Orthopedics OBJECTIVE ASSESSMENT Questions with Correct DETAILED Answers 2025/2026(A+ GRADED 100% GUARANTEED PASS)

Orthopedics OBJECTIVE ASSESSMENT Questions with Correct DETAILED Answers 2025/2026(A+ GRADED 100% GUARANTEED PASS) Besides inadequate intake of Vitamin D in elder adults, what other factor contributes to deficiencies? Impaired synthesis of previtamin D Decreased physical activity Diminished hepatic function Decreased body mass - ANSWER Impaired synthesis of previtamin D Explanation: Elderly adults are at increased risk of Vitamin D deficiency related to several factors. In addition to those mentioned, lack of sun exposure decreases synthesis of Vitamin D. As renal status declines in older patients, hydroxylation diminishes which diminishes available Vitamin D. Patient with dark skin are also at increased risk of Vitamin D deficiencies. A 60 year-old patient who is otherwise healthy, presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding? Limping and erythema about the anterior knee Swelling and pain to touch of the anterior knee Posterior knee pain, anterior knee edema, and redness Tenderness to touch of the tibial tubercle - ANSWER Swelling and pain to touch of the anterior knee Explanation: Prepatellar bursitis is often precipitated by an increase in activity involving the knee, such as was given in history by this patient. If it was infectious in origin, erythema would be present, but based on this patient's history and absence of risk factors, that is less likely. Prepatellar bursitis is characterized by swelling and inflammatory changes anterior to the patella, no symptoms posteriorly. The patient probably will limp due to pain. Tenderness to touch of the tibial tubercle is characteristic of Osgood Schlatter disease, but, is common in an under 19 years age group. Which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus (SLE)? Antinuclear antibody (ANA) Rheumatoid factor Elevated liver function studies Erythrocyte sedimentation rate (ESR) - ANSWER Antinuclear antibody (ANA) Explanation: The criteria for diagnosis of lupus have been established by the American College of Rheumatology. It includes 11 criteria: malar rash, discoid rash, sunrelated rash, painless oral ulcerations, joint pain or swelling involving two or more joints, inflammation involving the heart or lungs, renal disorder, a nonspecified neurological disorder (seizures or psychosis), CBC abnormalities such as anemia, leukopenia, or thrombocytopenia, immunologic disorders (another positive autoimmune test such as an anti-phospholipid antibody test), or positive ANA. Having 4 or more of these criteria either at one time or over time can constitute a diagnosis of SLE. An elevated sedimentation rate is a very non-specific measure of inflammation. A 55 year-old male patient describes severe pain at the base of his left first toe. He is limping and says he can't remember hurting his toe. Which symptom below suggests something other than gout? Pain Elevated sedimentation rate Erythema Fever - ANSWER Fever Explanation: This presentation is classic for gout except that gout is not associated with fever. This presentation coupled with fever should prompt the examiner to suspect septic arthritis. If this is the presentation, this patient should have a joint tap (or refer to an orthopedic surgeon). Synovial fluid will be aspirated and sent to the laboratory for evaluation. The fluid will contain white cells and bacteria if infection is present. Which symptoms are most commonly found in a patient with rheumatoid arthritis? Morning stiffness, positive rheumatoid antigen and antinuclear antibody Fever, symmetrical joint involvement, normal sedimentation rate Asymmetrical joint involvement, male gender, pain Nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody - ANSWER Morning stiffness, positive rheumatoid antigen and antinuclear antibody Explanation: Rheumatoid arthritis is a difficult diagnosis to make because there are many factors to evaluate and none are consistently positive in all patients. Clinical clues that should cause the examiner to suspect rheumatoid arthritis are symmetrical peripheral polyarthritis, morning stiffness lasting greater than one hour, the presence of rheumatoid nodules, bone erosions on x-ray, positive sedimentation rate as an early phase reactant, positive rheumatoid antigen, and positive antinuclear antibody. None of these characteristics are positive in all patients and other autoimmune rheumatic diseases can be part of the differential. A 6 year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from "playing outside too much". When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? Osgood-Schlatter disease Growing pains