APEA Ortho

APEA Ortho.

Question:

A tool for assessing risk factors for osteoporotic fractures is the:

 

DEXA.FRAX.  CorrectBRCA1.HAARM.  Incorrect

 

Explanation:

The FRAX calculator generates fracture risk based on age, body mass index, parental fracture history, use of glucocorticoids, presence of rheumatoid arthritis or secondary osteoporosis, and tobacco and alcohol use. It has been validated for black, Hispanic, and Asian women in the USA and has calculators that are country and continent specific. Duel energy x-ray absorptiometry, DEXA, is the optimal standard for measuring bone density. APEA Ortho. BRAC1 is a gene that can mutate and increase the risk of breast cancer. HAARM is the melanoma risk model.

Question:

Anserine bursitis arises from:

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excessive running.  Correctexcessive kneeling.  Incorrectarthritis.trauma

 

Explanation:

Anserine bursitis arises from excessive running, valgus knee deformity, fibromyalgias, and osteoarthritis. Prepatellar bursitis (“housemaid’s knee”) arises from excessive kneeling. A popliteal or “baker’s” cyst arises from distention of the gastrocnemius semimembranous bursa from underlying arthritis or trauma. APEA Ortho.

Question:

When examining the knee, which of the following symptoms could be indicative of a positive Adduction (Varus) Stress Test?

 

Pain in the lateral joint line  CorrectPain in the medial joint line  IncorrectPain in the anterior joint lineA click along the medial joint line.

 

Explanation:

The Adduction (or Varus) Stress Test is a maneuver that evaluates the function of the lateral collateral ligament. To perform this test, the knee is held in 30 degrees of flexion. With one hand on the medial side of the knee and one hand on the ankle, an adduction force is gently applied. If pain is noted in the lateral joint line, this could be indicative of a lateral collateral ligament tear. When tenderness extends more to the proximal or distal joint line, the collateral ligament may be the cause of pain instead of the meniscus APEA Ortho.

Question:

When assessing the knee, the examiner instructs the patient to straighten his knee. This motion would assess knee:

 

flexion.extension.  Correctinternal rotation.external rotation.

 

Explanation:

Having the patient straighten his leg assesses extension of the knee. The examiner instructs the patient to bend his knee. APEA Ortho. This maneuver assesses knee flexion. Internal rotation of the knee could be elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to swing his leg away from his midline while sitting assesses external rotation of the knee.

Question:

When performing an examination of a tender left finger on an adult, the surrounding tissue reveals warmth, edema, and redness. This finding could be suggestive of:

 

carcinoma.muscular atrophy. synovitis.  Incorrectgouty arthritis.  Correct

 

Explanation:

Redness, warmth, and edema over a tender joint suggest septic or gouty arthritis infection, or possibly rheumatoid arthritis.

Question:

An example of a fibrous joint would be the:

 

vertebral bodies of the spine.skull.   Correctshoulder.  Incorrectpubic symphysis of the pelvis.

 

Explanation:

The skull is an example of the fibrous joint. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints APEA Ortho.

Question:

To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the:

 

lateral joint line of the knee.on either side of the patella.upper edge of the tibial plateau.  Correcttop of the patella.

 

Explanation:

To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the upper edge of the tibial plateau. The lateral meniscus is palpated on the lateral joint line by placing the patient’s knee in slight flexion. To palpate the tibiofemoral joint, face the patient’s knee and place the thumbs in the soft-tissue depressions on either side of the patellar tendon.

Question:

A patient complains of a sharp burning pain in the neck and right arm with associated paresthesias and weakness. These symptoms may be associated with:

 

mechanical neck pain.mechanical neck pain with whiplash.cervical radiculopathy.  Correctcervical myelopathy.

 

Explanation:

With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm and stiffness and tightness in the upper back and shoulder, lasting up to 6 weeks. In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities.

Question:

A patient complains of lateral hip pain while pointing near the trochanter. This type of pain could be suggestive of:

 

sciatica.  Incorrectradicular pain.polyarticular arthritis.bursitis.  Correct

 

Explanation:

Lateral hip pain near the greater trochanter suggests trochanteric bursitis. Sciatica symptoms usually include a shooting pain below the knee, commonly in the lateral leg or posterior calf and accompanied by low back pain. Radicular pain refers to pain that radiates along the dermatome of a nerve due to inflammation or irritation of a nerve root, as with sciatica pain. Polyarticular arthritis refers to arthritis involving several joints.

Question:

The muscle of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is known as the:

 

infraspinatus muscle.  Correctpectoralis major. subscapularis muscle.  Incorrectsupraspinatus muscle.

 

Explanation:

One of the muscles of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is the infraspinatus muscle. The other one is the teres minor muscle. The pectoralis major muscle is situated on the anterior chest. The muscle that runs above the glenohumeral joint and inserts on the greater tubercle is known as the supraspinatus. The subscapularis muscle originates on the anterior surface of the scapula and crosses the joint anteriorly and inserts on the lesser tubercle.

Question:

Inspection of the hip begins with careful observation of a patient’s gait. A patient’s foot moves forward without bearing weight. This is known as the: APEA Ortho.

 

swing phase of gait.  Correctstance phase of gait.push off phase of gait.heel strike phase of gait.

 

Explanation:

Inspection of the hip begins with careful observation of a patient’s gait. There are 2 phases of gait: stance and swing. The swing phase occurs when the foot moves forward and does not bear weight. The stance phase occurs when the foot is on the ground bearing weight.

Question:

The axioscapular group of muscles:

 

pulls the shoulder backward.  Correctrotates the shoulder laterally.produce internal rotation of the shoulder.  Incorrectdraws the shoulder blade forward.

 

Explanation:

The axioscapular group pulls the shoulder backward and rotates the scapula. The scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and depresses and rotates the head of the humerus. The axiohumeral group produces internal rotation of the shoulder. The serratus anterior draws the shoulder blade forward.

Question:

When assessing the knee, the examiner instructs the patient to sit and swing his lower leg toward midline. This motion assesses knee:

 

flexion.extension.internal rotation.  Correctexternal rotation.

 

Explanation:

Internal rotation of the knee is elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to bend his knee assesses knee flexion. Having the patient straighten his leg assesses extension of the knee. APEA Ortho. Instructing the patient to swing his leg away from his midline while sitting would be a maneuver to assess external rotation of the knee.

Question:

When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of:

 

adduction.  Incorrectabduction.flexion.  Correctextension.

 

Explanation:

When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of flexion. Extension occurs when the patient moves his arm behind himself. Abduction occurs when the patient moves his arm away from the body laterally and overhead. Adduction occurs when the patient moves his arm across his body.

Question:

Static stabilizers of the shoulder are referred to as those structures that are:

 

muscular structures of the shoulder girdle.capable of movement. bony structures of the shoulder girdle.  Correctresponsible for stabilizing the humeral head in the glenoid cavity.  Incorrect

 

Explanation:

Static stabilizers are incapable of movement and include the bony structures of the shoulder girdle, the labrum, the articular capsule, and the glenohumeral ligaments that add to joint stability. Dynamic stabilizers are capable of movement and include the SITS muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles move the humerus and compress and stabilize the humeral head within the glenoid cavity.

Question:

To test the thumb for abduction, ask the patient to:

 

move his thumb across his palm and touch the base of the fifth finger.  Incorrectmove his thumb from the base of the fifth finger and then as far away from the palm as possible.touch the thumb to each of the other fingertips. place the fingers and thumbs in the neutral position with the palm up and then move the thumb anteriorly away from the palm.  Correct

 

Explanation:

Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To test extension, ask the patient to move his thumb from the base of the fifth finger, across the palm, and then as far away from the palm as possible. APEA Ortho. Touching the thumb to each of the other fingers tests opposition. Moving the thumb back to its neutral position assesses adduction.

Question:

Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the:

 

medial meniscus.lateral meniscus.  Correctlateral collateral ligament (LCL).  Incorrectposterior cruciate ligament (PCL).

 

Explanation:

Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the lateral meniscus.

Question:

The nurse practitioner instructs the patient to lie supine, bend his knee, and turn his lower leg and foot away from the midline. This maneuver would assess hip:

 

abductionextension.external rotation.  Incorrectinternal rotation.  Correct

 

Explanation:

To assess for hip internal rotation, the patient would lie supine, bend his knee, and turn his lower leg and foot away from the midline. To assess hip abduction, the patient would lie supine and move his lower leg away from the midline. To assess hip extension, the patient would lie face up, bend his knees, place feet flat on the table, and lift his buttocks off the table. To assess for external rotation of the hip, the patient would lie supine, bend his knee, and turn the lower leg and foot toward the midline. APEA Ortho.

Question:

Children with Legg-Calve Perthes disease should:

 

maintain a diet high in protein, vitamins and minerals.sleep on a firm mattress to prevent contractures.   Incorrectavoid weight bearing on the affected extremity.  Correctbe allowed to play basketball.

 

Explanation:

Legg–Calvé–Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head. APEA Ortho. The bone loss leads to some degree of collapse and deformity of the femoral head and sometimes secondary changes to the shape of the hip socket. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity so that the risk of developing a severe degenerative arthritis as an adult can be reduced. Diet and sleeping on a firm mattress do not alter the course of the disease. However, avoiding high impact sports such as basketball during treatment is essential since increased weight on the hip will cause further damage.

Question:

The convex medial end of the clavicle that articulates with the concave hollow in the upper sternum is referred to as the:

 

glenohumeral joint.sternoclavicular joint.  Correctacromioclavicular joint.manubrium joint.  Incorrect

 

Explanation:

The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. There is no manubrium joint; it is the broad upper part of the sternum.

Question:

When assessing a patient with complaints consistent with carpal tunnel syndrome, which one of the following symptoms is unlikely?

 

Dropping objectsInability to twist lids off jarsTingling of the first three digits of the handNumbness of the last two digits of the hand  Correct

 

Explanation:

For complaints of dropping objects, inability to twist lids off jars, aching at the wrist or even the forearm, and numbness of the first three digits, consider carpal tunnel syndrome.

Question:

When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as:

 

de Quervain’s test.Finkelstein’s test.  CorrectTinel’s test.Phalen’s test.

 

Explanation:

When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in his palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as Finkelstein’s test. Tinel’s test assesses for median nerve compression. The examiner would tap lightly over the median nerve of the carpal tunnel. To test Phalen’s sign, the patient would hold his wrists in flexion for 60 seconds while pressing the backs of his hands together to form right angles APEA Ortho.

Question:

Olecranon bursitis may be caused by all of the following except:

 

gout.trauma.frozen shoulder.  Correctosteoarthritis.

 

Explanation:

Olecranon bursitis refers to swelling and inflammation of the olecranon bursa and may result from trauma, gout, or arthritis.

Question:

Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except:

 

hallux valgus.metatarsalgia.Achilles tendinitis.  CorrectMorton’s neuroma.  Incorrect

 

Explanation:

Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux valgus, metatarsalgia, and Morton’s neuroma. Achilles tendinitis more commonly occurs in runners and affects the posterior foot as opposed to the forefoot.

Question:

Upon examination of the foot and ankle, the nurse practitioner notes point tenderness over the posterior aspects of the right malleolus. Additionally, the patient is unable to bear weight after 4 steps. This finding is most consistent with:

 

Achilles tendinitis.  Incorrectan ankle fracture.   Correcta ligamentous injury.rheumatoid arthritis.

 

Explanation:

Point tenderness over the posterior aspects of the right malleolus with an inability to bear weight after 4 steps could be consistent with an ankle fracture. Rheumatoid nodules and tenderness may be associated with Achilles tendinitis. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Tenderness on compression of the foot is an early sign of rheumatoid arthritis.

Question:

The small intrinsic muscles are located:

 

at the anterior surface of the vertebrae. on either side of the midline of the vertebrae.  Incorrectbetween the vertebrae.  Correctin front of the cervical vertebrae.

 

Explanation:

The small intrinsic muscles are located between the vertebrae. Prevertebral muscles run in front of the cervical vertebrae, and they contract generally to flex the neck and bow the head. The paravertebral muscles are located on both sides of the vertebrae and extend downward to the entire spine. Muscles that attach to the anterior surface of the vertebrae include the psoas muscles and the muscles of the abdominal wall. APEA Ortho.

Question:

The nurse practitioner instructs the patient look upward at the ceiling. This maneuver assesses cervical:

 

flexion.extension.  Correctrotation.lateral bending.

 

Explanation:

Assessing neck extension occurs by asking the patient to look upward at the ceiling. Bringing the chin to the chest assesses flexion of the cervical spine. Looking over one shoulder and then the other assesses rotation of the neck. Asking the patient to bring his ear to his shoulder assesses lateral bending of the cervical spine.

Question:

Upon examination of the left shoulder, the patient complains of a dull, aching pain when attempting active or passive range of motion and localized tenderness with external rotation. These symptoms could be suggestive of:

 

a complete rotator cuff tear.adhesive capsulitis.  Correctrotator cuff tendinitis.  Incorrectcalcific tendinitis.

 

Explanation:

Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. It progresses to restriction of active and passive range of motion and tenderness with external rotation. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Reports of sharp “catches” of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain.

Question:

The area at the posterior aspect of the spine lateral to the sacroiliac joint is known as the:

 

posterior superior iliac spine.  Correctischial tuberosity.superior ramus of pubis.pubic symphysis.

 

Explanation:

The posterior superior aspect of the spine lateral to the sacroiliac joint is known as the posterior superior iliac spine. The ischial tuberosity is a large swelling posteriorly on the superior ramus of the ischium. It marks the lateral boundary of the pelvic outlet and bares most of the weight when sitting. The superior ramus of pubis are the pubic bones that help form the obturator foramen. The pubic symphysis is a cartilage-like articulation between the pubic bones.

Question:

Which nerve in the arm runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process?

 

Median nerveUlnar nerve  CorrectRadial nerveBrachial plexus

 

Explanation:

The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. APEA Ortho. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The brachial plexus runs from the spine through the neck, the axilla, and into the arm.

Question:

When examining the knee, the presence of a palpable fluid wave with the returning fluid wave into the suprapatellar pouch is noted. This positive sign for effusion of the knee is known as the:

 

balloon sign.  Correctbulge sign.  Incorrectballoting sign.McMurray’s sign.

 

Explanation:

A positive balloon sign for effusion in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. Balloting of the patella is tested by compressing the suprapatellar pouch and pushing the patella sharply against the femur. If fluid returns to the suprapatellar pouch, then an effusion of the knee is diagnosed. McMurray’s test checks for tears in the medial meniscus.

Question:

Dynamic stabilizers of the shoulder are referred to as those structures that are:

 

incapable of movement.capable of movement.   Correctbony structures of the shoulder girdle.  Incorrectresponsible for joint stability.

 

Explanation:

Dynamic stabilizers are capable of movement and include the SITS muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles move the humerus and compress and stabilize the humeral head within the glenoid cavity. Static stabilizers are incapable of movement and include the bony structures of the shoulder girdle, the labrum, the articular capsule, and the glenohumeral ligaments that add to joint stability.

Question:

A structural channel beneath the palmar surface of the wrist and proximal hand is known as the:

 

median nerve plexus.carpal tunnel.  Correctcarpal sheath.flexor retinaculum.

