  The auricles
- B.
  
  The elbows
- C.
  
  The extensor surface of the hands
- D.
  
  The shoulders
Correct Answer
D. The shoulders

Explanation
Tophi are deposits of uric acid crystals that form in the joints and soft tissues of individuals with gout. These deposits typically occur in areas with lower temperatures, such as the extremities. The auricles, elbows, and extensor surface of the hands are common locations for tophi due to their cooler temperatures. However, the shoulders are not typically a common location for tophi formation.

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19.

Dietary recommendations for a person with gouty arthritis include avoiding foods high in:
- A.
  
  Artificial flavors and colors
- B.
  
  Purine
- C.
  
  Vitamin C
- D.
  
  Protein
Correct Answer
B. Purine

Explanation
People with gouty arthritis are advised to avoid foods high in purine because purine is broken down into uric acid in the body. High levels of uric acid can lead to the formation of urate crystals, which can accumulate in the joints and cause painful inflammation. Therefore, avoiding purine-rich foods can help reduce the risk of gout attacks and manage the symptoms of gouty arthritis.

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20.

Which of the following joints is most likely to be affected by osteoarthritis?
- A.
  
  Wrists
- B.
  
  Elbows
- C.
  
  Metacarpophalangeal joint
- D.
  
  Distal interphalangeal joint
Correct Answer
D. Distal interpHalangeal joint

Explanation
Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints such as the knees and hips. However, in this question, the most likely joint to be affected by osteoarthritis is the distal interphalangeal joint. This joint is located at the end of the fingers and is frequently affected by osteoarthritis, especially in older individuals. Osteoarthritis in the distal interphalangeal joint can cause pain, stiffness, and swelling, making it the most likely joint to be affected in this scenario.

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21.

Deformity of the proximal interphalangeal joints found in an elderly patient with OA is known as:
- A.
  
  Heberden nodes
- B.
  
  Bouchard nodes
- C.
  
  Hallus valgus
- D.
  
  Dupuytren contracture
Correct Answer
B. Bouchard nodes

Explanation
Bouchard nodes are a deformity of the proximal interphalangeal joints that are commonly found in elderly patients with osteoarthritis (OA). These nodes are bony enlargements that develop on the middle joints of the fingers, causing pain, stiffness, and limited range of motion. Unlike Heberden nodes, which affect the distal interphalangeal joints, Bouchard nodes specifically affect the proximal interphalangeal joints. Hallus valgus refers to a deformity of the big toe, and Dupuytren contracture is a condition that causes the fingers to bend inward.

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22.

Which of the following best describes the presentation of a patient with OA?
- A.
  
  Worst symptoms in weight-bearing joints later in the day
- B.
  
  Symmetrical early morning stiffness
- C.
  
  Sausage-shaped digits with associated skin lesions
- D.
  
  Back pain with rest and anterior uveitis
Correct Answer
A. Worst symptoms in weight-bearing joints later in the day

Explanation
Patients with osteoarthritis (OA) typically experience worsening symptoms in weight-bearing joints later in the day. This is because the joints have been subjected to increased stress and activity throughout the day, leading to inflammation and pain. The other options do not accurately describe the presentation of a patient with OA. Symmetrical early morning stiffness is more characteristic of rheumatoid arthritis, sausage-shaped digits with skin lesions are seen in psoriatic arthritis, and back pain with rest and anterior uveitis are more commonly associated with ankylosing spondylitis.

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23.

As part of the evaluation of patients with OA, the NP anticipates finding:
- A.
  
  Anemia of chronic disease
- B.
  
  Elevated CRP level
- C.
  
  Narrowing of the joint space on radiograph
- D.
  
  Elevated antinuclear antibody (ANA) test
Correct Answer
C. Narrowing of the joint space on radiograpH

Explanation
In patients with osteoarthritis (OA), narrowing of the joint space on a radiograph is a common finding. This narrowing occurs due to the degeneration of cartilage in the joint, leading to a reduction in the space between the bones. It is a characteristic feature of OA and helps in confirming the diagnosis. Anemia of chronic disease, elevated CRP level, and elevated antinuclear antibody (ANA) test are not specific to OA and may be seen in other conditions as well. Therefore, the presence of narrowing of the joint space on a radiograph is the most anticipated finding in patients with OA.

