NSG 464 FINAL EXAMS QUESTIONS AND ANSWERS

NSG 464 FINAL EXAMS QUESTIONS AND ANSWERS Osteoarthritis (OA) - CORRECT ANSWER-Heberden Nodes (DIP joints) and Bouchard Nodes (PIP joints) - hard and painless - flexion and deviation deformities - MCP rarely involved - Radial deviation Rheumatoid Arthritis (RA) - CORRECT ANSWER-Symmetric deformity in PIP, MCP, wrist joints - Tender, painful, stiff - DIP, MCP, wrist - Fusiform or spindle-shaped swelling of PIP joints - Ulnar deviation Pain Provocation Test - CORRECT ANSWER-Positive: shoulder pain from 60-120 degrees Nerve Impingement Sign - CORRECT ANSWER-Press on scapula, raise patient's arm Hawkins Impingement Sign - CORRECT ANSWER-flex arm and shoulder 90• w/ palm down and rotate arm internally -will compress greater tuberosity against coracoacromial ligament External Rotation Lag Test - CORRECT ANSWER-Flex arm 90 degrees with palm up, rotate into full external rotation - Positive: unable to maintain external rotation; supraspinatus and infraspinatus disorder Internal Rotation Lag Test - CORRECT ANSWER-Ask pt to place dorsum of hand on low back, elbow flexed 90 degrees - Lift hand off back, further internally rotating shoulder - Positive: unable to hold this position; subscapularis disorder Drop Arm Test - CORRECT ANSWER-Fully abduct arm to shoulder level and lower slowly - Positive: weakness, supraspinatus rotator cuff tear or bicipital tendinitis External Rotation Resistance Test - CORRECT ANSWER-Adduct and flex arm 90 degrees with thumb turned up - apply pressure to wrist positive: infraspinatus disorder Empty Can Test - CORRECT ANSWER-Elevate arms to 90° in front of pt and internally rotate arms with thumbs pointing down; ask pt to resist as you place downward pressure on arms Positive for Rotator cuff tear if weakness present Lateral Epicondylitis - CORRECT ANSWER-tennis elbow, characterized by pain on the outer side of the forearm Medial Epicondylitis - CORRECT ANSWER-golfer's elbow, characterized by pain on the palm-side of the forearm Colles fracture - CORRECT ANSWER-fracture of the distal radius at the wrist Scaphoid fracture - CORRECT ANSWER-Anatomical Snuffbox > Radial artery here Avascular necrosis, most commonly injured wrist bone Thumb Abduction Test - CORRECT ANSWER-Ask patient to raise the thumb straight up as you apply downward resistance Positive test - weakness on thumb abduction - Most sensitive carpal tunnel test Tinel Test - CORRECT ANSWER-Percussion on medial nerve - Positive: aching and numbing, tingling Phalen's Sign - CORRECT ANSWER-Hold backs of hands together with wrists in flexion for 60 seconds - Positive: numbness/tingling Sensation Test: median nerve - CORRECT ANSWER-pulp of index finger Sensation Test: ulnar nerve - CORRECT ANSWER-pulp of 5th finger Sensation Test: radial nerve - CORRECT ANSWER-dorsal web space of thumb and index finger Torticollis - CORRECT ANSWER-head tilt due to shortening or spasm of one sternomastoid muscle Spondylolithesis - CORRECT ANSWER-forward slipping of a vertebra over a lower vertebra; may compress spinal cord Scoliosis - CORRECT ANSWER-lateral curvature of the spine spina bifida - CORRECT ANSWER-congenital defects in the lumbar spinal column caused by imperfect union of vertebral parts Bulge Sign - CORRECT ANSWER-Minor effusion - Knee extended, apply pressure to "milk" fluid downward - Tap knee behind patella - Positive: fluid wave Balloon Sign - CORRECT ANSWER-Major effusion - Compress suprapatellar pouch against femur - Palpate for fluid "ballooning" into spaces next to patella under R thumb and index finger - Positive: palpable fluid wave; present in knee fractures Balloting Patella - CORRECT ANSWER-Major Effusion - Compress suprapatellar pouch and "ballotte" or push patella sharply against femur - Positive: palpable fluid wave returning into pouch Achilles Tendon Rupture - CORRECT ANSWER-Patient prone with knee/ankle flexed at 90 degrees, or ask pt to kneel on chair - Squeeze calf and watch for plantar flexion at ankle - Positive: absent plantar flexion; achilles tendon rupture - sudden severe "gunshot" pain, ecchymosis, flat-footed McMurray Test - CORRECT ANSWER-Assess medial/lateral meniscus - Positive: palpable click/pop; meniscal tear Abduction or Valgus stress test - CORRECT ANSWER-medial collateral ligament (MCL) - Positive: pain or gap in medial joint line Adduction or Varus stress test - CORRECT ANSWER-Lateral collateral ligament (LCL) - Positive: pain or gap in lateral joint line points Anterior Drawer Test - CORRECT ANSWER-ACL tear - Positive: forward jerk showing contours of upper tibia Lachman's Test - CORRECT ANSWER-ACL - Positive: significant forward excursion