BARKLEY FNP EXAMEN FINAL DEFINITIVO RAFAEL

BARKLEY FNP EXAMEN FINAL DEFINITIVO RAFAEL . What does a positive posterior drawer sign in a 10-year-old soccer player signify? a) Normal knee b) Instability of the knee c) Swelling on the knee d) Injury to the meni ...

BARKLEY FNP EXAMEN FINAL DEFINITIVO RAFAEL . What does a positive posterior drawer sign in a 10-year-old soccer player signify? a) Normal knee b) Instability of the knee c) Swelling on the knee d) Injury to the meniscus Explanation correct instability of the knee The drawer test is used to identify mediolateral or anteroposterior plane instability of the knee. The test is performed on the unaffected and affected knee for comparison. The anterior drawer test evaluates the anterior cruciate ligament (ACL). To perform the test, the patient lies supine and the knee is placed at 90-degree flexion. Grasp the posterior aspect of the tibia over the upper calf muscle; then, with a steady force, try to push the lower leg forward and backward. Anterior or posterior movement of the knee is positive. With the leg extended, stabilize the femur with one hand and the ankle with the other. Try to abduct and adduct the knee. There should be no medial or lateral movement. 1. A patient injures an ankle while playing soccer and reports rolling the foot inward while falling with immediate pain and swelling of the lateral part of the joint. The patient is able to bear weight and denies hearing an audible sound at the time of injury. What does this history indicate? a. Likely ankle sprain with a possible fracture b. Mild ankle injury without fracture c. Mild soft tissue injury only d. Serious ankle injury with certain fracture ANS: A Immediate swelling of the joint raises the index of suspicion for a fracture or a substantial amount of joint involvement. Without radiographs, none of these possibilities can be confirmed.REF: Clinical Presentation 2. A patient who is a distance runner reports pain in one heel that is worse in the morning and seems to improve with exercise. The provider notes localized swelling and a bony prominence at the heel. What is the initial treatment for this condition? a. Cessation of all sports activities and exercise b. Crutches and partial weight bearing c. Physical therapy for ultrasound therapy d. Referral to an orthopedist for MRI and evaluation ANS: A This patient has symptoms consistent with Achilles tendonitis. Immediate cessation of sports and exercise is the first step in management. Crutches and partial weight bearing may be indicated if symptoms do not improve with rest and NSAIDs. Physical therapy is used as adjunctive therapy. Symptoms that do not improve require referral.REF: Achilles Tendonitis/Management3. A patient reports elbow pain and the examiner elicits pain with resisted wrist flexion, forearm pronation, and passive wrist extension on the affected side. What is a likely cause of this pain? a. Lateral epicondylitis b. Medial collateral ligament instability c. Medial epicondylitis d. Ulnar neuritis ANS: C Medial epicondylitis will produce pain as described above. Lateral epicondylitis may result in pain with passive wrist flexion and active wrist extension. 2. A 19-year-old male athlete complains of acute knee pain after a football game. The nurse practitioner elicits McMurray's sign, which is positive on the patient's injured knee. This is a test for: a) Meniscal injury b) Inflammation of the knee joint c) Osteophytes of the knee joint d) Tenosynovitis Explanation With an acute knee injury, the knee should be assessed using McMurray's sign. A positive McMurray's sign indicates a meniscal injury. Inflammation of the knee, osteophytes, and tenosynovitis would not elicit a positive McMurray's sign. 3. The complications of untreated gout include: a) Impaired joint mobility and renal damage b) Impaired joint mobility and liver damage c) An increased risk of urinary tract infections d) Bladder cancer Explanation correct Impaired joint mobility and renal damage Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion. High urate levels can deposit in the kidney and also lead to kidney stones. 4. All of the following factors are associated with a higher risk of osteopenia and osteoporosis except: a) Excessive alcohol intake and cigarette smokingb) Asian or Caucasian ancestry c) Obesity d) Older age Explanation Obesity is not a risk factor for bone loss. But being female, older age, in menopause, having a small thin frame, being of Caucasian or Asian race, family history of osteoporosis, excessive alcohol use, and long-term cigarette smoking are risk factors. 5. A 36-year-old man presents to the nurse practitioner complaining of a history of cervical and upper back pain for many months. On examination, the range of motion of the patient's spine is limited, especially with lateral flexion. The other joints in the patient's body are normal. Only the spine seems to be affected. The patient reports that a laboratory test from a previous doctor showed increased ESR(erythrocyte sedimentation rate), negative antinuclear antigen (ANA), and negative rheumatoid factor. Which of the following is best described? a) Rheumatoid arthritis b) Lupus erythematosus c) Degenerative joint disease of the spine d) Ankylosing spondylitis Explanation correct d Ankylosing spondylitis (AS) is a lifelong autoimmune disease and form of arthritis that causes inflammation, pain, and stiffness, mainly in the spinal joints. The typical patient is a young adult. In the early stages of AS, the pain and stiffness often start in the lower back, but over time may move up the spine and into the neck. Most people with AS experience episodes of acute pain—known as flares—followed by periods when symptoms temporarily subside. There are no specific lab tests to identify ankylosing spondylitis. The erythrocyte sedimentation rate (ESR) is increased by the inflammation. There is a high risk of uveitis (red eyes, blurred to decreased vision, photophobia, floaters). 