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Dunphy Chapter 15 (Musculoskeletal)

Terms in this set (28)

One of the initial steps in assessing pt's w/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?

a. Bone
b. Synovium
c. Tendons
d. Fascia
b. Synovium
You have detected the presence of crepitus on exam of a pt with a musculskeletal complaint. Additionally, there is limited ROM w/both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
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
c. 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 pain should be examined first.
c. When possible, the pt 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 pt.
a. The uninvolved side should be examined initially and then compared to the involved side.
You are performing muscle strength testing on a pt presenting w/musculoskeletal pain and find that the pt has complete ROM w/gravity eliminated. Which numeric grade of muscle strength would you give this pt, 1-5?
2
Mrs. Gray is a 55yo woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any h/o trauma. Her exam 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 hx is significant for type 1 diabetes mellitus and HTN. Her social hx reveals that she is a secretary and that she is right-handed. Based on her examination and medical hx, you suspect adhesive capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's hx supports this dx?
Her h/o diabetes
Jennifer is an 18yo who comes to the ER 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?

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 most commonly the treatment of choice
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35yo woman who has been recently diagnosed with carpal tunnel syndrome. She has 2 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?

a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel.
b. Only people w/occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel.
c. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel.
d. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance.
a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-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 treatment is to prevent flexion and extension movements of the wrist.
b. Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position.
c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection.
d. All of the above
d. All of the above
Sam is a 25yo who has been diagnosed with low back strain based on his h/o 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 lumbar 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 erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue
b. 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 25yo pt 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?

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 maximum 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."
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."
Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the ER with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks
d. Paresthesia of the perineum and buttocks
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 discontinued 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 3mo period is an indication for surgical intervention.
d. All of the above.
c. Intolerable pain for more than a 3mo period is an indication for surgical intervention.
John is a 16yo boy who presents to the ER 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?
McMurray circumduction test
The clinician suspects that a client has a 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 degrees. 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:
Apprehension sign
The clinician is caring for Diane, a 22yo 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 exam or history would alert the clinician to the need for obtaining radiographs?

a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above
d. All of the above
Mr. Jackson is a 65yo 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 appropriate response from the clinician?

a. "Complementary therapies should be considered only if surgical interventions are not successful."
b. "I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition."
c. "I would be happy to discuss all the treatment options with you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy."
d. "It would be crazy to use complementary therapies to treat such a serious condition."
c. "I would be happy to discuss all the treatment options with you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy."
Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways?

a. By decreasing the erosive activity of osteoclasts
b. By promoting osteoclastogenesis
c. By inhibiting osteoclast apoptosis
d. All of the above
a. By decreasing the erosive activity of osteoclasts
Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?

a. Bone alkaline phosphatase levels
b. Urinary N-telopeptide assay
c. Bone mass density measurement by densitometry
d. Magnetic resonance imaging
c. Bone mass density measurement by densitometry
What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
1500mg/day
Mrs. Allen is a 60yo woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?

a. Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs.
b. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying.
c. This class of drugs can be taken at any time of the day without regard to meals.
d. None of the above
b. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying.
Which stage of Paget's disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
Mixed
Which of the following statements concerning the treatment of fibromyalgia syndrome is true?

a. There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible.
b. Treatment is directed toward controlling discomfort, improving sleep, and maintaining function.
c. Fibromyalgia syndrome can be difficult to manage, requiring a variety of approaches and multiple meds.
d. All of the above
d. All of the above
One of the most frequent presenting signs/symptoms of osteoporosis is:
Bony fracture
Mrs. Thomas was seen in the office c/o pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the dx and is most consistent with lateral epicodylitis (tennis elbow) is:

a. Ecchymosis, edema, and erythema over the lateral epicondyle
b. Pain at the elbow with resisted movements at the wrist and forearm
c. Inability to supinate and pronate the arm
d. Inability to flex or extend the elbow against resistance
b. Pain at the elbow with resisted movements at the wrist and forearm
A 70yo female has fallen 2wks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. ROM is uncomfortable and severely diminished due to pain. No crepitus is heard or felt. Her fingers are warm, pulse is strong, and cap refill is less than 2sec. What should you do?

a. Make an immediate referral for an orthopedic eval without further assessment
b. Tell her that it takes time for these bruises to improve, so she should be patient
c. Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint
d. Send her to the ER for reduction of this obvious wrist fracture
c. Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint
T/F
Osteoarthritis is primarily a noninflammatory condition.
True
T/F
The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis.
False
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