APEA Question Bank Ortho 317 Question & Answers 100% Verified Q & A 2025

Question: A tool for assessing risk factors for osteoporotic fractures is the: FRAX Explanation: The FRAX calculator generates fracture risk based on age, body mass index, parental fracture history, use of glucocorticoids, presence of rheumatoid arthritis or secondary osteoporosis, and tobacco and alcohol use. It has been validated for black, Hispanic, and Asian women in the USA and has calculators that are country and continent specific. Duel energy x-ray absorptiometry, DEXA, is the optimal standard for measuring bone density. BRAC1 is a gene that can mutate and increase the risk of breast cancer. HAARM is the melanoma risk model. Question: Anserine bursitis arises from: excessive running. Correct excessive kneeling. Incorrect arthritis trauma Explanation: Anserine bursitis arises from excessive running, valgus knee deformity, fibromyalgia’s, and osteoarthritis. Prepatellar bursitis (“housemaid’s knee”) arises from excessive kneeling. A popliteal or “baker’s” cyst arises from distention of the gastrocnemius semi membranous bursa from underlying arthritis or trauma. Question: When examining the knee, which of the following symptoms could be indicative of a positive Adduction (Varus) Stress Test? Pain in the lateral joint Explanation: The Adduction (or Varus) Stress Test is a maneuver that evaluates the function of the lateral collateral ligament. To perform this test, the knee is held in 30 degrees of flexion. With one hand on the medial side of the knee and one hand on the ankle, an addiction force is gently applied. If pain is noted in the lateral joint line, this could be indicative of a lateral collateral ligament tear. When tenderness extends more to the proximal or distal joint line, the collateral ligament may be the cause of pain instead of the meniscus. Question: When assessing the knee, the examiner instructs the patient to straighten his knee. This motion would assess knee: Extension Explanation: Having the patient straighten his leg assesses extension of the knee. The examiner instructs the patient to bend his knee. This maneuver assesses knee flexion. Internal rotation of the knee could be elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to swing his leg away from his midline while sitting assesses external rotation of the knee. Question: When performing an examination of a tender left finger on an adult, the surrounding tissue reveals warmth, edema, and redness. This finding could be suggestive of: gouty arthritis Explanation: Redness, warmth, and edema over a tender joint suggest septic or gouty arthritis infection, or possibly rheumatoid arthritis. Question: An example of a fibrous joint would be the: Skull Explanation: The skull is an example of the fibrous joint. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints. Question: To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the: upper edge of the tibial plateau Explanation: To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the upper edge of the tibial plateau. The lateral meniscus is palpated on the lateral joint line by placing the patient's knee in slight flexion. To palpate the tibiofemoral joint, face the patient's knee and place the thumbs in the soft-tissue depressions on either side of the patellar tendon. Question: A patient complains of a sharp burning pain in the neck and right arm with associated paresthesias and weakness. These symptoms may be associated with: Cervical radiculopathy Explanation: With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm and stiffness and tightness in the upper back and shoulder, lasting up to 6 weeks. In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. Question: A patient complains of lateral hip pain while pointing near the trochanter. This type of pain could be suggestive of: Bursitis Explanation: Lateral hip pain near the greater trochanter suggests trochanteric bursitis. Sciatica symptoms usually include a shooting pain below the knee, commonly in the lateral leg or posterior calf and accompanied by low back pain. Radicular pain refers to pain that radiates along the dermatome of a nerve due to inflammation or irritation of a nerve root, as with sciatica pain. Polyarticular arthritis refers to arthritis involving several joints. Question: The muscle of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is known as the: infraspinatus muscle Explanation: One of the muscles of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is the infraspinatus muscle. The other one is the teres minor muscle. The pectoralis major muscle is situated on the anterior chest. The muscle that runs above the glenohumeral joint and inserts on the greater tubercle is known as the supraspinatus. The subscapularis muscle originates on the anterior surface of the scapula and crosses the joint anteriorly and inserts on the lesser tubercle. Question: The muscle of the scapulohumeral group that originates on the anterior surface of the scapula and crosses the joint anteriorly and inserts on the lesser tubercle is the: Answer: A. Infraspinatus muscle B. Teres minor muscle C. Subscapularis muscle (correct) D. Supraspinatus muscle Question: Inspection of the hip begins with careful observation of a patient's gait. A patient's foot moves forward without bearing weight. This is known as the: Swing phase of gait Explanation: Inspection of the hip begins with careful observation of a patient's gait. There are 2 phases of gait: stance and swing. The swing phase occurs when the foot moves forward and does not bear weight. The stance phase occurs when the foot is on the ground bearing weight. Question: The axioscapular group of muscles: Pulls the shoulder backward Explanation: The axioscapular group pulls the shoulder backward and rotates the scapula. The scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and depresses and rotates the head of the humerus. The axiohumeral group produces internal rotation of the shoulder. The serratus anterior draws the shoulder blade forward. Question: When assessing the knee, the examiner instructs the patient to sit and swing his lower leg toward midline. This motion assesses knee: Internal rotation Explanation: Internal rotation of the knee is elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to bend his knee assesses knee flexion. Having the patient straighten his leg assesses extension of the knee. Instructing the patient to swing his leg away from his midline while sitting would be a maneuver