1. A 55-year-old woman brings her mother, who is 82 years of age, to the emergency department of a local hospital. She reports she found her mother on the floor when she checked on her that morning. Her mother was awake and oriented, but needed help getting up. Her mother states that she thinks she passed out. She is being evaluated by a physician who orders an EKG and x-rays of both hips. Regarding laboratory testing, which of the following tests is important to perform initially? a) Urinalysis b) Serum electrolytes c) Blood glucose d) Hemoglobin and hematocrit Explanation correct cChecking the blood glucose is indicated for patients with syncopal and near-syncopal episodes. The nurse practitioner should also perform a thorough history of the incident. Possible causes of syncope are cardiac arrhythmia, vasovagal, hypoglycemia, orthostatic hypotension, seizure, accidental fall, and others. 2. Thiazide diuretics have been shown to have a beneficial effect on the bones, making them a desirable treatment option in hypertensive women with osteopenia or osteoporosis. What is the mechanism of action for their effect on the bones? a) Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoblast production b) Thiazide diuretics increase both calcium and magnesium retention by the kidneys c) Thiazide diuretics increase bone mineral density (BMD) d) Thiazide diuretics influence electrolyte excretion by the kidneys Explanation correct a This positive side effect of thiazides results in a decrease in calcium bone loss and an increase in bone mineral density. 3. A 36-year-old woman complains of fatigue and headaches accompanied by widespread muscle and joint pain that started 6 months ago. She reports insomnia and feeling tired even with adequate sleep. She was diagnosed with major depression 1 year ago and is currently on escitalopram (Lexapro) 20 mg PO daily. She is also taking B-complex vitamins and melatonin at bedtime for sleep. During the physical exam, the nurse practitioner notes bilateral areas of tender points on the neck, jaw, shoulders, chest, upper back, and greater trochanter. The symptoms and physical exam findings are highly suggestive of which condition? a) Rheumatoid arthritis b) Osteoarthritis c) Fatigue syndrome d) Fibromyalgia Explanation correct d The American College of Rheumatology (2010) uses several criteria to diagnose fibromyalgia: widespread pain index, symptoms present at a similar level for at least 3 months, and presence of pain or tenderness at certain body sites. The locations in the body (widespread pain index) are neck, jaw, shoulder girdle, upper and lower arm, chest, abdomen, upper and lower back, upper and lower leg, and hip (trochanters). Other criteria include fatigue, sleep problems, and cognitive symptoms. The exact cause of fibromyalgia is unknown. Treatment is symptomatic. 4. What is the significance of a positive Lachman sign? a) Instability of the knee caused by damage to the anterior cruciate ligament of the knee b) Posterior cruciate ligament laxity which may cause locking of the knee c) Achilles tendon ruptured) Patellar tendon rupture Explanation A positive Lachman sign is highly suggestive of damage to (i.e., rupture of) the anterior cruciate ligament (ACL) of the knee. The anterior drawer sign may also be positive. The examiner notes laxity of the abnormal knee joint compared with the normal knee. The Lachman test or maneuver is considered more sensitive for ACLdamage than the anterior drawer test. 5. Which of the following individuals is most likely to be at higher risk for osteoporosis? a) 70-year-old woman of African ancestry who walks daily for exercise b) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the past 12 years to control her severe asthma c) 55-year-old Caucasian woman who is an aerobics instructor d) 45-year-old Asian woman who has been on high-dose steroids for 1 week Explanation correct b Risk factors for osteoporosis include postmenopause, early menopause, use of chronic steroids, smoking, excessive use of alcohol, sedentary lifestyle, insufficient intake of calcium and vitamin D in the diet, and being an Asian or Caucasian female. 6. Carpal tunnel syndrome is due to inflammation of the: a) Ulnar nerve b) Radial nerve c) Brachial nerve d) Median nerve Explanation Compression of the median nerve within the carpal tunnel produces characteristic symptoms”burning; tingling; numbness over the thumb, index, middle, and ring fingers. The Phalen maneuver is a diagnostic test for carpal tunnel syndrome. It is performed by pushing the back of the hands together for 1 minute. Eliciting carpal tunnel symptoms indicates a positive result for the test. 7. All of the following measures have been found to help lower the risk of osteoporosis except: a) Drinking organic orange juice b) Eating low-fat dairy foods c) Performing weight-bearing exercises d) Vitamin D supplementation Explanation correct aCommercial orange juice is fortified with calcium and vitamin D. But organic products usually do not have any additives such as calcium. Vitamin D levels must be sufficient for the body to absorb calcium. Eating foods high in vitamin D and calcium along with calcium and vitamin D supplements is advised to protect the bones and prevent bone loss. Performing weight-bearing exercises daily also increases bone strength. 8. Which of the following conditions is considered a radiculopathy? a) Polymyalgia rheumatica b) Sciatica c) Stroke d) Dementia Explanation Sciatica is a radiculopathy of the sciatic nerve, which is part of the sacral nerves of the cauda equina. A radiculopathy is spinal nerve root irritation or inflammation that is caused by compression of one (or more) of the five spinal nerve roots. Some of the most common causes of sciatica are protruding or ruptured disk, osteoarthritis of the spine, and metastases. Radiculopathy symptoms include burning pain or sensation, numbness, tingling, and/or weakness