NURS 524 Final Exam Questions and Answers| New Update with 100% Correct Answers
Straight leg test tests for presence of disk herniation
Calcium/Vitamin D dose for adults Calcium: 1000-1200mg/day; Vitamin D: 400 IU daily
Back pain "red flags" Unrelenting night pain
Pain at rest
History or suspicion of CA
Fever >38 degrees X 48 hours
Osteoporosis
Other systemic disease
Neuromotor or sensory deficit
Chronic oral steroids
Immunosuppresssion
Serious accident or injury
Clinical suspicion of ankylosing spondylitis
>50 years old or <20 at onset of pain
Drug/ETOH abuse
Failure to respond to 4-6 weeks of therapy
Back Pain imaging DO NOT perform unless positive red flags
Order AP/Lateral Spinal Xray
DO NOT order oblique view (adds minimal information, doubles radiation)
MRI only if pt. is potential candidate for surgery or epidural steroid injection (suspected
radiculopathy)
Differential diagnosis for back pain Reactive Arthritis
,Osteomyelitis (fevers, pain at rest)
Malignancy/Metastasis/Multiple myeloma (unexplained weight loss)
Postural backaches (obese, pregnancy) (dull, persistent, stiffness that worsens as day
progresses)
Herniated disk (sudden onset, pain radiates to buttock/down leg/possibly to foot; sharp pain;
may have paresthesias or muscle weakness; may increase pain with coughing/sneezing, sitting,
and lateral bending)
Degenerative disk disease (aggravated by flexion and sitting)
Facet Joint (mechanism of injury extension, rotation, compression; aggravated by extension and
rotation)
Lumbosacral arthritis (gradual onset, morning stiffness, radiation less common)
Spinal stenosis (pain worsens with walking and prolonged standing, spinal extension; may
report relief when leaning forward on shopping cart; May not complain of back pain, but of
aching and cramping in thighs and calves)
Ankylosing spondylitis
Intervertebral Sprain (sudden onset often related to lifting, turning, twisting; aggravated by
flexion)
Compression fracture/osteoporosis
Spondylolithesis (displacement of vertebrae)
Sacroiliac joint (mechanism of injury fall onto buttocks; aggravated by walking and sitting)
Nerve Root Irritation (mechanism of injury flexion and compression; aggravated by flexion and
sitting)
Depression
Renal colic
AAA
GU problem (prostatitis, PID)
IBS
(INFLAMMATORY BACK PAIN OFTEN IMPROVES WITH EXERCISE, MECHANICAL PAIN WORSENS
WITH EXERCISE)
(RECTAL AND PELVIC EXAMS should be performed, especially in pts over 40)
,Reiter's syndrome / Reactive arthritis an autoimmune acute arthritis in response to an
enteric or urogenital infection; more common in MEN ages 18-35; present with low-grade
fever, asymmetric arthralgia and stiffness, low back pain that increases with rest, and urethritis
Ankylosing Spondylitis chronic multisystem inflammatory disorder involving SI joint and axial
skeleton; chronic inflammation leads to granulation tissue that invades the joints and is
gradually replaced by cartilage and then ossification; usual onset before age 40; insidious onset
of low back pain; more common in men; hereditary; present with presence of symptoms > 3
months; symptoms worse in morning or with inactivity; improvement of symptoms with
exercise; fatigue, uveitis, renal/pulmonary/neurologic/CV/GI diseases
Differential diagnosis of pelvic girdle pain Degenerative disk disease with facet impingement
(buttock/posterior thigh pain, worse with pelvic extension)
Degenerative disk disease with nuclear prolapse dysfunction
Sacroiliitis (buttock or posterior thigh pain that is worse with rest and relieved with activity)
OA of hip (pain in groin, buttock, knee worse with activity, relieved by rest)
Meralgia paresthetica anterosuperior (injury to lateral cutaneous nerve of thigh - obesity or
pregnancy; tenderness over iliac spine)
Trochanteric bursitis (pain in lateral thigh, worse at night with activity; tenderness over greater
trochanter)
Cauda equina syndrome Caused by pressure on unmyelinated fibers - surgical emergency;
SX= central back pain, leg weakness, impotence, urinary frequency/retention/incontinence,
saddle anesthesia, and loss of sphincter tone.
Treatment for herniated disk About 90% of pts with back pain respond with conservative
treatment; May take up to 2 months; NSAID X 2 weeks (Naproxen or Ibuprofen - no more than
600mg TID) and muscle relaxant (Flexoril) X 3 days; Teach don't drive; bedrest not encouraged
(48 hours max); No lifting > 5 lbs; No twisting or bending; Follow up frequently (2 weeks);
Weight loss if needed; When pain decreases, start stretching and strengthening exercises;
Teach dont sit for longer than 20 minutes; Sleep on side in knee-chest position with pillow
between legs; apply moist heat to back of legs 3-4 times daily;
, Anterior/Posterior Drawer Test To perform: Hips flexed 45 degrees, knees flexed 90
degrees, feet flat on table; examiner sits on pts feet and holds leg above calf with both hands;
pull forward (anterior) and push back (posterior); normal = 6-8 mm of laxity; If positive, may
indicate ACL or PCL rupture
Lachman Test Flex knee 20-30 degrees; grasp femur with one hand, and grasp calf with
other hand; firmly pull to displace tibia on femur; assess laxity; may indicate ACL tear
McMurray's Test Assesses for tear in medial or lateral meniscus; Flex knee and hip, and have
pt. relax. Palpate joint space with one hand. Hold heel of pts foot with other hand; externally
rotate tibia and slowly extend leg, feeling for a click in the knee joint; then repeat with tibia
internally rotated
Valgus/Varus stress Valgus = "knock knees"
Varus = "bow-legged"
Tests MCL and LCL integrity
Apley's Test Pt. lies prone; Leg flexed 90 degrees; Compression test = lean on pts foot and
apply pressure to heel; internally and externally rotate tibia; popping and crepitus with pain is a
positive sign and indicates a meniscus tear
Differential Diagnosis of Knee Pain ACL tear
MCL tear (often injured when ACL torn)
Meniscus injury (more often medial; sometimes causes "locking of joint due to flap of cartilage;
often occurs with ACL tear)
PCL tear (can also be seen when the tibial tuberosity "sags" posteriorly)
Ligamentous laxity
Patellar Subluxation (the patella may sublux laterally, causing chronic recurrent knee pain;
usually in adolescent females)
Straight leg test tests for presence of disk herniation
Calcium/Vitamin D dose for adults Calcium: 1000-1200mg/day; Vitamin D: 400 IU daily
Back pain "red flags" Unrelenting night pain
Pain at rest
History or suspicion of CA
Fever >38 degrees X 48 hours
Osteoporosis
Other systemic disease
Neuromotor or sensory deficit
Chronic oral steroids
Immunosuppresssion
Serious accident or injury
Clinical suspicion of ankylosing spondylitis
>50 years old or <20 at onset of pain
Drug/ETOH abuse
Failure to respond to 4-6 weeks of therapy
Back Pain imaging DO NOT perform unless positive red flags
Order AP/Lateral Spinal Xray
DO NOT order oblique view (adds minimal information, doubles radiation)
MRI only if pt. is potential candidate for surgery or epidural steroid injection (suspected
radiculopathy)
Differential diagnosis for back pain Reactive Arthritis
,Osteomyelitis (fevers, pain at rest)
Malignancy/Metastasis/Multiple myeloma (unexplained weight loss)
Postural backaches (obese, pregnancy) (dull, persistent, stiffness that worsens as day
progresses)
Herniated disk (sudden onset, pain radiates to buttock/down leg/possibly to foot; sharp pain;
may have paresthesias or muscle weakness; may increase pain with coughing/sneezing, sitting,
and lateral bending)
Degenerative disk disease (aggravated by flexion and sitting)
Facet Joint (mechanism of injury extension, rotation, compression; aggravated by extension and
rotation)
Lumbosacral arthritis (gradual onset, morning stiffness, radiation less common)
Spinal stenosis (pain worsens with walking and prolonged standing, spinal extension; may
report relief when leaning forward on shopping cart; May not complain of back pain, but of
aching and cramping in thighs and calves)
Ankylosing spondylitis
Intervertebral Sprain (sudden onset often related to lifting, turning, twisting; aggravated by
flexion)
Compression fracture/osteoporosis
Spondylolithesis (displacement of vertebrae)
Sacroiliac joint (mechanism of injury fall onto buttocks; aggravated by walking and sitting)
