SMD 513 FInal
Positive Smooth Pursuit Test
- Nystagmus - Eye lag or asynchronous eyes - Inability to track the finger - Reproduction of symptoms
Key features of Maxillary Fx
- Swelling - Numbness of the front of the face b/t eyes and mouth if the fx involves infraorbital foramen and nerve - Nose bleed Lefort FX (maxilla totally separated from the skull) - Malocclusion - Nose bleed - Fx involves the lateral wall of the nasal cavity - X-ray needed to dtetermine any other fx
An athlete comes into the athletic training room complaining of low back pain with active extension activities. Knowing just this information, what type(s) of pathologies may this athlete be suffering from? 1. Yes 2. No - Spondylolysis - Disc herniaton - Facet joint dysfunction - Erector spinae strain
1 - Spondylolysis 2 - Disc herniaton 1 - Facet joint dysfunction 1 - Erector spinae strain
Match the following location of the body where you would test the sensation of the following peripheral nerves. 1. Lateral deltoid 2. Palmer surface of the 5th finger 3. Lateral side of forearm near elbow 4. Dorsal side of hand in the webspace 5. Palmer side of index finger
1 = Axillary 2 = Ulnar 3 = Musculocutaneous 4 = Radial nerve 5 = Median
Indicate which nerve root may be injured for the examples below. 1.Athlete has an inability to flex their wrist 2.Athlete has an inability to abduct their shoulder 3.Athlete has an inability to flex their elbow 4.Athlete has an inability to laterally flex their head 5.Athlete has an inability to resist finger abduction
1 = C7 2 = C5 3 = C6 4 = C3 5 = T1
Define athletic pubalgia & List three (3) key features you would expect to find on your physical exam?
1) Diffuse groin pain w exertion 2) More lateral and proximal pain. 3) TTP on pubic tubercle.
A player is lying motionless on the ground with the elbows, wrists, and fingers in flexion. What is the term given to the posture of this athlete? a) Decorticate b) Aphasia c) Second Impact syndrome d) Decerebrate
A
A subdural hematoma is more likely to occur than an epidural hematoma in athletics. a) True b) False
A
After the head is struck, the brain continues to move in the fluid and may be contused against the opposite side, causing this type of injury: a) Contrecoup b) Direct c) Cerebral d) Whiplash
A
An athlete gets hit in the head with a ball. Upon evaluation, the athlete had lost consciousness for a period of time, and now seems very confused and irritable. She complains of a headache, floating specks in her vision, and nausea. When observing the her, you notice that she is restless and her pupils are unequal. You notice that bruising is developing behind the ears. What condition should you be most concerned about at this time based on these signs/symptoms? a) Skull Fracture b) Post-traumatic Headache c) Concussion d) Subdural Hematoma e) Both B & C
A
Most serious cervical injuries in football result from purposeful: a) Axial loading as a result of spearing b) Hyperextension resulting from pushing the face mask up c) Hyperflexion as a result of tackling the legs of the opponent d) Opponents grabbing face masks and twisting them
A
The term spinal motion restriction implies: a) Complete spinal immobilization is unlikely to occur, regardless of the device or technique applied b) A cervical collar is most effective in immobilizing the cervical spine c) Manual stabilization is superior in reducing spinal motion d) In a spine-injured patient complete restriction of motion is imperative to achieve
A
Two commonly used tests in the cognitive category are serial 7's and naming the months in reverse order. a) True b) False
A
Upon evaluation of a head injury during the first quarter of a basketball game you determine that a player has experienced a concussion (you do not suspect anything else). How would you proceed with your evaluation? Choose all that apply. 1. Monitor signs and symptoms throughout the contest; 2. Give home instructions for individual to take home for night care; 3. Return the athlete to play but wait until the fourth quarter; 4. Have the athlete get a CT scan immediately a) 1,2 b) 1,4 c) 1,2,4 d) all of the above
A
What fracture can be detected by holding on to the upper row of teeth and rocking them back and forth? a) Maxillary b) Zygomatic c) Nasal d) Mandible
A
Which condition is a progressive degenerative disease of the brain and also involves the accumulation of tau protein? a) Chronic Traumatic Encephalopathy b) Mild Traumatic Brain Injury c) Second Impact Syndrome d) Postconcussion syndrome
A
Which of the following are indications for an x-ray according to the Canadian C-spine rules? a) Unable to actively rotate neck 45 degrees b) Sitting upright in the emergency department c) Absence of c-spine tenderness d) b&c e) All of the above
A
Which of the following should not be done when managing a bleeding nose? a) Tilt the head back to decrease bleeding b) Place a cold compress over the nose c) Apply finger pressure to the affected nostrils for 5 minutes
A
Your preceptor asks you to test the muscle strength of the deltoid and wrist extensors. What peripheral nerves would you be assessing?
Axillary and Radial
A senior college wrestler comes to you and reveals that 3 weeks ago he sustained a blow to the head. He thought the incident was "No big deal." He has a history of previous concussions. Today he reports that he has a persistent headache, inability to concentrate on school, and has become very moody with his peers. Select the pathology below that this athlete may be suffering from. a) Post-traumatic headache b) Post-concussion syndrome c) Subdural hematoma d) Epidural hematoma
B
According to the NATA position statement on the Management of Sport Concussion it is important to wake the patient during the night following a concussive event. a) True b) False
B
All of these tendons border the anatomical snuff box EXCEPT: a) Abductor Pollicis Longus b) Abductor Pollicis Brevis c) Extensor Pollicis Brevis d) Extensor Pollicis Longus
B
An athlete comes to you complaining of eye pain. She states that she got poked in the eye yesterday at practice. She denies any eye watering and upon observation you see a pooling of blood in front of her iris. What condition do you suspect? a) Conjunctivitis b) Hyphema c) Corneal Laceration d) Ocular Hematoma
B
An athlete who has a fractured maxilla would have all of the following signs/symptoms except: a) The appearance of a long face b) Lower lip numbness c) Malocclusion d) Nose bleed
B
Choose which is MOST important to consider when returning an individual to play following a head injury. a) Anterograde amnesia b) Whether or not they still have symptoms c) Retrograde amnesia d) How long he or she lost consciousness
B
Kienbock's Disease is: a) avascular necrosis of the scaphoid b) avascular necrosis of the lunate c) avascular necrosis of the hamate d) none of the above
B
Loss of consciousness is an indicator of a severe concussion. a) True b) False
B
The signs and symptoms of a subdural hematoma always occur more rapidly than an epidural hematoma. a) True b) False
B
What statistical measure provides a rate of true negatives among individuals who do NOT have the condition being tested (i.e. the number of true negatives compared to false positives)? a) sensitivity b) specificity c) positive predictive value d) negative predictive value
B
When an individual indicates that he no longer has symptoms during activities of daily living 1 week after a concussion, and his baseline assessment is within normative ranges, what is the next step in the RTP progression? a) Run outside during practice b) Exercise on the treadmill or bike c) Non-contact drills with team d) Unrestricted practice
B
When comparing the Cl and C2 vertebrae with the C3 and C4 vertebrae, what is the primary significance of C1 and C2? a) Allows flexion and extension to occur b) Allows for rotation to occur c) Are easily palpable in comparison with C3and C4 d)Have significant prominent spinous processes
B
When you assess dermatomes and myotomes you are testing: a) Cranial nerves b) Nerve roots c) Peripheral nerves d) All of the above
B
Which statistical measure is used to help you rule out a potential diagnosis? a) Specificity b) Sensitivity
B
Which unique cervical vertebra is known as the axis? a) C1 b) C2 c) C3 d) C7
B
You diagnose a patient with an avulsion fracture of the palmar side of the distal phalanx. Determine what injury has occurred if the patient has an inability to flex at the DIP. a) Mallet finger b) Jersey finger c) Boutonniere deformity d) Volkmann's contracture e) Dupuytren's contracture
B
An athlete presents to the athletic training room for a pre-season orthopedic screening. Upon evaluation you discover that he has had multiple hamstring strains and notice the athlete has a significantly large lumbar lordotic curve (Lower Cross Syndrome). What exercises might you recommend to him? Mark all that apply. a) Hamstring stretching b) Hip flexor stretching c) Abdominal stretching d) Low back stretching
B & D
All of the following are key features of a zygomatic fracture EXCEPT? a) Nosebleed b) Diplopia c) Numbness of lower lip d) Tenderness below eye orbit
C
An athlete comes into the ATR two weeks following an injury. Upon evaluation you discover the following signs: significant motor and mild sensory deficits. What grade of "burner" is this? a) Neurapraxia b) Neurotmesis c) Axonotmesis
C
Choose which tests below assess memory and concentration function. a) BESS, delayed recall, serial 7s, b) Delayed recall, serial 7s, Romberg test c) Delayed recall, serial 7s, months of year backwards d) BESS, Romberg test, consensual light reflex testing
C
Of the three meninges, the outermost, consisting of a dense, fibrous, inelastic sheath that encloses the brain and cord, is the: a) Arachnoid b) Cerebral cortex c) Dura mater d) Pia mater