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24.

FIrst-line pharmacological intervention for milder OA should be a trial of:
- A.
  
  Acetaminophen
- B.
  
  Naproxen
- C.
  
  Celecoxib
- D.
  
  Intra-articular corticosteroid injection
Correct Answer
A. AcetaminopHen

Explanation
The first-line pharmacological intervention for milder OA should be a trial of Acetaminophen. Acetaminophen is a commonly used medication for pain relief and is considered a safe and effective option for managing mild to moderate osteoarthritis pain. It works by reducing pain signals in the brain and is generally well-tolerated with minimal side effects. Other options like Naproxen, Celecoxib, and intra-articular corticosteroid injections may be considered for more severe cases or when acetaminophen does not provide sufficient pain relief.

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25.

In caring for a patient with OA of the knee, you advise that:
- A.
  
  Straight-leg raising should be avoided
- B.
  
  Heat should be applied to painful joints after exercise
- C.
  
  Quadriceps-strengthening exercises should be performed
- D.
  
  Physical activity should be avoided
Correct Answer
C. Quadriceps-strengthening exercises should be performed

Explanation
In caring for a patient with OA of the knee, it is advised to perform quadriceps-strengthening exercises. This is because strengthening the quadriceps muscles helps to stabilize and support the knee joint, reducing stress on the joint and improving overall function. These exercises can help to alleviate pain, improve mobility, and slow down the progression of OA. Straight-leg raising should be avoided as it can put excessive strain on the knee joint. Heat should be applied to painful joints after exercise to help relax muscles and reduce pain. Physical activity should not be avoided completely, but rather modified to accommodate the patient's condition and limitations.

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26.

Glucosamine and chondroitin are OTC nutritional supplements that are usually taken to help with the management of:
- A.
  
  Rheumatoid arthritis
- B.
  
  OA
- C.
  
  Reiter syndrome
- D.
  
  Gouty arthritis
Correct Answer
B. OA

Explanation
Glucosamine and chondroitin are OTC nutritional supplements that are commonly used to manage osteoarthritis (OA). OA is a degenerative joint disease that causes the breakdown of cartilage in the joints. These supplements are believed to help reduce pain and improve joint function in individuals with OA. While they may provide some relief for other types of arthritis, such as rheumatoid arthritis, Reiter syndrome, or gouty arthritis, their primary use is for managing OA.

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27.

Which of the following is not characteristic of rheumatoid arthritis (RA)?
- A.
  
  More common in women at a 3:1 ratio
- B.
  
  Family history of rheumatoid disease often reported by patient
- C.
  
  Peak age for disease onset in individuals age 50 to 70 years
- D.
  
  Wrists, ankles, and toes often involved
Correct Answer
C. Peak age for disease onset in individuals age 50 to 70 years

Explanation
The given answer, "Peak age for disease onset in individuals age 50 to 70 years," is not characteristic of rheumatoid arthritis (RA). Rheumatoid arthritis typically affects individuals between the ages of 30 and 50, with a peak onset in the 40s. The disease is more common in women at a 3:1 ratio, and a family history of rheumatoid disease is often reported by patients. Additionally, RA commonly affects the wrists, ankles, and toes.

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28.

Which of the following best describes the presentation of a person with RA?
- A.
  
  Worst symptoms in weight-bearing joints later in the day
- B.
  
  Symmetrical early-morning stiffness
- C.
  
  Sausage-shaped digits with characteristic skin lesions
- D.
  
  Back pain with rest and anterior uveitis
Correct Answer
B. Symmetrical early-morning stiffness

Explanation
The correct answer is symmetrical early-morning stiffness. This is because one of the hallmark symptoms of rheumatoid arthritis (RA) is stiffness in the joints, particularly in the morning. This stiffness is often symmetrical, meaning it affects the same joints on both sides of the body. This presentation is characteristic of RA and helps differentiate it from other forms of arthritis. The other options listed in the question, such as worst symptoms in weight-bearing joints later in the day or sausage-shaped digits with characteristic skin lesions, are not typically associated with RA.