 

Explanation:

A structural channel beneath the palmar surface of the wrist and proximal hand is known as the carpal tunnel. The carpal sheath covers the tendons. The flexor retinaculum is the transverse ligament that holds the sheath in place. APEA Ortho.

Question:

When describing muscle strength, the term paraplegia means:

 

impaired strength.absence of strength.paralysis of all four extremities.paralysis of the legs.  Correct

 

Explanation:

Paraplegia means paralysis of the legs. Impaired strength is called weakness, or paresis. Absence of strength is called paralysis, or plegia. Quadriplegia means inability to move or paralysis of all four limbs.

Question:

A patient reports sharp “catches” of pain, grating, and weakness in the right shoulder when lifting the arm overhead. These symptoms could be suggestive of:

 

a complete rotator cuff tear.adhesive capsulitis.rotator cuff tendinitis.  Correctcalcific tendinitis.

 

Explanation:

Reports of sharp “catches” of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. APEA Ortho. It progresses to restriction of active and passive range of motion. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain.

Question:

The structure that encloses the spinal cord is known as the:

 

articular process.spinous process.articular facets.vertebral foramen.  Correct

 

Explanation:

The vertebral foramen encloses the spinal cord. The structure that projects from the spinal column posteriorly in the midline is referred to as the spinous process. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets.

Question:

When examining the patient for wrist adduction, the nurse practitioner instructs the patient with his palms down to:

 

point his fingers toward the ceiling. move his fingers toward the midline.   Correctmove his fingers away from the midline.point his fingers toward the floor.   Incorrect

 

Explanation:

Adduction occurs by moving fingers toward the midline. When examining the patient for wrist flexion, the nurse practitioner instructs the patient to position his palms down and to point his fingers toward the floor. Extension occurs with pointing fingers toward the ceiling. Abduction occurs by having the patient bring his fingers away from the midline.

Question:

An example of a cartilaginous joint would be the:

 

vertebral bodies of the spine.  Correctskull. shoulder.knee.

 

Explanation:

Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. The skull is an example of the fibrous joint.

Question:

When grading muscle strength, a five would indicate:

 

no muscular contraction detected.barely detectable trace of contraction.active movement of the body part with gravity eliminated.active movement against full resistance without fatigue APEA Ortho.  Correct

 

Explanation:

A grade of five for muscle strength would indicate active movement against full resistance without fatigue. Zero muscular strength would indicate no muscular contraction was noted on exam. A grade of one indicates a barely detectable trace of contraction noted on exam. For active movement of the body part with gravity eliminated, a grade of two would be noted.

Question:

With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a positive test for a:

 

lateral collateral ligament (LCL) tear.medial collateral ligament (MCL) tear.posterior cruciate ligament (PCL) tear.medial meniscal tear.  Correct

 

Explanation:

With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a medial meniscal tear or a positive McMurray test. The Adduction (Varus) Stress Test evaluates the function of the lateral collateral ligament, while the Abduction (Valgus) Stress Test evaluates the medial collateral ligament APEA Ortho. To test the posterior cruciate ligament, the posterior drawer sign would be assessed.

Question:

When examining the elbow for range of motion, the nurse practitioner instructs the patient to bend his elbow. This motion is an example of:

 

extension.flexion.  Correctsupination.pronation.

 

Explanation:

Instructing the patient to bend his elbow is an example of flexion. Extension occurs with straightening the elbow. Turning the palms upward demonstrate supination. Turning the palms downward demonstrates pronation.

Question:

The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses:

 

cervical flexion.cervical extension.rotation.lateral bending.  Correct

 

Explanation:

Looking over one shoulder and then the other would be assessing rotation of the neck and having the patient bring his ear to his shoulder would be assessing lateral bending of the neck. Assessing neck extension would be having the patient look upward at the ceiling. Bringing the chin to the chest would be assessing flexion of the neck.

Question:

The nurse practitioner instructs the patient to move his extended fingers so that each touches its nearest finger. This motion assesses the fingers and thumbs for:

 

adduction.  Correctabduction.flexion.  Incorrectextension.

 

Explanation:

Instructing the patient to make a fist with the left hand and to place his left thumb on top of the distal fingers assesses flexion. Extension occurs when the patient is able to completely move the fingers away from the palm and fingers are most distal from the palm. Asking the patient to move the fingers as far apart from each other as possible demonstrates abduction. The fingers must be kept in the same plane. The ability to move the fingers so that each digit touches the finger next to it assesses adduction. The fingers must be kept in the same plane.

Question:

The nurse practitioner would tap lightly over the median nerve in the carpal tunnel to assess:

 

Finkelstein’s test.Tinel’s test.  CorrectPhalen’s test.  Incorrectthumb abduction.

 

Explanation:

The examiner taps lightly over the median nerve in the carpal tunnel to assess Tinel’s sign. A positive Tinel’s test may indicate carpal tunnel syndrome. Asking the patient to point his thumb upward while the examiner applies downward resistance tests thumb abduction. To test thumb movement, instruct the patient to grasp his thumb against his palm and then move his wrist toward the midline in ulnar deviation. This maneuver is commonly known as Finkelstein’s test. To test Phalen’s sign, the patient would hold his wrists in flexion for 60 seconds while pressing the backs of his hands together to form right angles.

Question:

Which one of the following conditions can plantar fasciitis be associated?

 

Achilles tendinitisAn ankle fracture A ligamentous injuryRheumatoid arthritis  Correct

 

Explanation:

Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. This condition can be seen in prolonged standing or heel-strike exercise and also in rheumatoid arthritis, and gout.

Question:

A patient complains of shooting pains below the knee radiating into the lateral leg and calf. This type of low back pain is referred to as:

 

radicular low back pain.  Correctmechanical low back pain.lumbar spinal stenosis.pseudoclaudication pain.  Incorrect

 

Explanation:

Radicular low back pain, or sciatica, presents with shooting pains below the knee, into the lateral leg or posterior calf. It may be accompanied by paresthesias and/or weakness in the affected leg. Mechanical low back pain often arises from muscle and ligament injuries (~70%) or age-related intervertebral disc or facet disease. Common symptoms include aching pain in the lumbosacral area that radiates to the upper leg. APEA Ortho. Common risk factors include heavy lifting, poor conditioning, and obesity. Lumbar spinal stenosis or “pseudoclaudication” refers to pain in the back or legs with walking that improves with rest, lumbar flexion, or both.

Question:

Where the head of the humerus articulates with the shallow glenoid fossa of the scapula is known as the:

 

glenohumeral joint.  Correctsternoclavicular joint.acromioclavicular joint.  Incorrectmanubrium joint.

 

Explanation:

The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. There is no manubrium joint; it is the broad upper part of the sternum.

Question:

Which of the following symptoms would be suggestive of lumbar spinal stenosis?

 

Calf wastingThigh pain after 30 seconds of lumbar extension  CorrectAbsent ankle jerkLoss of normal lumbar lordosis

 

Explanation:

Lumbar spinal stenosis arises from hypertrophic degenerative disease of one or more vertebral facets and thickening of the ligamentum flavum, causing narrowing of the spinal canal. Symptoms include posture flexed forward, lower extremity weakness, hyporeflexia, and thigh pain after 30 seconds of lumbar extension. Calf wasting and absent ankle jerk are typically noted in patients with sciatica or disc disease. Loss of the normal lumbar lordosis is a common cause of low back pain.

Question:

When inspecting the face, asymmetry is noted. This finding could be suggestive of:

 

trigeminal neuralgia.temporomandibular joint dysfunction syndrome.  Correcttemporal arthritis.a normal finding.

 

Explanation:

Facial asymmetry can be seen in temporomandibular joint dysfunction syndrome (TMJ).

On ophthalmoscopic examination, optic atrophy appears:

White

APEA Ortho