NURP 532 Exam With Complete
Solution
What is the SMART approach for musculoskeletal conditions? - Answer S- visual scan or
survey of region- red, inflammation, swelling
M- motion completed by patient- abduction, adduction, flexion, extension
A- assisted motion completed by clinician- passive ROM, frozen shoulder
R- resisted testing of muscles and tendons
T- tests that are special- assess joints, tendons, and muscles
What are indications for early imaging for MSK conditions? - Answer - suspicion of
non-MSK etiology
- trauma plus functional loss
- failed conservative measures- failed RICE or tx
- patient insistence
- fevers, night sweats- indicate infection or malignancy
- unintentional weight loss
- night pain
- personal hx of cancer
- age over 50
- current or recent use of steroids
- any neoplasm or infectious cause of back pain
- pain over 6 weeks
- nonresponsive to conservative tx for more than 6 weeks
What are indications for PT? - Answer - traumatic disorders with mild or moderate
functional loss
- chronic postural pain disorders
- recurrent pain disorders
,- mechanical musculoskeletal disorders
- early nerve entrapment
- symptomatic joint degeneration
- acute unresolved pain
What are indications for orthopedic referral? - Answer - obvious tissue disruption
- trauma with significant loss of function
- continued functional deficit or pain after six weeks
- recurrent dislocation or subluxation
- need for joint injection
- failure of conservative measures
- patient insistence
What can plain X-ray imaging reveal? MRI and CT? - Answer - plain X-ray- fracture,
osteomyelitis, arthritis, infection
- MRI and CT- radiculopathy/pinched nerve, occult fracture, ligament injuries, meniscus
injuries
- CT done usually when MRI are contraindicated since CT has lots of radiation and is
usually not preferred
What does the Ottawa ankle rule do? - Answer - determines fracture risk and if X-ray
images is needed in ankle
- any malleolus tenderness, either the lateral or medical malleolus then get X-ray
- pain over the 5th metatarsal or if you have pain in the midfoot and pt is only able to take
4 steps, then you definitely need imaging of the foot
What does Ottawa knee rule do? - Answer - determines fracture risk and if X-ray images
is needed in knee
- if older than 55
- isolated tenderness of patella
- tenderness of fibular head
- unable to flex more than 90 degrees
- unable to walk 4 steps
,- unable to bear weight; limping counts as bearing weight
T/F: limping counts as bearing weight - Answer true
What are risk factors of plantar fasciitis? s/sx? dx? tx? - Answer - risk factors- lots of
running and walking, high BMI in non-athletic pts, men ages 40-60
- s/sx- plantar fascia has proximal insertion point at heel that elicits pain; classic sign is
pain worse first thing in the morning when taking first steps
- dx- Windlass test- dorsiflexion of big toe via provider manipulation will cause pain
before reaching maximum dorsiflexion
- tx- 1st line tx- NSAIDs
- subsequent tx- SPRICE
What is the most common tendon related ankle pain? - Answer - strains- tear to tendon-
muscle to bone
- Achilles tendonitis- tear to largest tendon of calf/Achilles tendon that connects knee to
ankle
What is the most common ligament related ankle pain? s/sx? dx? tx? - Answer - sprains-
tear to ligament- most common ankle injury
- lateral ankle ligament inversion (soles of foot faces inward)- rolling of ankle
- s/sx- tenderness, swelling, bruising, and ligament laxity; popping and immediate
swelling/bruising at time of injury
- dx- clinical presentation/clinical presentation
- fx dx if concerned- Ottawa Ankle Rules
- tx- RICE (rest, ice, compression, elevate) protocol and depending on level of sprains
severity will determine/guide your therapy
What are s/sx of achilles tendon rupture? dx? tx? - Answer - s/sx- sudden weakness in
ankle, inability to raise up on toes, limp and pain, and pain right over achilles tendon;
may feel pop at time of injury
- dx- thompson test- squeeze calf and foot should plantar flex; UX or MRI
- tx- refer to ortho immediatey, immobilization immediately with surgery
What are s/sx of morton neuroma? dx? tx? - Answer - heel wearing is risk; fibrosis of
plantar nerve due to compression
- s/sx- severe pain and burning in the region of the third web space, pain aggravated by
