NURS 611 FINAL EXAM LATEST MARYVILLE UNIVERSITY
QUESTIONS AND COMPLETE SOLUTIONS GRADED A+
3 types of joints - Answer: 1. Synovial (freely movable, knee and shoulder)
2. Cartilaginous (slightly movable, vertebral bodies, symphysis pubis, sternomanubrial joint)
3. Fibrous (immovable, skull sutures)
Types of synovial joints - Answer: 1. Ball and socket (shoulder/hip)
2. Hinge (wrist, interphalangeal joints of hands/foot)
3. Condylar (knee, temporomandibular joint)
Tips for assessing joint pain - Answer: 1. Point to the pain
2. Clarify onset, mechanism of injury, activity
3. Articular or extraarticular, acute or chronic, inflammatory or noninflammatory, localized
(monoarticular) or diffuse (polyarticular)
4. Clarify the attributes of each symptom including context, associations, etc.
5. Symptom analysis
Describe the following types of pain
Muscle
Nerve root
Nerve
Sympathetic nerve
Bone
Fracture
Vascular - Answer: Muscle: dull, cramping, aching
Nerve root: sharp shooting
nerve: sharp, lightening like
Sympathetic: burning, pressure like, stinging
Bone: deep, nagging, dull
,Fracture: sharp, severe, intolerable
Vascular: throbbing, diffuse
Red flags for lower back pain - Answer: Age <20 or >50
History of cancer
Unexplained weight loss, fever, or general decline in health
Pain lasting >1mo, unresponsive to treatment
Pain worse at night or present at rest
history of IVDA, addiction, immunosuppression
Presence of active infection or HIV
Long term steroid therapy
Saddle anesthesia
Bladder or bowel incontinence
Neurological deficits
Lower extremity weakness
Shoulder pain can be two nonmusculoskeletal reasons - Answer: Referred abdominal pain
Cardiac pain
Hawkins test
Indication
Movement
Positive - Answer: Subacromial impingement
90 degree arm, 90 degree elbow flexed
Forcibly internally rotate
Positive if pain, nerve burning
Empty can test
Indication
Movement
Positive - Answer: Impingement, rotater cuff tear
, ARms elevated 90 degrees, then internally rotate 30 degrees (dumping out cans)
Resist abduction
Unable, positive
Apley's test
Indication
Movement
Positive - Answer: Rotator cuff tendonitis
REach overhead, reach behind as far as possible
Apprehension test
Indication
Movement
Positive - Answer: Arm at 90 degrees, shoulder at 90 degrees, abducted.
Externally rotate patient's arm, look for slipping, apprehension, resistance
Anterior joint instability
Lateral epichondylitis - Answer: tennis elbow
Medial epichondylitis - Answer: golfer's elbow
Ganglion cysts - Answer: Non-cancerous, fluid-filled cysts are common masses or lumps in the hand and
usually found on the back of the wrist.
not aesthetic but do not need ot be removed unless compressing nerves
Snuffbox - Answer: Radial fossa
Can press here if suspect scaphoid fracture. XR may be negative but still need referral due to risk of
avascular necrosis
Suspect if recent fall with wrist pain
QUESTIONS AND COMPLETE SOLUTIONS GRADED A+
3 types of joints - Answer: 1. Synovial (freely movable, knee and shoulder)
2. Cartilaginous (slightly movable, vertebral bodies, symphysis pubis, sternomanubrial joint)
3. Fibrous (immovable, skull sutures)
Types of synovial joints - Answer: 1. Ball and socket (shoulder/hip)
2. Hinge (wrist, interphalangeal joints of hands/foot)
3. Condylar (knee, temporomandibular joint)
Tips for assessing joint pain - Answer: 1. Point to the pain
2. Clarify onset, mechanism of injury, activity
3. Articular or extraarticular, acute or chronic, inflammatory or noninflammatory, localized
(monoarticular) or diffuse (polyarticular)
4. Clarify the attributes of each symptom including context, associations, etc.
5. Symptom analysis
Describe the following types of pain
Muscle
Nerve root
Nerve
Sympathetic nerve
Bone
Fracture
Vascular - Answer: Muscle: dull, cramping, aching
Nerve root: sharp shooting
nerve: sharp, lightening like
Sympathetic: burning, pressure like, stinging
Bone: deep, nagging, dull
,Fracture: sharp, severe, intolerable
Vascular: throbbing, diffuse
Red flags for lower back pain - Answer: Age <20 or >50
History of cancer
Unexplained weight loss, fever, or general decline in health
Pain lasting >1mo, unresponsive to treatment
Pain worse at night or present at rest
history of IVDA, addiction, immunosuppression
Presence of active infection or HIV
Long term steroid therapy
Saddle anesthesia
Bladder or bowel incontinence
Neurological deficits
Lower extremity weakness
Shoulder pain can be two nonmusculoskeletal reasons - Answer: Referred abdominal pain
Cardiac pain
Hawkins test
Indication
Movement
Positive - Answer: Subacromial impingement
90 degree arm, 90 degree elbow flexed
Forcibly internally rotate
Positive if pain, nerve burning
Empty can test
Indication
Movement
Positive - Answer: Impingement, rotater cuff tear
, ARms elevated 90 degrees, then internally rotate 30 degrees (dumping out cans)
Resist abduction
Unable, positive
Apley's test
Indication
Movement
Positive - Answer: Rotator cuff tendonitis
REach overhead, reach behind as far as possible
Apprehension test
Indication
Movement
Positive - Answer: Arm at 90 degrees, shoulder at 90 degrees, abducted.
Externally rotate patient's arm, look for slipping, apprehension, resistance
Anterior joint instability
Lateral epichondylitis - Answer: tennis elbow
Medial epichondylitis - Answer: golfer's elbow
Ganglion cysts - Answer: Non-cancerous, fluid-filled cysts are common masses or lumps in the hand and
usually found on the back of the wrist.
not aesthetic but do not need ot be removed unless compressing nerves
Snuffbox - Answer: Radial fossa
Can press here if suspect scaphoid fracture. XR may be negative but still need referral due to risk of
avascular necrosis
Suspect if recent fall with wrist pain
