NR 511 Week 5 Quiz Latest Update Graded A+

NR 511 Week 5 Quiz Latest Update Graded A+ A 16 year old boy present to the office with complaints of low back pain after lifting heavy boxes. In discussing with him proper body mechanics to prevent future injuries, the clinician should advise which of the following? • Hold boxes away from your body at arm's length • Bend your knees and face the object straight on • Keep your feet firmly together • Bend and twist simultaneously as you twist Bend your knees and face the object straight on A 48 year old male presents with acute low back pain in the right that increases when standing and bending. Upon physical exam, lower extremity muscle strength is 5/5 and straight leg raise test is negative. Which of the following is the most likely diagnosis? - Herniated nucleus pulposus - Osteoarthritis - Muscle Strain - Spondyloisthesis Muscle strain Muscle strain is usually located in the low back and is unilateral in location. The onset is acute and pain increases with standing and bending and decreases with sitting. the straight leg raises test and plain xray are both negative A 49 year old female present with low back pain radiating into the right leg. An X-ray of the lumbosacral spine is WNL. which of the folloing diagnoses do you explore further? - Herniated nucleus pulposus - Scoliosis - Osteoarthritis - Compression fracture Herniated nucleus pulposus A plain xray will not show a herniated nucleus pulposus or a muscle straing. it will show spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note that xrays of the spain are not indicated in low back pain unless the cause of the pains is thought to be body in origin or traumatic in nature or theres is a need to rule out systemic disease. A 55 year old female present with complaints of pain and parasthesisa in the left ulnar aspext of the forearm, thumb, and middle finger following a C6 and C7 nerve root dermatomal pattern. This is known as _________? - Peripheral polyneuropathy - Cervical radiculopathy - Brachial plexus neuritis - Thoracic outlet syndrome Cervican radiculopathy Cervical root compresssion of C6 and C7 causes cervical rediculopathy. Brachial plexus neuritis present with dysfunction franging from momentary parasthesias to completely flail extremities and is usuallly caused by injuries to the C5 and C6 nerve roots. Peripheral polyneuropathy is associated with distal sensorimotor parasthesia and diminished deep tendon reflexes. Thoracic outlet syndrome is caused by compression of the brachial plexus and/or sublcavian vessles as they exit the space b/w the superior shoulder girdle and the first rib. Symptoms are color changes in the hand and sensory changes and weakness in the 4th and 5th fingers. A 13 year old obeses (BMI aboe the 95th percentile) boy repoerts low-grade left knee pain for the past 2 months. He denies antecedent trauma but admits frequent "horseplay" with his friends. The pain has progressivley worsened and he is now unable to bear weight at all on his left leg. His current complaints inclused left groin, thigh, and medial knee pain and tenderness. His examination demonstrates negative drawer, Lachman, and McMurray tests; left hip with decreased internal rotation and abduction; and external hip rotation with knee flexion. Based on the above scenario, the clinican should suspect which of the following? - A left meniscal tear - A slipped capital femoral epiphysis (SCFE) - A left anterior cruciated ligament (ACL) tear - Osgood-Schlatter disease SCFE is a displacement of the femoral head relative to the femoral neck that occurs through the physis (growth plate) of the femur. The vast majority of clients with this condition are obese as the added wieght increases shear stress across the physis. the mean age at diagnsosi is 12 for females and 13.5 for males. Surgery is often required via in situ pin fixation (single screw) to stabilize the growth plate A 62 year old woman present to the clinic with low back pain. She states she has developed episodes of fecal incontinence and numbness in her right leg over the last week. Upon examination the clinician notes decreased perianal sensation to pinprick. What should the clinician do next? - Send the pt for electromyelography (EMG) testing - Prescribe physical therapy for 6 weeks - Order a MRI - Refer the patient to the emergency room Refer the patient to the emergency room Cauda equina is characterized by loww of bowel/bladder control or saddle-pattern anesthesia (perineum). If left untrested, compresssion can cause ischemia and premamnent nerve damage leading to incontinence and paralysis. the pt should be immediately referred to the ER. A 28 year old male present to the clinic for follo-up from the emergency department, where he was seen for right forearm pain 3 days ago. He works as a carpenter and is right hand dominant. He states he was diagnosed with right forearm tendinitis and is not sure what this means. As part of treaching, the