C
Spondylolisthesis is characterized by: a) A defect in the body of the vertebra b) Pain during trunk flexion c) Anterior slipping of one vertebra on another d) All of the above
C
What is the name of the gelatinous interior within a vertebral disc? a) stenosis b) annulus fibrosus c) nucleus pulposus d) dorsal root ganglion
C
What is the name of the opening where the spinal nerves come out of? a) transverse foramen b) spinal canal c) intervertebral foramen d) pedicles
C
What should one suspect when examining an unconscious athlete who suffered a head injury? a) cervical strain b) cervical sprain c) cervical spine fracture d) cervical spine fracture
C
What special tests are MOST appropriate when assessing an athlete who you feel may have a herniated disc? a) Shoulder depression test and Valsalva b) Shoulder depression test, Valsalva, and Adson's test c) Spurling's test and Valsalva d) Spurling's test, Valsalva, and Allen's test
C
Which muscle is NOT part of the hypothenar eminence? a) Opponens Digiti Minimi b) Abductor Digiti Minimi c) Adductor Digiti Minimi d) Flexor Digiti Minimi
C
Which test is the most widely used on the field test for assessing concussion related signs and symptoms, cognition, balance, and coordination? a) ANAM b) ImPACT test c) SCAT5 d) Glasgow Coma Score
C
According to the NATA's 2020 consensus recommendations on prehospital care of athletes with c-spine injury, what method of transfer has the best outcomes for patients in a supine position? a) Kendrick Extrication Device (KED) b) Log-roll with a push c) Log-roll with a pull d) 8-person lift and slide
D
An athlete comes to you complaining of pain and visual disturbances of her right eye. She states that she got hit a couple of days ago. She complains of diplopia at the end ranges of her vision and you notice during eye tracking that her right eye does not move as far as her left, specifically when looking up. What condition should you suspect? a) Sty b) Detached retina c) Corneal abrasion d) Blow out fracture
D
Identify what cranial nerves are specifically being assessed if you have an athlete follow your finger as you complete the letter X and T in the air and assess pupil response? a) 3,4,7 b) 2,3,5 c) 2,3,6 d) 3,4,6
D
Interpret the clinical findings to ascertain the diagnosis for a patient who complains of a dull, achy elbow/forearm pain, TTP elicited over the supinator muscle, and wrist drop. a) Median Nerve Entrapment at the Elbow b) C6 disc herniation c) Ulnar nerve palsy d) Radial nerve palsy e) Cyclists or Handle Bar Palsy
D
One innominate consists of a fusion of all of these bones EXCEPT: a) Ilium b) Ischium c) Pubis d) Sacrum
D
Smooth pursuits is part of the ____ assessment group. a) Standardized assessment of concussion b) Sport Concussion Assessment Tool 5 c) Immediate Post-Concussion Assessment and Cognitive Testing d) Vestibular ocular motor screening
D
What possible signs could an individual with thoracic outlet syndrome present with? a) Vascular problems b) Nerve problems c) Tight pectoralis minor d) All of the above
D
When speaking with a parent about the administration of OTC medications for head injuries, it is important to remember. a)Advil is recommended b)Aspirin is recommended c)Ibuprofen is recommended d)Medication is not advised
D
When you ask an athlete to shrug their shoulders what cranial nerve(s) are being assessed through their completion of this task? a) 8 b) 9 c) 10 d) 11
D
Which of the following describes the inability of an athlete to remember events after the injury has occurred? a) Retrograde amnesia b) Unconsciousness c) Tinnitus d) Anterograde amnesia
D
Which of the following eye injuries is painless and results in the athlete seeing floating specks, flashes of light and having blurred vision? a) Hyphema b) Conjunctivitis c) Corneal abrasion d) Detached retina
D
Which of the following is a reason why pediatric patients are more vulnerable to concussion compared to adults? a) the brain is still developing b) greater head-to-body ratio c) weaker neck musculature d) all of the above e) none of the above
D
Which of the following is caused by a bacterial infection of the external auditory canal? a) otitis media b) tympanic membrane rupture c) impacted cerumen d) otitis externa
D
Phalen's Test
Implication: Carpal Tunnel Syndrome - reverse prayer Positive: Tingling, Paresthesia, abnormal sensation to median nerve distributuion
Finkelstein Test
Implication: De Quervain's Disease - Stress on Abductor Pollicus Longus & Extensor pollicus Brevis Positive: Pain along those tendons
Well SLR Test (Passive)
Implication: Disk Herniation Positive: Radiating symptoms in opposite leg
Milgram Test
Implication: Disk Herniation or Nerve Root irritation - increase intrathecal pressure Positive: Patient can't hold 30 seconds, Too much pain, Can't lift the legs
Lasegue's Test (SLR Test)
Implication: Disk Herniation or Tumor - reproduce radicular symtoms Positive Test: Symptoms increase down the leg 35°-70°: Sciatic nerve root tension 70°< : Lumbar spine or SI pathology
Quadrant Test
Implication: Facet Joint or Nerve root Irritation - maximally narrow the facet joint and intervertebral foramen Positive: Symptoms reproduced in lumbar spine or down the leg
Slump Test
Implication: Increaded tension in the neuromeningeal tract - Increase tension in cord as test progresses Positive: Any symptoms that come on throughout the steps of the test
Watson's Test
Implication: Instability of Scaphoid Bone -Push the scaphoid into dorsal direction Positive: Subluxation of the Scaphoid bone (Should feel clunk when letting go)
Femoral Nerve Stretch Test
Implication: L2, L3, L4 nerve root lesion -hold position for 45-60 sec to reproduce symptoms in the anterior thigh or low back Positive: Unilateral neurological pain in the naterior thigh, lu,bar area
Tennis Elbow Test
Implication: Lateral Epicondylitis - contraction of extensor digitorum Positive: Pain
Cozen's Test
Implication: Lateral Epicondylitis Positive: Pain
Mill's Elbow Test
Implication: Lateral Epicondylitis Positive: Pain and Tenderness
Hoover test
Implication: Malingering Athlete Positive: Does not lift leg, or sense no pressure from the opposite leg pressing down
Golfer's Elbow Test
Implication: Medial Epicondylitis Positive: Pain and Tenderness
Murphy's sign or Drop Knuckle Test
Implication: Metacarpal Fx Positive: Look for level of knuckle
Spurling's Test
Implication: Nerve Root Irritation - Compress intervertebral foramen Positive: Pain or reproduction of symptoms radiating down the patient's arm
Brachial Plexus Traction Test
Implication: Nerve Root Irritation - Recreate stretch mechanism of brachial plexus Positive: Reproduction of pain and/or paresthesia symptoms throughout the arm
Kernig-Brudzinski Test
Implication: Nerve root entrapment by Disk Herniation or narrowing of intervertebral foramen Positive: Pain during active leg raise
Valsava Test
Implication: Nerve root irritation - Increase intrathecal pressure Positive: Increased Spinal or radicular pain
Varus Stress Test
Implication: RCL Sprain Positive: Pain and/or laxity
Bilateral SLR Test
Implication: SI Joint Pathology or Lumbar Pathology Pain < 70°: SI Joint pathology Pain > 70°: Lumbar Joint Pathology Positive: Pain
Bowstring Test
Implication: Sciatic Nerve Irritation Positive: Symptoms return due to pressue
Spring Test
Implication: Segmental Instabilities Positive: Pain, Hypo-, or Hypermobile vertebrae
Stork Test
Implication: Shear forces on the pars interarticularis by the iliopsoas pulling anteriorly on the vertebrae - Put stress across the posterior element of the lumbar spine Positive: Pain in the lumbar area or SI area of the standing leg
TFCC Load Test
Implication: TFCC Sprain -Axial load of ulnar side of wrist joint Positive: Pain, clicking, or crepitus on ulnar side
Supination Lift Test
Implication: TFCC Sprain Positive: Pain, Clicking, or Crepitus
Allen's Test (Look Away)
Implication: Thoracic Outlet Syndrome - Entrapment of the subclavian artery due to tight pec minor Positive: The radial pulse disappears or reproduction of neurologic symptoms
Adson's Test (Look toward)
Implication: Thoracic Outlet Syndrome - Entrapment of the subclavian artery due to tight scalene muscles Positive: The radial pulse dissappears or diminishes
Valgus Stress Test - Milking Manuever - Moving Valgus Stress Test
Implication: UCL Sprain Positive: Pain and/or laxity (between 120 deg and 70 deg during Moving Valgus)
Valgus Stress Test (Thumb)
Implication: UCL Spriain of the Thumb Positive: Pain and Laxity or Laxity of 30° or more
Froment's Sign (Pinch Test)
Implication: Ulnar Nerve Paralysis (Paralyis of Adductor Pollicis) or UCL Sprain of the Thumb Positive: Can't hold paper
The name of the brachial plexus cord which is derived from the upper trunk is the _______ cord.
Lateral
What suspected pathology does the tongue depressor test diagnose?
LeFort Fx
______ is an avulsion fracture of the extensor tendon of the distal phalanx resulting in an inability to ______ the DIP.
Mallet Finger & Extend
In the video, the clinician states the he is going to watch the patients eyes during the test. Why is the clinician watching the patients eyes?
The clinician is watching the patients eyes to determine if any nystagmus occurs, if the eyes can follow or track normally or smoothly, and if one eye lags behind.