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29.

NSAIDs cause gastric injury primarily by:
- A.
  
  Direct irritative effect
- B.
  
  Slowing GI motility
- C.
  
  Thinning of the protective gastric mucosa
- D.
  
  Enhancing prostaglandin synthesis
Correct Answer
C. Thinning of the protective gastric mucosa

Explanation
NSAIDs cause gastric injury primarily by thinning the protective gastric mucosa. The protective gastric mucosa acts as a barrier between the stomach lining and the acidic gastric contents. NSAIDs inhibit the production of prostaglandins, which are responsible for maintaining the integrity of the gastric mucosa. This inhibition leads to a decrease in the production of protective mucus and bicarbonate secretion, making the gastric mucosa more susceptible to injury from the acidic environment. As a result, NSAIDs can cause gastric ulcers and other gastrointestinal complications.

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30.

Of the following individuals, who is at highest risk for NSAID-induced gastropathy?
- A.
  
  A 28-year-old man with and ankle sprain who has taken ibuprofen for the past week and who drinks four to six beers each weekend
- B.
  
  A 40-year-old woman who smokes and takes about 6 doses of naproxen sodium per month to control dysmenorrhea
- C.
  
  A 43-year-old man with dilated cardiomyopathy who uses ketoprofen 1-2 times weekly for low back pain
- D.
  
  A 72-year-old man who takes aspirin 4 times a day for control of OA
Correct Answer
D. A 72-year-old man who takes aspirin 4 times a day for control of OA

Explanation
The 72-year-old man who takes aspirin 4 times a day for control of OA is at the highest risk for NSAID-induced gastropathy. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can cause damage to the lining of the stomach and increase the risk of gastrointestinal bleeding. The fact that he takes aspirin four times a day suggests that he is using a high dose, which further increases his risk. Additionally, his age may also contribute to a higher risk as older individuals are generally more susceptible to the adverse effects of NSAIDs on the gastrointestinal system.

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31.

Which of the following is the preferred method of preventing NSAID-induced gastric ulcer?
- A.
  
  A high-dose histamine 2 receptor antagonist
- B.
  
  Timed antacid use
- C.
  
  Sucralfate (Carafate)
- D.
  
  Misoprostol (Cytotec)
Correct Answer
D. Misoprostol (Cytotec)

Explanation
Misoprostol (Cytotec) is the preferred method of preventing NSAID-induced gastric ulcer because it is a synthetic prostaglandin E1 analog that helps to protect the stomach lining by increasing mucus production, reducing acid secretion, and promoting blood flow to the stomach. This helps to prevent the development of ulcers caused by NSAID use.

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32.

Taking a high dose of aspirin or ibuprofen causes:
- A.
  
  An increase in the drug's half-life
- B.
  
  Enhanced renal excretion of the drug
- C.
  
  A change in the drug's mechanism of action
- D.
  
  A reduction of antiprostaglandin effect
Correct Answer
A. An increase in the drug's half-life

Explanation
Taking a high dose of aspirin or ibuprofen causes an increase in the drug's half-life. This means that the drug will stay in the body for a longer period of time before it is eliminated. This can be due to various factors such as saturation of metabolic enzymes or competition for elimination pathways. As a result, the drug's effects may be prolonged and potentially increase the risk of adverse reactions.

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33.

Which of the following statements is most accurate concerning RA?
- A.
  
  Joint erosions are often evident on radiographs or MRI
- B.
  
  RA is seldom associated with other autoimmune diseases
- C.
  
  A butterfly-shaped facial rash is common
- D.
  