to assess external rotation of the knee. Question: When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of: A. Adduction B. Abduction C. Flexion (Correct) D. Extension Explanation: When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of flexion. Extension occurs when the patient moves his arm behind himself. Abduction occurs when the patient moves his arm away from the body laterally and overhead. Adduction occurs when the patient moves his arm across his body. Question: Static stabilizers of the shoulder are referred to as those structures that are: muscular structures of the shoulder le of movement. bony structures of the shoulder girdle. Correctresponsible for stabilizing the humeral head in the glenoid cavity. Incorrect Explanation: Static stabilizers are incapable of movement and include the bony structures of the shoulder girdle, the labrum, the articular capsule, and the glenohumeral ligaments that add to joint stability. Dynamic stabilizers are capable of movement and include the SITS muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles move the humerus and compress and stabilize the humeral head within the glenoid cavity. Question: To test the thumb for abduction, ask the patient to: Place the fingers and thumbs in the neutral position with the palm up and then move the thumb anteriorly away from the palm Explanation: Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To test extension, ask the patient to move his thumb from the base of the fifth finger, across the palm, and then as far away from the palm as possible. Touching the thumb to each of the other fingers tests opposition. Moving the thumb back to its neutral position assesses adduction. Question: Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the: lateral meniscus Explanation: Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the lateral meniscus. Question: The nurse practitioner instructs the patient to lie supine, bend his knee, and turn his lower leg and foot away from the midline. This maneuver would assess hip: internal rotation. Correct Explanation: To assess for hip internal rotation, the patient would lie supine, bend his knee, and turn his lower leg and foot away from the midline. To assess hip abduction, the patient would lie supine and move his lower leg away from the midline. To assess hip extension, the patient would lie face up, bend his knees, place feet flat on the table, and lift his buttocks off the table. To assess for external rotation of the hip, the patient would lie supine, bend his knee, and turn the lower leg and foot toward the midline. Question: Children with Legg-Calve Perthes disease should: avoid weight bearing on the affected extremity Explanation: Legg–Calvé–Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head. The bone loss leads to some degree of collapse and deformity of the femoral head and sometimes secondary changes to the shape of the hip socket. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity so that the risk of developing a severe degenerative arthritis as an adult can be reduced. Diet and sleeping on a firm mattress do not alter the course of the disease. However, avoiding high impact sports such as basketball during treatment is essential since increased weight on the hip will cause further damage. Question: The convex medial end of the clavicle that articulates with the concave hollow in the upper sternum is referred to as the: Sternoclavicular joint Explanation: The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. There is no manubrium joint; it is the broad upper part of the sternum. Question: When assessing a patient with complaints consistent with carpal tunnel syndrome, which one of the following symptoms is unlikely? Dropping objects Inability to twist lids off jars Tingling of the first three digits of the hand Numbness of the last two digits of the hand (Correct) Explanation: For complaints of dropping objects, inability to twist lids off jars, aching at the wrist or even the forearm, and numbness of the first three digits, consider carpal tunnel syndrome. Question: When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as: Finkelstein's test Explanation: When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in his palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as Finkelstein's test. Tinel's test assesses for median nerve compression. The examiner would tap lightly over the median nerve of the carpal tunnel. To test Phalen's sign, the patient would hold his wrists in flexion for 60 seconds while pressing the backs of his hands together to form right angles. Question: Olecranon bursitis may be caused by all of the following except: Frozen shoulder Explanation: Olecranon bursitis refers to swelling and inflammation of the olecranon bursa and may result from trauma, gout, or arthritis. Question: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except: Achilles tendinitis Explanation: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux valgus, metatarsalgia, and Morton's neuroma. Achilles tendinitis more commonly occurs in runners and affects the posterior foot as opposed to the forefoot. Question: Upon examination of the foot and ankle, the nurse practitioner notes point tenderness over the posterior aspects of the right malleolus. Additionally, the patient is unable to bear weight after 4 steps. This finding is most consistent with: an ankle fracture Explanation: Point tenderness over the posterior aspects of the right malleolus with an inability to bear weight after 4 steps could be consistent with an ankle fracture. Rheumatoid nodules and tenderness may be associated with Achilles tendinitis. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Tenderness on compression of the foot is an early sign of rheumatoid arthritis. Question: The small intrinsic muscles are located: between the vertebrae Explanation: The small intrinsic muscles are located between the vertebrae. Prevertebral muscles run in front of the cervical vertebrae, and they contract generally to flex the neck and bow the head. The paravertebral muscles are located on both sides of the vertebrae and extend downward to the entire spine. Muscles that attach to the anterior surface of the vertebrae include the psoas muscles and the muscles of the abdominal wall. Question: The nurse practitioner instructs the patient look upward at the ceiling. This maneuver assesses cervical: Extension Explanation: Assessing neck extension occurs by asking the patient to look upward at the ceiling. Bringing the chin to the chest assesses flexion of the cervical spine. Looking over one shoulder and then the other assesses rotation of the neck. Asking the patient to bring his ear to his shoulder assesses lateral bending of the cervical spine. Question: Upon examination of the left shoulder, the patient complains of a dull, aching pain when attempting active or passive range of motion and localized tenderness with external rotation. These symptoms could be suggestive of: Adhesive capsulitis Explanation: Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. It progresses to restriction of active and passive range of motion and tenderness with external rotation. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Reports of sharp "catches" of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain. Question: The area at the posterior aspect of the spine lateral to the sacroiliac joint is known as the: Posterior superior iliac spine Explanation: The posterior superior aspect of the spine lateral to the sacroiliac joint is known as the posterior superior iliac spine. The ischial tuberosity is a large swelling posteriorly on the superior ramus of the ischium. It marks the lateral boundary of the pelvic outlet and bares most of the weight when sitting. The superior ramus of pubis are the pubic bones that help form the obturator foramen. The pubic symphysis is a cartilage-like articulation between the pubic bones. Question: Which nerve in the arm runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process? Ulnar nerve Explanation: The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The brachial plexus runs from the spine through the neck, the axilla, and into the arm. Question: When examining the knee, the presence of a palpable fluid wave with the returning fluid wave into the suprapatellar pouch is noted. This positive sign for effusion of the knee is known as the: balloon sign Explanation: A positive balloon sign for effusion in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. Balloting of the patella is tested by compressing the suprapatellar pouch and pushing the patella sharply against the femur. If fluid returns to the suprapatellar pouch, then an effusion of the knee is diagnosed. McMurray's test checks for tears in the medial meniscus. Question: Dynamic stabilizers of the shoulder are referred to as those structures that are: capable of movement Explanation: Dynamic stabilizers are capable of movement and include the SITS muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles move the humerus and compress and stabilize the humeral head within the glenoid cavity. Static stabilizers are incapable of movement and include the bony structures of the shoulder girdle, the labrum, the articular capsule, and the glenohumeral ligaments that add to joint stability. Question: A structural channel beneath the palmar surface of the wrist and proximal hand is known as the: Carpal tunnel Explanation: A structural channel beneath the palmar surface of the wrist and proximal hand is known as the carpal tunnel. The carpal sheath covers the tendons. The flexor retinaculum is the transverse ligament that holds the sheath in place. Question: When describing muscle strength, the term paraplegia means: paralysis of the legs Explanation: Paraplegia means paralysis of the legs. Impaired strength is called weakness, or paresis. Absence of strength is called paralysis, or plegia. Quadriplegia means inability to move or paralysis of all four limbs. Question: A patient reports sharp "catches" of pain, grating, and weakness in the right shoulder when lifting the arm overhead. These symptoms could be suggestive of: a complete rotator cuff ive or cuff tendinitis. Correctcalcific tendinitis. Explanation: Reports of sharp "catches" of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. It progresses to restriction of active and passive range of motion. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain. Question: The structure that encloses the spinal cord is known as the: vertebral foramen Explanation: The vertebral foramen encloses the spinal cord. The structure that projects from the spinal column posteriorly in the midline is referred to as the spinous process. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets. Question: When examining the patient for wrist adduction, the nurse practitioner instructs the patient with his palms down to: move his fingers toward the midline Explanation: Adduction occurs by moving fingers toward the midline. When examining the patient for wrist flexion, the nurse practitioner instructs the patient to position his palms down and to point his fingers toward the floor. Extension occurs with pointing fingers toward the ceiling. Abduction occurs by having the patient bring his fingers away from the midline. Question: An example of a cartilaginous joint would be the: Vertebral bodies of the spine Explanation: Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. The skull is an example of the fibrous joint. Question: When grading muscle strength, a five would indicate: Active movement against full resistance without fatigue Explanation: A grade of five for muscle strength would indicate active movement against full resistance without fatigue. Zero muscular strength would indicate no muscular contraction was noted on exam. A grade of one indicates a barely detectable trace of contraction noted on exam. For active movement of the body part with gravity eliminated, a grade of two would be noted. Question: With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a positive test for a: medial meniscal tear Explanation: With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a medial meniscal tear or a positive McMurray test. The Adduction (Varus) Stress Test evaluates the function of the lateral collateral ligament, while the Abduction (Valgus) Stress Test evaluates the medial collateral ligament. To test the posterior cruciate ligament, the posterior drawer sign would be assessed. Question: When examining the elbow for range of motion, the nurse practitioner instructs the patient to bend his elbow. This motion is an example of: A. Extension b. Flexion (correct) c. Supination d. pronation. Explanation: Instructing the patient to bend his elbow is an example of flexion. Extension occurs with straightening the elbow. Turning the palms upward demonstrate supination. Turning the palms downward demonstrates pronation. Question: The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses: