CHAPTER 09- Musculoskeletal Review Flashcards Preview

Family Nurse Practitioner (FNP) > CHAPTER 09- Musculoskeletal Review > Flashcards

Flashcards in CHAPTER 09- Musculoskeletal Review Deck (49)
Loading flashcards...
1

For which of the following diagnoses are patients most likely to complain of pain on the plantar surface of the foot?

  1. Metatarsal stress fracture
  2. Pes cavus
  3. Pes planus
  4. Morton’s neuroma

4. Morton’s neuroma

Morton’s neuroma is a painful condition that affects the ball of the foot, most commonly between the area of the third and fourth toe.

2

What is the most common cause of heel pain?

  1. Plantar fasciitis
  2. Achilles tendonopathy
  3. Ankle sprain
  4. Compartment syndrome

1. Plantar fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia that runs across the bottom of the foot and connects the calcaneus bone to the toes. Plantar fasciitis commonly causes stabbing pain that usually occurs with the very first steps in the morning.

3

Pain with a standing (weight bearing) heel raise will occur with which of the following diagnoses?

  1. Achilles tendonopathy
  2. Lateral ankle sprain
  3. Compartment syndrome
  4. Medial ankle sprain

1. Achilles tendonopathy

When performing a physical exam, most people with Achilles tendinopathy will complain of pain when they stand on the affected leg and raise their heel off the ground. This movement reproduces their pain.

4

The following picture shows a foot deformity that is characteristic of which of the following diagnoses?

  1. Compartment syndrome
  2. Diabetes mellitus
  3. Charcot foot
  4. Pes cavus

3. Charcot foot

Diabetes damages blood vessels, decreasing the blood flow to the feet. Poor circulation weakens bone, and can cause disintegration of the bones and joints in the foot and ankle. As a result, people with diabetes are at a high risk for developing Charcot foot. The combination of bone disintegration and trauma can warp and deform the shape of the foot.

5

Which of the following is true of the Ottawa foot and ankle rules?

  1. Has a high specificity for foot and ankle fractures
  2. Has high sensitivity for foot and ankle fractures
  3. Is specific for fractures of the cuboid bone
  4. Is correlated with decreased foot and ankle ROM

2. Has high sensitivity for foot and ankle fractures

Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30–40%.

6

Severe uncontrolled pain, swelling, and pain with a history of foot trauma is consistent with which of the following diagnoses?

  1. Pes cavus
  2. Pes planus
  3. Achilles tendonopathy
  4. Compartment syndrome

4. Compartment syndrome

Compartment syndrome causes severe pain that does not go away with analgesic medications and is not relieved when the foot is raised. In more severe cases, it may include paresthesia, pallor, and pulselessness.

7

Which of the following is true of a lateral ankle sprain?

  1. Trauma involving an eversion force
  2. Decreased ankle plantar flexion ROM
  3. Treatment may involve an external support initially
  4. Tenderness over the deltoid ligament

3. Treatment may involve an external support initially

Early management of a lateral ankle sprain includes RICE (rest, ice, compression, and elevation). External support may allow the structures around the ankle to rest, provide compression and support, and prevent recurrence.

8

A traction injury to the tibial tuberosity in adolescents is termed what?

  1. Osgood–Schlatter disease
  2. Prepatellar bursitis
  3. Infrapatellar bursitis
  4. Quadriceps tendonopathy

1. Osgood–Schlatter disease

Osgood–Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the patellar tendon attaches to the tibia.

9

Which of the following knee conditions may require surgery?

  1. Osgood–Schlatter disease
  2. Medial tibial stress syndrome
  3. Pes anserine bursitis
  4. Patellar subluxation

4. Patellar subluxation

Some patients with patellar subluxation are not cured by conservative treatment and may need surgery. The surgeon may initially perform an arthroscopy to assess the mechanics of the knee joint and ascertain if there is an issue that can be corrected.

10

Pes anserine bursitis:

  1. Describes inflammation of the gastrocnemius-semimembranosus bursa.
  2. Is also known as a Baker’s cyst.
  3. Includes the semimembranosus tendon.
  4. Can be caused by an LE biomechanical fault.

4. Can be caused by an LE biomechanical fault.

Pes anserine bursitis can be caused by repetitive activities, incorrect sports training techniques (e.g., a lack of stretching), obesity, osteoarthritis of the knee, incorrect positioning of the knee, turning the leg sharply with the foot planted on the ground, injury such as a direct hit to the leg, a tear in the cartilage of the knee, or flat feet.

11

Swelling on the posterior aspect of the knee:

  1. May be repatellar bursitis.
  2. May be pes anserine bursitis.
  3. May be associated with meniscus tears.
  4. Usually indicates popliteal artery compromise.

3. May be associated with meniscus tears.

Symptoms of a torn knee meniscus include pain, swelling posteriorly, popping, and the feeling that the knee is "locking."

12

A patient with a meniscus tear may present with which of the following?

  1. A history of patellar subluxation
  2. Mechanical catching and joint line tenderness
  3. Trauma involving valgus stress to the knee
  4. Trauma involving varus stress to the knee

2. Mechanical catching and joint line tenderness

Symptoms of a torn meniscus commonly include the patient stating that there is a feeling of mechanical "catching" and joint line tenderness.

13

A football player is hit on the lateral side of the right knee while twisting to the left. Which ligament is most likely to be injured?

  1. LCL
  2. MCL
  3. ACL
  4. PCL

2. MCL

The MCL (medial collateral ligament) can be injured during activities that involve bending, twisting, or a quick change of direction. The MCL can be injured in football when the outside of the knee is hit (i.e., a valgus force). This type of injury can also occur during skiing and in other sports with lots of stop-and-go movements, jumping, or weaving.

14

Which of the following injuries results in rapid and moderate to severe effusion?

  1. LCL
  2. MCL
  3. ACL
  4. Meniscus tear

3. ACL

A gross effusion will most commonly be present within a few hours after an ACL injury; however, absence of an effusion does not mean an ACL injury has not occurred.

15

Medial tibial stress syndrome may involve which of the following muscles?

  1. Quadriceps femoris
  2. Gastrocnemius
  3. Soleus
  4. Peroneal brevis

3. Soleus

Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain. It is related to inflammation of the soleus muscle that is located in the posterior part of the calf.

16

Limping and pain in a child’s leg of insidious onset may be indicative of what?

  1. Intertrochanteric fracture
  2. Hip dislocation
  3. Legg-Calve-Perthes disease
  4. Hip impingement

3. Legg-Calve-Perthes disease

Legg–Calvé–Perthes disease occurs when the blood supply is temporarily interrupted to the femoral head of the hip joint. Without sufficient blood flow, the bone begins to die and can break easily, and subsequently may heal poorly.

17

Which of the following is true of intertrochanteric fractures?

  1. Affects men more than women
  2. Has a 50–60% mortality rate in the first year after the fracture
  3. Primary intervention is ORIF
  4. Carries a 30% chance of re-fracture

3. Primary intervention is ORIF

Open reduction and internal fixation (ORIF) is indicated for all intertrochanteric fractures, unless the patient’s medical condition is such that any anesthesia, general or spinal, is contraindicated.

18

A patient is involved in an MVA where his knee hits the dashboard of the car. Which of the following are possible injuries?

  1. Anterior hip dislocation
  2. PCL ligament tear
  3. Patellar dislocation
  4. ACL tear

2. PCL ligament tear

PCL tears make up less than 20% of injuries to the knee ligaments. Injuries that tear the PCL often damage some of the other ligaments or cartilage in the knee as well. PCL injuries are often due to a blow to the knee while it’s bent. Common causes include: striking the knee against the dashboard during an auto accident or falling on the knee while it’s bent.

19

Which of the following is true of hip dislocations?

  1. 75% of dislocations are anterior.
  2. With a posterior dislocation, the femoral nerve may be injured.
  3. After a posterior dislocation, the limb is held in full external rotation.
  4. Osteonecrosis is a potential complication.

4. Osteonecrosis is a potential complication.

Osteonecrosis of the hip may occur with any hip dislocation. It occurs when the blood supply to the bone is disrupted. Osteonecrosis is also called avascular necrosis or aseptic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip.

20

What is the most commonly injured hip adductor muscle?

  1. Adductor magnus
  2. Adductor brevis
  3. Pectineus
  4. Adductor longus

4. Adductor longus

The adductor muscles of the thigh are responsible for moving the leg across the body and are susceptible to muscle strains. Strains of the adductor muscles occur where the muscle tendons attach to the pelvic bone.

21

A tear to the inferior portion of the shoulder labrum is termed:

  1. A Bankart lesion.
  2. A SLAP tear.
  3. An inferior AC joint strain.
  4. An inverse biceps tear.

1. A Bankart lesion.

A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

22

A patient falling directly on the shoulder with tenderness over the superior-anterior shoulder is present in what?

