NR 511 Final Exam Marking Scheme
One of the initial steps in assessing patients with musculoskeletal
complaints is to determine whether the complain is articular or nonarticular
in origin. Which of the following in an example of an articular structure?
A. Bone
B. Synovium
C. Tendons
D. Fascia - ANS-Synovium
You have detected the presence of crepitus on examination of a patient with a
musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with
both active and passive movement. These findings suggest that the origin of the
musculoskeletal complaint is:
A. Articular
B. Inflammatory
C. Nonarticular
D. A and B - ANS-Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain?
A. Decreased CRP
B.hyperalbuminemia
C. Morning stiffness
D. Weight gain - ANS-Morning stiffness
Which of the following statements concerning the musculoskeletal exam is true? A.
The uninvolved side should be examined initially and then compared to the involved
side
B. The part of the body that is causing the patient pain should be examined first C.
When possible, the patient should not be asked to perform active ROM exercises to
avoid causing pain
D. Radiographs should always be obtained prior to examination so as not to cause
further injury to the patient. - ANS-When possible, the patient should not be asked to
perform active ROM exercises to avoid causing pain
You are performing muscle strength testing on a patient presenting with musculoskeletal
pain and find that the patient has complete ROM with gravity eliminated. Which numeric
grade of muscle strength would you give this patient?
,A. 1
B. 2
C. 3
D. 4
E. 5 - ANS-B
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited
movement in her right shoulder. She denies any history of trauma. Her exam reveals a
75% reduction in both active and passive range of motion of the right shoulder. Mrs.
Gray is also experiencing tenderness with motion and pain at the deltoid insertion. Her
medical history is significant for type 1 diabetes mellitus and hypertension. Her social
history reveals that she is a secretary and that she is right-handed. Based on her exam
and medical history, you suspect adhesive capulitis or "frozen shoulder." Which clue in
Mrs. Gray's history supports this diagnosis?
A. HX HTN
B. Her affected shoulder is her dominant arm
C. Her HX of DM
D. Her work as a secretary predisposes her to repetitive motions - ANS-HX of DM
Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a
soccer game. Jennifer explains that she fell on her left side and kept her arm out
straight to break her fall. She has been experiencing severe pain and limited range of
motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated
shoulder. Which of the following statements are true concerning shoulder dislocation?
A. Posterior dislocations are more common than anterior dislocations B. There is a
risk of neurovascular and neurosensory trauma, so the clinician should check for
distal pulses
C. Recurrent dislocations are uncommon and would require great force to result in injury
D. Surgery is the most common treatment of choice - ANS-There is a risk of
neurovascular and neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal
tunnel syndrome. She has two young children and asks the clinician what the chances
are that they will also develop carpal tunnel syndrome. Which of the following responses
would be correct regarding the risk of developing carpal tunnel syndrome?
- Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to
account for about half the risk of developing carpal tunnel.
- Only people with occupations that require repeated flexion extension of the wrist, use
,of hand tools that require forceful gripping, or hand tools that vibrate are at risk for
developing carpal tunnel.
- An underlying musculoskeletal disorder must be present for a person to develop carpal
tunnel.
- Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. -
ANS-Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought
to account for about half the risk of developing carpal tunnel.
Which of the following statements is true regarding the treatment of carpal tunnel
syndrome?
A. The goal of TX is to prevent flexion and extension movements of the wrist B.
Splints are used in carpal tunnel syndrome, because they allow for free movement
the fingers and thumb while maintaining the wrist in a neutral position C
Corticosterioid injections are discouraged in the treatment of CTS because of the
risks for median nerve damage, scarring, and infection
D. All of the above - ANS-All of the above
Sam is a 25-year-old man who has been diagnosed with low back strain based on his
history of localized low back pain and muscle spasm along with a normal neurological
examination. As the clinician, you explain to Sam that low back pain is a diagnosis of
exclusion. Which of the following symptoms would alert the clinician to the more serious
finding of a herniated nucleus pulposus or ruptured disc?
A. Morning stiffness and limited mobility of the L spine
B. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
C. Fever, chills, and elevated ESR
D. Pathologic fractures, severe night pain, weight loss, and fatigue - ANS-Unilateral
radicular pain symptoms that extend below the knee and are equal to or greater than
the back pain
The clinician has instructed Sam, a 25 year old patient with low back strain, to use
NSAIDs to manage his symptoms of pain and discomfort. Which of the following
statements would be most appropriate when teaching Sam about NSAIDs? A. You
should start with the lowest dose that is effective in managing your pain, because
long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage.