  Parvovirus B19 infection can contribute to its development
Correct Answer
A. Joint erosions are often evident on radiograpHs or MRI

Explanation
Joint erosions are often evident on radiographs or MRI in patients with rheumatoid arthritis (RA). This is because RA is a chronic autoimmune disease that primarily affects the joints, leading to inflammation, synovial hypertrophy, and destruction of cartilage and bone. Radiographs and MRI scans can show characteristic signs of joint erosions, such as narrowing of joint spaces, bone destruction, and soft tissue swelling. These imaging modalities are useful in diagnosing and monitoring the progression of RA, as well as assessing the effectiveness of treatment interventions.

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34.

Principles of treating patients with RA include:
- A.
  
  Initial therapy with an NSAID, then adding other meds as directed by clinical response
- B.
  
  Early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage
- C.
  
  Pain relief as the chief therapeutic goal
- D.
  
  Recognizing that joint splinting is seldom advisable
Correct Answer
B. Early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage

Explanation
The correct answer is early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage. This principle is based on the understanding that early intervention with DMARDs can help slow down the progression of joint damage in patients with rheumatoid arthritis (RA). DMARDs are a class of medications that work to suppress the immune system and reduce inflammation, thereby preventing further damage to the joints. By starting DMARD therapy early, healthcare providers aim to minimize joint destruction and improve long-term outcomes for patients with RA.

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35.

Which of the following tests is most specific to the diagnosis of RA?
- A.
  
  Elevated levels of rheumatoid factor
- B.
  
  Abnormally high ESR
- C.
  
  Depressed total white blood cell count
- D.
  
  Positive ANA titer
Correct Answer
A. Elevated levels of rheumatoid factor

Explanation
Elevated levels of rheumatoid factor are the most specific test for the diagnosis of rheumatoid arthritis (RA). Rheumatoid factor is an antibody that is present in the blood of many individuals with RA. While it is not present in all cases of RA, its presence is highly indicative of the disease. Abnormally high ESR (erythrocyte sedimentation rate) and depressed total white blood cell count can be seen in various inflammatory conditions, not just RA. Positive ANA (antinuclear antibody) titer can also be found in other autoimmune diseases, not specifically RA. Therefore, elevated levels of rheumatoid factor are the most specific to the diagnosis of RA.

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36.

A 52-year-old woman has RA. She now presents with decreased tearing, "gritty"-feeling eyes and a dry mouth. You consider a diagnosis of:
- A.
  
  Systemic lupus erythematosus
- B.
  
  Vasculitis
- C.
  
  Sjogren syndrome
- D.
  
  Scleroderma
Correct Answer
C. Sjogren syndrome

Explanation
The patient's symptoms of decreased tearing, "gritty"-feeling eyes, and a dry mouth are consistent with Sjogren syndrome. Sjogren syndrome is an autoimmune disorder that primarily affects the salivary and lacrimal glands, resulting in dry mouth and dry eyes. It commonly occurs in patients with rheumatoid arthritis (RA), which the patient already has. Systemic lupus erythematosus and vasculitis can cause similar symptoms, but the combination of dry eyes and dry mouth is more characteristic of Sjogren syndrome. Scleroderma can also cause dry eyes and dry mouth, but it typically presents with other symptoms such as skin thickening and Raynaud phenomenon.

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37.

Cyclooxygenase-1 (COX-1) contributes to:
- A.
  
  Inflammatory response
- B.
  
  Pain transmission
- C.
  
  Maintenance of gastric protective mucosal layer
- D.
  
  Renal arteriole function
Correct Answer
C. Maintenance of gastric protective mucosal layer

Explanation
COX-1 is an enzyme that plays a crucial role in the production of prostaglandins, which are important for maintaining the integrity of the gastric mucosal layer. This layer acts as a protective barrier in the stomach, preventing the acidic gastric juices from damaging the underlying tissues. COX-1 inhibitors, such as aspirin, can disrupt the production of prostaglandins and increase the risk of gastric ulcers and bleeding. Therefore, COX-1 contributes to the maintenance of the gastric protective mucosal layer.

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38.

Cyclooxygenase-2 (COX-2) contributes to all of the following except:
- A.
  
  Inflammatory response
- B.
  
  Pain transmission
- C.
  
