NR509 MidTerm Advanced Physical Assessment (NR-
509): Articular & Extra-Articular Conditions
Chamberlain
1. A patient reports joint swelling, tenderness, crepitus, and instability. These
findings are most consistent with:
A. Extra-articular disease
B. Articular disease
C. Tendinitis
D. Bursitis
Answer: B
Rationale: Articular disease involves the joint itself, causing swelling, tenderness,
crepitus, instability, deformity, and limited active/passive ROM.
2. Which finding is more characteristic of extra-articular disease than articular
disease?
A. Joint swelling
B. Crepitus
C. Point tenderness adjacent to the joint
D. Joint deformity
Answer: C
Rationale: Extra-articular disorders cause focal tenderness near, not within, the joint.
They rarely cause swelling, instability, or deformity.
3. Acute intra-articular joint pain (<6 weeks) is most likely caused by:
A. Osteoarthritis
B. Gout
C. Fibromyalgia
D. Polymyalgia rheumatica
Answer: B
Rationale: Acute arthritis (<6 weeks) includes infectious arthritis, gout, pseudogout, and
Reiter syndrome. Osteoarthritis is chronic and noninflammatory.
,4. Saddle anesthesia and urinary retention are red flags for:
A. Herniated cervical disc
B. Cauda equina syndrome
C. Multiple sclerosis
D. Spinal stenosis
Answer: B
Rationale: Cauda equina syndrome is a surgical emergency caused by massive lumbar
disc herniation or other mass lesions compressing the cauda equina.
5. Sudden, painless, unilateral vision loss suggests:
A. Optic neuritis
B. Retinal detachment
C. Acute glaucoma
D. Cataract
Answer: B
Rationale: Retinal detachment presents with sudden, painless unilateral vision loss.
Optic neuritis is painful.
6. An obtunded patient is best described as:
A. Unresponsive to painful stimuli
B. Opening eyes, responding slowly, and appearing confused
C. Fully alert but disoriented to time
D. In a deep coma with GCS 3
Answer: B
Rationale: Obtunded patients open eyes to stimuli but are slow and confused;
alertness and interest in the environment are decreased.
7. Lateral gaze is controlled by which cranial nerve?
A. CN III
B. CN IV
C. CN VI
D. CN VIII
Answer: C
Rationale: The abducens nerve (CN VI) innervates the lateral rectus muscle, which
abducts the eye.
, 8. Which items should be listed under adult illnesses in the past medical history?
A. Childhood immunizations
B. Diabetes, hypertension, hepatitis, asthma, and HIV
C. Current medications
D. Family history of cancer
Answer: B
Rationale: Adult illnesses include medical conditions such as diabetes, hypertension,
hepatitis, asthma, and HIV, with dates.
9. Absence of the red reflex suggests:
A. Normal aging
B. Cataract or opacity of the vitreous
C. Macular degeneration
D. Strabismus
Answer: B
Rationale: An absent red reflex may indicate lens opacity (cataract), vitreous opacity,
or less commonly retinoblastoma or detached retina.
10. Classic symptoms of seasonal allergies include:
A. Fever and productive cough
B. Itchy watery eyes, sneezing, and postnasal drainage
C. Unilateral facial pain and purulent nasal discharge
D. Sore throat and swollen tonsils
Answer: B
Rationale: Seasonal allergies cause itching, watery eyes, sneezing, ear congestion, and
postnasal drainage.
11. A young adult with multiple sclerosis develops sudden, painful vision loss in one
eye. Most likely diagnosis:
A. Retinal detachment
B. Optic neuritis
C. Subconjunctival hemorrhage
D. Central retinal artery occlusion
Answer: B
Rationale: Optic neuritis causes unilateral, often painful visual loss and is associated
with multiple sclerosis.
509): Articular & Extra-Articular Conditions
Chamberlain
1. A patient reports joint swelling, tenderness, crepitus, and instability. These
findings are most consistent with:
A. Extra-articular disease
B. Articular disease
C. Tendinitis
D. Bursitis
Answer: B
Rationale: Articular disease involves the joint itself, causing swelling, tenderness,
crepitus, instability, deformity, and limited active/passive ROM.
2. Which finding is more characteristic of extra-articular disease than articular
disease?
A. Joint swelling
B. Crepitus
C. Point tenderness adjacent to the joint
D. Joint deformity
Answer: C
Rationale: Extra-articular disorders cause focal tenderness near, not within, the joint.
They rarely cause swelling, instability, or deformity.
3. Acute intra-articular joint pain (<6 weeks) is most likely caused by:
A. Osteoarthritis
B. Gout
C. Fibromyalgia
D. Polymyalgia rheumatica
Answer: B
Rationale: Acute arthritis (<6 weeks) includes infectious arthritis, gout, pseudogout, and
Reiter syndrome. Osteoarthritis is chronic and noninflammatory.
,4. Saddle anesthesia and urinary retention are red flags for:
A. Herniated cervical disc
B. Cauda equina syndrome
C. Multiple sclerosis
D. Spinal stenosis
Answer: B
Rationale: Cauda equina syndrome is a surgical emergency caused by massive lumbar
disc herniation or other mass lesions compressing the cauda equina.
5. Sudden, painless, unilateral vision loss suggests:
A. Optic neuritis
B. Retinal detachment
C. Acute glaucoma
D. Cataract
Answer: B
Rationale: Retinal detachment presents with sudden, painless unilateral vision loss.
Optic neuritis is painful.
6. An obtunded patient is best described as:
A. Unresponsive to painful stimuli
B. Opening eyes, responding slowly, and appearing confused
C. Fully alert but disoriented to time
D. In a deep coma with GCS 3
Answer: B
Rationale: Obtunded patients open eyes to stimuli but are slow and confused;
alertness and interest in the environment are decreased.
7. Lateral gaze is controlled by which cranial nerve?
A. CN III
B. CN IV
C. CN VI
D. CN VIII
Answer: C
Rationale: The abducens nerve (CN VI) innervates the lateral rectus muscle, which
abducts the eye.
, 8. Which items should be listed under adult illnesses in the past medical history?
A. Childhood immunizations
B. Diabetes, hypertension, hepatitis, asthma, and HIV
C. Current medications
D. Family history of cancer
Answer: B
Rationale: Adult illnesses include medical conditions such as diabetes, hypertension,
hepatitis, asthma, and HIV, with dates.
9. Absence of the red reflex suggests:
A. Normal aging
B. Cataract or opacity of the vitreous
C. Macular degeneration
D. Strabismus
Answer: B
Rationale: An absent red reflex may indicate lens opacity (cataract), vitreous opacity,
or less commonly retinoblastoma or detached retina.
10. Classic symptoms of seasonal allergies include:
A. Fever and productive cough
B. Itchy watery eyes, sneezing, and postnasal drainage
C. Unilateral facial pain and purulent nasal discharge
D. Sore throat and swollen tonsils
Answer: B
Rationale: Seasonal allergies cause itching, watery eyes, sneezing, ear congestion, and
postnasal drainage.
11. A young adult with multiple sclerosis develops sudden, painful vision loss in one
eye. Most likely diagnosis:
A. Retinal detachment
B. Optic neuritis
C. Subconjunctival hemorrhage
D. Central retinal artery occlusion
Answer: B
Rationale: Optic neuritis causes unilateral, often painful visual loss and is associated
with multiple sclerosis.