Nerve Root Irritation (mechanism of injury flexion and compression; aggravated by flexion and
sitting)
Depression
Renal colic
AAA
GU problem (prostatitis, PID)
IBS
(INFLAMMATORY BACK PAIN OFTEN IMPROVES WITH EXERCISE, MECHANICAL PAIN WORSENS
WITH EXERCISE)
(RECTAL AND PELVIC EXAMS should be performed, especially in pts over 40)
,Reiter's syndrome / Reactive arthritis an autoimmune acute arthritis in response to an
enteric or urogenital infection; more common in MEN ages 18-35; present with low-grade
fever, asymmetric arthralgia and stiffness, low back pain that increases with rest, and urethritis
Ankylosing Spondylitis chronic multisystem inflammatory disorder involving SI joint and axial
skeleton; chronic inflammation leads to granulation tissue that invades the joints and is
gradually replaced by cartilage and then ossification; usual onset before age 40; insidious onset
of low back pain; more common in men; hereditary; present with presence of symptoms > 3
months; symptoms worse in morning or with inactivity; improvement of symptoms with
exercise; fatigue, uveitis, renal/pulmonary/neurologic/CV/GI diseases
Differential diagnosis of pelvic girdle pain Degenerative disk disease with facet impingement
(buttock/posterior thigh pain, worse with pelvic extension)
Degenerative disk disease with nuclear prolapse dysfunction
Sacroiliitis (buttock or posterior thigh pain that is worse with rest and relieved with activity)
OA of hip (pain in groin, buttock, knee worse with activity, relieved by rest)
Meralgia paresthetica anterosuperior (injury to lateral cutaneous nerve of thigh - obesity or
pregnancy; tenderness over iliac spine)
Trochanteric bursitis (pain in lateral thigh, worse at night with activity; tenderness over greater
trochanter)
Cauda equina syndrome Caused by pressure on unmyelinated fibers - surgical emergency;
SX= central back pain, leg weakness, impotence, urinary frequency/retention/incontinence,
saddle anesthesia, and loss of sphincter tone.
Treatment for herniated disk About 90% of pts with back pain respond with conservative
treatment; May take up to 2 months; NSAID X 2 weeks (Naproxen or Ibuprofen - no more than
600mg TID) and muscle relaxant (Flexoril) X 3 days; Teach don't drive; bedrest not encouraged
(48 hours max); No lifting > 5 lbs; No twisting or bending; Follow up frequently (2 weeks);
Weight loss if needed; When pain decreases, start stretching and strengthening exercises;
Teach dont sit for longer than 20 minutes; Sleep on side in knee-chest position with pillow
between legs; apply moist heat to back of legs 3-4 times daily;
, Anterior/Posterior Drawer Test To perform: Hips flexed 45 degrees, knees flexed 90
degrees, feet flat on table; examiner sits on pts feet and holds leg above calf with both hands;
pull forward (anterior) and push back (posterior); normal = 6-8 mm of laxity; If positive, may
indicate ACL or PCL rupture
Lachman Test Flex knee 20-30 degrees; grasp femur with one hand, and grasp calf with
other hand; firmly pull to displace tibia on femur; assess laxity; may indicate ACL tear
McMurray's Test Assesses for tear in medial or lateral meniscus; Flex knee and hip, and have
pt. relax. Palpate joint space with one hand. Hold heel of pts foot with other hand; externally
rotate tibia and slowly extend leg, feeling for a click in the knee joint; then repeat with tibia
internally rotated
Valgus/Varus stress Valgus = "knock knees"
Varus = "bow-legged"
Tests MCL and LCL integrity
Apley's Test Pt. lies prone; Leg flexed 90 degrees; Compression test = lean on pts foot and
apply pressure to heel; internally and externally rotate tibia; popping and crepitus with pain is a
positive sign and indicates a meniscus tear
Differential Diagnosis of Knee Pain ACL tear
MCL tear (often injured when ACL torn)
Meniscus injury (more often medial; sometimes causes "locking of joint due to flap of cartilage;
often occurs with ACL tear)
PCL tear (can also be seen when the tibial tuberosity "sags" posteriorly)
Ligamentous laxity
Patellar Subluxation (the patella may sublux laterally, causing chronic recurrent knee pain;
usually in adolescent females)