B You should start with the lowest dose that is effective in managing your pain to avoid
developing tolerance to the medication
C. You should take the max recommended dose of NSAIDs so that you will not need to
, take narcotics to control your pain
D. It is important to take NSAIDs on an empty stomach in order to increase absorption -
ANS-You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage.
Janet is 30y/o woman who has been diagnosed with a herniated disc at the L5-S1. She
is currently in the emergency room with suspicion of cauda equina compression. Which
of the following is a sign or symptom of cauda equina compression? A. Paresthesia of
the perineum & buttock
B. A reduced or absent ankle reflex
C. Numbness in the lateral foot
D. Gastrocnemius weakness - ANS-Paresthesia of the perineum & buttock
Which of the following statements is true concerning the management of the client with
a herniated disc?
A. Muscle relaxants and narcotics can be used to control moderate pain but should be
d/c after 3 weeks of use
B. An epidural injection is helpful in reducing leg pain that has persisted for at least 3
weeks after the herniation occurred
C. Intolerable pain for more than a 3 month period is an indication for surgical
intervention
D All of the above - ANS-Intolerable pain for more than a 3 month period is an indication
for surgical intervention
John is a 16 y/o boy presents to your office after hurting his knee in a football game. He
described twisting his knee & then being able to extend it completely. John tells you he
heard a pop when the injury occurred & has been experiencing localized pain. You
suspect a meniscal tear. Which test would be most appropriate to assess for the
presence of a meniscal tear?
A. Lachman test
B. Vulgus stress test
C. McMurray circumduction test
D. Varus stress test - ANS-McMurray circumduction test
The clinician suspects that a clients has patellar instability. In order to test for this, the
client is seated with the quadriceps relaxed, and the knee is placed in extension.
Next
the patella is displaced laterally, and the knee is flexed to 30 degrees. If instability is
One of the initial steps in assessing patients with musculoskeletal
complaints is to determine whether the complain is articular or nonarticular
in origin. Which of the following in an example of an articular structure?
A. Bone
B. Synovium
C. Tendons
D. Fascia - ANS-Synovium
You have detected the presence of crepitus on examination of a patient with a
musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with
both active and passive movement. These findings suggest that the origin of the
musculoskeletal complaint is:
A. Articular
B. Inflammatory
C. Nonarticular
D. A and B - ANS-Articular
Which of the following signs or symptoms indicate an inflammatory etiology to
musculoskeletal pain?
A. Decreased CRP
B.hyperalbuminemia
C. Morning stiffness
D. Weight gain - ANS-Morning stiffness
Which of the following statements concerning the musculoskeletal exam is true? A.
The uninvolved side should be examined initially and then compared to the involved
side
B. The part of the body that is causing the patient pain should be examined first C.
When possible, the patient should not be asked to perform active ROM exercises to
avoid causing pain
D. Radiographs should always be obtained prior to examination so as not to cause
further injury to the patient. - ANS-When possible, the patient should not be asked to
perform active ROM exercises to avoid causing pain
You are performing muscle strength testing on a patient presenting with musculoskeletal
pain and find that the patient has complete ROM with gravity eliminated. Which numeric
grade of muscle strength would you give this patient?
,A. 1
B. 2
C. 3
D. 4
E. 5 - ANS-B
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited
movement in her right shoulder. She denies any history of trauma. Her exam reveals a
75% reduction in both active and passive range of motion of the right shoulder. Mrs.
Gray is also experiencing tenderness with motion and pain at the deltoid insertion. Her
medical history is significant for type 1 diabetes mellitus and hypertension. Her social
history reveals that she is a secretary and that she is right-handed. Based on her exam
and medical history, you suspect adhesive capulitis or "frozen shoulder." Which clue in
Mrs. Gray's history supports this diagnosis?
A. HX HTN
B. Her affected shoulder is her dominant arm
C. Her HX of DM
D. Her work as a secretary predisposes her to repetitive motions - ANS-HX of DM
Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a
soccer game. Jennifer explains that she fell on her left side and kept her arm out
straight to break her fall. She has been experiencing severe pain and limited range of
motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated
shoulder. Which of the following statements are true concerning shoulder dislocation?
A. Posterior dislocations are more common than anterior dislocations B. There is a
risk of neurovascular and neurosensory trauma, so the clinician should check for
distal pulses
C. Recurrent dislocations are uncommon and would require great force to result in injury
D. Surgery is the most common treatment of choice - ANS-There is a risk of
neurovascular and neurosensory trauma, so the clinician should check for distal pulses
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal
tunnel syndrome. She has two young children and asks the clinician what the chances
are that they will also develop carpal tunnel syndrome. Which of the following responses
would be correct regarding the risk of developing carpal tunnel syndrome?
- Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to
account for about half the risk of developing carpal tunnel.
- Only people with occupations that require repeated flexion extension of the wrist, use
,of hand tools that require forceful gripping, or hand tools that vibrate are at risk for
developing carpal tunnel.
- An underlying musculoskeletal disorder must be present for a person to develop carpal
tunnel.
- Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. -
ANS-Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought
to account for about half the risk of developing carpal tunnel.
Which of the following statements is true regarding the treatment of carpal tunnel
syndrome?
A. The goal of TX is to prevent flexion and extension movements of the wrist B.
Splints are used in carpal tunnel syndrome, because they allow for free movement
the fingers and thumb while maintaining the wrist in a neutral position C
Corticosterioid injections are discouraged in the treatment of CTS because of the
risks for median nerve damage, scarring, and infection
D. All of the above - ANS-All of the above
Sam is a 25-year-old man who has been diagnosed with low back strain based on his
history of localized low back pain and muscle spasm along with a normal neurological
examination. As the clinician, you explain to Sam that low back pain is a diagnosis of
exclusion. Which of the following symptoms would alert the clinician to the more serious
finding of a herniated nucleus pulposus or ruptured disc?
A. Morning stiffness and limited mobility of the L spine
B. Unilateral radicular pain symptoms that extend below the knee and are equal to or
greater than the back pain
C. Fever, chills, and elevated ESR
D. Pathologic fractures, severe night pain, weight loss, and fatigue - ANS-Unilateral
radicular pain symptoms that extend below the knee and are equal to or greater than
the back pain
The clinician has instructed Sam, a 25 year old patient with low back strain, to use
NSAIDs to manage his symptoms of pain and discomfort. Which of the following
statements would be most appropriate when teaching Sam about NSAIDs? A. You
should start with the lowest dose that is effective in managing your pain, because
long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage.
B You should start with the lowest dose that is effective in managing your pain to avoid
developing tolerance to the medication
C. You should take the max recommended dose of NSAIDs so that you will not need to
, take narcotics to control your pain
D. It is important to take NSAIDs on an empty stomach in order to increase absorption -
ANS-You should start with the lowest dose that is effective in managing your pain,
because long-term use of NSAIDs can result in GI disorders such as ulcers and
hemorrhage.
Janet is 30y/o woman who has been diagnosed with a herniated disc at the L5-S1. She
is currently in the emergency room with suspicion of cauda equina compression. Which
of the following is a sign or symptom of cauda equina compression? A. Paresthesia of
the perineum & buttock
B. A reduced or absent ankle reflex
C. Numbness in the lateral foot
D. Gastrocnemius weakness - ANS-Paresthesia of the perineum & buttock
Which of the following statements is true concerning the management of the client with
a herniated disc?
A. Muscle relaxants and narcotics can be used to control moderate pain but should be
d/c after 3 weeks of use
B. An epidural injection is helpful in reducing leg pain that has persisted for at least 3
weeks after the herniation occurred
C. Intolerable pain for more than a 3 month period is an indication for surgical
intervention
D All of the above - ANS-Intolerable pain for more than a 3 month period is an indication
for surgical intervention
John is a 16 y/o boy presents to your office after hurting his knee in a football game. He
described twisting his knee & then being able to extend it completely. John tells you he
heard a pop when the injury occurred & has been experiencing localized pain. You
suspect a meniscal tear. Which test would be most appropriate to assess for the
presence of a meniscal tear?
A. Lachman test
B. Vulgus stress test
C. McMurray circumduction test
D. Varus stress test - ANS-McMurray circumduction test
The clinician suspects that a clients has patellar instability. In order to test for this, the
client is seated with the quadriceps relaxed, and the knee is placed in extension.
Next
the patella is displaced laterally, and the knee is flexed to 30 degrees. If instability is