  Maintenance of the gastric protective mucosal layer
- D.
  
  Renal arteriole constriction
Correct Answer
C. Maintenance of the gastric protective mucosal layer

Explanation
COX-2 is an enzyme that is involved in the production of prostaglandins, which are important mediators of inflammation and pain. It is also responsible for renal arteriole constriction, which helps regulate blood flow to the kidneys. However, COX-2 does not play a role in the maintenance of the gastric protective mucosal layer. This layer is primarily maintained by other factors such as mucus production and bicarbonate secretion.

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39.

Which of the following special examinations should be periodically obtained during hydoxychloroquine sulfate use?
- A.
  
  Dilated eye retinal exam
- B.
  
  Bone marrow biopsy
- C.
  
  Pulmonary fx test
- D.
  
  Exercise tolerance test
Correct Answer
A. Dilated eye retinal exam

Explanation
During the use of hydroxychloroquine sulfate, a dilated eye retinal exam should be periodically obtained. This is because hydroxychloroquine can cause retinal toxicity, which can lead to irreversible vision loss. Therefore, regular eye exams are necessary to monitor for any signs of retinal damage and to ensure early detection and intervention if needed.

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40.

To confirm the results of a McMurray test, you ask the patient to:
- A.
  
  Squat
- B.
  
  Walk
- C.
  
  Flex the knee
- D.
  
  Rotate the knee
Correct Answer
A. Squat

Explanation
To confirm the results of a McMurray test, the patient is asked to squat. Squatting is a movement that puts stress on the knee joint, specifically the meniscus. If the patient experiences pain or a clicking sensation during squatting, it may indicate a meniscal tear. This additional test helps to further assess the condition of the knee and confirm the findings of the McMurray test.

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41.

Which of the following best describes the presentation of a patient with complete median meniscus tear?
- A.
  
  Joint effusion
- B.
  
  Heat over the knee
- C.
  
  Inability to kneel
- D.
  
  Loss of smooth joint movement
Correct Answer
C. Inability to kneel

Explanation
A complete median meniscus tear refers to a tear in the cartilage in the middle of the knee joint. This tear can cause instability and pain in the knee, making it difficult for the patient to kneel. Therefore, the best description of the presentation of a patient with a complete median meniscus tear is the inability to kneel.

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42.

To help prevent a meniscal tear, you advise:
- A.
  
  Limiting participation in sports
- B.
  
  Quadriceps-strengthening exercises
- C.
  
  Using a knee brace
- D.
  
  Applying ice to the knee before exercise
Correct Answer
B. Quadriceps-strengthening exercises

Explanation
Quadriceps-strengthening exercises can help prevent a meniscal tear because the quadriceps muscles play a crucial role in stabilizing the knee joint. Strengthening these muscles can help improve overall knee stability and reduce the risk of injury. This is why advising individuals to engage in quadriceps-strengthening exercises is an effective preventive measure against meniscal tears. Limiting participation in sports, using a knee brace, and applying ice to the knee before exercise may have their benefits, but they do not specifically target the strengthening of the quadriceps muscles.

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43.

Initial treatment for meniscal tear includes all of the following except:
- A.
  
  NSAIDs
- B.
  
  Applying ice
- C.
  
  Elevation
- D.
  
  Joint aspiration
Correct Answer
D. Joint aspiration

Explanation
Joint aspiration is not typically part of the initial treatment for a meniscal tear. Initial treatment usually focuses on reducing pain and inflammation, which can be achieved through the use of NSAIDs, applying ice, and elevating the affected joint. Joint aspiration, on the other hand, involves removing fluid from the joint using a needle and syringe, and it is typically done for diagnostic or therapeutic purposes in certain conditions, but not for the initial treatment of a meniscal tear.

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44.

The phalen test is described as:
- A.
  
  Reproduction of symptoms with forced flexion of the wrists
- B.
  
  Abnormal tingling when the median nerve is tapped.
- C.
  
  Pain on internal rotation
- D.
  
