NSG6020 week 9 quiz 2018

• Jacob, a
33-year-old construction worker, complains of a “lump on his back” over his
scapula. It has been there for about a year and is getting larger. He says his
wife has been able to squeeze out a cheesy-textured substance on occasion. He
worries this may be cancer. When gently pinched from the side, a prominent
dimple forms in the middle of the mass. What is most likely?

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• 8-year-old
retired farmer comes to your office for evaluation of a skin lesion. On the
right temporal area of the forehead, you see a flattened papule the same color
as his skin, covered by a dry scale that is round and feels hard. He has
several more of these scattered on the forehead, arms, and legs. Based on this
description, what is your most likely diagnosis?

B Seborrheic
keratosis

C Basal cell
carcinoma

D Squamous cell
carcinomaTerm

• A new
patient is complaining of severe pruritus that is worse at night. Several
family members also have the same symptoms. Upon examination, areas of
excoriated papules are noted on some of the interdigital webs of both hands and
on the axillae. This finding is most consistent with:

A. Contact
dermatitis

B. Impetigo

C. Larva migrans

D. Scabies

• A
58-year-old man comes to your office complaining of bilateral back pain that
now awakens him at night. This has been steadily increasing for the past 2
months. Which one of the following is the most reassuring in this patient with
back pain?

A. Age over 50

B. Pain at night

C. Pain lasting more than 1 month or not
responding to therapy

D. Pain that is bilateralTerm

• A
32-year-old warehouse worker presents for evaluation of low back pain. He notes
a sudden onset of pain after lifting a set of boxes that were heavier than
usual. He also states that he has numbness and tingling in the left leg. He
wants to know if he needs to be off of work. What test should you perform to
assess for a herniated disc?

A Leg-length test

B. Straight-leg
raise

C.Tinel’s test

D. Phalen’s
testTerm

• Mrs.
Anderson presents with an itchy rash which is raised and appears and disappears
in various locations. Each lesion lasts for many minutes. What most likely
accounts for this rash?

Insect bites

Urticaria or hives

Psoriasis

Purpura

Term

• A
50-year-old woman presents with “left hip pain” of several weeks duration.
There is marked tenderness when you press over her proximal lateral thigh. What
do you think she has?

A Osteoarthritis

B. Rheumatoid
arthritis

C. Sciatica

D. Trochanteric
bursitis

• A
28-year-old graduate student comes to your clinic for evaluation of pain “all
over.” With further questioning, she is able to relate that the pain is worse
in the neck, shoulders, hands, low back, and knees. She denies swelling in her
joints. She states that the pain is worse in the morning. There is no
limitation in her range of motion. On physical examination, she has several
points on the muscles of the neck, shoulders, and back that are tender to
palpation. Muscle strength and range of motion are normal. Which one of the
following is likely the cause of her pain?

A. Rheumatoid arthritis

B. Osteoarthritis

C. Fibromyalgia

D. Polymyalgia rheumatica

• A mother
brings her 11-month-old to you because her mother-in-law and others have told
her that her baby is jaundiced. She is eating and growing well and performing
the developmental milestones she should for her age. On examination, you indeed
notice a yellow tone to her skin from head to toe. Her sclerae are white. To
which area should your next questions be related?

Diet

Family history of liver diseases

Family history of blood diseases

Ethnicity of the child

Term

• You are
beginning the examination of the skin on a 25-year-old teacher. You have
previously elicited that she came to the office for evaluation of fatigue,
weight gain, and hair loss. You strongly suspect that she has hypothyroidism.
What is the expected moisture and texture of the skin of a patient with
hypothyroidism?

A. Moist and smooth

B. Moist and rough

C. Dry and smooth

D. Dry and rough

• You are
assessing a patient with joint pain and are trying to decide whether it is
inflammatory or noninflammatory in nature. Which one of the following symptoms
is consistent with an inflammatory process?

• You are
assessing a patient with diffuse joint pains and want to make sure that only
the joints are the problem, and that the pain is not related to other diseases.
Which of the following is a systemic cause of joint pain?

• A
19-year-old college sophomore comes to the clinic for evaluation of joint
pains. The student has been back from spring break for 2 weeks; during her
holiday, she went camping. She notes that she had a red spot, shaped like a
target, but then it started spreading, and then the joint pains started. She
used insect repellant but was in an area known to have ticks. She has never
been sick and takes no medications routinely; she has never been sexually
active. What is the most likely cause of her joint pain?

• An
85-year-old retired housewife comes with her daughter to establish care. Her
daughter is concerned because her mother has started to fall more. As part of
her physical examination, you ask her to walk across the examination room.
Which of the following is not part of the stance phase of gait?

• A
32-year-old warehouse worker presents for evaluation of low back pain. He notes
a sudden onset of pain after lifting a set of boxes that were heavier than
usual. He also states that he has numbness and tingling in the left leg. He
wants to know if he needs to be off of work. What test should you perform to
assess for a herniated disc?

• A
33-year-old construction worker comes for evaluation and treatment of acute
onset of low back pain. He notes that the pain is an aching located in the
lumbosacral area. It has been present intermittently for several years; there
is no known trauma or injury. He points to the left lower back. The pain does
not radiate and there is no numbness or tingling in the legs or incontinence.
He was moving furniture for a friend over the weekend. On physical examination,
you note muscle spasm, with normal deep tendon reflexes and muscle strength.
What is the most likely cause of this patient’s low back pain

• A
50-year-old realtor comes to your office for evaluation of neck pain. She was
in a motor vehicle collision 2 days ago and was assessed by the emergency
medical technicians on site, but she didn’t think that she needed to go to the
emergency room at that time. Now, she has severe pain and stiffness in her
neck. On physical examination, you note pain and spasm over the paraspinous
muscles on the left side of the neck, and pain when you make the patient do
active range of motion of the cervical spine. What is the most likely cause of this
neck pain?

• A
28-year-old graduate student comes to your clinic for evaluation of pain “all
over.” With further questioning, she is able to relate that the pain is worse
in the neck, shoulders, hands, low back, and knees. She denies swelling in her
joints; she states that the pain is worse in the morning; there is no
limitation in her range of motion. On physical examination, she has several
points on the muscles of the neck, shoulders, and back that are tender to
palpation; muscle strength and range of motion are normal. Which of the
following is likely the cause of her pain?

• A
68-year-old retired banker comes to your clinic for evaluation of left shoulder
pain. He swims for 30 minutes daily, early in the morning. He notes a sharp,
catching pain and a sensation of something grating when he tries overhead
movements of his arm. On physical examination, you note tenderness just below
the tip of the acromion in the area of the tendon insertions. The drop arm test
is negative, and there is no limitation with shoulder shrug. The patient is not
holding his arm close to his side, and there is no tenderness to palpation in
the bicipital groove when the arm is at the patient’s side, flexed to 90
degrees, and then supinated against resistance. Based on this description, what
is the most likely cause of his shoulder pain?

• A high
school soccer player “blew out his knee” when the opposing goalie’s head and
shoulder struck his flexed knee while the goalie was diving for the ball. All
of the following structures were involved in some way in his injury, but which
of the following is actually an extra-articular structure?

• Ray works
a physical job and notes pain when he attempts to lift his arm over his head. When
you move the shoulder passively, he has full range of motion without pain and
there is no gross swelling or tenderness. What type of joint disease does this
most likely represent?

• Mark is a
contractor who recently injured his back. He was told he had a “bulging disc”
to account for the burning pain down his right leg and slight foot drop. The
vertebral bodies of the spine involve which type of joint?

• Which of
the following synovial joints would be an example of a condylar joint?

• A
58-year-old man comes to your office complaining of bilateral back pain that
now awakens him at night. This has been steadily increasing for the past 2
months. Which one of the following is the most reassuring in this patient with
back pain?

• Marion
presents to your office with back pain associated with constipation and urinary
retention. Which of the following is most likely?

• Louise, a
60-year-old, complains of left knee pain associated with tenderness throughout,
redness, and warmth over the joint. Which of the following is least helpful in
determining if a joint problem is inflammatory?

• Pain,
swelling, loss of both active and passive motion, locking, and deformity would
be consistent with which of the following?

• You are
working in a college health clinic and seeing a young woman with a red,
painful, swollen DIP joint on the left index finger. There are also a few
papules, pustules, and vesicles on reddened bases, located on the distal
extremities. This would be consistent with which of the following?

• An obese
55-year-old woman went through menarche at age 16 and menopause 2 years ago.
She is concerned because an aunt had severe osteoporosis. Which of the
following is a risk factor for osteoporosis?

• A
38-year-old woman comes to you and has multiple small joints involved with
pain, swelling, and stiffness. Which of the following is the most likely
explanation?

• Mrs.
Fletcher comes to your office with unilateral pain during chewing, which is
chronic. She does not have facial tenderness or tenderness of the scalp. Which
of the following is the most likely cause of her pain?

• A man’s
wife is upset because when she hugs him with her hands on his left shoulder
blade, “it feels creepy.” This came on gradually after a recent severe
left-sided rotator cuff tear. How long does it usually take to develop muscular
atrophy with increased prominence of the scapular spine following a rotator
cuff tear?

• Phil
comes to your office with left “shoulder pain.” You find that the pain is
markedly worse when his left arm is drawn across his chest (adduction). Which
of the following would you suspect?

• Two weeks
ago, Mary started a job which requires carrying 40-pound buckets. She presents
with elbow pain worse on the right. On examination, it hurts her elbows to
dorsiflex her hands against resistance when her palms face the floor. What
condition does she have?

• A high
school football player injured his wrist in a game. He is tender between the
two tendons at the base of the thumb. Which of the following should be
considered?

• Mrs.
Fletcher complains of numbness of her right hand. On examination, sensation of
the volar aspect of the web of the thumb and index finger and the pulp of the
middle finger are normal. The pulp of the index finger has decreased sensation.
Which of the following is affected?

• A
50-year-old woman presents with “left hip pain” of several weeks duration.
There is marked tenderness when you press over her proximal lateral thigh. What
do you think she has?

• Sarah
presents with left lateral knee pain and has some locking in full extension.
There is tenderness over the medial joint line. When the knee is extended with
the foot externally rotated and some valgus stress is applied, a click is
noted. What is the most likely diagnosis?

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