Chapter 12: Musculoskeletal Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Osteoarthritis of the cervical and lumbar spine causes pain that is related to all of the following
except:
A. Bone spur formation
B. Pressure of the ligaments
C. Reactive muscle spasm
D. Crystal deposition

____ 2. In differentiating osteoarthritis from chronic gout, pseudogout, or septic arthritis, the most valuable
diagnostic study would be:
A. Erythrocyte sedimentation rate (ESR)
B. Synovial fluid analysis
C. C-reactive protein analysis
D. Complete blood cell count

____ 3. Patients with osteoarthritis of the hip and knee often have a distinguishable gait described as:
A. Ataxic
B. Festinating
C. Antalgic
D. Steppage

____ 4. Which of the following best describes the pain associated with osteoarthritis?
A. Constant, burning, and throbbing with an acute onset?
B. Dull and primarily affected by exposure to cold and barometric pressure
C. Begins upon arising and after prolonged weight bearing and/or use of the joint
D. Begins in the morning but decreases with activity

____ 5. Joint effusions typically occur later in the course of OA, especially in the:
A. Knee
B. Elbow
C. DIP joints
D. Hips

____ 6. You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which
two clinical findings are common in patients with PMR?
A. Neutropenia and hypochromic, normocytic anemia
B. Normochromic, normocytic anemia and thrombocytosis
C. Microcytic, hypochromic anemia and reticulocytopenia
D. Macrocytic, hyperchromic anemia and leukocytopenia

____ 7. You suspect that your patient has polymyalgia rheumatica and now are concerned that the patient
may also have Giant Cell Arteritis (GCA). Which of the following two symptoms are most indicative
of GCA and PMR?
A. Jaw pain and heart murmur
 B. Joint swelling and sudden loss of central vision bilaterally
C. Hoarseness and the total inability to grasp small objects
D. Scalp tenderness and aching in shoulder and pelvic girdle

____ 8. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with
corticosteroids until the condition has resolved. You look over her records and it has been 2 years
since her last physical examination and any laboratory or diagnostic tests as she relocated and had
not yet identified a health-care provider. In prioritizing your management plan, your first orders
should include:
A. Recommending she increase her dietary intake of Calcium and Vitamin D
B. Ordering once a year bisphosphonate and a proton pump inhibitor
C. Participate in a fall prevention program
D. Dual-energy x-ray (DEXA) scan and updating immunizations

____ 9. Which of the following differential diagnosis for patients presenting with polymyalgia rheumatica
(PMR) can be ruled out with a muscle biopsy?
A. Parkinson’s disease
B. Polymyositis
C. Late onset rheumatoid arthritis
D. Giant Cell Arteritis

____ 10. In reviewing laboratory results for patients suspected with polymyalgia rheumatica (PMR), you
realize that there is no definitive test to diagnosis PRM, rather clinical response to treatment. Results
you would expect to see include:
A. Elevated erythrocyte sedimentation rate (ESR) greater than 50mm per hour
B. Elevated rheumatoid factor and anti-citrullinated protein antibodies (RF and
ACPA)
C. Decreased C-reactive protein level (CR-P)
D. Elevated thyroid stimulating hormone (TSH)

____ 11. Which of the following is the most appropriate laboratory test for monitoring gout therapy over the
long-term?
A. Erythrocyte sedimentation rate (ESR)
B. Completer blood count (CBC)
C. Serum urate level
D. Serum albumin

____ 12. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a
patient with gout to avoid which of the following dietary items:
A. Green leafy vegetables
B. Beer, sausage, fried seafood
C. Sugar
D. Gluten and bread items

____ 13. The best method of verifying a diagnosis of gout in a joint is which of the following:
A. Radiographic examination of the joint with two views
B. Ultrasound
C. Palpation
 D. Joint aspiration and polarized-light microscopy

____ 14. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or
elevated bleeding risk):
A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days
B. Doxycycline 100 mg BID for 5 days
C. Prednisolone 35 mg QD for 5 days
D. Ice therapy

____ 15. The nurse practitioner orders bilateral wrist X-rays on a 69-year-old gentleman complaining of pain
in both wrists for the past 6 weeks not related to any known trauma. The nurse practitioner suspects
elderly onset rheumatoid arthritis. The initial radiographic finding in a patient with elderly onset
rheumatoid arthritis would be:
A. Symmetric joint space narrowing
B. Soft tissue swelling
C. Subluxations of the joints
D. Joint erosions

____ 16. The nurse practitioner is examining the hands of a 55-year-old woman with rheumatoid arthritis and
notes bilateral spindle shaped deformities on the middle interphalangeal joints. These are known as:
A. Haygarth’s nodes
B. Heberden’s nodes
C. Bouchard’s nodes
D. Benediction hands

____ 17. A 72-year-old female patient has been diagnosed with gout. She also has a long history of chronic
congestive heart failure. The most likely contributing factor to the development of gout in this older
female is:
A. Lead intoxication
B. Illegal whiskey
C. Binge-eating
D. Thiazide diuretics

____ 18. Which of the following statements about osteoarthritis is true?

____ 19. In considering the specificity of laboratory data, the most reliable diagnostic test listed below would
be:
A. Elevated erythrocyte sedimentation rate (ESR) to rule out inflammation
B. CBC to rule out infection
C. Antinuclear Antibody (ANA) test to rule out a collagen disease
D. Synovial fluid analysis to differentiate between an infectious versus an
inflammatory infusion
____ 20. When examining the spine of an older adult you notice a curvature with a sharp angle. This is
referred to as a:
A. Gibbus
B. Scoliosis
C. Kyphosis
D. Lordosis
Chapter 12: Musculoskeletal Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: D PTS: 1
2. ANS: B PTS: 1
3. ANS: C PTS: 1
4. ANS: C PTS: 1
5. ANS: A PTS: 1
6. ANS: B PTS: 1
7. ANS: D PTS: 1
8. ANS: D PTS: 1
9. ANS: B PTS: 1
10. ANS: A PTS: 1
11. ANS: C PTS: 1
12. ANS: B PTS: 1
13. ANS: D PTS: 1
14. ANS: A PTS: 1
15. ANS: B PTS: 1
16. ANS: A PTS: 1
17. ANS: D PTS: 1
18. ANS: A PTS: 1
19. ANS: D PTS: 1
20. ANS: A PTS: 1