Question 1

Pain in the shoulder that occurs as a patient attempts to lower the raised arm slowly to her side indicates

Accepted Answer

To examine for rotator cuff damage,manually abduct the patient's affected arm.Then ask the patient to slowly lower the raised arm to the side while maintaining extension of the arm.If the patient is unable to slowly lower the arm to the side (e.g.,the arm quickly falls to the side of the torso),or if severe pain occurs in the shoulder while the arm is slowly lowered,the patient has a rotator cuff tear.Scapular winging is an increased outward prominence of the scapula and is indicative of serratus anterior muscle injury or weakness.Bursitis is an inflammation of the bursa,the connective tissue structure surrounding a joint.The main symptom is severe pain upon movement.Acromioclavicular joint separation (separated shoulder)causes pain in the acromioclavicular joint.Swelling frequently occurs at the distal end of the clavicle.

Question 2

A patient has hard,nontender enlargements on his distal interphalangeal joints.These are called

Accepted Answer

Osteoarthritis is associated with bony enlargement of the distal interphalangeal joint of the finger (Heberden's nodes).These enlargements are hard,nontender,and usually symmetrical.
A ganglion cyst is a benign growth that is usually nontender and more prominent on the dorsum of the hand and wrist.Bouchard's node is a bony enlargement of the proximal interphalangeal joint of the finger and is associated with osteoarthritis.Tophi are calculus-containing sodium urate deposits that develop in periarticular fibrous tissue,typically in patients with gout.

Question 3

A patient with a herniated lumbar disk who reports low back pain with straight leg raising will experience increased pain when you

Accepted Answer

A patient with a herniated lumbar disk who reports low back pain with straight leg raising will experience increased pain when you dorsiflex the foot while the leg is in the raised position.Irritation of the nerve roots of the lumbosacral area causes pain in the sciatic nerve.Low back pain should not be experienced when the patient lowers the leg.Bending the knee should not cause pain.

Question 4

In addition to pain and decreased perfusion,manifestations of neurovascular deterioration include

Accepted Answer

Neurovascular deterioration is referred to as the "5 Ps" (pain,pallor,decreased perfusion,paresthesia,and paralysis).Neurovascular deterioration can occur in compartment syndrome.It is a severe complication of musculoskeletal trauma in which swelling is limited because of a confined space.Pain is the most significant and earliest clinical manifestation.Paresis in options "b" and "d" means incomplete paralysis and is not included in the signs and symptoms of neurovascular deterioration.Polyneuralgia in options "b" and "c" is not a sign or symptom of neurovascular deterioration.Pruritus means itching,and itching is not a sign or symptom of neurovascular deterioration.

Question 5

A foot with a low longitudinal arch is referred to as

Accepted Answer

Pes planus refers to a foot with a low longitudinal arch and is called flat foot.It involves pronation or turning in of the medial side of the foot.Pes varus describes a foot that is turned inward toward the midline (inversion),but the sole rests on the ground.Pes valgus occurs when the foot is turned laterally away from the midline (eversion),but the sole rests on the ground.This is called pigeon toes or toeing in.Pes cavus refers to a foot with an exaggerated arch height

Question 6

A patient experiences a spasm of her facial muscles in response to a light tap over the facial nerve below the temple.This finding most likely indicates

Accepted Answer

A spasm of the facial muscles in response to a light tap over the facial nerve below the temple most likely indicates neuroexcitability associated with hypocalcemia.This is a positive Chvostek's sign and is associated with hypocalcemia and tetanus infection.Pain,limited ROM,and crepitus can occur in temporomandibular joint dysfunction.Temporomandibular joint dysfunction can occur secondary to malocclusion,arthritis,dislocation,poorly fitting dentures,myofacial dysfunction,and trauma.

Question 7

Your patient has a positive bulge sign and a palpable click upon ballottement,which most likely indicate

Accepted Answer

For swelling in the suprapatellar pouch of the knee,the bulge sign confirms the presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other.Firmly stroke up on the medial aspect of the knee two or three times to displace any fluid.Tap the lateral aspect.Watch the medial side in the hollow for a distinct bulge from a fluid wave.This is a positive bulge sign and indicates joint effusion.Ballottement is performed to detect large effusions in the knee.Use your left hand to compress the suprapatellar pouch to move any fluid into the knee joint.With your right hand,push the patella sharply against the femur.Feel for a click.Normally,there is no palpable click.However,if there is a large effusion in the knee,the presence of fluid between the femur and patella causes the patella to float on top of the femur.As the patella is pushed back,fluid is displaced,and a palpable click is felt when the patella hits the femur; therefore,the patient with a positive bulge sign and a palpable click upon ballottement most likely has a large effusion of the knee.A positive Apley's sign is suggestive of torn cartilage within the knee joint.This is indicated by limited movement of the knee joint or by audible clicks.

Question 8

You are caring for an 82-years-old patient who fell in his home and is now complaining of pain in his left hip and leg.To determine the length of your patient's legs,you position him supine with his legs extended and measure from the

Accepted Answer

To measure limb length,you place the patient in a supine position with the legs extended and measure from the anterior superior iliac spine to the medial malleolus.Limb length measurements should be within 1 to 3 cm of each other.

Question 9

Numbness and paresthesia in the palmar aspect of the hand and the first three fingers occurring after maintaining wrist flexion of 90° for 1 minute is a positive

Accepted Answer

A positive Phalen's test is indicative of carpal tunnel syndrome.The numbness and paresthesia disappear when the wrist joint is returned to its neutral anatomic position.A positive Tinel's sign,indicated by a tingling or pricking sensation that occurs in the hand,thumb,index,and middle fingers when the median nerve is tapped,is indicative of median nerve compression (carpal tunnel syndrome).A positive Trendelenburg test is indicative of hip dislocation.

Question 10

A patient's inability to touch his thumb with the little finger of the same hand indicates involvement of the

Accepted Answer

There are several aspects of assessing the status of the distal limbs and digits.One method is to ask the patient to perform specific movements of the distal limb on command.To assess the median nerve,ask the patient to perform opposition of the thumb to the little finger of the same hand.A normal finding is that there will be complete motor function of the distal limb and digits,and the patient will not experience any numbness or tingling.To assess the ulnar nerve,ask the patient to perform abduction of the fingers.To assess the radial nerve,ask the patient to perform hyperextension of the thumb or wrist.Metacarpophalangeal joints refer to the metacarpal bones of the hand and the phalanges of the fingers.These are involved in assessing the ROM of the hands,not in assessing any nerves.

Question 11

Your patient was admitted after a fall in her home.After measuring the patient's legs,you determine that her left leg is 4.5 cm shorter than her right leg.This difference most likely indicates

Accepted Answer

Limb length measurements should be within 1 to 3 cm of each other.A displaced proximal femoral shaft fracture (hip fracture)can result in limb shortening and internal or external rotation.The patient is unable to straighten the leg into its neutral anatomic position.Sudden unilateral decrease in limb length occurs with dislocation of the hip.Flexion contractures of the hip occur with long-term degenerative joint diseases.

Question 12

To assess for a ruptured Achilles tendon,you perform the Thompson test by manually squeezing the calf muscles of the patient's leg.What finding would suggest a ruptured Achilles tendon?

Accepted Answer

A positive Thompson squeeze test is manifested by the absence of plantar flexion of that foot which suggests a ruptured Achilles tendon.Although pain is a symptom of a ruptured Achilles tendon,the Thompson test does not use pain as an indicator of a rupture.

Question 13

To assess for Trousseau's sign,place a blood pressure cuff on the patient's upper arm and inflate to

Accepted Answer

To assess a patient for Trousseau's sign,place a blood pressure cuff on the patient's upper arm and inflate to 10 mm Hg above the patient's systolic blood pressure for 1-3 minutes.A positive Trousseau's sign is indicated when there is a visible twitching of the hand and fingers while the blood pressure cuff is being inflated.This is associated with hypocalcemia and tetanus.

Question 14

A patient with a stable,closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage.The nurse suspects compartment syndrome and notifies the health care provider when the patient experiences

Accepted Answer

The lower leg and forearm are especially susceptible to compartment syndrome.The clinical manifestations include increased and uncontrolled pain despite narcotic analgesia,with pain aggravated by passive movement of the distal limb.Additionally,increased limb girth,shiny tight skin,slow capillary refill,skin pallor,and decreased digit sensation and movement are noted.Decreased peripheral pulse volume is a late indicator.Pain distal to the injury (not at the fracture site)that is not relieved by narcotics and pallor,as well as coolness and loss of normal color (not warmth and redness)are additional manifestations.Muscle spasms of the lower arm are not a manifestation.

