MEDBRIDGE - OCS PRACTICE EXAM 1 REVIEW
What are the 5 CPR points for cervical myelopathy?
1.) Gait deviation 2.) + Hoffmans 3.) Inverted supinator sign 4.) + Babinksi 5.) >45 years old 3/5 or 4/5 = post test probability of 94-99%
What are the 5 CPR points for meniscus pathology/tears?
1.) Hx of catching or locking reported by the pat. 2.) Joint line tenderness 3.) Pain with forced hyperextension (modified bounce home test) 4.) Pain with maximal passive knee flexion 5.) Pain or audible click with McMurray's maneuver
What are the 5 CPR points for carpal tunnel?
1.) Shaking hands to relieve symptoms 2.) wrist ratio > .67 3.) Symptom severity scale > 1.9 4.) Diminished sensation in median sensory field 1 (thumb) 5.) age > 45 years old.
How many points are the CPR for cervical myelopathy?
5
How many points are there for the CPR for meniscus pathology/tears?
5
How many points are there in the CPR for carpal tunnel?
5
What is a Bankart lesion?
A Bankart lesion is avulsion of the glenoid labrum
What is Type 1 for Neers classification of lessions in impingement syndrome?
A type I acromion, as established by Bigliani et al., corresponds to a flat-shaped acromion. [Bigliani, L. U., Ticker, J. B., Flatow, E. L., Soslowsky, L. J., & Mow, V. C. (1991). The relationship of acromial architecture to rotator cuff disease. Clinics in Sports Medicine, 10(4), 823-838.] check_circle
What is Type 2 for Neers classification of lessions in impingement syndrome?
A type II acromion is a curved acromion that is parallel to the humeral head, according to a classification system developed by Bigliani et al. [Bigliani, L. U., Ticker, J. B., Flatow, E. L., Soslowsky, L. J., & Mow, V. C. (1991). The relationship of acromial architecture to rotator cuff disease. Clinics in Sports Medicine, 10(4), 823-838.]
What is Type 3 for Neers classification of lessions in impingement syndrome?
A type III acromion is an acromion that is hooked at the edge, according to Bigliani et al.'s classification system. [Bigliani, L. U., Ticker, J. B., Flatow, E. L., Soslowsky, L. J., & Mow, V. C. (1991). The relationship of acromial architecture to rotator cuff disease. Clinics in Sports Medicine, 10(4), 823-838.]
Q19.) A physical therapist intends to utilize manual therapy for a patient with neck pain and decides to perform a premanipulative hold in passive rotation. For what length of time should the physical therapist hold the patient in passive rotation? A.) 10 seconds B.) 30 seconds C.) 60 seconds D.) 90 seconds
A.) 10 seconds Ten seconds is an appropriate amount of time to determine if vertebral basilar artery insufficiency is present during premanipulative holds. Note that the 2020 IFOMPT Cervical framework does not recommend premanipulative holds. [Rivett D. A. (2006). Adverse events and the vertebral artery: can they be averted? Manual Therapy, 11(4), 241-242.] check_circle
Q54.) If a physical therapist used the deep neck flexor endurance test with a patient with weak deep neck flexors, for what amount of time would a patient with neck pain be expected to hold an isometric contraction of the deep neck flexors? A.) 24 seconds B.) 35 seconds C.) 40 seconds D.) 50 seconds
A.) 24 seconds In those with neck pain who were tested using the deep neck flexor endurance test, 24.1 seconds was the average found in a study by Harris et al. References: Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34. Harris, K. D., Heer, D. M., Roy, T. C., Santos, D. M., Whitman, J. M., & Wainner, R. S. (2005). Reliability of a measurement of neck flexor muscle endurance. Physical Therapy, 85(12), 1349-1355. check_circle
Q59.) A physical therapist believes a nerve entrapment is the cause for a patient's weakness in her anterior forearm. Manual muscle testing reveals weakness in the flexor pollicis longus, the lateral half of the flexor digitorum profundus, and the pronator quadratus. Which diagnosis would cause this pattern of weakness? A.) Anterior interosseous nerve entrapment B.) Carpal tunnel syndrome C.) Posterior interosseous nerve entrapment D.) Pronator teres syndrome
A.) Anterior interosseous nerve entrapment In those who have anterior interosseous nerve entrapment, this pattern of weakness would be present. [Dutton, M. (2008). Orthopaedic examination, evaluation, and intervention (2nd ed.). McGraw-Hill Medical.] check_circle With pronator teres syndrome, there would be weakness with median nerve muscles in the forearm and hand, but the muscles listed in this case are specifically innervated by the anterior interosseous branch of the median nerve.
Q50.) An axillary nerve lesion has caused significant impairments for a patient who was in a motor vehicle accident. Of the following, which is a distal attachment site of a muscle that is innervated by the axillary nerve? A.) Inferior facet of the greater tuberosity of the humerus B.) Lateral third of clavicle, acromion, and spine of scapula C.) Medial part of the bicipital groove D.) Middle third lateral border of the scapula
A.) Inferior facet of the greater tuberosity of the humerus This is the distal attachment of the teres minor, which is innervated by the axillary nerve. check_circle
Q31.) A physical therapist is working to rule in a lateral meniscal tear. Which of the following special tests is the best at ruling in tears? A.) Joint line tenderness B.) McMurray test C.) Thessaly test at five degrees of flexion D.) Thessaly test at twenty degrees of flexion
A.) Joint line tenderness Palpating the lateral joint line has the highest specificity at 97%, per Logerstedt et al. (2010). [Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., Godges, J. J., & Orthopaedic Section of the American Physical Therapist Association (2010). Knee stability and movement coordination impairments: Knee ligament sprain. The Journal of Orthopaedic and Sports Physical Therapy, 40(4), A1-A37.] check_circle
Q16.) In differentiating between radiculopathy and facet joint dysfunction, which of the following referral patterns is most common if L5-S1 facet dysfunction is present? A.) Lumbar spine to gluteal region B.) Lumbar spine to groin region C.) Lumbar spine to lateral knee region D.) Lumbar spine to trochanteric region
A.) Lumbar spine to gluteal region The L5-S1 facet joint often refers pain to the gluteal region as determined by Fukui et al. [Fukui, S., Ohseto, K., Shiotani, M., Ohno, K., Karasawa, H., & Naganuma, Y. (1997). Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. The Clinical Journal of Pain, 13(4), 303-307.]
Q13.) The patient is seen for three visits the first week and returns to physical therapy the following Tuesday. She states that the posterior Achilles tendon pain has fully resolved and that she only has symptoms in her low back and posterior gluteal region on the right. She indicates that she has the same feeling on the right posterior heel region as she does on the left, so she feels that her sensation is returning. The straight-leg raise, prone instability, slump, and crossed straight-leg raise tests are all now negative. AROM is 75% of normal for flexion and extension, with no change in symptoms during either motion. Using this new information, the physical therapist determines that the treatment-based classification subgroup for this patient has changed. What is the most likely subgroup this patient fits into now? A.) Lumbopelvic joint manipulation B.) Specific exercise C.) Stabilization D.) Traction
A.) Lumbopelvic joint manipulation This patient no longer has any peripheralization of symptoms, and the location of symptoms fits those who would benefit from a lumbopelvic manipulation. The patient also has no neurological findings when returning to physical therapy, and all special tests are negative, so a lumbopelvic manipulation is appropriate for this patient. [Fritz, J. M., Cleland, J. A., & Childs, J. D. (2007). Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. Journal of Orthopedic Sports Physical Therapy, 37, 290-302.] check_circle
Q12.) Based on evidence to support of the use of mechanical traction for those who fit into the traction subgroup from the treatment-based classification, which parameters should be used for mechanical traction? A.) Prone for a maximum of 12 minutes with 40% to 60% of body weight B.) Prone for a maximum of 24 minutes with 30% to 50% of body weight C.) Supine for a maximum of 12 minutes with 40% to 60% of body weight D.) Supine for a maximum of 24 minutes with 30% to 50% of body weight
A.) Prone for a maximum of 12 minutes with 40% to 60% of body weight The parameters in the study by Fritz et al. (2007) investigating the traction subgroup used prone mechanical traction. Individuals were first placed in a prone position that promoted centralization of their symptoms, which could be a slightly flexed or side-flexed position. After three minutes of traction, the table was repositioned into a neutral or slightly extended position. A traction force of 40%-60% of the patient's body weight was allowed during treatment. [Fritz, J. M., Cleland, J. A., & Childs, J. D. (2007). Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. Journal of Orthopedic Sports Physical Therapy, 37, 290-302.] check_circle
Q66.) A 63-year-old female patient with suspected thoracic outlet syndrome has numbness, tingling, and heaviness in her right hand. She reports coldness to her hand, as well as a pale color when her left hand is pink/red. She also has weakness in her intrinsic hand muscles. What should the physical therapist's next step be in regard to intervention? A.) Refer the patient back to the physician for possible arterial thoracic outlet syndrome B.) Send the patient to the emergency room for a serious medical condition caused by the thoracic outlet syndrome C.) Strengthen the patient's hand intrinsic muscles D.) Treat the patient's sensory deficits with desensitization techniques
