Buttaro Part 15 Muskuloskeletal FNP
Questions and answers download to pass!!!
Quiz :non-pharmacologic treatment plan to assist a patient with chronic low back pain -
ANSWER :a) PT: sooner is better
b) ROM exercises
c) Manual Therapy
d) Therapeutic Modalities
1. Ice
2. Superficial heat
3. Ultrasound to treat tendon, ligament, and joint injuries
4. TENS
5. Traction
Quiz :Apprehension Test - ANSWER :shoulder physical exam maneuvers
Abduct to 90o and slowly externally rotate patietn's arm to a position where it might easily
dislocate Impending dislocation or glenohumeral instability is signaled by noticeable look of
apprenhension on patient's face, with patient resisting furthrr motion
Quiz :Drop Arm Test - ANSWER :Have patient hold affected extremity in a fully abduction
position, then ask patient to slowly lower arm to side
Rotator cuff tearing or supraspinatus tearing is suggested if patient's arm drops to side (as
opposed to being slowly lowered to side) from a position of 90o of abduction
Quiz :Empty can test - ANSWER :Have patient hold out affected arm as if offering
examiner a can of soda (abduction to 90o) and then have pateitn turn arm to epmpty the
contents (internal rotation)
Rotator cuff tendinitis or tear is suggested if pain is produced or weakness noted by maneuver
of "emptying the can"
Quiz :Impingement test - ANSWER :Have patient elevate arm slowly into overhead position
Rotator cuff strain, tendinitis, or tear is suggested if patient experiences sharp "catches" of
pain or impingment with this maneuver
Quiz :Yergason test - ANSWER :Have patient fully flex elbow (90o). Grasp the pateint's
flexed elbow in one hand while holding patient's wrist in other hand; to test stability of biceps
tendon, externally rotate the patient's arm as patient resists and, at the same time, pull
downaward on patient's elbow
Pain with this maneuver suggest that the biceps tendon is unstable in the biceps groove; no
pain is experienced with a stable tendon
Quiz :Modified dynamic labral shear test - ANSWER :Have patient stand with arm flexed
90o at the elvow, abducted in the scapular plan more than 120o, and externally rotated to
,tightness. Stand behind pateitn and guide the involved upper extremity into maximal
horizontal abduction. Apply a shear load to the joint by maintaining external rotation and
horizontal abduction and lowering arm from 120o to 60o of abduction
Reproduction of pain and/or painful click or catch in the posterior joint line between 120o
and 90o abduction suggest labral tear
Quiz :Sulcus Sign - ANSWER :Have patient stand with arm at the side. Apply traction
through the patient's arm in the inferior direction
Indicates glenohumeral laxity or instability
Quiz :Spurling Test - ANSWER :Have patient flex cervical spine laterally toward the
ipsilateral shoulder. Apply a downward axial force to the head.
Pain radiating toward the shoulder and arm may indicate nerve root compression, implicating
the cervical spine as the souce of shjoulder pain.
Quiz :signs and symptoms of stress fractures - ANSWER :a) Gradual onset with pain in the
shaft of bone
b) Pain may increase with activity and decrease with rest
c) Patients can usually identify very specific area of pain
d) In tibia, pain may mimic that if MTSS (shin splint) and compartment syndrome
Quiz :Cervical dermatones - ANSWER :
Quiz :Red flag conditions in MS needing immediate referral - ANSWER :a) Fever, urinary
or bowel incontinence
b) Saddle anesthesia
c) Persistent unrelieved pain—Cauda equine—Refer to ED
Quiz :pharmacologic treatment of acute low back pain. - ANSWER :a) NSAIDs, Muscle
Relaxors, Gabapentin
b) No Steroids
Quiz :Dermatones in MS - ANSWER :
Quiz :1st degree collateral knee ligament strains present as - ANSWER :Tenderness along
body of ligament
-Minimum or no swelling
-No joint widening with ligament stress
Quiz :2nd degree collateral knee ligament strain - ANSWER :Partial avulsion of fibers from
femoral condyle
Pain at joint line of ligament insertion
-Swelling with tenderness localized to attachment point
-Slight to moderate increase in joint widening with stress
, Quiz :3rd degree collateral knee ligament strain - ANSWER :Complete rupture of ligament
(often ACL or PCL or tibial plateau fracture)
Significant pain at ligament insertion and joint line
-Significant swelling with ecchymosis
-Increased joint widening with minimum stress
Quiz :Valgus stress test - ANSWER :Have the patient lie supine and extend the knee.