Acute lymphocytic leukemia (ALL) Psychogenic pain - ANSWER Acute lymphocytic leukemia (ALL) Explanation: Bone pain is common in children, especially adolescents. However, a six yearold with complaints of mid-bone pain should be evaluated for ALL. OsgoodSchlatter produces pain in the knees. Growing pain usually occurs at nighttime. There is no information from history to suggest psychogenic pain, but ALL must always be considered since it is the most common malignancy in children. The child should be assessed for lymphadenopathy since this accompanies bone pain in ALL at least 50% of the time. A patient who frequently has episodes of gout should avoid which groups of food? Beans, rice, and tea Scrambled eggs, milk, and toast Roast beef with gravy, rice Fish and steamed vegetables - ANSWER Roast beef with gravy, rice Explanation: Patients who have gout exacerbations should avoid foods high in purines. A low purine diet can significantly reduce risk of gout. Uric acid is a byproduct of purine metabolism. Purines can be found in high concentrations in beef, pork, bacon, lamb, seafood, beer, bread, gravy, and most alcoholic beverages. Foods considered low in purines are fruits and fruit juices, green veggies, nuts, dairy products, chocolate. The age at which a child can first walk backwards is: 12 months. 15 months. 18 months. 24 months. - ANSWER 18 months. Explanation: Common developmental tasks for an 18 month old include: walking backwards, throwing a ball, saying 15-20 words, pointing to multiple body parts, pointing and naming objects in a book, and stacking 3-4 blocks. The "get up and go" test in an elderly patient is used to evaluate: risk for falls. lower extremity strength. mental acuity. driving safety. - ANSWER risk for falls. Explanation: The "get up and go" test is used to evaluate musculoskeletal function. The patient is asked to rise from a seated position in an armchair, walk across the room, turn around, and return to the chair. This test evaluates the patient's gait, balance, leg strength, and vestibular function. It should be assessed in patients who report a fall or who present after a fall but who appear without injury. A long distance runner is diagnosed with a tibial stress fracture. Which statement is true about the injury? The pain worsens with rest. The patient should be casted for 6 weeks. Plain x-rays will confirm the diagnosis. Rest and an alternative activity are recommended. - ANSWER Rest and an alternative activity are recommended. Explanation: Stress fractures are an example of an overuse injury. These occur in patients who are engaged in repetitive physical activities. These commonly occur in the feet and shins, though it is usually unilateral. X-rays usually do not demonstrate stress fractures, so history and exam are important. Treatment involves resting the injured joint. Engaging in an alternative exercise (termed, cross-training) that does not stress the fractured area, is recommended. One example of cross training is swimming. Casting and crutches are reserved for use when conservative treatments are not effective. What should the nurse practitioner assess in a patient who reports a fall but does not have serious physical injury? Blood pressure while the patient is seated Medications taken a few hours before the fall Visual acuity and ability to distinguish colors The ability to get out of a chair easily - ANSWER Medications taken a few hours before the fall Explanation: There are many things to assess when a patient reports a fall. The blood pressure should be compared in various positions: sitting to standing, lying to sitting, to assess for orthostatic hypotension. Assessing blood pressure only in a sitting position will not help identify orthostatic hypotension. Medication history in the last 72 hours would be important. Sometimes medications taken the night before will leave a patient with decreased alertness the following day. The circumstances surrounding the fall should be discussed. Visual assessment should be assessed, but color differentiation is not specific to the assessment. Gait and balance assessment as well as assessment of cognitive changes should be done. A 4 year-old was brought into the clinic by her mother who reports that she pulled her arms upward to pick her up and now the child won't use her right arm. A nursemaid's elbow is suspected. Which statement below is correct? The child is crying because her arm hurts. She will need to be admitted to the hospital for fracture reduction. Her arm is slightly flexed and held close to her body. Her elbow is held straight at her side and her fingers are in a fist. - ANSWER Her arm is slightly flexed and held close to her body Explanation: Nursemaid's