NURP 502 Exam 4 - Questions with Verified Answers Latest Update 2025 Already Passed
What are the sprain classifications? - Answers Grade I: ligament is minimally torn, stable joint
Grade II: partial tear, greater instability
Grade III: complete tear, complete instability
Grade I sprain? - Answers involves minimal tearing of ligament and associated fibers, as well as a varying
degree of internal hemorrhage (A).
Grade II sprain? - Answers Second-degree sprain usually results in definite structural breakdown as a
result of partial tearing. Hemorrhage is both internal and periligamentous, with moderately extensive
inflammatory edema (B).
Grade III sprain? - Answers is most severe and often involves complete rupture of the ligament body (C).
Avulsion at the points of origin or insertion usually results in one or more small bone fragments, which
may often be identified radiographically (D).
What is a STRAIN? - Answers is a stretching or tearing of muscle or tendon
What is tendonitis? - Answers Tendonitis is the inflammation, irritation, and swelling of a tendon. It can
occur as a result of injury, overuse, or with aging as the tendon loses elasticity. Any action that places
prolonged repetitive strain on the forearm muscles can cause tendonitis. The most common symptom of
tendonitis is pain, tenderness, and the increase of pain with movement.
What conditions are you look for with acute back pain? - Answers Infection
Cauda equina
Vertebral compression fractures
Ankylosing spondylitis
Progressive motor deficits
What is the management for back pain? - Answers 1st line- Acetaminophen w or w/o NSAIDS
2nd line- Muscle relaxants w NSAIDS/Acetaminophen
Use of opioids only if pain is severe and/or refractory
When do you do x-ray? - Answers Usually wait until finish 1st line therapies: physical therapy, rest,
meds, etc.
,What are alternative therapies to consider when managing back pain? - Answers Acupuncture, massage,
injections.
TCAs, physical therapy
When taking the history of an ankle injury, what is important to ask? - Answers If the injury was an
eversion or inversion
What are key PE techniques for the ankle? - Answers Inspect, palpate, ROM, proactive (strength,
anterior drawer, syndesmosis squeeze, inversion stress test), functional (wt bearing, gait, ability to
hop/stand on affected ankle)
What is the squeeze test? - Answers Examiner grasps the patient's leg midway up the calf and performs
a compress and release motion. A positive test is considered if the patient experiences pain in the area
of the syndesmosis. + test = severe injury
The Squeeze Test for syndesmosis injury following an ankle sprain is positive when pain is felt upon
squeezing the fibula and tibia together.
What are the Ottawa Ankle Rules? - Answers Radiographs unnecessary if the following conditions are
met:
1. Patient able to walk 4 steps at time of injury or evaluation
2. No bony tenderness over distal 6cm of either malleolus
Necessary if:
1. Pt cannot bear wt in office
2. Tenderness over medial and lateral malleoli, base of 5th metatarsal, or navicular bone
If an x-ray is needed of the shoulder, describe
the x-ray you need to order? - Answers 4 view x-ray of the shoulder
Internal anteriorposterior (AP)
Grashey/AP Oblique
Axillary
Y Views
What are some finding you could expect to see on x-ray of the shoulder? - Answers Fracture
,Glenohymeral arthritis
Significant AC joint separation
What might you consider in a patient >40 y/o with shoulder pain/bruising after a fall? - Answers In a
patient >40 with no prior history shoulder pain, negative x-rays, consider a massive rotator cuff tear.
MRI would be more sensitive to this condition
This will require an ortho referral if positive for a tear
What are differential diagnoses for knee injury? - Answers Several, some include the following:
ACL
MCL
Sprain/strain
Ruptured achilles
Chondromalacia (patellar fx= surgical emergency)
What are the Ottawa rules for Knee pain? - Answers > 65 y/o
Patellar pain
Tenderness at head of fibula
Inability to flex knee at 90 degrees
Inability to bear weight (4 steps) immediately after injury and on exam
What is important about a knee x-ray for the older population? - Answers Get an x-ray of both knees to
be able to compare
How do you manage knee pain? - Answers PRICE
Protection, plan, pain control
Rest
Ice
Compression
Elevation
Pain control = NSAIDS, protection= brace if necessary
, Which of the following is a "red flag" in the initial evaluation of low back pain?
a. acute onset
b. severity
c. fever
d. herniation of lumbar disc on previous MRI - Answers c
Which of the following meds is more effective than placebo in the short-term tx of chronic low back
pain?
a. NSAIDS
b. SSRIs
c. Topical lidocaine patches
d. Skeletal muscle relaxants - Answers a
Which of the following is the biggest risk factor for an ankle sprain?
a. wearing high heels
b. prior knee sprain
c. prior ankle sprain
d. playing basketball - Answers c.
once you have had one ankle sprain, the integrity of ligaments never returns to 100%, so you are set up
for increased risk for future sprains
Which of the following elements on PE would indicate the possibility of ankle fx and should be evaluated
by x-ray?
a. ability to bear wt on affected ankle
b. tenderness over medial malleolus
c. swelling of affected ankle
d. bruising of affected ankle - Answers b.