  1. Subacromial pain syndrome
  2. Rotator cuff strain
  3. AC joint injury
  4. First rib stress fracture

3. AC joint injury

Acromioclavicular joint injuries are often seen with contact sports injuries and car accidents. The acromioclavicular joint is located at the top of the shoulder where the acromion process and the clavicle meet to form a joint.

23

Shoulder pain radiating down the lateral side of the humerus to the elbow after a fall on to an outstretched arm could be caused by what?

  1. Adhesive capsulitis
  2. AC joint strain
  3. RTC tear
  4. Biceps tear

3. RTC tear

A rotator cuff tear may result from an acute injury such as a fall or may be caused by chronic wear and tear with degeneration of the tendon. Typically, there is pain in the front of the shoulder that radiates down the side of the arm. It may be present with overhead activities such as lifting or reaching.

24

Which of the following is true of adhesive capsulitis (frozen shoulder)?

  1. It is correlated with RTC tears.
  2. It is more likely to occur in patients under 30 years of age.
  3. It may take upward of 14 months to resolve.
  4. It is treated with immobilization in the freezing stage.

3. It may take upward of 14 months to resolve.

Shoulder pain associated with adhesive capsulitis is progressive and initially felt mostly at night, or when the shoulder is moved close to the end of its range of motion. The pain usually progresses to constant pain at rest that is aggravated by all movements of the shoulder. In approximately 90% of patients with adhesive capsulitis, the pain may last 1–2 years.

25

Of the following, which is the most commonly fractured bone in the body?

  1. The scaphoid
  2. The humerus
  3. The ulna
  4. The radius

4. The radius

Arm fractures account for almost 50% of all broken bones. The radius is commonly fractured when a person tries to break their "fall on an outstretched hand" (FOOSH).

26

Kienbock’s disease refers to what?

  1. Avascular necrosis of the scaphoid bone
  2. Osteonecrosis of the lunate
  3. Partial subluxation of the TFCC
  4. Non-union fracture of the distal radius

2. Osteonecrosis of the lunate

Kienbock’s disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted. Without adequate blood supply, the bone can die. This is called osteonecrosis. Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.

27

A patient is being evaluated for a complaint of pain at the base of the thumb. The provider performs a Finkelstein test and the results are positive. This is indicative of which of the following disease processes?

  1. DeQuervain’s tenosynovitis
  2. Carpal tunnel syndrome
  3. Ligamentous strain
  4. Trigger finger

1. DeQuervain’s tenosynovitis

The test known as the Finkelstein test can help the clinician confirm De Quervain’s tenosynovitis. To perform the test, the thumb is bent down across the palm of your hand, and then covered with the fingers. The patient then bends the wrist toward their little finger. If this causes pain, it is likely due to De Quervain’s tenosynovitis.

28

Thickening of the palmar skin of the hand in older adults is termed what?

  1. DeQuervain’s tenosynovitis
  2. Trigger finger
  3. Dupuytren’s contracture
  4. Swan neck deformity

3. Dupuytren’s contracture

Dupuytren’s contracture is a hand deformity that usually develops over years. Knots of tissue form under the skin, eventually creating a thick cord that can pull one or more fingers into a bent position.

29

Trigger finger is the layperson’s term for:

  1. Dupuytren’s contracture.
  2. DeQuervain’s tenosynovitis.
  3. Ligamentous strain of the DIP joint.
  4. Stenosing tenosynovitis.

4. Stenosing tenosynovitis.

Stenosing tenosynovitis is a condition commonly known as "trigger finger." It is sometimes also called "trigger thumb." Trigger fingers are more common with certain medical conditions such as rheumatoid arthritis, gout, and diabetes. Repeated and strong gripping may lead to the condition. In most cases, the cause of the trigger finger is not known.

30

Raynaud’s phenomenon is associated with which of the following?

  1. Men, cold climates, and a history of hypothyroid
  2. Women, scleroderma, and cold climates
  3. Men, stroke, and DM
  4. Women, sedentary occupation, smoking

2. Women, scleroderma, and cold climates

People of all ages can have Raynaud’s phenomenon. Raynaud’s phenomenon may run in families, especially in families that typically have autoimmune disorders. The primary form is the most common. It most often starts between age 15 and 25, and is most common in women and people living in cold places.