  Palmar atrophy
Correct Answer
A. Reproduction of symptoms with forced flexion of the wrists

Explanation
The correct answer is "Reproduction of symptoms with forced flexion of the wrists." This is because the Phalen test is a diagnostic test used to assess for carpal tunnel syndrome. In this test, the patient is asked to forcefully flex their wrists and hold them in that position for a minute. If the patient experiences tingling, numbness, or pain in the median nerve distribution (thumb, index, middle, and half of the ring finger), it suggests a positive test and indicates possible carpal tunnel syndrome. Therefore, the reproduction of symptoms with forced flexion of the wrists is the characteristic feature of the Phalen test.

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45.

The Tinel test is best described as:
- A.
  
  Reproduction of symptoms with forced flexion of the wrists
- B.
  
  Abnormal tingling when the median nerve is tapped
- C.
  
  Pain on internal rotation
- D.
  
  Palmar atrophy
Correct Answer
B. Abnormal tingling when the median nerve is tapped

Explanation
The Tinel test is a diagnostic test used to assess for nerve compression or injury. It involves tapping or percussing the affected area along the course of a nerve. In the case of the Tinel test for the median nerve, abnormal tingling or a "pins and needles" sensation is elicited when the nerve is tapped. This abnormal tingling suggests nerve irritation or compression along the pathway of the median nerve. The test helps to identify conditions such as carpal tunnel syndrome, where the median nerve is compressed at the wrist.

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46.

Risk factors for carpal tunnel syndrome (CTS) include all of the following except:
- A.
  
  Pregnancy
- B.
  
  Untreated hypothyroidism
- C.
  
  Repetitive motion
- D.
  
  Multiple sclerosis
Correct Answer
D. Multiple sclerosis

Explanation
Carpal tunnel syndrome (CTS) is a condition characterized by compression of the median nerve in the wrist, leading to symptoms like pain, numbness, and weakness in the hand and fingers. Risk factors for CTS include pregnancy, untreated hypothyroidism, and repetitive motion, as these can all contribute to increased pressure on the median nerve. However, multiple sclerosis is not a risk factor for CTS. Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system, causing damage to the protective covering of nerve fibers. While it can cause various neurological symptoms, it is not directly associated with the development of CTS.

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47.

Which of the following is least likely to be reported by patients with CTS?
- A.
  
  Worst symptoms during the day
- B.
  
  Burning sensation in the affected hand
- C.
  
  Tingling pain that radiates to the forearm
- D.
  
  Nocturnal numbness
Correct Answer
A. Worst symptoms during the day

Explanation
Patients with carpal tunnel syndrome (CTS) typically experience symptoms such as tingling pain that radiates to the forearm, burning sensation in the affected hand, and nocturnal numbness. However, the least likely symptom to be reported by patients with CTS is worst symptoms during the day. This is because CTS symptoms often worsen at night or during activities that involve repetitive hand movements, such as typing or gripping objects. Therefore, patients are more likely to experience more severe symptoms during these times rather than during the day.

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48.

Initial therapy for patients with CTS includes:
- A.
  
  Intra-articular injection
- B.
  
  Joint splinting
- C.
  
  Systemic corticosteroids
- D.
  
  Referral for surgery
Correct Answer
B. Joint splinting

Explanation
Joint splinting is the initial therapy for patients with CTS because it helps to immobilize the affected joint, reducing pressure on the median nerve. This can help alleviate symptoms such as pain, numbness, and tingling in the hand and fingers. Splinting also promotes rest and allows for the inflammation to subside. Intra-articular injections and systemic corticosteroids may be used as additional treatment options if splinting alone is not sufficient. Referral for surgery is typically considered if conservative measures fail to provide relief.

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49.

Primary prevention of CTS includes:
- A.
  
  Screening for thyroid dysfunction
- B.
  
  Treatment of OA
- C.
  
  Stretching and toning exercises
- D.
  
