Week 8 quiz
Question 1. Which of the following best describes the pain associated with osteoarthritis?
Constant, burning, and throbbing with an acute onset
Dull and primarily affected by exposure to cold and barometric pressure
Begins upon arising and after prolonged weight bearing and/or use of the joint
Begins in the morning and limits continued ambulation
Question 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical examination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include:
Recommending she increase her dietary intake of Calcium and Vitamin D
Ordering once a year bisphosphonate and a proton pump inhibitor
Participate in a fall prevention program
Dual-energy X-ray (DEXA) scan and updating immunizations
Question 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items:
Green leafy vegetables
Beer, sausage, fried seafood
Gluten and bread items
Question 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses:
Question 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of:
Question 6. Which of the following statements about osteoarthritis is true?
It affects primarily weight-bearing joints
It is a systemic inflammatory illness
The metacarpal phalangeal joints are commonly involved
Prolonged morning stiffness is common
Question 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk):
Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days
Doxycycline 100 mg twice daily for 5 days
Prednisolone 35 mg four times a day for 5 days
Question 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems:
Systemic lupus erythematosus
Question 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect?
Question 10. A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis?
All of the above
Question 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical examination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate:
Knee ligament injury
Question 12. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon?
Straight leg raising sign
Lumbar herniated disc on X-ray
Loss of left sided patellar reflex
Question 13. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of:
Carpal tunnel syndrome
Osteoarthritis of the wrist
Question 14. Which of the following describes the pathology of De Quervain’s tenosynovitis?
Irritation of a tendon located on the radial side of the wrist, near the thumb
Impingement of the median nerve, causing pain in the palm and fingers
Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist
Ulnar nerve compression at the olecranon process
Question 15. What is the most common cause of hip pain in older adults?
Trauma due to fall
Question 16. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an X-ray of the feet be ordered?
Yes, there is tenderness over the fifth metatarsal
No, there is not tenderness over the navicular bone
Yes, the patient cannot bear weight on the foot
A and C
Question 17. 38-year-old Asian male, Mr. Chen, with past medical history significant for prehypertension who has recently taken up softball presents with three to five weeks of shoulder pain when throwing overhead. Ice minimally alleviates pain. Medications: Naproxen minimally alleviates shoulder pain. Allergies: Penicillin-associated rash. Family history: Brother has rheumatoid arthritis.
Which of the following musculoskeletal causes of shoulder pain would merit urgent diagnosis and management?
Septic subacromial bursitis
Impingement of the supraspinatus tendon
Rotator cuff tear
Tendinopathy of the long head of the biceps
Rotator cuff impingment
Question 19. What is the essential dynamic stabilizer of the shoulder joint?
Rotator muscle group
Teres major muscle
Question 20. Given Mr. Chen’s repetitive overhead activities, some injury to his rotator cuff muscle group is most likely. Of the following exam findings, which one would not support the diagnosis of rotator cuff tendinopathy?
Positive Apley’s Scratch test
Weakness and pain with empty can testing
Limited active ROM
Inability to raise arm above his head