FINAL EXAM: NR511 (LATEST UPDATE ) DIFFERENTIAL
DIAGNOSIS & PRIMARY CARE PRACTICUM EXAM QUESTIONS AND
100%CORRECT DETAILED ANSWERS|| GRADED A+
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 -ANSWER: 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 -ANSWER: 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 -ANSWER: 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. -ANSWER: 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 -ANSWER: 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 -ANSWER: 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 -ANSWER: 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. -ANSWER: 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 -ANSWER: 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 -ANSWER: 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 -ANSWER:
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 -ANSWER: 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 -ANSWER: Intolerable pain for more than a 3 month period is an indication for
surgical intervention
DIAGNOSIS & PRIMARY CARE PRACTICUM EXAM QUESTIONS AND
100%CORRECT DETAILED ANSWERS|| GRADED A+
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 -ANSWER: 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 -ANSWER: 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 -ANSWER: 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. -ANSWER: 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 -ANSWER: 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 -ANSWER: 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 -ANSWER: 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. -ANSWER: 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 -ANSWER: 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 -ANSWER: 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 -ANSWER:
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 -ANSWER: 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 -ANSWER: Intolerable pain for more than a 3 month period is an indication for
surgical intervention
