Chamberlain NR 511 Final Questions With Complete
Solutions
31. Describe how to perform a
Tinnel test Correct Answer Purpose: Assess for compression
neuropathy
Procedure: Percuss the median nerve at the wrist. If the patient
complains of tingling in the digits (POSITIVE TINEL SIGN),
compression at the site of percussion is likely.
8. Discuss common characteristics (objective findings) of
patients with lumbar spinal stenosis Correct Answer - Muscle
weakness
- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms
o Sphincter tone decreased
o Don't confuse w/ prostate problems in older men
Carpal Tunnel Phalen's test Correct Answer
Carpal Tunnel syndrome diagnostics Correct Answer o Median
nerve conduction velocity study most useful
o xray if limited wrist movement only
Carpal Tunnel Syndrome: Correct Answer - Peripheral nerve
compression of the medial nerve
- Caused by repetitive flexion and extension of the wrist or
direct compression of medial nerve
,- Pain and/or numbness are usual presenting symptoms
o Burning, tingling, or itching numbness of the hand and fingers,
especially the thumb, middle, and index fingers
- Most often dominant hand - may be bilateral
- Pain increases with wrist flexion or extension
- Paresthesia and numbness along thumb, index, long and radial
half of ring fingers
- Nighttime wakening of N/T in affected limb
- Positive Phalen's test, Positive Tinel's sign
Carpal Tunnel Tinels sign Correct Answer
Carpal Tunnel Treatment Correct Answer o Rest, splinting
o NSAIDS, NO CORTICOSTEROIDS
o Vitamin B6, and management of concurrent diseases
o Often resolves after pregnancy if symptoms related
Cat & Dog Bites Correct Answer o Pathogens
Pasturella multocida & capnocytophaga canimorsis
o Alternative ATB w/ activity against Pasturella
Doxycycline 100mg 2xday
Bactrim DS 2xday
PCN VK 500mg 4xday
Ciprofloxacin 500mg 2xday
• PLUS
o Metronidazole 500mg 3xday
o Clindamycin 450mg 3xday
- ALL bites treatment considerations
, o Treatment
Copiously irrigate with sterile saline
Remove grossly visible debris
Prophylactic ATB are given if
• Deep puncture wounds
• Wounds requiring surgical repair
• Moderate to severe wounds w/ associated crush injury
• Wounds in areas of underlying venous and/or lymphatic
compromise
• Wounds on the hands or in close proximity to a bone or joint
• Wounds on the face or in the genital area
• Immunocompromised hosts
Cellulitis Correct Answer o Pathogens
Strep (A,B,C,G,F)
Staph
o Symptoms
Skin erythema, edema, warmth, pain, possible fever
Lymphangitis, lymphadenopathy, peau d'orange (orange peel
texture)
No fever/chills, localized symptoms only
Underlying infection, lymphedema, venous insufficienc
o Treatment
I&D if abscess is involved
Solutions
31. Describe how to perform a
Tinnel test Correct Answer Purpose: Assess for compression
neuropathy
Procedure: Percuss the median nerve at the wrist. If the patient
complains of tingling in the digits (POSITIVE TINEL SIGN),
compression at the site of percussion is likely.
8. Discuss common characteristics (objective findings) of
patients with lumbar spinal stenosis Correct Answer - Muscle
weakness
- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms
o Sphincter tone decreased
o Don't confuse w/ prostate problems in older men
Carpal Tunnel Phalen's test Correct Answer
Carpal Tunnel syndrome diagnostics Correct Answer o Median
nerve conduction velocity study most useful
o xray if limited wrist movement only
Carpal Tunnel Syndrome: Correct Answer - Peripheral nerve
compression of the medial nerve
- Caused by repetitive flexion and extension of the wrist or
direct compression of medial nerve
,- Pain and/or numbness are usual presenting symptoms
o Burning, tingling, or itching numbness of the hand and fingers,
especially the thumb, middle, and index fingers
- Most often dominant hand - may be bilateral
- Pain increases with wrist flexion or extension
- Paresthesia and numbness along thumb, index, long and radial
half of ring fingers
- Nighttime wakening of N/T in affected limb
- Positive Phalen's test, Positive Tinel's sign
Carpal Tunnel Tinels sign Correct Answer
Carpal Tunnel Treatment Correct Answer o Rest, splinting
o NSAIDS, NO CORTICOSTEROIDS
o Vitamin B6, and management of concurrent diseases
o Often resolves after pregnancy if symptoms related
Cat & Dog Bites Correct Answer o Pathogens
Pasturella multocida & capnocytophaga canimorsis
o Alternative ATB w/ activity against Pasturella
Doxycycline 100mg 2xday
Bactrim DS 2xday
PCN VK 500mg 4xday
Ciprofloxacin 500mg 2xday
• PLUS
o Metronidazole 500mg 3xday
o Clindamycin 450mg 3xday
- ALL bites treatment considerations
, o Treatment
Copiously irrigate with sterile saline
Remove grossly visible debris
Prophylactic ATB are given if
• Deep puncture wounds
• Wounds requiring surgical repair
• Moderate to severe wounds w/ associated crush injury
• Wounds in areas of underlying venous and/or lymphatic
compromise
• Wounds on the hands or in close proximity to a bone or joint
• Wounds on the face or in the genital area
• Immunocompromised hosts
Cellulitis Correct Answer o Pathogens
Strep (A,B,C,G,F)
Staph
o Symptoms
Skin erythema, edema, warmth, pain, possible fever
Lymphangitis, lymphadenopathy, peau d'orange (orange peel
texture)
No fever/chills, localized symptoms only
Underlying infection, lymphedema, venous insufficienc
o Treatment
I&D if abscess is involved