clinician explains that the condition is caused by inflammation of one or more of the tendons. Which of the following describes tendons? - The ropelike bundles of collagen fibrils that connect bone to bont - the collagen fibers that connect muscle to bone - the fibrocartilaginous disks that separate bony surfaces - The pouches of synovial fluid that cushion bone and other joint structures Tendons are the collagen fibers that connect muscle to bone. A 55 year old patient is able to complete ROM against gravity with some resistance. The NP would assign which of the following numerical grades to this manual muscle testing description? - 2 - 3 - 5 - 4 Normal muscle strength and function and complete ROM against gravity w/ full or normal resistance would be given a numerical grade of 5. Complete ROM against gravity with some resistance is given a 4 and described as good muscle strength. Complete ROM against graviatiy is indiciatve of fair muscle strength and graded at a 3. A grade of 2, denoting poor muscle strength, is given for complete ROM with gravity eliminated. A 42 year old professional golfer complains of chronic back pain for many years. His workup reveals that it is not the result of degenerative disc problem. His back "goes out" about tsice per year, and he is out of work for about a week each time. Which of the following should the clinician advise? - Make and appt with a neurosurgeon ofr surgical consultation - Start on daily low-dose narcotic to take away the pain - Consider changing careers to something less physical - Being a Planned exercise program to strengthen back muscles The pt amy benefit from a regular planned exercise program to strengthen his back muscles and attempt to reduce the probability of future episodes of back pain The valgus stress trest, varus stress test, Lachman test, and thumb sign are all considered standard tests to check the integrity of the ligaments of the knee. Which of the following would the clinician choose to assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury? - Lachman test - Varus stress test - Thumb Sign - Valgus stress test Lachman test assesses the ACL In assessing the skeletal muscles, the clinican turns the patient's forarm so that the palm is face up. this is called: - Eversion - Supination - Abduction - Pronation Supination A conservative approach is recommended in the inital approach to the managment of low back pain. which of the following would be an appropriate treatment plan for a 32 year old obese male (BMI 33) diagnosed with an acute lumbar strain. - Epidural steroid injections (ESI) - Surgery - Bedrest - NSAIDS NSAIDS It has been proven that rest has little to no effect on the resolution of LBP. Pts should do whatever activities are tolerable. Almost 90% of cases resolve wihtin 1-6 wks this inisital management should include non-pharmacologic (massage, heat, etc.) pharmacological ( NSAIDS and short term use of muscle relaxants) and activity. Surgery and ESI are not inidicated in the initial managment of LBP A 55 year old female presnt to the clinical with complaints of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, the clinican notes tenderness at the "antamocial snuffmox" this finding moste likely indicates which of the following? - Scaphoid fx - Ulnar styloid fx - Hamate fx - Radial head fx There is tenderness over the "anatomical snuffbox" in a scaphoid (aka navicular) fx, the most common injurty of the carpal bones. Poor blood suppply puts the scaphoid boneat risk of avascular necrosis; therefore, wrist pain and tenderness in the anatomical snuff box, even w/o hx of antecedent trauma warrante a wrist xray A 16 year old male presents wo the clinical after sustaining a football injury to his right knee. The clinican elicits a positive anterior/posterior drawer sign. The test indicates an injury to the _____? - Crucial ligament - Lateral Meniscus - Collateral ligament - Medial meniscus Cruciate ligament - positive anterior/posterior drawer signs indicate injury to the anterior cruciate ligament and posterior cruciate ligament, respectively. The drawer and Lachman tests are utilized to assess for cruciate ligament injury A 10 year olf male presnt to the clinica after jumpting of a 2-foot wall, twisting his foor and ankle upon landing. His ankle xray demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis. Based on the Salter-Harris classification of growht plate injuries, the clinican knows that this is a _____? - Salter-Harris II fx - Salter-Harris III fx - Salter-Harris IV fx - Salter-Harris V fx Satler-Harris III fracture Salter Harris classification system of grwoth plate injuries divides most growth plate injuries into 5 categories based on damage: - SH I fx travels through the phyis. - SH II fx travels through the metaphysis and physis - SH III fx travels through the epiphysis and physis - SH IV fx travels through the metaphsyis, epiphysis, and physis - SH V fx involves compression injury of the physis