A school- age child with an acute ankle inversion injury resulting in lateral nakle pain and swelling is
most likely to have which injury?
a. sprained anterior talofibular ligament (ATFL)
What are the sprain classifications? - Answers Grade I: ligament is minimally torn, stable joint
Grade II: partial tear, greater instability
Grade III: complete tear, complete instability
Grade I sprain? - Answers involves minimal tearing of ligament and associated fibers, as well as a varying
degree of internal hemorrhage (A).
Grade II sprain? - Answers Second-degree sprain usually results in definite structural breakdown as a
result of partial tearing. Hemorrhage is both internal and periligamentous, with moderately extensive
inflammatory edema (B).
Grade III sprain? - Answers is most severe and often involves complete rupture of the ligament body (C).
Avulsion at the points of origin or insertion usually results in one or more small bone fragments, which
may often be identified radiographically (D).
What is a STRAIN? - Answers is a stretching or tearing of muscle or tendon
What is tendonitis? - Answers Tendonitis is the inflammation, irritation, and swelling of a tendon. It can
occur as a result of injury, overuse, or with aging as the tendon loses elasticity. Any action that places
prolonged repetitive strain on the forearm muscles can cause tendonitis. The most common symptom of
tendonitis is pain, tenderness, and the increase of pain with movement.
What conditions are you look for with acute back pain? - Answers Infection
Cauda equina
Vertebral compression fractures
Ankylosing spondylitis
Progressive motor deficits
What is the management for back pain? - Answers 1st line- Acetaminophen w or w/o NSAIDS
2nd line- Muscle relaxants w NSAIDS/Acetaminophen
Use of opioids only if pain is severe and/or refractory
When do you do x-ray? - Answers Usually wait until finish 1st line therapies: physical therapy, rest,
meds, etc.
,What are alternative therapies to consider when managing back pain? - Answers Acupuncture, massage,
injections.
TCAs, physical therapy
When taking the history of an ankle injury, what is important to ask? - Answers If the injury was an
eversion or inversion
What are key PE techniques for the ankle? - Answers Inspect, palpate, ROM, proactive (strength,
anterior drawer, syndesmosis squeeze, inversion stress test), functional (wt bearing, gait, ability to
hop/stand on affected ankle)
What is the squeeze test? - Answers Examiner grasps the patient's leg midway up the calf and performs
a compress and release motion. A positive test is considered if the patient experiences pain in the area
of the syndesmosis. + test = severe injury
The Squeeze Test for syndesmosis injury following an ankle sprain is positive when pain is felt upon
squeezing the fibula and tibia together.
What are the Ottawa Ankle Rules? - Answers Radiographs unnecessary if the following conditions are
met:
1. Patient able to walk 4 steps at time of injury or evaluation
2. No bony tenderness over distal 6cm of either malleolus
Necessary if:
1. Pt cannot bear wt in office
2. Tenderness over medial and lateral malleoli, base of 5th metatarsal, or navicular bone
If an x-ray is needed of the shoulder, describe
the x-ray you need to order? - Answers 4 view x-ray of the shoulder
Internal anteriorposterior (AP)
Grashey/AP Oblique
Axillary
Y Views
What are some finding you could expect to see on x-ray of the shoulder? - Answers Fracture
,Glenohymeral arthritis
Significant AC joint separation
What might you consider in a patient >40 y/o with shoulder pain/bruising after a fall? - Answers In a
patient >40 with no prior history shoulder pain, negative x-rays, consider a massive rotator cuff tear.
MRI would be more sensitive to this condition
This will require an ortho referral if positive for a tear
What are differential diagnoses for knee injury? - Answers Several, some include the following:
ACL
MCL
Sprain/strain
Ruptured achilles
Chondromalacia (patellar fx= surgical emergency)
What are the Ottawa rules for Knee pain? - Answers > 65 y/o
Patellar pain
Tenderness at head of fibula
Inability to flex knee at 90 degrees
Inability to bear weight (4 steps) immediately after injury and on exam
What is important about a knee x-ray for the older population? - Answers Get an x-ray of both knees to
be able to compare
How do you manage knee pain? - Answers PRICE
Protection, plan, pain control
Rest
Ice
Compression
Elevation
Pain control = NSAIDS, protection= brace if necessary
, Which of the following is a "red flag" in the initial evaluation of low back pain?
a. acute onset
b. severity
c. fever
d. herniation of lumbar disc on previous MRI - Answers c
Which of the following meds is more effective than placebo in the short-term tx of chronic low back
pain?
a. NSAIDS
b. SSRIs
c. Topical lidocaine patches
d. Skeletal muscle relaxants - Answers a
Which of the following is the biggest risk factor for an ankle sprain?
a. wearing high heels
b. prior knee sprain
c. prior ankle sprain
d. playing basketball - Answers c.
once you have had one ankle sprain, the integrity of ligaments never returns to 100%, so you are set up
for increased risk for future sprains
Which of the following elements on PE would indicate the possibility of ankle fx and should be evaluated
by x-ray?
a. ability to bear wt on affected ankle
b. tenderness over medial malleolus
c. swelling of affected ankle
d. bruising of affected ankle - Answers b.
A school- age child with an acute ankle inversion injury resulting in lateral nakle pain and swelling is
most likely to have which injury?
a. sprained anterior talofibular ligament (ATFL)
