Orthopaedic Nurses Certification Board (ONCB) Metabolic/Inflammatory/Tumors Practice Exam

In a patient suspected of having ankylosing spondylitis, what symptom is most commonly observed?

1. Pain in shoulder that is aggravated by repetitive movements

2. Tender joints in feet and lower back with restricted back motion

3. Popping sounds with movement, and palpable nodules

4. Fever, elevated white blood cell count, and pain with compression

The correct answer is: Tender joints in feet and lower back with restricted back motion

The most commonly observed symptom in a patient suspected of having ankylosing spondylitis is tenderness in the joints of the feet and lower back, along with restricted range of motion in the back. Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine, leading to back pain and stiffness. Patients often experience inflammatory back pain, which typically improves with physical activity and worsens with rest. As the condition progresses, it can lead to fusion of the vertebrae, significantly reducing spinal flexibility. The tenderness in the lower back and associated joint involvement is a hallmark of this condition. The restricted motion can manifest in various ways, including difficulty in achieving full extension of the spine, inducing discomfort during everyday activities. In contrast, the other symptoms listed, while potentially associated with different conditions, are not as characteristic of ankylosing spondylitis. For instance, pain in the shoulder from repetitive movements is more likely associated with conditions affecting the shoulder joint, and popping sounds with movement may indicate joint instability or damage unrelated to spondylitis. Similarly, systemic symptoms like fever and elevated white blood cell count are more typical of inflammatory or infectious processes, rather than specific symptoms of ankylosing spondylitis.