Question 1

John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game.He described twisting his knee and then being unable to extend it completely.John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain.The clinician suspects a meniscal tear.Which test would be most appropriate to assess for the presence of a meniscal tear?

Accepted Answer

The McMurray circumduction test is the most appropriate test for assessing the presence of a meniscal tear. This test involves placing the patient's leg in a flexed position and then rotating it while applying pressure to the knee joint. If there is a meniscal tear, this motion may cause a clicking or popping sensation, indicating the presence of the tear. The other tests listed (valgus stress, Lachman, and varus stress) are used for assessing ligament injuries in the knee joint, not meniscal tears.

Question 2

What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?

Accepted Answer

D

Question 3

Sam is a 25-year-old 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?

Accepted Answer

Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain are common signs of a herniated nucleus pulposus or ruptured disc. The other symptoms listed in options A, C, and D are more indicative of other conditions such as ankylosing spondylitis, infection, or malignancy, respectively.

Question 4

The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle.Diane asks the clinician if she will need an x-ray.The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane's description of her injury.Which of the following clues in Diane's examination or history would alert the clinician to the need for obtaining radiographs?

Accepted Answer

Any of the above findings indicate the need for obtaining radiographs. Inability to bear weight, marked swelling and discoloration, and crepitation with palpation or movement are all signs of potential fractures or other significant injuries that would require further investigation.

Question 5

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 examination reveals a 75% reduction in both active and passive ROM of the right shoulder.Mrs.Gray also is 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 examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder." Which clue in Mrs.Gray's history supports this diagnosis?

Accepted Answer

Patients with diabetes mellitus have a higher risk of developing adhesive capsulitis, also known as "frozen shoulder." This condition is characterized by stiffness and pain in the shoulder joint, and diabetes is a well-established risk factor.

Question 6

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 also will develop carpal tunnel syndrome.Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?

Accepted Answer

Carpal tunnel syndrome commonly occurs in families, indicating a genetic component to its development. Research suggests that genetic factors account for about one-half the risk of developing carpal tunnel syndrome. Therefore, there is a higher likelihood for Mrs. Anderson's children to develop carpal tunnel syndrome due to their genetic predisposition.

Question 7

Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of 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?

Accepted Answer

Cauda equina compression can cause paresthesia, or abnormal sensations such as burning, tingling, or numbness, in the perineum and buttocks due to irritation of the nerve roots. This is a serious condition that requires urgent medical attention. Gastrocnemius weakness and reduced ankle reflexes may be indicative of peripheral nerve damage, but are not specific to cauda equina compression. Numbness in the lateral foot may suggest involvement of a different nerve distribution.

Question 8

Which of the following statements is true concerning the management of the client with a herniated disc?

Accepted Answer

The answer of Which of the following statements is true...

Question 9

Which of the following statements is true regarding the treatment of carpal tunnel syndrome?

Accepted Answer

The answer of Which of the following statements is true...

Question 10

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:

Accepted Answer

Crepitus is the grinding or popping sensation felt or heard during joint movement, which indicates articular involvement in the musculoskeletal complaint. Additionally, limited ROM with both active and passive movement also indicates joint involvement, suggesting an articular origin of the complaint.

Question 11

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 the use of NSAIDs?

Accepted Answer

Starting with the lowest effective dose of NSAIDs is important because long-term use of NSAIDs can result in GI disorders. It is important to minimize the risk of adverse effects when using NSAIDs, and starting with the lowest effective dose is one way to do so.

Question 12

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?

Accepted Answer

When a patient has complete range of motion (ROM) with gravity eliminated, it indicates that the muscle can move through its full ROM but not against gravity. This corresponds to a muscle strength grade of 2 on the 0-5 muscle grading scale.

Question 13

Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?

Accepted Answer

Bone mass density measurement by densitometry is considered the gold standard for definitively diagnosing osteoporosis. Densitometry includes dual-energy x-ray absorptiometry (DXA) as well as quantitative computed tomography (QCT) and quantitative ultrasound (QUS). Bone alkaline phosphatase levels and urinary N-telopeptide assay are markers of bone turnover and can provide information about bone metabolism but are not definitive diagnostic tests for osteoporosis. Magnetic resonance imaging (MRI) can be used to evaluate bone health, but it is not considered the gold standard for diagnosing osteoporosis.

Question 14

Mr.Jackson is a 65-year-old man recently diagnosed with osteoarthritis.The clinician has explained to Mr.Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life.Mr.Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis.What would be the most appropriate response from the clinician?

Accepted Answer

The most appropriate response from the clinician would be to provide Mr. Jackson with all available treatment options.Complementary therapies, such as acupuncture, acupressure, and tai-chi have shown promise when used with standard medical therapy in the treatment of osteoarthritis. It's important for the clinician to provide Mr. Jackson with accurate and comprehensive information and allow him to make an informed decision about his treatment plan.

Question 15

Jennifer is an 18-year-old 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 ROM in her left shoulder.The clinician has diagnosed Jennifer with a dislocated shoulder.Which of the following statements are true concerning shoulder dislocation?

Accepted Answer

There is a risk of neurovascular and neurosensory trauma in shoulder dislocations, so it is important for the clinician to check for distal pulses. A and C are false as anterior dislocations are more common than posterior dislocations and recurrent dislocations are common and can occur with minimal force. D is not always necessary as some cases can be managed non-surgically.

Question 16

One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin.Which of the following is an example of an articular structure?

Accepted Answer

The synovium is a part of the joint capsule and is an example of an articular structure. Bone, tendons, and fascia are nonarticular structures.

Question 17

Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

Accepted Answer

Morning stiffness is a common sign of musculoskeletal pain caused by inflammation. Decreased C-reactive protein and hyperalbuminemia are not consistent with an inflammatory etiology, and weight gain is not specific to musculoskeletal pain.

Question 18

Which of the following statements concerning the musculoskeletal examination is true?

Accepted Answer

The uninvolved side should be examined initially and then compared to the involved side in order to establish a baseline for comparison. This allows the examiner to identify any abnormalities or differences between the two sides.

Question 19

The clinician suspects that a client has patellar instability.In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension.Next the patella is displaced laterally, and the knee flexed to 30¡.If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain.Testing for patellar instability in this way is known as:

Accepted Answer

Testing for patellar instability in the manner described is known as the apprehension sign. The bulge sign involves detecting fluid in the suprapatellar pouch, while the thumb sign is used to assess for patellar subluxation or dislocation by pressing the patella laterally with the thumb. None of these alternatives are relevant for assessing patellar instability in the manner described.

Question 20

Normal estrogen function is important for preventing osteoporosis in both men and women.Estrogen works to prevent osteoporosis in which of the following ways?

Accepted Answer

Estrogen works to prevent osteoporosis by decreasing the activity of osteoclasts, which are responsible for breaking down and resorbing bone tissue. This helps to maintain bone density and reduce the risk of fractures. Estrogen does not promote osteoclastogenesis (the formation of new osteoclasts) or inhibit osteoclast apoptosis (the natural cell death of osteoclasts).

Quiz 15: Musculoskeletal Problems