elbow is a subluxation of the radial head. The typical position of the affected arm is as described in the answer above. The patient is usually not in pain unless someone attempts to move the elbow. Reduction of the elbow can be done in an ER with the child seated in the caregiver's lap by hyper pronation of the forearm. It is painful but very brief. No treatment is necessary after reduction. A man fell off a 3-foot stepladder while working at home. He presents to your office with complaints of foot pain. He has point tenderness over the lateral malleolus, swelling, but he is able to ambulate. How should this be managed? ACE wrap and rest Rest, ice, compression, and elevation X-ray of the foot and ankle Non-weight bearing for 3-7 days - ANSWER X-ray of the foot and ankle Explanation: This patient suffered trauma to his foot and/or ankle after a fall. A sprain is in the differential, but a fracture must be ruled out before this patient is allowed to continue to ambulate. An x-ray is needed now and he must be kept nonweight bearing until this is ruled out. A fracture should be suspected since the stem of the question indicates "point tenderness". A 16 year-old complains that his knees hurt. His mother states that he has complained of knee pain for the past 2 weeks. He has a prominent tibial tubercle. What should be part of the differential diagnosis? Osgood-Schlatter disease Growing pains Acute lymphocytic leukemia (ALL) Psychogenic pain - ANSWER Osgood-Schlatter disease Explanation: Osgood-Schlatter is an osteochondritis of the tibial tubercle that can produce pain in the knees of adolescents. Pain gradually increases over time and can become extremely painful, especially if the knee sustains a direct hit or when the patient kneels. The diagnosis can be made on clinical presentation without the need for imaging studies. This is usually treated by rest, ice/heat, NSAIDs, and strengthening of the quadriceps muscle. Activity should not be stopped, but instead slowed down if symptoms become too painful. A 70 year-old African American male complains of pain in his back and trunk. Cardiovascular disease is ruled out. He has a normocytic normochromic anemia with hypercalcemia. A likely diagnosis is: multiple myeloma. lymphoma. leukemia. prostate cancer. - ANSWER multiple myeloma. Explanation: Multiple myeloma is a neoplastic proliferation in the bone marrow which results in skeletal destruction. It is more common in older patients; the average age of diagnosis is 66 years. Common clinical findings are pain in the long bones, especially those of the trunk and back. Accompanying findings are anemia, usually normocytic/ normochromic, hypercalcemia, and renal insufficiency. A 49 year-old patient has osteoarthritis in the lumbar spine and hip. His hip xray demonstrates bone on bone. What can be done to resolve his complaints of pain in his hip? Acetaminophen onlyAn NSAID onlyAcetaminophen and physical therapy IncorrectAcetaminophen and a referral to orthopedics - ANSWER Acetaminophen and a referral to orthopedics Explanation: This patient has severe osteoarthritis if the x-ray reveals "bone on bone". He should be given something to help manage his pain (acetaminophen initially). He needs referral to an orthopedic doctor for evaluation if this is consistent with his desire. Medications alone will likely not resolve his pain. Additionally, he is 49 years old with no mention of other diseases and would likely be a good candidate because of his young age. What joints are least commonly involved in osteoarthritis? Fingers Wrists Hips Knees - ANSWER Wrists Explanation: Osteoarthritis (OA) is characterized by destruction of the articular cartilage. The fingers, knees, hips, and spine are most commonly affected. OA is more common in men before age 45 years, but is more common in females after age 55 years. Often osteophytes form in the diseased joints. The most commonly involved joints are found in the fingers. A patient has suspected plantar fasciitis. The plantar fascia is best examined: with the great toe dorsiflexed. with the foot in neutral position. while the patient stands. with the ankle at a 90 degree angle. - ANSWER with the great toe dorsiflexed. Explanation: When the great toe is dorsiflexed, the plantar fascia is easy to palpate because it tightens and can be easily palpated on the sole of the foot. Anterior heel pain is usually easily appreciated when the patient has plantar fasciitis. A 60 year-old adult with an antalgic gait and complaints of hip pain is examined. He has trochanteric tenderness. What is the most common cause of this? Bone cancer Trochanteric strain Trochanteric bursitis Osteoarthritis - ANSWER Trochanteric bursitis Explanation: