FNP 2 Musculoskeletal-Exam
Questions with Complete Solutions|
Verified Answers
What 2 drugs are given for remission and prevention for RA?
methotrexate (Pregnancy X, Nausea)
Hydroycloroquine (Preg C, retinal exams)
What can you give along with methotrexate to decrease the nausea side effect?
folate supplements
How do you dx fibromyalgia?
in absence of systemic disease
*widespread pain
*Mild or greater tenderness in 11 of 18 tender points
*No response to steroids
Pt may have widespread musculoskeletal pain, fatigue, non-restorative sleep,
depression, HA, and GI complaints
What are some treatment options for fibromyalgia? (4)
Tricyclic antidepressants for pain and sleep
cyclovenaprines for muscle pain
SSRI for daytime pain
Lyrica
What 2 things are hallmark for fibromyalgia?
persistent widespread pain
chronic fatigue
What are some things that you'll see on the PE for fibromyalgia?
1. Pain + fatigue
2. somatic complaints (chronic rhinitis, allergies, IBS, migraine)
3. "tenderpoints" where pain is the only objective finding
4. muscle strength is normal although effect may be affected by pain and theres no
evidence of synovitis or soft tissue inflammation
,What is the Supraspinatus test
arms at 90 abduction, and internal rotation (thumbs down). Examiner experts
pressure on the upper arm while pt resists.
+ is pain and indicates supraspinatus tendinitis. (rotator cuff)
What is impingement syndrome?
Tendons of the rotator cuff and the subacromial bursa are pinched beneath the
acromion. Pinching is worse when the arm is raise away from the side of the
body. (Connective tissue rubbing on a shoulder blade)
How do you assess impingement syndrome?
Hawkins-Kennedy test is positive with internal rotation
How do you differentiate impingement from rotator cuff tear?
with RCT the patient will not be able to hold their arm straight up. May even
have muscular atrophy.
With IMP strength is normal but pt will "give out" b/c of pain.
What does a positive drop arm test indicate?
Abduct to 90 and have pt slowly lower arm to their side.
pain indicates rotator cuff tear
What 2 tests can you do to test for impingement?
Neer impingement test
Hawkins-Kennedy impingement test
supraspinatus tears
In ages >40; what type of rotator cuff tear is most common?
What are some s/sx of rotator cuff tear?
pain in the shoulder or arm esp with arm movement.
radiation of pain to the upper, lateral arm
Pain at night
Shoulder feels weak, numb, or tingly
Pt can't move arm away from the body
Loss of shoulder ROM
What can cause extrinsic pain (outside the shoulder) pain? (4)
, Myocadial ischemia, splenic injury, ectopic pregnancy, and cervical root compression
Whats another term for lateral epicondylitis?
Tennis elbow
Inflammation of the tendons that join the forearm muscles on the outside of
the elbow
Lateral epicondylitis/Tennis elbow
Which tendon is involved in lateral epicondylitis?/tennis elbow?
The Extensor Carpi Radialis Brevis.
S/Sx of lateral epicondylitis
TENNIS ELBOW
pain/burning on the outer part of the elbow
weak grip strength
pain that's reproduced by resistive wrist extension (examiner apply pressure to
force first into flexion[down] while pt extends wrist [up])
whats another term for medial epicondylitis?
Golfer's elbow
inflammation in the tendons that connect the forearm to the elbow
Medial epicondylitis (golfer's elbow)
This is caused by overusing the muscles in the forearm that allows you to grip,
rotate your arm, and flex your wrist
Medial epicondylitis (golfer's elbow)
s/sx of Medial epicondylitis (golfer's elbow)
Pain on the inside of the elbow
pain made worse by restive wrist flexion (examiner appling pressure to force wrist
into extension [up] while pt flexes wrist [down]
What is the sign for a scaphoid fracture?
Snuffbox test: tenderness upon palpation of the anatomical snuffbox, thumb hurts
Questions with Complete Solutions|
Verified Answers
What 2 drugs are given for remission and prevention for RA?
methotrexate (Pregnancy X, Nausea)
Hydroycloroquine (Preg C, retinal exams)
What can you give along with methotrexate to decrease the nausea side effect?
folate supplements
How do you dx fibromyalgia?
in absence of systemic disease
*widespread pain
*Mild or greater tenderness in 11 of 18 tender points
*No response to steroids
Pt may have widespread musculoskeletal pain, fatigue, non-restorative sleep,
depression, HA, and GI complaints
What are some treatment options for fibromyalgia? (4)
Tricyclic antidepressants for pain and sleep
cyclovenaprines for muscle pain
SSRI for daytime pain
Lyrica
What 2 things are hallmark for fibromyalgia?
persistent widespread pain
chronic fatigue
What are some things that you'll see on the PE for fibromyalgia?
1. Pain + fatigue
2. somatic complaints (chronic rhinitis, allergies, IBS, migraine)
3. "tenderpoints" where pain is the only objective finding
4. muscle strength is normal although effect may be affected by pain and theres no
evidence of synovitis or soft tissue inflammation
,What is the Supraspinatus test
arms at 90 abduction, and internal rotation (thumbs down). Examiner experts
pressure on the upper arm while pt resists.
+ is pain and indicates supraspinatus tendinitis. (rotator cuff)
What is impingement syndrome?
Tendons of the rotator cuff and the subacromial bursa are pinched beneath the
acromion. Pinching is worse when the arm is raise away from the side of the
body. (Connective tissue rubbing on a shoulder blade)
How do you assess impingement syndrome?
Hawkins-Kennedy test is positive with internal rotation
How do you differentiate impingement from rotator cuff tear?
with RCT the patient will not be able to hold their arm straight up. May even
have muscular atrophy.
With IMP strength is normal but pt will "give out" b/c of pain.
What does a positive drop arm test indicate?
Abduct to 90 and have pt slowly lower arm to their side.
pain indicates rotator cuff tear
What 2 tests can you do to test for impingement?
Neer impingement test
Hawkins-Kennedy impingement test
supraspinatus tears
In ages >40; what type of rotator cuff tear is most common?
What are some s/sx of rotator cuff tear?
pain in the shoulder or arm esp with arm movement.
radiation of pain to the upper, lateral arm
Pain at night
Shoulder feels weak, numb, or tingly
Pt can't move arm away from the body
Loss of shoulder ROM
What can cause extrinsic pain (outside the shoulder) pain? (4)
, Myocadial ischemia, splenic injury, ectopic pregnancy, and cervical root compression
Whats another term for lateral epicondylitis?
Tennis elbow
Inflammation of the tendons that join the forearm muscles on the outside of
the elbow
Lateral epicondylitis/Tennis elbow
Which tendon is involved in lateral epicondylitis?/tennis elbow?
The Extensor Carpi Radialis Brevis.
S/Sx of lateral epicondylitis
TENNIS ELBOW
pain/burning on the outer part of the elbow
weak grip strength
pain that's reproduced by resistive wrist extension (examiner apply pressure to
force first into flexion[down] while pt extends wrist [up])
whats another term for medial epicondylitis?
Golfer's elbow
inflammation in the tendons that connect the forearm to the elbow
Medial epicondylitis (golfer's elbow)
This is caused by overusing the muscles in the forearm that allows you to grip,
rotate your arm, and flex your wrist
Medial epicondylitis (golfer's elbow)
s/sx of Medial epicondylitis (golfer's elbow)
Pain on the inside of the elbow
pain made worse by restive wrist flexion (examiner appling pressure to force wrist
into extension [up] while pt flexes wrist [down]
What is the sign for a scaphoid fracture?
Snuffbox test: tenderness upon palpation of the anatomical snuffbox, thumb hurts
