NURP 502 Exam 4 Questions and answers
2025
What .are .the .sprain .classifications? .- .ANS✓✓-Grade .I: .ligament .is .minimally
.torn, .stable .joint
Grade .II: .partial .tear, .greater .instability
Grade .III: .complete .tear, .complete .instability
Grade .I .sprain? .- .ANS✓✓-involves .minimal .tearing .of .ligament .and .associated
.fibers, .as .well .as .a .varying .degree .of .internal .hemorrhage .(A).
Grade .II .sprain? .- .ANS✓✓-Second-degree .sprain .usually .results .in .definite
.structural .breakdown .as .a .result .of .partial .tearing. .Hemorrhage .is .both .internal
.and .periligamentous, .with .moderately .extensive .inflammatory .edema .(B).
Grade .III .sprain? .- .ANS✓✓-is .most .severe .and .often .involves .complete .rupture
.of .the .ligament .body .(C).
Avulsion .at .the .points .of .origin .or .insertion .usually .results .in .one .or .more
.small .bone .fragments, .which .may .often .be .identified .radiographically .(D).
What .is .a .STRAIN? .- .ANS✓✓-is .a .stretching .or .tearing .of .muscle .or .tendon
What .is .tendonitis? .- .ANS✓✓-Tendonitis .is .the .inflammation, .irritation, .and
.swelling .of .a .tendon. .It .can .occur .as .a .result .of .injury, .overuse, .or .with .aging
.as .the .tendon .loses .elasticity. .Any .action .that .places .prolonged .repetitive
.strain .on .the .forearm .muscles .can .cause .tendonitis. .The .most .common
.symptom .of .tendonitis .is .pain, .tenderness, .and .the .increase .of .pain .with
.movement.
What .conditions .are .you .look .for .with .acute .back .pain? .- .ANS✓✓-Infection
Cauda .equina
Vertebral .compression .fractures
Ankylosing .spondylitis
Progressive .motor .deficits
What .is .the .management .for .back .pain? .- .ANS✓✓-1st .line- .Acetaminophen .w
.or .w/o .NSAIDS
2nd .line- .Muscle .relaxants .w .NSAIDS/Acetaminophen
Use .of .opioids .only .if .pain .is .severe .and/or .refractory
,When .do .you .do .x-ray? .- .ANS✓✓-Usually .wait .until .finish .1st .line .therapies:
.physical .therapy, .rest, .meds, .etc.
What .are .alternative .therapies .to .consider .when .managing .back .pain? .- .ANS✓
✓-Acupuncture, .massage, .injections. .
TCAs, .physical .therapy
When .taking .the .history .of .an .ankle .injury, .what .is .important .to .ask? .- .ANS✓✓
-If .the .injury .was .an .eversion .or .inversion
What .are .key .PE .techniques .for .the .ankle? .- .ANS✓✓-Inspect, .palpate, .ROM,
.proactive .(strength, .anterior .drawer, .syndesmosis .squeeze, .inversion .stress
.test), .functional .(wt .bearing, .gait, .ability .to .hop/stand .on .affected .ankle)
What .is .the .squeeze .test? .- .ANS✓✓-Examiner .grasps .the .patient's .leg .midway
.up .the .calf .and .performs .a .compress .and .release .motion. .A .positive .test .is
.considered .if .the .patient .experiences .pain .in .the .area .of .the .syndesmosis. .+
.test .= .severe .injury
The .Squeeze .Test .for .syndesmosis .injury .following .an .ankle .sprain .is .positive
.when .pain .is .felt .upon .squeezing .the .fibula .and .tibia .together.
What .are .the .Ottawa .Ankle .Rules? .- .ANS✓✓-Radiographs .unnecessary .if .the
.following .conditions .are .met:
1. .Patient .able .to .walk .4 .steps .at .time .of .injury .or .evaluation
2. .No .bony .tenderness .over .distal .6cm .of .either .malleolus
Necessary .if: .
1. .Pt .cannot .bear .wt .in .office
2. .Tenderness .over .medial .and .lateral .malleoli, .base .of .5th .metatarsal, .or
.navicular .bone
If .an .x-ray .is .needed .of .the .shoulder, .describe
the .x-ray .you .need .to .order? .- .ANS✓✓-4 .view .x-ray .of .the .shoulder .
Internal .anteriorposterior .(AP)
Grashey/AP .Oblique
Axillary
Y .Views
What .are .some .finding .you .could .expect .to .see .on .x-ray .of .the .shoulder? .-
.ANS✓✓-Fracture
Glenohymeral .arthritis
Significant .AC .joint .separation
What .might .you .consider .in .a .patient .>40 .y/o .with .shoulder .pain/bruising .after
.a .fall? .- .ANS✓✓-In .a .patient .>40 .with .no .prior .history .shoulder .pain, .negative
.x-rays, .consider .a .massive .rotator .cuff .tear. .MRI .would .be .more .sensitive .to
.this .condition
,This .will .require .an .ortho .referral .if .positive .for .a .tear
What .are .differential .diagnoses .for .knee .injury? .- .ANS✓✓-Several, .some
.include .the .following:
ACL
MCL
Sprain/strain
Ruptured .achilles
Chondromalacia .(patellar .fx= .surgical .emergency)
What .are .the .Ottawa .rules .for .Knee .pain? .- .ANS✓✓-> .65 .y/o
Patellar .pain
Tenderness .at .head .of .fibula
Inability .to .flex .knee .at .90 .degrees
Inability .to .bear .weight .(4 .steps) .immediately .after .injury .and .on .exam
What .is .important .about .a .knee .x-ray .for .the .older .population? .- .ANS✓✓-Get
.an .x-ray .of .both .knees .to .be .able .to .compare
How .do .you .manage .knee .pain? .- .ANS✓✓-PRICE
Protection, .plan, .pain .control
Rest
Ice
Compression .
Elevation
Pain .control .= .NSAIDS, .protection= .brace .if .necessary
Which .of .the .following .is .a ."red .flag" .in .the .initial .evaluation .of .low .back .pain?
a. .acute .onset
b. .severity
c. .fever
d. .herniation .of .lumbar .disc .on .previous .MRI .- .ANS✓✓-c
Which .of .the .following .meds .is .more .effective .than .placebo .in .the .short-term .tx
.of .chronic .low .back .pain?
a. .NSAIDS
b. .SSRIs
c. .Topical .lidocaine .patches
d. .Skeletal .muscle .relaxants .- .ANS✓✓-a
Which .of .the .following .is .the .biggest .risk .factor .for .an .ankle .sprain?
a. .wearing .high .heels
b. .prior .knee .sprain
c. .prior .ankle .sprain
d. .playing .basketball .- .ANS✓✓-c. .
once .you .have .had .one .ankle .sprain, .the .integrity .of .ligaments .never .returns .to
.100%, .so .you .are .set .up .for .increased .risk .for .future .sprains
, Which .of .the .following .elements .on .PE .would .indicate .the .possibility .of .ankle
.fx .and .should .be .evaluated .by .x-ray?
a. .ability .to .bear .wt .on .affected .ankle
b. .tenderness .over .medial .malleolus
c. .swelling .of .affected .ankle
d. .bruising .of .affected .ankle .- .ANS✓✓-b.
A .school- .age .child .with .an .acute .ankle .inversion .injury .resulting .in .lateral
.nakle .pain .and .swelling .is .most .likely .to .have .which .injury?
a. .sprained .anterior .talofibular .ligament .(ATFL)
b. .Sprained .deltoid .ligament
c. .Muscle .strain
d. .Fracture .of .the .growth .plate .at .the .distal .fibula .- .ANS✓✓-d.
What .is .the .first .line .tx .for .mild .chronic .shoulder .pain .caused .by .osteoarthritis?
a. .injection .of .steroids .with .lidocaine
b. .hydrocodone
c. .acetaminophen
d. .oral .corticosteroids .- .ANS✓✓-c
Which .of .the .following .imaging .modalities .should .be .used .to .assess .for .rotator
.cuff .tear?
a. .Anteroposterior .x-ray .of .the .shoulder
b. .MRI .of .the .shoulder .without .contrast
c. .CT .scan .of .the .shoulder .with .contrast
d. .Axillary .x-ray .of .the .shoulder .- .ANS✓✓-b
Which .of .the .following .ligaments .and .tendonsare .located .inside .the .knee .joint?
a. .ACL
b. .MCL
c. .Lateral .collateral .ligament
c. .Patellar .tendon .- .ANS✓✓-a. .
These .crossover .the .knee
Which .of .the .following .knee .injuries .is .least .likely .to .cause .acute .swelling .in
.the .first .48 .hours .after .injury?
a. .meniscus .tear
b. .ACL .rupture
c. .posterior .cruciate .ligament .rupture
d. .Medial .collateral .ligament .sprain .- .ANS✓✓-d.
According .to .the .Ottawa .knee .rules, .which .of .the .following .factors .should
.prompt .consideration .of .an .x-ray .to .evaluate .fx .after .a .traumatic .knee .injury?
a. .age .<45
b. .tenderness .of .the .quadriceps .muscle
c. .tenderness .of .the .patella
d. .ability .to .bear .wt .for .6 .steps .- .ANS✓✓-c
2025
What .are .the .sprain .classifications? .- .ANS✓✓-Grade .I: .ligament .is .minimally
.torn, .stable .joint
Grade .II: .partial .tear, .greater .instability
Grade .III: .complete .tear, .complete .instability
Grade .I .sprain? .- .ANS✓✓-involves .minimal .tearing .of .ligament .and .associated
.fibers, .as .well .as .a .varying .degree .of .internal .hemorrhage .(A).
Grade .II .sprain? .- .ANS✓✓-Second-degree .sprain .usually .results .in .definite
.structural .breakdown .as .a .result .of .partial .tearing. .Hemorrhage .is .both .internal
.and .periligamentous, .with .moderately .extensive .inflammatory .edema .(B).
Grade .III .sprain? .- .ANS✓✓-is .most .severe .and .often .involves .complete .rupture
.of .the .ligament .body .(C).
Avulsion .at .the .points .of .origin .or .insertion .usually .results .in .one .or .more
.small .bone .fragments, .which .may .often .be .identified .radiographically .(D).
What .is .a .STRAIN? .- .ANS✓✓-is .a .stretching .or .tearing .of .muscle .or .tendon
What .is .tendonitis? .- .ANS✓✓-Tendonitis .is .the .inflammation, .irritation, .and
.swelling .of .a .tendon. .It .can .occur .as .a .result .of .injury, .overuse, .or .with .aging
.as .the .tendon .loses .elasticity. .Any .action .that .places .prolonged .repetitive
.strain .on .the .forearm .muscles .can .cause .tendonitis. .The .most .common
.symptom .of .tendonitis .is .pain, .tenderness, .and .the .increase .of .pain .with
.movement.
What .conditions .are .you .look .for .with .acute .back .pain? .- .ANS✓✓-Infection
Cauda .equina
Vertebral .compression .fractures
Ankylosing .spondylitis
Progressive .motor .deficits
What .is .the .management .for .back .pain? .- .ANS✓✓-1st .line- .Acetaminophen .w
.or .w/o .NSAIDS
2nd .line- .Muscle .relaxants .w .NSAIDS/Acetaminophen
Use .of .opioids .only .if .pain .is .severe .and/or .refractory
,When .do .you .do .x-ray? .- .ANS✓✓-Usually .wait .until .finish .1st .line .therapies:
.physical .therapy, .rest, .meds, .etc.
What .are .alternative .therapies .to .consider .when .managing .back .pain? .- .ANS✓
✓-Acupuncture, .massage, .injections. .
TCAs, .physical .therapy
When .taking .the .history .of .an .ankle .injury, .what .is .important .to .ask? .- .ANS✓✓
-If .the .injury .was .an .eversion .or .inversion
What .are .key .PE .techniques .for .the .ankle? .- .ANS✓✓-Inspect, .palpate, .ROM,
.proactive .(strength, .anterior .drawer, .syndesmosis .squeeze, .inversion .stress
.test), .functional .(wt .bearing, .gait, .ability .to .hop/stand .on .affected .ankle)
What .is .the .squeeze .test? .- .ANS✓✓-Examiner .grasps .the .patient's .leg .midway
.up .the .calf .and .performs .a .compress .and .release .motion. .A .positive .test .is
.considered .if .the .patient .experiences .pain .in .the .area .of .the .syndesmosis. .+
.test .= .severe .injury
The .Squeeze .Test .for .syndesmosis .injury .following .an .ankle .sprain .is .positive
.when .pain .is .felt .upon .squeezing .the .fibula .and .tibia .together.
What .are .the .Ottawa .Ankle .Rules? .- .ANS✓✓-Radiographs .unnecessary .if .the
.following .conditions .are .met:
1. .Patient .able .to .walk .4 .steps .at .time .of .injury .or .evaluation
2. .No .bony .tenderness .over .distal .6cm .of .either .malleolus
Necessary .if: .
1. .Pt .cannot .bear .wt .in .office
2. .Tenderness .over .medial .and .lateral .malleoli, .base .of .5th .metatarsal, .or
.navicular .bone
If .an .x-ray .is .needed .of .the .shoulder, .describe
the .x-ray .you .need .to .order? .- .ANS✓✓-4 .view .x-ray .of .the .shoulder .
Internal .anteriorposterior .(AP)
Grashey/AP .Oblique
Axillary
Y .Views
What .are .some .finding .you .could .expect .to .see .on .x-ray .of .the .shoulder? .-
.ANS✓✓-Fracture
Glenohymeral .arthritis
Significant .AC .joint .separation
What .might .you .consider .in .a .patient .>40 .y/o .with .shoulder .pain/bruising .after
.a .fall? .- .ANS✓✓-In .a .patient .>40 .with .no .prior .history .shoulder .pain, .negative
.x-rays, .consider .a .massive .rotator .cuff .tear. .MRI .would .be .more .sensitive .to
.this .condition
,This .will .require .an .ortho .referral .if .positive .for .a .tear
What .are .differential .diagnoses .for .knee .injury? .- .ANS✓✓-Several, .some
.include .the .following:
ACL
MCL
Sprain/strain
Ruptured .achilles
Chondromalacia .(patellar .fx= .surgical .emergency)
What .are .the .Ottawa .rules .for .Knee .pain? .- .ANS✓✓-> .65 .y/o
Patellar .pain
Tenderness .at .head .of .fibula
Inability .to .flex .knee .at .90 .degrees
Inability .to .bear .weight .(4 .steps) .immediately .after .injury .and .on .exam
What .is .important .about .a .knee .x-ray .for .the .older .population? .- .ANS✓✓-Get
.an .x-ray .of .both .knees .to .be .able .to .compare
How .do .you .manage .knee .pain? .- .ANS✓✓-PRICE
Protection, .plan, .pain .control
Rest
Ice
Compression .
Elevation
Pain .control .= .NSAIDS, .protection= .brace .if .necessary
Which .of .the .following .is .a ."red .flag" .in .the .initial .evaluation .of .low .back .pain?
a. .acute .onset
b. .severity
c. .fever
d. .herniation .of .lumbar .disc .on .previous .MRI .- .ANS✓✓-c
Which .of .the .following .meds .is .more .effective .than .placebo .in .the .short-term .tx
.of .chronic .low .back .pain?
a. .NSAIDS
b. .SSRIs
c. .Topical .lidocaine .patches
d. .Skeletal .muscle .relaxants .- .ANS✓✓-a
Which .of .the .following .is .the .biggest .risk .factor .for .an .ankle .sprain?
a. .wearing .high .heels
b. .prior .knee .sprain
c. .prior .ankle .sprain
d. .playing .basketball .- .ANS✓✓-c. .
once .you .have .had .one .ankle .sprain, .the .integrity .of .ligaments .never .returns .to
.100%, .so .you .are .set .up .for .increased .risk .for .future .sprains
, Which .of .the .following .elements .on .PE .would .indicate .the .possibility .of .ankle
.fx .and .should .be .evaluated .by .x-ray?
a. .ability .to .bear .wt .on .affected .ankle
b. .tenderness .over .medial .malleolus
c. .swelling .of .affected .ankle
d. .bruising .of .affected .ankle .- .ANS✓✓-b.
A .school- .age .child .with .an .acute .ankle .inversion .injury .resulting .in .lateral
.nakle .pain .and .swelling .is .most .likely .to .have .which .injury?
a. .sprained .anterior .talofibular .ligament .(ATFL)
b. .Sprained .deltoid .ligament
c. .Muscle .strain
d. .Fracture .of .the .growth .plate .at .the .distal .fibula .- .ANS✓✓-d.
What .is .the .first .line .tx .for .mild .chronic .shoulder .pain .caused .by .osteoarthritis?
a. .injection .of .steroids .with .lidocaine
b. .hydrocodone
c. .acetaminophen
d. .oral .corticosteroids .- .ANS✓✓-c
Which .of .the .following .imaging .modalities .should .be .used .to .assess .for .rotator
.cuff .tear?
a. .Anteroposterior .x-ray .of .the .shoulder
b. .MRI .of .the .shoulder .without .contrast
c. .CT .scan .of .the .shoulder .with .contrast
d. .Axillary .x-ray .of .the .shoulder .- .ANS✓✓-b
Which .of .the .following .ligaments .and .tendonsare .located .inside .the .knee .joint?
a. .ACL
b. .MCL
c. .Lateral .collateral .ligament
c. .Patellar .tendon .- .ANS✓✓-a. .
These .crossover .the .knee
Which .of .the .following .knee .injuries .is .least .likely .to .cause .acute .swelling .in
.the .first .48 .hours .after .injury?
a. .meniscus .tear
b. .ACL .rupture
c. .posterior .cruciate .ligament .rupture
d. .Medial .collateral .ligament .sprain .- .ANS✓✓-d.
According .to .the .Ottawa .knee .rules, .which .of .the .following .factors .should
.prompt .consideration .of .an .x-ray .to .evaluate .fx .after .a .traumatic .knee .injury?
a. .age .<45
b. .tenderness .of .the .quadriceps .muscle
c. .tenderness .of .the .patella
d. .ability .to .bear .wt .for .6 .steps .- .ANS✓✓-c