Stabilize the femur with one hand and hold the ankle with other hand. Apply valgus force
against the ankle (away from the midline) and external rotation.
***Laxity in this position indicates injury to the MCL. Repeat the movement with the
patient's knee flexed to 30 degrees. No excessive medial movement of the knee is expected.
Quiz :Varus Stress Test - ANSWER :Have the patient lie supine and extend the knee.
Stabilize the femur with one hand and hold the ankle with your other hand. Apply varus force
against the ankle (toward the midline) and internal rotate.
Excessive laxity is felt as the joint opening. Laxity in this position indicates injury to the
LCL. Repeat the movement with the patient's knee flexed to 30 degrees. No excessive lateral
movement of the knee is expected.
Quiz :16) Identify signs and symptoms of cruciate ligament injuries. - ANSWER :a) Patient
with ACL injury may recall a "pop" or "snap"
b) Swelling and pain
c) Unable to fully flex or extend the knee
Quiz :Lachman Test - ANSWER :The knee should be flexed about 15-30o. One hand is
placed just below the knee joint on the posterior aspect of the tibia-fibula. The other hand is
placed on the anterior aspect of the femur just above the joint. The examiner lifts up the lower
leg while pushing down on the upper leg. If the ACL is intact, after a few millimeters of
movement, the examiner should feel a "knock" or a firm "stop" as the ACL prevents the tibia
from sliding forward.
***In the absence of a firm end point, a ligament tear should be suspected.
Quiz :Anterior Drawer Test - ANSWER :The knee should be flexed about 90o, with the foot
kept flat on the examination suface. The examiner sits on the patient's foot anf firmly grasps
the lower leg, placing the fingers below the popliteal space and the thumbs on the tibial
tuberosity. The examiner PULLS gently but firmsly on the tibia, attempting to slide the tibia
forward.
A "soft" or absent end point indicates a tear in the ACL
Quiz :Posterior Drawer test - ANSWER :With the patient positioned the same as for the
anterior drawer test, the examiner PUSHES posteriorly on the tibia.
A torn PCL allows the tibia to slide backwards.
Quiz :Hip pain in the Older Adult is associated with - ANSWER :Traumatic
Questions and answers download to pass!!!
Quiz :non-pharmacologic treatment plan to assist a patient with chronic low back pain -
ANSWER :a) PT: sooner is better
b) ROM exercises
c) Manual Therapy
d) Therapeutic Modalities
1. Ice
2. Superficial heat
3. Ultrasound to treat tendon, ligament, and joint injuries
4. TENS
5. Traction
Quiz :Apprehension Test - ANSWER :shoulder physical exam maneuvers
Abduct to 90o and slowly externally rotate patietn's arm to a position where it might easily
dislocate Impending dislocation or glenohumeral instability is signaled by noticeable look of
apprenhension on patient's face, with patient resisting furthrr motion
Quiz :Drop Arm Test - ANSWER :Have patient hold affected extremity in a fully abduction
position, then ask patient to slowly lower arm to side
Rotator cuff tearing or supraspinatus tearing is suggested if patient's arm drops to side (as
opposed to being slowly lowered to side) from a position of 90o of abduction
Quiz :Empty can test - ANSWER :Have patient hold out affected arm as if offering
examiner a can of soda (abduction to 90o) and then have pateitn turn arm to epmpty the
contents (internal rotation)
Rotator cuff tendinitis or tear is suggested if pain is produced or weakness noted by maneuver
of "emptying the can"
Quiz :Impingement test - ANSWER :Have patient elevate arm slowly into overhead position
Rotator cuff strain, tendinitis, or tear is suggested if patient experiences sharp "catches" of
pain or impingment with this maneuver
Quiz :Yergason test - ANSWER :Have patient fully flex elbow (90o). Grasp the pateint's
flexed elbow in one hand while holding patient's wrist in other hand; to test stability of biceps
tendon, externally rotate the patient's arm as patient resists and, at the same time, pull
downaward on patient's elbow
Pain with this maneuver suggest that the biceps tendon is unstable in the biceps groove; no
pain is experienced with a stable tendon
Quiz :Modified dynamic labral shear test - ANSWER :Have patient stand with arm flexed
90o at the elvow, abducted in the scapular plan more than 120o, and externally rotated to
,tightness. Stand behind pateitn and guide the involved upper extremity into maximal
horizontal abduction. Apply a shear load to the joint by maintaining external rotation and
horizontal abduction and lowering arm from 120o to 60o of abduction
Reproduction of pain and/or painful click or catch in the posterior joint line between 120o
and 90o abduction suggest labral tear
Quiz :Sulcus Sign - ANSWER :Have patient stand with arm at the side. Apply traction
through the patient's arm in the inferior direction
Indicates glenohumeral laxity or instability
Quiz :Spurling Test - ANSWER :Have patient flex cervical spine laterally toward the
ipsilateral shoulder. Apply a downward axial force to the head.
Pain radiating toward the shoulder and arm may indicate nerve root compression, implicating
the cervical spine as the souce of shjoulder pain.
Quiz :signs and symptoms of stress fractures - ANSWER :a) Gradual onset with pain in the
shaft of bone
b) Pain may increase with activity and decrease with rest
c) Patients can usually identify very specific area of pain
d) In tibia, pain may mimic that if MTSS (shin splint) and compartment syndrome
Quiz :Cervical dermatones - ANSWER :
Quiz :Red flag conditions in MS needing immediate referral - ANSWER :a) Fever, urinary
or bowel incontinence
b) Saddle anesthesia
c) Persistent unrelieved pain—Cauda equine—Refer to ED
Quiz :pharmacologic treatment of acute low back pain. - ANSWER :a) NSAIDs, Muscle
Relaxors, Gabapentin
b) No Steroids
Quiz :Dermatones in MS - ANSWER :
Quiz :1st degree collateral knee ligament strains present as - ANSWER :Tenderness along
body of ligament
-Minimum or no swelling
-No joint widening with ligament stress
Quiz :2nd degree collateral knee ligament strain - ANSWER :Partial avulsion of fibers from
femoral condyle
Pain at joint line of ligament insertion
-Swelling with tenderness localized to attachment point
-Slight to moderate increase in joint widening with stress
, Quiz :3rd degree collateral knee ligament strain - ANSWER :Complete rupture of ligament
(often ACL or PCL or tibial plateau fracture)
Significant pain at ligament insertion and joint line
-Significant swelling with ecchymosis
-Increased joint widening with minimum stress
Quiz :Valgus stress test - ANSWER :Have the patient lie supine and extend the knee.
Stabilize the femur with one hand and hold the ankle with other hand. Apply valgus force
against the ankle (away from the midline) and external rotation.
***Laxity in this position indicates injury to the MCL. Repeat the movement with the
patient's knee flexed to 30 degrees. No excessive medial movement of the knee is expected.
Quiz :Varus Stress Test - ANSWER :Have the patient lie supine and extend the knee.
Stabilize the femur with one hand and hold the ankle with your other hand. Apply varus force
against the ankle (toward the midline) and internal rotate.
Excessive laxity is felt as the joint opening. Laxity in this position indicates injury to the
LCL. Repeat the movement with the patient's knee flexed to 30 degrees. No excessive lateral
movement of the knee is expected.
Quiz :16) Identify signs and symptoms of cruciate ligament injuries. - ANSWER :a) Patient
with ACL injury may recall a "pop" or "snap"
b) Swelling and pain
c) Unable to fully flex or extend the knee
Quiz :Lachman Test - ANSWER :The knee should be flexed about 15-30o. One hand is
placed just below the knee joint on the posterior aspect of the tibia-fibula. The other hand is
placed on the anterior aspect of the femur just above the joint. The examiner lifts up the lower
leg while pushing down on the upper leg. If the ACL is intact, after a few millimeters of
movement, the examiner should feel a "knock" or a firm "stop" as the ACL prevents the tibia
from sliding forward.
***In the absence of a firm end point, a ligament tear should be suspected.
Quiz :Anterior Drawer Test - ANSWER :The knee should be flexed about 90o, with the foot
kept flat on the examination suface. The examiner sits on the patient's foot anf firmly grasps
the lower leg, placing the fingers below the popliteal space and the thumbs on the tibial
tuberosity. The examiner PULLS gently but firmsly on the tibia, attempting to slide the tibia
forward.
A "soft" or absent end point indicates a tear in the ACL
Quiz :Posterior Drawer test - ANSWER :With the patient positioned the same as for the
anterior drawer test, the examiner PUSHES posteriorly on the tibia.
A torn PCL allows the tibia to slide backwards.
Quiz :Hip pain in the Older Adult is associated with - ANSWER :Traumatic
