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 - ANS: B
The drawer test is used to iden
...
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 - ANS: B
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.
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
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 isused as adjunctive therapy. Symptoms that do not improve require referral.REF: Achilles
Tendonitis/Management
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.
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 - ANS: A
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.
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 - ANS: A
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.
All of the following factors are associated with a higher risk of osteopenia and osteoporosis
except:
a) Excessive alcohol intake and cigarette smoking
b) Asian or Caucasian ancestry
c) Obesity
d) Older age - ANS: C
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