CEPA Midterm 1 Questions With Complete Solutions !!!

An 18-year-old tennis player falls and lands awkwardly on her shoulder. She has pain immediately at the apex of the shoulder where the clavicle and acromion of the scapula joint (AC joint). She has point tenderness over the acromioclavicular (AC) joint and is unable to raise her arm. She is diagnosed with a sprain of the AC joint. Which of the following best describes this synovial joint? A. Saddle B. Pivot C. Hinge D. Plane E. Condyloid - ANS Correct: Plane. Multiaxial, single, or multiple planes of motion. A 17-year-old baseball pitcher presents to the office for evaluation of elbow pain. He describes pain on the medial side of his elbow during the release phase of pitching. He is diagnosed with a tear of the ulnar collateral ligament of the elbow. The elbow is which of the following types of synovial joints? A. condyloid B. pivot C. plane D. saddle E. hinge - ANS Correct: hinge. Uniaxial, bending and straightening in a single axis. A 15-year-old field hockey player is running in straight line when she hears a loud pop has immediate pain and swelling in her right ankle. She is unable to bear weight through that ankle. On x-ray at the urgent care, she is told she "popped" an osteochondritis dissecans (OCD) of the dome of the talus. The structure on the "cap", or the surface of the talus, that was disrupted is which of the following synovial joint components? A. Synovial lining B. Articular disk C. Articular capsule D. Articular cartilage E. Ligament - ANS Correct: Articular cartilage. Hyaline (Type II) connective tissue on ends of bone. A 67-year-old male presents to the clinic to follow up on his previous visit regarding his blood pressure management. The physician enters the patient room and after greeting the patient asks, "How have things have been going since our last visit?" This is an example of which of the following types of interview techniques? A. direct follow-up question B. open-ended question C. summarizing D. facilitation E. probing question - ANS Correct: open-ended question. Open-ended questions require more than a one-word answer and allow the patient to express their concerns. A 23-year-old is consulted in the post-partum ward at the hospital after giving birth to her first child because of a constant, sharp 8/10 pain that started shortly after a normal vaginal delivery. She says the pain is worse with movement of her legs. Physical examination reveals that her pain is exacerbated by pelvic rock. She has an obvious torsion at the fibrocartilaginous symphysis pubis joint and is diagnosed with pubis somatic dysfunction. Which of the following best describes this joint? A. Fibrous synarthrosis B. Cartilaginous amphiarthrosis C. Fibrous amphiarthrosis D. Cartilaginous synarthrosis E. Synovial diarthrosis - ANS Correct: Cartilaginous amphiarthrosis. Fibrocartilage connective tissue lacking a joint cavity. Immobile or nearly immobile joint with a strong union between the articulating bones. Protects underlying soft tissue structures. A 48-year-old male presents to the emergency department with pain in his right kidney area. CT scan of the pelvis and kidneys reveals no abnormalities, and a urinalysis reveals results that are suggestive of a urinary tract infection. A urine culture is sent for further testing. The provider sends a prescription to the pharmacy for the patient to pick up. The provider says, "I want to make sure that I explained our plan clearly. Can you tell me what you understand you need to do after leaving today?" This is an example of which of the following? A. collaboration B. achieving consensus C. identifying concerns D. teach back method E. shared decision making - ANS Correct: teach back method. The teach back method is a way of helping to ensure understanding has occurred. The patient is asked to verbalize their understanding of some part of the patient encounter such as the diagnosis, plan, or follow-up instructions. A 14-year-old female is brought to the office with a 2-day history of a sore throat. She denies any fever, cough, runny nose, or abdominal pain. She has had no ill contacts. She has not taken any antibiotics recently. Vital signs are within normal limits. Physical examination reveals tender cervical lymph nodes and bilateral tonsillar enlargement with exudate. Abdominal examination reveals no abdominal tenderness. Which of the preceding elements would be considered a symptom and belong in the subjective portion of the note? A. lymph node tenderness B. no abdominal tenderness C. tonsillar exudate D. no runny nose or cough E. normal vital signs - ANS Correct: no runny nose or cough. These are symptoms that the patient would tell the provider about and would be included in the subjective portion of the note. A 78-year-old female is brought to the emergency department after falling and hitting her head. Medications include daily aspirin. A CT scan of the head is normal, with no evidence of acute bleeding. In which of the following sections of the note should the provider's reasoning for ordering the CT scan be documented? A. objective B. past medical history C. plan D. subjective E. imaging results - ANS Correct: plan. The provider's reasoning for ordering a CT scan is a part of their medical decision-making and would be included in the assessment and plan portion of the documentation. A 21-year-old female presents to the office for evaluation of a rash. Before beginning the interview, the physician notes an out of state address and comments, "I notice you are here from out of town. What brings you to this area?" Which of the following elements of rapport building is the physician demonstrating? A. interest B. respect C. support D. empathy E. sympathy - ANS Correct: interest. Interest refers to demonstrating interest in a person outside of their medical needs. Asking about what brings the patient to the area reflects this idea. A 5-year-old boy is brought to the emergency department and diagnosed with diabetic ketoacidosis. He is transferred from the emergency department to the intensive care unit (ICU) for admission. The transferring physician gives a verbal report to the admitting nurse but does not complete a written note because he is very busy. The patient arrives in the ICU to be evaluated by the admitting team. Which of the following is most likely to be immediately impacted by the lack of documentation? A. Emergency department physician B. Admitting healthcare provider C. Quality improvement team D. Medical records department E. The patient's family - ANS Correct: Admitting healthcare provider. Without written documentation, much of the history as well as the record of care up to this point can be lost. This makes it difficult for the admitting team to evaluate the patient or write orders. Though the nurse received a verbal report, this is unlikely to contain all relevant information and might not get transmitted in full to the admitting physician. A 37-year-old patient presents to the office with a "tension" headache on the right side that starts at the base of her skull, at the top of her neck. Her pain is worse during times of stress and at the end of the workday. She adds that she has aching in her upper back over the medial aspect of the superior border of her scapula. Physical examination reveals the patient's scapula is "stuck" in elevation with restricted depression. Which of the following is the primary contributor to this patient's pain and scapular restriction? A. Transverse part of trapezius B. Levator scapula C. Descending part of trapezius D. Rhomboid major E. Rhomboid minor - ANS Correct: Levator scapula. Originates C1-C4 transverse process, inserts superior angle, medial border of scapula. Elevates scapula. A 12-year-old is diagnosed with lumbar scoliosis during a screening at her elementary school. She has no pain, and the family is unaware of her condition. Which of the following muscles will be most likely be involved in her lumbar scoliosis? A. Multifidus B. Spinalis cervicis C. Levator costarum longus D. Splenius capitis E. Longissimus capitis - ANS Correct: Multifidus. Fibers run from sacrum to the cervical spine, only muscle with lumbar attachments...lumbar scoliosis A 52-year-old nurse practitioner presents to the office with upper back spasms and pain while turning her head. She states that she works from home doing telehealth and is on the computer for 12 hours a day, 5 days a week. Physical examination reveals the cervical musculature is tender to palpation over the upper neck and mastoid on the affected side. She is diagnosed with a rotational somatic dysfunction of the upper back and neck from an intrinsic muscle of the upper back. Which of the following muscles is the most likely cause of this patient's somatic dysfunction? A. multifidus B. splenius capitis C. levatores costarum D. spinalis cervicis E. longissimus capitis - ANS Correct: splenius capitis. Fibers run from nuchal ligament to mastoid; rotates the head.