  Wrist splinting
Correct Answer
C. Stretching and toning exercises

Explanation
Stretching and toning exercises are included in the primary prevention of carpal tunnel syndrome (CTS) because they help to improve flexibility and strength in the muscles and tendons of the wrist and hand. By doing these exercises regularly, it can help to reduce the risk of developing CTS by keeping the wrist and hand in proper alignment and reducing strain on the median nerve. Additionally, these exercises can also help to improve blood circulation and reduce inflammation in the wrist, further preventing the development of CTS.

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50.

Most episodes of low back pain are caused by:
- A.
  
  An acute precipitating event
- B.
  
  Disk herniation
- C.
  
  Muscle or ligamentous strain
- D.
  
  Nerve impingement
Correct Answer
C. Muscle or ligamentous strain

Explanation
Most episodes of low back pain are caused by muscle or ligamentous strain. This is because the muscles and ligaments in the back can be easily strained or injured due to factors such as poor posture, lifting heavy objects incorrectly, or sudden movements. These strains can lead to inflammation and pain in the affected area. While disk herniation and nerve impingement can also cause low back pain, they are less common causes compared to muscle or ligamentous strain.

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Current Version
Mar 22, 2023

Quiz Edited by
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Dec 20, 2010

Quiz Created by
Ctichy84

Np Test 5: Musculoskeletal

The most common cause of acute bursitis is:

First-line treatment options for bursitis usually include:

Patients with olecranon bursitis typically present with:

Patients with subscapular bursitis typically present with:

Patients with gluteus medius or deep trochanteric bursitis typically present with:

Likely sequelae of intrabursal corticosteroid injection include:

First-line therapy for prepatellar bursitis should include:

Patients with lateral epicondylitis typically present with:

Risk factors for lateral epicondylitis include all of the following except:

Initial therapy for treatment of lateral epicondylitis includes:

Patients with medial epicondylitis typically present with:

Risk factors for medial epicondylitis include playing:

Risk factors for acute gouty arthritis include:

The clinical presentation of acute gouty arthritis affecting the base of the great toe includes:

The most helpful diagnostic test to perform during acute gouty arthritis is:

First-line therapy for treating patients with acute gouty arthritis includes:

Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection?

The most common locations for tophi include all of the following except:

Dietary recommendations for a person with gouty arthritis include avoiding foods high in:

Which of the following joints is most likely to be affected by osteoarthritis?

Deformity of the proximal interphalangeal joints found in an elderly patient with OA is known as:

Which of the following best describes the presentation of a patient with OA?

As part of the evaluation of patients with OA, the NP anticipates finding:

FIrst-line pharmacological intervention for milder OA should be a trial of:

In caring for a patient with OA of the knee, you advise that:

Glucosamine and chondroitin are OTC nutritional supplements that are usually taken to help with the management of:

Which of the following is not characteristic of rheumatoid arthritis (RA)?

Which of the following best describes the presentation of a person with RA?

NSAIDs cause gastric injury primarily by:

Of the following individuals, who is at highest risk for NSAID-induced gastropathy?

Which of the following is the preferred method of preventing NSAID-induced gastric ulcer?

Taking a high dose of aspirin or ibuprofen causes:

Which of the following statements is most accurate concerning RA?

Principles of treating patients with RA include:

Which of the following tests is most specific to the diagnosis of RA?

A 52-year-old woman has RA. She now presents with decreased tearing, "gritty"-feeling eyes and a dry mouth. You consider a diagnosis of:

Cyclooxygenase-1 (COX-1) contributes to:

Cyclooxygenase-2 (COX-2) contributes to all of the following except:

Which of the following special examinations should be periodically obtained during hydoxychloroquine sulfate use?

To confirm the results of a McMurray test, you ask the patient to:

Which of the following best describes the presentation of a patient with complete median meniscus tear?

To help prevent a meniscal tear, you advise:

Initial treatment for meniscal tear includes all of the following except:

The phalen test is described as:

The Tinel test is best described as:

Risk factors for carpal tunnel syndrome (CTS) include all of the following except:

Which of the following is least likely to be reported by patients with CTS?

Initial therapy for patients with CTS includes:

Primary prevention of CTS includes:

Most episodes of low back pain are caused by: