Nurs 623-624 exam with correct answers 2023-24

Nurs 623-624 Exam 4 2023-24 •Anterior drawer test has a low sensitivity and high specificity for confirming ACL pathology, so a positive test strongly suggests a problem but a negative test does not rule out an ACL tear. - correct answer A positive test strongly suggests a problem but a negative test does not rule out an ACL tear. When assessing the patient with musculoskeletal problems, it is important to determine if the problem is: - correct answer acute or chronic, articular or nonarticular, inflammatory or noninflammatory, and localized or systemic in distribution. Acute (less than 6 weeks duration) or chronic (more than 6 weeks duration), Flammatory or inflammatory Articular structures - correct answer • synovium, • synovial fluid, • articular cartilage, • intra-articular ligaments, • joint capsule, • juxta-articular bone Articular problems are characterized by - correct answer deep or diffuse pain, • deep or diffuse pain, • limited ROM (passive & active), • swelling, • crepitation, • instability, • 'locking', • Deformity Nonarticular (or periarticular) structures - correct answer • identified as supportive extra-articular ligaments, • tendons, • bursae, • muscle, • fascia, • bone, • nerve, • overlying skin • Nonarticular disorders are characterized by - correct answer painful active, but not passive ROM, • demonstrated point or focal ternderness in regions distinct from articular structures, • physical findings far from the joint capsule. • Usually do not find crepitus, instability or deformity History - correct answer • Chronology of complaint gives important diagnostic clues • onset, or did it develop over some time • evolution of the problem, such as chronic, intermittent, • migratory and duration of the problem. Physical Examination - correct answer • Distinguish between mechanical problems, soft tissue disease, and noninflammatory and inflammatory joint disease. • Inspecting the involved site and observe for side to side symmetry • The uninvolved side should be examined first and compared with the involved side (this will mean the painful portion of the exam will be last) • evaluate for warmth over the joint, joint effusion, and pain on joint motion. You should have the patient perform as much active ROM as possible during the exam, Low Back Pain - correct answer • Also called low back strain or lumbar strain • Injury to paravertebral spinal muscles, ligamentous injuries, disc herniation or leaking of substances from nucleus pulposus • Back pain associated with neurological deficit, decreased or absent pulses, or bowel or bladder dysfunction is potentially life threatening & warrants immediate referral. • Low back pain is a common complaint seen in primary care. • Pain may be caused by a herniated disc or from leaking of substances from the nucleus pulposus that can induce inflammation and cause irritation. • often difficult to localize an injury to a specific structure. Chronic low back pain is - correct answer pain that lasts longer than 3 months. Symptoms associated with chronic low back pain are - correct answer typically recurrent and episodic, but may be unremitting. Treatment for injury to muscle and ligamentous structures is similar. - correct answer Acute vs. chronic Acute LBP will often spontaneously resolve and the patient may be back to functioning normally within a month Factors to consider in diagnosing cause of pain: - correct answer • Age, pain onset (acute or insidious), • Pain location as unilateral or bilateral can help differentiate among these differentials. • Pain increases. Pain decreases, Straight-leg raising Younger patients, under 50 years of age, are more likely to have - correct answer spondylolisthesis, • muscle strain, • scoliosis, • herniated disc. Older than 50 are more likely to have pain - correct answer related to arthritis, • spinal stenosis, Pain onset, insidious • acute a herniated disk or leaking substances from the nucleus pulposus can induce - correct answer •inflammation and cause irritation. Acute Lumber Radiculopathy - correct answer Herniated disc, acute lumbar radiculopathy, Sciatica sciatica - correct answer • cause unilateral radicular pain. • The pain may extend below the knee and the leg pain may be equal to that of the back pain. • often acute in onset, pain increases when sitting or bending, decreases when standing, straight leg raise will be positive. xray will be negative with a herniated disc, so further diagnostic testing may be indicated. Treatment for back pain includes: - correct answer Meds and non-pharmacological treatment Meds for back pain are - correct answer Acetaminophen, NSAIDs , Muscle relaxants, and Opioids. Muscle relaxants (needed for short term therapy, generally less than a week ). • Opioids • should be used cautiously, as there is a substantial risk for physical dependence with this class of medications. Risk for NSAIDS: - correct answer • most appropriate when teaching about the use of NSAIDs to manage pain - think GI issues with NSAIDs. • Long-term use of NSAIDs can lead to serious GI issues, such as ulcers and hemorrhage, so this class of medications should be used cautiously and at the lowest possible dose. Benefit of Acetaminophen vs NSAIDs - correct answer acetaminophen has less of a risk for adverse effects and has comparable efficacy. Non-pharmacologic treatment - correct answer Activity. Participate in about 30 minutes a day of exercise that is tolerable. Rest has not been proven to help in resolving back pain Referral for back pain - correct answer • not find enough pain relief with pharmacological therapy • pain lasts for more than 3 months and is not alleviated with medication, the patient should be referred to a surgeon for evaluation. • Surgical intervention for herniated disc • neurosurgeon or orthopedic surgeon may be needed in particular cases. Dementia - - correct answer long term, continues decline Meds for Dementia - correct answer o Namenda (less S/E) o Aricept (s/e - Nausea, GI upset, Diarrhea) PT Education Does not reverse dementia, slows down progression 3 types of dementia - correct answer o Lewis body dementia, Vascular Dementia, and Alzeheimers Dementia. Related to Parkinson's Areas of the brain are "muted" from Parkinson's eating away at the brain o Vascular Dementia Related to people with CVA's Areas of blood flow is cut off causing dementia Behaviors are harder to control o Alzheimers Dementia Lewis Body Dementai - correct answer Related to Parkinson's. Areas of brain is "muted" from Parkinson's eating away at the brain o Vascular Dementia - correct answer Related to people with CVA's, Areas of blood flow is cut off causing dementia, Behaviors are harder to control Alzheimers Dementia - correct answer type of dementia that is seen in individuals over 65 Delirium - - correct answer short term (acute onset), Usually self-resolves once the medical issue is taken care of (i.e. anesthesia out of system, etc.), Anti-psychotics - Seroquel, Risperdal (short length of need), Urinary Incontinent, and confusion Geriatric - correct answer § Start low, go slow (start with low doses and slowly increase) § Will see a lot more autoimmune disorders o RA will be more severe, seeing contractures, o Herbeden's nodes from OA, o petechiae on arms, o bruising o not tolerating meds as well Syncope - correct answer Usually related to Cardiovascular system and also needing Neurological evaluation The greatest risk of long term complication for Geriatic population - correct answer is related to a hip fracture, if you have a fall and break your hip, you are more likely to not do as well as you would if you fell and broke ankle and wrist. If they take a PPI, you want to try and get them off, because PPI's can increase the risk of fracture by 29%. What is the psoas sign? - correct answer Right lower quadrant pain is elicited when the patient extends the hip. while lying on their left side. The pain is due to inflammation of the peritoneum overlying the psoas muscles and inflammation of the psoas muscles themselves. Straightening out the leg causes the pain because it stretches the muscles, and flexing the hip into the "fetal position' relives the pain. OBTURATOR'S SIGN - correct answer Pain is elicited on passive internal rotation of the flexed thigh. Examinator moves the lower leg laterally while applying resistance to the lateral side of the knee resulting in internal rotation of the femur. Musculoskeletal Problems - correct answer Musculoskeletal problems are common complaints in primary care. They are a frequent cause of disability in the working population. Proper diagnosis of the musculoskeletal problem is essential. Certain conditions left untreated can lead to progressive joint instability and a higher risk of further injury if the recovery is not complete. Rule out any musculoskeletal injuries. Cauda equine - correct answer Complication of herniated disc • Herniation of discs L1 to S1 may be involved Multiple lumbar nerve root compressions Medical emergency ambulance ride to the hospital; requires immediate decompression Whenever you are diagnosing a patient, it is important to always think "What can I not afford to miss?" Well when it comes to back pain, cauda equine is the diagnosis you do NOT want to miss Symptoms of cauda equina syndrome - correct answer Symptoms are Leg weakness, Saddle area anesthesia (perineum and buttocks), Bowel or bladder incontinence, Impotence Whenever you are diagnosing a patient with back pain, it is important to always think "What can I not afford to miss?" - correct answer Cauda equine is the diagnosis you do NOT want to miss. • Back pain that is associated with neurological deficit, decreased or absent pulses, or bowel or bladder dysfunction. - correct answer potentially life threatening & warrants immediate referral. Carpal Tunnel Syndrome • - correct answer Peripheral Nerve Compression • Entrapment neuropathy • Compression of median nerve • Paresthesia and numbness in median distribution Clinical Presentation of Carpal Tunnel Syndrome - correct answer Symptoms are often in the dominant hand. Carpal tunnel is more common in women • Subjective complaints of Carpel Tunnel Syndrome: o - correct answer Paresthesias and numbness in a median distribution, which involves the: 1. thumb and index finger, 2. middle or long finger, 3. radial half of ring finger. o Repetitive motions or stationary tasks for long periods of time worsen the pain and numbness. o A patient may awaken at night from the pain and burning, numbness in the fingers. numbness in thumb and 1, 2 digits of right hand. back in Which of the following would you include in your physical exam? • Objective exam of Carpel Tunnel includes: - correct answer inspection of the wrist, hands, and fingers. Assessment should include the Phalen's maneuver, Tinel's sign, Carpal compression test Diagnostic tools of Caerpel Tunnel Syndrome: - correct answer Median nerve conduction velocity study (EMG??), Palen's Test and Tinel's Sign Disadvantage at EMG (Median nerve conduction velocity study: - correct answer Invasive, Expensive. Measures the velocity of sensory conduction nerve entrapment that may be conclusively validated. May be abnormal without s/s of CPT Management of Carpet Tunnel Syndrome: - correct answer Conservative, Splint, NSAIDS, Corticosteroid injections. and Surgery Goal of treatment for Carpel Tunnel Syndrome - correct answer prevent flexion and extension movements of the wrist Drug of choice for treatment of Carpel Tunnel Syndrome - correct answer Oral NSAIDs are the drug of choice, provided the patient is a good candidate Corticosteroids are discouraged because - correct answer these can lead to nerve damage, scar tissue, or infection. The advantages of a splint for treatment of Carpel Tunnel - correct answer it allows free movement of the fingers and thumb can help keep the wrist in a neutral position. Surgery is a good idea for carpel tunnel when: • - correct answer Surgery may be needed for unremitting symptoms when conservative treatment has failed to be effective for the patient. Osteoarthritis - correct answer • Degenerative joint disease, • Most common articular disease in those over 45 years of age, • Gradual and progressive • leading cause of disability • Prevalence in men and women is equal • Loss of articular cartilage and degeneration Primary osteoarthritis results from: - correct answer advancing age, obesity, occupational overloading of joints, or familial type II collagen gene polymorphisms. Classifications of Osteoarthritis - correct answer Primary & secondary classifications Secondary osteoarthritis may develop from - correct answer after trauma, infections, osteonecrosis, congenital malalignment, or with inflammatory arthritis or metabolic disease. herpes zoster infection of CN5 opthalamix branch - correct answer can result in corneal blindness. Rash at tip of nose and temple area - correct answer Rule out shingles infection of the trigeminal nerve.SOA Headache treated with high-dosed oxygen - correct answer cluster headache. Headache treated with high-dosed anticonvulsants: - correct answer trigeminal neuralgia. Muscle tension headaches - correct answer only bilateral headache Muscle Tension Headache - correct answer Bandlike head pain; may last for days. Migraine headache - correct answer Throbbing, nausea, photophobia, phonophobia. Trigeminal neuralgia, the fifth cranial nerve(tic douloureux): - correct answer Pain on one side of face/cheek is precipitated by talking, chewing, cold food, or cold air on affected area. Low back pain (LBP), is also referred to as: - correct answer low back sprain or lumbar sprain is an injury to the paravertebral spinal muscles. The term may also describe ligamentous injuries to the facet joints or anulus fibrosus. Temporal arteritis: - correct answer Indurated temporal artery, pain behind eye/scalp. cluster headache - correct answer Only HA accompanied by tearing and nasal congestion; severe pain is behind one eye/one side of the head. It occurs several times a day. Spontaneously resolves. Seen more in middle-aged males. Risk factors of osteoarthritis include - correct answer genetics, being female, • joint injury, • past trauma, • advancing age, • obesity, • mechanical stress Most common symptoms of osteoarthritis - correct answer Joint pain Other common symptoms os osteoarthritis - correct answer Pain tends to worsen with activity, Morning joint stiffness; generally lasts about 30 minutes, Joint locking or instability Diagnosis of oteoarthritis: • - correct answer history & physical exam is often enough information • Xrays help confirm diagnosis and rule out other conditions. Treatment goals - correct answer • Alleviate pain and Improve functional status Pharmacologic treatment of osteoarthritis - correct answer Acetaminophen, NSAIDs, Tramadol, • Topical capsaicin, Biofreeze, Bengay, IcyHot, Lidoderm patch, • Intra-articular injections, should be limited to 3-4 per year Non-Pharmacologic treatment of osteoarthritis - correct answer Weight loss, joint protection, Exercise for muscle strengthening: for the knee, Quadriceps strengthening Weight-bearing exercise; home safety, Complementary therapies (with standard medical treatment): acupuncture, acupressure, and Tai-Chi osteoporosis characteristics - correct answer Generalized skeletal disorder • Normal bone mineralization, but low bone mass (bone mineral density) and disruption of the bony architecture • Results in an increased risk of fragility fractures • recommended by the American Association of Clinical Endocrinologists (AACE) that all perimenopausal and postmenopausal women be evaluated for Osteoporosis if they are willing to be treated if a low bone mineral density is found (DEXA) - correct answer measures bone density in the spine, hips, and forearms, as a baseline after menopause, with frequency as recommended by MD Clinical clinical manifestation of osteoporosis - correct answer vertebral and hip fractures, but any skeletal site can be affected. Osteoporosis characteristics - correct answer More common in females than males, more common is white women than black, Hispainc & asian women prevalence same as white women. Modifiable risk factors of osteoporosis - correct answer Lifestyle factors: ie. Low body weight, smoking, xcessive alcohol, Low dietary calcium or vitamin D. Disease-related risk factors of osteoporosis - correct answer Autoimmune disorders such as rheumatoid arthritis, ulcerative colitis, psoriasis, and thyrotoxicosis, among others Medication-related risk factors of osteoporosis - correct answer Glucocorticoids excessive thyroxine, and long term phenytoin use Other risk factors of osteoporosis - correct answer Age, family history, genetics, postmenopausal Diagnosis of osteoporosis - correct answer Clinical assessment alone is often not enough • Risk assessment tool: SCORE instrument • Bone Mass Density by densitometry: gold standard for diagnosis, definitive for diagnosing either osteopenia or osteoporosis. LBP is also defined as: - correct answer activity intolerance because of lower back or back-related leg symptoms of less than 3 months' duration Back pain can be life-threatening when: - correct answer associated with a neurological deficit, decreased or absent pulses, or boweland bladder dysfunction is potentially life threateningand warrants immediate referral Back pain is second only to headache as - correct answer the reason for a complaint of pain. The pain may be described as "mechanical" . - correct answer it is back pain that is aggravated by activities such as bending, stooping, or twisting. Back pain is second only to - correct answer headache as the reason for a complaint of pain. What is paresthesia? - correct answer sensation of numbness, prickling, or tingling experienced in central and peripheral nerve lesions What are the causes of paresthesia? - correct answer cervical radiculopathy, brachial plexus neuritis or radiculitis, thoracic outlet syndrome, femoral neuropathy, peripheral polyneuropathy- DM, Guillain-Barre, alcoholism, vit b deficiencies, AIDS, hypothyroidism, amyloidosis, and renal failure What is paresis - correct answer Paresis is weakness. It may be local to a single extremity or the face, or it may involve more than one extremity What are differences in paresthesia and paresis ? - correct answer Paresthesia is an abnormal sensation described as numb-ness or tingling, cramping, or pain without a known stimulus, felt along peripheral nerve pathways. Paresis is weakness. It may be local to a single extremity or the face, or it may involve more than one extremity. Paresis may develop suddenly or gradually and may be permanent or transient. Differences in paresthesia and paresis: - correct answer Feelings associated with paresthesia are annoying "pins and needles" sensations that often cause the patient to touch or rub the affected area. Paresthesia is a common complaint, especially in patients with certain systemic diseases or those on certain drugs Neck pain subjective - correct answer pain- middle to lower part of posterior neck, headache (occipital), pain may radiate to shoulders but not down the arm, pain is usually dull, aching exacerbated by movement and alleviated by rest. Can have fatigue, sleep disturbance, irritability, and difficulty concentrating. Neck pain objective - correct answer Decreased ROM, Spurling's sign is negative, tenderness with palpation over both the anterior and posterior structures of the cervical spine, specifically the paraspinous muscles, spinous processes, interspinous ligaments, or medial border of the scapula. The shoulder exam, as well as the remainder of the physical exam, is typically norma Dupuytren's contracture - correct answer visible, palpable fibrous bands, reminiscent of tendons, can extend from the palm to the proximal interphalangeal joint of Dupuytren-affected fingers. Patients have trouble grasping objects, pulling on gloves, and putting hands in pockets. DeQuevain's tenosynovitis - correct answer Pain at the base of the thumb or at the radial styloid process on abduction and extension of the thumb. Presents with pain at the radial side of the wrist, usually with lifting. This pain is aggravated by attempts to move the thumb or make a fist. Patients may complain of pain while turning a key or a doorknob or while attempting to open a jar. a. McMurray circumduction test- b. - correct answer meniscal tear Apprehension sign (Fairbank test)- - correct answer patella instability Lachman test- - correct answer anterior cruciate ligament Valgus stress test- - correct answer medial collateral ligament (MCL) Varus stress test- - correct answer lateral collateral ligament (LCL) Cornerstone of OA therapy - correct answer • Nonpharmacological interventions which include the following: o Patient education, Heat and cold, Weight loss, Exercise, Physical therapy, Occupational therapy, Unloading in certain joints (e.g., knee, hip) • Prescribing in older adults - correct answer o Start low and go slow, Use caution before starting medications, Remember to discontinue medications Do not go for new drugs unless proven safe in elderly Review medications at every visit . Beers Criteria - correct answer List of medications use with caution in age > 65 due to potential for harmful effects How would you differentiate a diagnosis of bacterial meningitis from a migraine headache? - correct answer • Patients with bacterial meningitis usually present with a triad of symptoms: fever, headache and nuchal rigidity. Migraine do not have nuchal rigidity or fever Purulent forms of acute meningitis are usually caused by what three types of bacteria? - correct answer H influenzae, • N meningitidis, • S pneumoniae What is the main principle in the management of stroke prevention? - correct answer • The main principle in the management of stroke is prevention and early recognition and treatment What are the two types of cerebrovascular accidents (CVAs)? - correct answer ischemic and hemorrhagic Describe the most often causes of the two different types of CVAs. - correct answer Causes of ischemic stroke - correct answer obstructions from atherosclerosis, embolus, thrombus, hemorrhage or vasospasm. Causes of hemorrhagic stroke - correct answer intracerebral hemorrhage from ruptured aneurysms, arteriovenous malformation, hypertensive arteriolar dis-ease, and amyloid deposition What are the principal goals for the management of multiple sclerosis? - correct answer to delay the progression of the disease, manage chronic symptoms, and treat acute exacerbations. What is the mainstay of treatment for acute exacerbations of multiple sclerosis? - correct answer Glucocorticoids Multiple Sclerosis is commonly diagnosed in what age group? - correct answer MS is most commonly diagnosed between ages 20 and 50. The first symptoms of the disease usually occur between ages 20 and 40. What is the most common initial (early) symptom of multiple sclerosis? - correct answer spinal cord syndrome with spastic paraparesis and no clear sensory level. Progressive weakness and spasticity (stiffness) of the legs. Early phase of MS o - correct answer Presents with symptoms that may last from days to months and may disappear abruptly. The initial symptom of MS - correct answer is often blurred or double vision, red-green color distortion, or sometimes even blindness in one eye. Second most common complaints of MS - correct answer speech impediments, tremors, and dizziness • LHERMITTE SIGN - correct answer (electric shock-like sensations that run down the back and/or limbs upon flexion of the neck) • Essential tremor, action tremor, tremor when affected limb is being used. • Sensory disturbances of the extremities, • spasticity and weakness of legs, MOST COMMON • bladder and bowel dysfunction, • ataxic gait, paresthesia's in the extremities, fatigue, optic neuritis, and trigeminal neuralgia. - correct answer The most common immune-mediated inflammatory demyelinating disease of the central nervous system - correct answer multiple sclerosis (MS). What are the principle goals for management of multiple sclerosis? - correct answer Decrease relapse rate and Slower accumulation of brain lesions