foot elevation, pain in boot between the heads of metatarsals common between 3/4th
, metatarsals
- dx- mulder sign- squeeze foot and palpate area between 3/4th metatarsals; positive if
click is felt; UX or MRI
- tx- pt education on wider shoes, insoles, separation of toes with small pad, NSAIDs,
cortisone, surgery
What are the tx differences for grade 1, 2, and 3 sprains? - Answer - grade 1- no
ligament tear, minimal s/sx, no pain with weight bearing, tx- PRICE, exercise, and PT,
return to play 5-14 days
- grade 2- stretch/partial tear, moderate s/sx, moderate pain with weight bearing, tx-
PRICE, exercise, PT, AND BRACE/TAPE; return to play 14- 21 days
- grade 3- complete tear; severe s/sx, severe pain with weight bearing, tx- PRICE,
exercise, PT, brace/tape, AND SURGERY; return to play 6-12 weeks
What are risk factors of anterior cruciate ligament tear? s/sx? dx? tx? - Answer - risk
factors- sports player will plant foot and kind of goes to the side and twists and will hear
pop and immediate swelling and pain in area of knee
- s/sx- may not be able to walk depending on degree of tear; laxity of knee
- dx- anterior drawer test- thumb behind knee and pull will increase laxity; Lachman test-
more accurate- pull of femur and tibia will cause soft mushy end feel; MRI can confirm dx
if needed
- tx- refer to ortho since this is a severe injury that causes instability; may need surgery
and PT
What are risk factors of meniscus tear? s/sx? dx? tx? - Answer - risk factors- sports
injury that usually accompanies along with ACL tear via pivoting movement/manuver
- medial meniscus is more common than lateral meniscus
- s/sx- trouble flexing and extending knee
- dx- McMurray test- one hand on femur and another hand on tibia; then flex pt's knee
and then twist as you extend; if click is heard, then there could be meniscal tear; MRI
can confirm dx if needed
- tx- non-sport individual- can refer to PT/RICE; sport individual- symptomatic and failed
conservative management should get surgery via ortho referral
What is the most common cause of hip replacement? - Answer osteoarthritis
What are risk factors of osteoarthritis? s/sx? dx? tx? - Answer - risk factors- sickle cell
disease
Solution
What is the SMART approach for musculoskeletal conditions? - Answer S- visual scan or
survey of region- red, inflammation, swelling
M- motion completed by patient- abduction, adduction, flexion, extension
A- assisted motion completed by clinician- passive ROM, frozen shoulder
R- resisted testing of muscles and tendons
T- tests that are special- assess joints, tendons, and muscles
What are indications for early imaging for MSK conditions? - Answer - suspicion of
non-MSK etiology
- trauma plus functional loss
- failed conservative measures- failed RICE or tx
- patient insistence
- fevers, night sweats- indicate infection or malignancy
- unintentional weight loss
- night pain
- personal hx of cancer
- age over 50
- current or recent use of steroids
- any neoplasm or infectious cause of back pain
- pain over 6 weeks
- nonresponsive to conservative tx for more than 6 weeks
What are indications for PT? - Answer - traumatic disorders with mild or moderate
functional loss
- chronic postural pain disorders
- recurrent pain disorders
,- mechanical musculoskeletal disorders
- early nerve entrapment
- symptomatic joint degeneration
- acute unresolved pain
What are indications for orthopedic referral? - Answer - obvious tissue disruption
- trauma with significant loss of function
- continued functional deficit or pain after six weeks
- recurrent dislocation or subluxation
- need for joint injection
- failure of conservative measures
- patient insistence
What can plain X-ray imaging reveal? MRI and CT? - Answer - plain X-ray- fracture,
osteomyelitis, arthritis, infection
- MRI and CT- radiculopathy/pinched nerve, occult fracture, ligament injuries, meniscus
injuries
- CT done usually when MRI are contraindicated since CT has lots of radiation and is
usually not preferred
What does the Ottawa ankle rule do? - Answer - determines fracture risk and if X-ray
images is needed in ankle
- any malleolus tenderness, either the lateral or medical malleolus then get X-ray
- pain over the 5th metatarsal or if you have pain in the midfoot and pt is only able to take
4 steps, then you definitely need imaging of the foot
What does Ottawa knee rule do? - Answer - determines fracture risk and if X-ray images
is needed in knee
- if older than 55
- isolated tenderness of patella
- tenderness of fibular head
- unable to flex more than 90 degrees
- unable to walk 4 steps
,- unable to bear weight; limping counts as bearing weight
T/F: limping counts as bearing weight - Answer true
What are risk factors of plantar fasciitis? s/sx? dx? tx? - Answer - risk factors- lots of
running and walking, high BMI in non-athletic pts, men ages 40-60
- s/sx- plantar fascia has proximal insertion point at heel that elicits pain; classic sign is
pain worse first thing in the morning when taking first steps
- dx- Windlass test- dorsiflexion of big toe via provider manipulation will cause pain
before reaching maximum dorsiflexion
- tx- 1st line tx- NSAIDs
- subsequent tx- SPRICE
What is the most common tendon related ankle pain? - Answer - strains- tear to tendon-
muscle to bone
- Achilles tendonitis- tear to largest tendon of calf/Achilles tendon that connects knee to
ankle
What is the most common ligament related ankle pain? s/sx? dx? tx? - Answer - sprains-
tear to ligament- most common ankle injury
- lateral ankle ligament inversion (soles of foot faces inward)- rolling of ankle
- s/sx- tenderness, swelling, bruising, and ligament laxity; popping and immediate
swelling/bruising at time of injury
- dx- clinical presentation/clinical presentation
- fx dx if concerned- Ottawa Ankle Rules
- tx- RICE (rest, ice, compression, elevate) protocol and depending on level of sprains
severity will determine/guide your therapy
What are s/sx of achilles tendon rupture? dx? tx? - Answer - s/sx- sudden weakness in
ankle, inability to raise up on toes, limp and pain, and pain right over achilles tendon;
may feel pop at time of injury
- dx- thompson test- squeeze calf and foot should plantar flex; UX or MRI
- tx- refer to ortho immediatey, immobilization immediately with surgery
What are s/sx of morton neuroma? dx? tx? - Answer - heel wearing is risk; fibrosis of
plantar nerve due to compression
- s/sx- severe pain and burning in the region of the third web space, pain aggravated by
foot elevation, pain in boot between the heads of metatarsals common between 3/4th
, metatarsals
- dx- mulder sign- squeeze foot and palpate area between 3/4th metatarsals; positive if
click is felt; UX or MRI
- tx- pt education on wider shoes, insoles, separation of toes with small pad, NSAIDs,
cortisone, surgery
What are the tx differences for grade 1, 2, and 3 sprains? - Answer - grade 1- no
ligament tear, minimal s/sx, no pain with weight bearing, tx- PRICE, exercise, and PT,
return to play 5-14 days
- grade 2- stretch/partial tear, moderate s/sx, moderate pain with weight bearing, tx-
PRICE, exercise, PT, AND BRACE/TAPE; return to play 14- 21 days
- grade 3- complete tear; severe s/sx, severe pain with weight bearing, tx- PRICE,
exercise, PT, brace/tape, AND SURGERY; return to play 6-12 weeks
What are risk factors of anterior cruciate ligament tear? s/sx? dx? tx? - Answer - risk
factors- sports player will plant foot and kind of goes to the side and twists and will hear
pop and immediate swelling and pain in area of knee
- s/sx- may not be able to walk depending on degree of tear; laxity of knee
- dx- anterior drawer test- thumb behind knee and pull will increase laxity; Lachman test-
more accurate- pull of femur and tibia will cause soft mushy end feel; MRI can confirm dx
if needed
- tx- refer to ortho since this is a severe injury that causes instability; may need surgery
and PT
What are risk factors of meniscus tear? s/sx? dx? tx? - Answer - risk factors- sports
injury that usually accompanies along with ACL tear via pivoting movement/manuver
- medial meniscus is more common than lateral meniscus
- s/sx- trouble flexing and extending knee
- dx- McMurray test- one hand on femur and another hand on tibia; then flex pt's knee
and then twist as you extend; if click is heard, then there could be meniscal tear; MRI
can confirm dx if needed
- tx- non-sport individual- can refer to PT/RICE; sport individual- symptomatic and failed
conservative management should get surgery via ortho referral
What is the most common cause of hip replacement? - Answer osteoarthritis
What are risk factors of osteoarthritis? s/sx? dx? tx? - Answer - risk factors- sickle cell
disease