Question 15

The Lachman test is performed to examine a patient's knee for

Accepted Answer

The Lachman test is performed to assess a patient's knee for stability of the anterior cruciate ligament.A positive Lachman test is demonstrated when the infrapatellar tendon slope is no longer observed as the tibia is moved forward.This means there is damage to the anterior cruciate ligament of the knee.The McMurray's test is performed to assess the integrity of the meniscus cartilage of the knee.The Drawer test assesses the knee for stability of the anterior and posterior cruciate ligaments.There is no test to assess the integrity of the infrapatellar tendon.

Question 16

Dorsiflexion of the feet is assessed by instructing the patient to

Accepted Answer

One method to assess the strength of the ankles and feet is to put your hand on top of the patient's foot and ask the patient to point the toes toward the chest despite your resistance.This is called dorsiflexion.Another method to assess strength is to place your hand on the sole of the patient's foot and ask the patient to point the toes toward the floor despite your resistance.This is called plantar flexion.To assess ROM of the ankles and feet,ask the patient to turn the soles of the feet outward (eversion)and to turn them inward (inversion).

Question 17

A patient is unable to prevent the spread fingers on his left hand from moving together when the nurse applies resistance.This condition may indicate injury to his

Accepted Answer

The inability to prevent the spread fingers on a hand from moving together when the nurse applies resistance indicates ulnar nerve injury.Radial nerve injury can cause wrist drop.This is the inability of the patient to flex the fisted hand downward at the wrist.Median nerve injury affects thumb opposition.This is demonstrated by weakness of opposition of the thumb and ipsilateral finger against resistance.Thenar eminence is the rounded prominence at the base of the thumb.Muscular atrophy of the thenar eminence occurs in median nerve compression such as in carpal tunnel syndrome.

Question 18

Internal rotation of the shoulder is examined by asking the patient to

Accepted Answer

Internal rotation of the shoulder is examined by asking the patient to place both hands behind the back and reach up,trying to touch the scapula.To examine for hyperextension of the shoulders,ask the patient to move the arms backward in an arc as far as possible.Asking the patient to move the arm in an arc toward the midline and cross it as far as possible examines for abduction of the shoulders.External rotation is examined by asking the patient to place both hands behind the head with elbows flexed.

Question 19

Examination of the range of motion of a patient's cervical spine is flexion,45°; hyperextension,55°; lateral bending,40° to left and right; and rotation,70° to left and right.These findings most likely indicate

Accepted Answer

The cervical spine's alignment is straight and the head is held erect.The normal ROM for the cervical spine is flexion,45°; hyperextension,55°; lateral bending,40° to left and right; and rotation,70° to left and right.Therefore,the ROM for the patient's cervical spine is normal.Klippel-Feil syndrome is the congenital absence of one or more cervical vertebrae along with fusion of the upper cervical vertebrae and bilateral elevation of the scapulae,resulting in a shortened neck appearance.It may be accompanied by a low hairline,webbing of the neck,and decreased neck mobility.Degenerative joint disease of the cervical vertebrae can result in lateral tilting of the head and neck.Spondylosis can cause cervical spine signs and symptoms such as inability of the patient to perform ROM,and pain and tenderness on palpation.

Question 20

You note that your patient's gluteal cleft is lateral to the imaginary line you drew from her head straight down her spine.This finding indicates

Accepted Answer

A list is a leaning of the spine.If an imaginary line is drawn straight down from T1,the gluteal cleft is lateral to it.A list can result from a herniated vertebral disc and painful paravertebral muscle spasms.In structural scoliosis,which occurs most frequently in adolescent females,the imaginary line rests in the gluteal cleft,and the spine deviates from this straight line.The curvature of the spine is visible despite voluntary attempts at proper posture.In kyphosis,an excessive convexity of the thoracic spine,the patient presents with the chin tilted downward onto the chest and with abdominal protrusion.There is also a decrease in the interval between the lower rib cage and the iliac crest.Functional scoliosis manifests itself only in a standing position and is the result of unequal leg length or poor posture.

Quiz 19: Musculoskeletal System