on MRI embolic stroke - correct answer Afib hemorrhagic stroke - correct answer HYPERTENSIVE VASCULOPATHY • Amyloid angiopathy • Ruptured saccular aneurysm • Vascular malformation Hemmorhagic stroke - correct answer Most common cause of stroke . What is the practice guideline for the initial imaging study for patients with suspected acute CVA (and why)? - correct answer CT scan is most successful and cost effective. CT scan is easier to access than other sources. CT is still included in ACLS guidelines. CT within three hours to rule out hemorrhagic/determine ischemic to initiate TPA. What is the main principle in the management of stroke prevention? - correct answer Manage modifiable risk factors. Aspirin . Describe how you would educate the patient on the signs of a CVA? How can you tell if someone is having a stroke? - correct answer Think FAST What are the recommendation for antibiotics if you suspect bacterial meningitis? - correct answer Vancomycin Plus Cefotaxime or Ceftriaxone X's 7 days ESR (Erythrocytes Sedimentation rate) - correct answer Most useful for diagnosis of Temporal arteritis, Rheumatoid arthritis, and polymyalgia rheumatica. ESR is not diagnostic of any particular disease but rather - correct answer it is an indication that the disease process is ongoing and must be investigated NSAID's Cardiovascular effects - correct answer Increase risk for adverse cardiovascular events including MI and stroke, can exacerbate heart failure. Presenting s/s of Multiple sclerosis which typically presents in a young adult with a clinically isolated syndrome suggestive of MS - correct answer optic neuritis, long tract symptoms/signs (eg, numbness, paresthesia, or weakness), a brainstem syndrome (eg, internuclear ophthalmoplegia), or a spinal cord syndrome (eg, transverse myelitis). A Approximately 5 to 10 percent of adult patients have the primary progressive form of MS, - correct answer which presents with gradual accumulation of disability from the onset, without superimposed acute relapses. •Lachman test: - correct answer 94% specific and is helpful in diagnosing anterior cruciate ligament (ACL) injury. •McMurray and Apley tests - correct answer Indicated in diagnosing meniscal tears. Posterior drawer test - correct answer used to diagnose posterior cruciate ligament (PCL) injury. •Collateral ligament stress test - correct answer also known as the valgus and varus stress tests, evaluates the intact function of the medial collateral ligament (MCL) and the lateral collateral ligament (LCL), respectively. Fairbank test, also known as the Apprehension test - correct answer identify dislocation of the patella. Knee exam - correct answer •Inspect both knees anteriorly and posteriorly. •Observe the gait,•Inspect the knees for swelling, ecchymosis, erythema, abrasions, puncture wounds, and active range of motion (ROM), •Assess the popliteal space for swelling that may occur with popliteal aneurysm, Baker's cyst, and tumors. As the patient lies supine, palpate the joint line, muscles, tendons, ligaments, and bones in an attempt to localize tenderness. Knee Exam (cont) - correct answer An effusion may be demonstrated by eliciting the bulge sign: As the patient lies supine, massage the medial knee toward the head, then stroke the lateral aspect of the knee toward the medial aspect. A bulge sign or effusion is indicated if fluctuance occurs over the medial aspect. Palpation for crepitus while the knee is passively flexed and extended helps to determine if meniscal injury is present. • Do muscle testing of the quadriceps and hamstrings. Differential diagnosis for shoulder pain - correct answer Musculoskeletal disease, Trauma, Neurovascular problems, Systemic Disease - correct answer Apley scratch test, Internal/external in flexion, Internal/external in abduction. Low Back Pain Treatment - correct answer Acetaminophen, NSAIDs, Muscle relaxants, and opioids (rarely used). Muscle relaxants - correct answer No more effective thn placebo but no evidence they are better than NSAIDs in relieving symptoms of acute LBP. Can be addictive and a CNS suppressant. Cause dry mouth. Recommended activity for back pain. - correct answer Continue daily activity that is tolerable. Weight loss, physical activities, and exercise for 30 minutes a day, walking or biking with lumbar flexion and/or extension exercises) is important. HIp evaluation begins with: - correct answer Assessment of gait. Additional assessment of hip includes - correct answer Passive ROM to detect creitus, limitation of movement, muscle spasm, flexion contracture, or guarding. Flexion and extension need to be performed with the knee straight as well as flexed. Flexion and extension should be assessed with knee flexed and well as straight. Other assessment of hip includes - correct answer Abduction, adduction, and internal and external rotation are assessed. Femoral and pedal pulses are auscultatied for strength and bruits. Neurological testing of hip includes - correct answer Testing for sensation and deep tendon reflexes concldes the exam. Diagnositc testing of the hip should include - correct answer hip X-ray films. Knee Exam: - correct answer Inspection of both knees, observe the gait, assess the popliteal space for swelling due to popliteal aneurysm, baker;s cyst, and tumors. Knee exam continued: - correct answer Inspect the knee for swelling, erythema, abrasions, puncture wounds, and active range of motion. Palpate the knee joint for - correct answer •muscles, tendons, ligaments, and bones in an attempt to localize tenderness. Palpation for crepitus while the knee is passively flexed and extended helps to determine if meniscal injury is present. What is the bulge sign? - correct answer As the patient lies supine, massage the medial knee toward the head, then stroke the lateral aspect of the knee toward the medial aspect. A bulge sign or effusion is indicated if fluctuance occurs over the medial aspect. What does a postiive bulge sign indicate? - correct answer An effusion may be demonstrated by eliciting the bulge sign: Knee testing - correct answer Lachman test, McMurry test, Apley tests, Anterior drawer test, Posterior drawer test, Collateral ligament stress test, (Valgus and Varus stress tests, and Fairband test (Apprehension test). Lachman test: - correct answer 94% specific and is helpful in diagnosing anterior cruciate ligament (ACL) injury Indicated in diagnosing meniscal tears. - correct answer McMurray and Apley tests Anterior drawer test: - correct answer low sensitivity and high specificity for confirming ACL pathology, so a positive test strongly suggests a problem but a negative test does not rule out an ACL tear Posterior drawer test is used to - correct answer diagnose posterior cruciate ligament (PCL) injury. diagnose Collateral ligament stress test, also known as the valgus and varus stress tests, - correct answer evaluates the intact function of the medial collateral ligament (MCL) and the lateral collateral ligament (LCL), respectively. Fairbank test, - correct answer also known as the Apprehension test, can identify dislocation of the patella. Osteo DX - correct answer BMD measurement by densitometry is currently considered the gold standard diagnostic test for definitively diagnosing either osteopenia or osteoporosis. Osteopenia - correct answer The diagnostic term used when BMD is found to be less than normal but not severe enough to be considered osteoporotic. BMD densitometry is - correct answer noninvasive and can be completed in 5 to 15 minutes. The GOld Standard for dicumenting osteoporosis of the proximal femur and lumbar spine - correct answer dual-energy x-ray absorptiometry (DEXA) GOUT Tx - correct answer Avoid thiazide diuretics, Prophylaxis after 2nd or 3rd attack with colchicine or Probenecid or allourinol to decrease uric acid levels. Avoid high purine foods. Confusion - correct answer NOt a disease process or state but symptom of something going on, Inability to think quickly of coherently, Usually demonstrates impairment of cognitive functioning, anappropriate reactions to stimuli, sudden or gradual, temporary or irreversible, many have precipitating factors, polypharmacy, Types of headaches: - correct answer Muscle contraction (tension) , Vascular (migraine or cluster, Mixed (combo or the two) Traction or inflammatoryl Muscle contraction - correct answer most common is young adults, females most severe, 40% family hx. Traction or inflammatory: - correct answer Abrupt, severe, explosive-emergency secondary to intracranial bleed. Vascular headache - correct answer Migraine or cluster Peripheral Neuropathies causes: - correct answer Diabetes, Nerve Compression, or pinched nerve, Bit B12 or folate deficiency. Reduction of blood supply resulting in nerve tissue damage. Pheripheral neuropathy is defined as - correct answer Easkness, numbness and pain in hands of feet Medial Nerve innervates: - correct answer Thumb, index finger, middle finger, and 1/2 of ring finger What is dizziness? - correct answer Dizziness is feeling lite headed, disoriented, or an altered state of balance. What is Vertigo - correct answer Vertigo is the feeling of spinning when you are not moving. Peripheral vertigo - correct answer more common,inner ear etiology (e.g. semicircular canal debris, vestibular nerve infection, Meniere disease) positional testing-->delayed horizontal nystagmus. An illusion of movement Central vertigo - correct answer Brain stem or cerebellar lesion (e.g., vestibular nuclei, posterior fossa tumor). Positional testing --< immediate nystagmus in any direction; may change directions. Disequilibrium - correct answer a sense of imbalance that occurs primarily when walking.