NR511 Week 5 Quiz Latest 2020 MAY

NR511 Differential Diagnosis and Primary Care

Week 5 Quiz

Question 1A 55-year-old female presents to the clinic with complaints of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, the clinician notes tenderness at the “anatomical snuffbox.” This finding most likely indicates which of the following?

Scaphoid fracture.

Ulnar styloid fracture.

Hamate fracture.

Radial head fracture.

Question 2A 28-year-old male presents to the clinic for follow-up from the emergency department, where he was seen for right forearm pain 3 days ago. He works as a carpenter and is right hand dominant. He states he was diagnosed with right forearm tendinitis and is not sure what this means. As part of teaching, the clinician explains that the condition is caused by inflammation of one or more of the tendons. Which of the following describes tendons?

The collagen fibers that connect muscle to bone.

The pouches of synovial fluid that cushion bone and other joint structures.

The ropelike bundles of collagen fibrils that connect bone to bone.

The fibrocartilaginous disks that separate bony surfaces.

Question 3A conservative approach is recommended in the initial approach to the management of low back pain. Which of the following would be an appropriate treatment plan for a 32-year-old obese male (BMI 33) diagnosed with an acute lumbar strain?

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

Bedrest.

Surgery.

Epidural Steroid Injections (ESI).

Question 4A 10-year-old male presents to the clinic after jumping off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis. Based on the Salter-Harris classification of growth plate injuries, the clinician knows that this is a ______?

Salter-Harris V fracture.

Salter-Harris III fracture.

Salter-Harris IV fracture.

Salter-Harris II fracture.

Question 5A 48-year-old male presents with acute low back pain in the right that increases when standing and bending. Upon physical exam, lower extremity muscle strength is 5/5 and straigh leg raise test is negative. Which of the following is the most likely diagnosis?

Spondylolisthesis.

Osteoarthritis.

Muscle strain.

Herniated nucleus pulposus.

Question 6A 42-year-old professional golfer complains of chronic back pain for many years. His workup reveals that it is not the result of a degenerative disc problem. His back “goes out” about twice per year, and he is out of work for about a week each time. Which of the following should the clinician advise?

Make an appointment with a neurosurgeon for a surgical consultation.

Start on a daily low-dose narcotic to take away the pain.

Consider changing careers to something less physical.

Begin a planned exercise program to strengthen back muscles.

Question 7In assessing the skeletal muscles, the clinician turns the patient’s forearm so that the palm is face up. This is called:

Abduction.

Supination.

Eversion.

Pronation.

Question 8A 49-year-old female presents with low back pain radiating into the right leg,. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further?

Osteoarthritis.

Compression fracture.

Scoliosis.

Herniated nucleus pulposus.

Question 9A 55-year-old patient is able to complete range of motion (ROM) against gravity with some resistance. The nurse practitioner would assign which of the following numerical grades to this manual muscle testing description?

4

2

5

3

Question 10A 62-year-old woman presents to the clinic with chronic low back pain. She states she has developed episodes of fecal incontinence and numbness in her right leg over the last week. Upon examination the clinician notes decreased perianal sensation to pinprick. What should the clinician do next?

Prescribe physical therapy for 6 weeks.

Order a MRI.

Send the patient for Electromyelography (EMG) testing.

 Refer the patient to the Emergency Room (ER).

Question 11A 16-year-old male patient presents to the clinic after sustaining a football injury to his right knee. The clinician elicits a positive anterior/posterior drawer sign. This test indicates an injury to the ______?

Collateral ligament.

Medial meniscus.

Lateral meniscus.

Cruciate ligament.

Question 12A 13-year-old obese (body mass index [BMI] above the 95th percentile) boy reports low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits to frequent “horseplay” with his friends. The pain has progressively worsened, and he is now unable to bear weight at all on his left leg. His current complaints include left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and external hip rotation with knee flexion. Based on the above scenario, the clinician should suspect which of the following?

A left meniscal tear.

 A left anterior cruciate ligament (ACL) tear.

 A slipped capital femoral epiphysis (SCFE).

Osgood-Schlatter disease.

Question 13The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests to check the integrity of the ligaments of the knee. Which of the following would the clinician choose to assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury?

Thumb sign.

Lachman test. 

Valgus stress test.

Varus stress test.

Question 14A 55-year-old female patient presents with complaints of pain and paresthesias in the left ulnar aspect of the forearm, thumb, and middle finger following a C6 & C7 nerve root dermatomal pattern. This is known as ________?

Brachial plexus neuritis.

Cervical radiculopathy.

Thoracic outlet syndrome.

Peripheral polyneuropathy.

Question 15A 16-year-old boy presents to the office with complaints of low back pain after lifting heavy boxes. In discussing with him proper body mechanics to prevent future injuries, the clinician should advise which of the following?

  “Keep your feet firmly together.”

 “Hold boxes away from your body at arm’s length.”

 “Bend your knees and face the object straight on.”

 “Bend and twist simultaneously as you lift.”