A.) Refer the patient back to the physician for possible arterial thoracic outlet syndrome This patient has signs and symptoms consistent with arterial thoracic outlet syndrome, and the patient should be assessed thoroughly by a medical provider. References: Goodman, C. C., & Snyder, T. K. (2013). Differential diagnosis for physical therapists: Screening for referral. Elsevier Health Sciences. Vath, S. A., Owens, B. D., & Stoneman, P. (2007). Insidious onset of shoulder girdle weakness. The Journal of Orthopaedic and Sports Physical Therapy, 37(3), 140-147. check_circle
Q61.) A 26-year old-male is referred to physical therapy with a brachial plexus injury. He was golfing with friends when they decided to race golf carts. Unfortunately, he flipped his golf cart, and when he landed, he experienced a forceful cervical side flexion to the left. He was diagnosed with Erb's palsy. What would be an expected finding with this diagnosis? A.) Weakness of the deltoid muscle B.) Weakness of the finger intrinsics C.) Weakness of the triceps D.) Weakness of the upper trapezius
A.) Weakness of the deltoid muscle Erb's palsy is a brachial plexus upper trunk injury, and the upper trunk involves the C5-C6 nerve roots. The deltoid muscle is innervated by the axillary nerve, which includes the C5-C6 nerve roots. Hence, this would be weak with Erb's palsy. [Dutton, M. (2008). Orthopaedic examination, evaluation, and intervention (2nd ed.). McGraw-Hill Medical.] check_circle
Q35.) A physical therapist is treating a patient with a posterolateral corner injury and is measuring the difference in tibial external rotation between a patient's injured left knee and healthy right knee. The patient has a difference of 4 degrees between the knees. What grade of injury has this patient sustained on the left knee? A.) grade 1 B.) grade 2 C.) grade 3 D.) grade 4
A.) grade 1 This patient has a grade I injury due to the difference in tibial external rotation being less than 5 degrees. [Jung, Y. B., Nam, C. H., Jung, H. J., Lee, Y. S., & Ko, Y. B. (2009). The influence of tibial positioning on the diagnostic accuracy of combined posterior cruciate ligament and posterolateral rotatory instability of the knee. Clinics in Orthopedic Surgery, 1(2), 68-73.] check_circle
Q33.) A physical therapist assesses for a medial collateral ligament tear via the valgus stress test at 0 degrees. The patient had approximately 6-10 millimeters of separation between the femur and tibia during the test. What does this signify? A.). Abnormal B.) Nearly normal C.) Normal D.) Severely abnormal
A.). Abnormal When a gap of 6-10 millimeters occurs, it is considered to be abnormal. [Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., Godges, J. J., & Orthopaedic Section of the American Physical Therapist Association (2010). Knee stability and movement coordination impairments: Knee ligament sprain. The Journal of Orthopaedic and Sports Physical Therapy, 40(4), A1-A37.] check_circle
Q20.) Which person has the highest risk of cervical radiculopathy? A.) 36 YO B.) 43 YO C.) 62 YO D.) 80 YO
B.) 43 YO Cervical radiculopathy is most often seen in individuals in their 40s or 50s. check_circle
If Klumpke's palsy were present instead of Erb's palsy, which muscle would be weak with manual muscle testing? A.) Flexor carpi radialis B.) Flexor carpi ulnaris C.) Palmaris longus D.) Pronator teres
B.) Flexor carpi ulnaris A lower trunk injury of the brachial plexus causes Klumpke's palsy, and C8-T1 are involved. The flexor carpi ulnaris is innervated by these nerve root segments, so this is correct. References: Dutton, M. (2008). Orthopaedic examination, evaluation, and intervention (2nd ed.). McGraw-Hill Medical. Netter, F. H. (2014). Atlas of human anatomy (6th ed.). Saunders/Elsevier. check_circle
Which of the following is a precaution to thrust joint manipulation? A.) Active spondyloarthropathies B.) Hyper-mobility C.) Upper motor neuron lesion D.) Vertebral bone disease
B.) Hyper-mobility Although hypermobility may appear to be a contraindication to thrust joint manipulation, it is a precaution as some individuals with hypermobility may still benefit from the use of thrust joint manipulation. [Rushton, A., Rivett, D., Carlesso, L., Flynn, T., Hing, W., & Kerry, R. (2014). International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. Manual Therapy, 19 (3), 222-228.] check_circle
Q78.) A physical therapist with fifteen years of experience wants to use iontophoresis on her patient with heel pain. A recent graduate of physical therapy school tells the older physical therapist that iontophoresis has not been shown to work per the literature. What is the correct information regarding the use of iontophoresis in heel pain? A.) Iontophoresis may or may not provide two to four months of pain relief and improved function in those with heel pain B.) Iontophoresis may or may not provide two to four weeks of pain relief and improved function in those with heel pain C.) Iontophoresis should be used because it provides short-term relief of two to four weeks in patients' pain and overall function D.) Iontophoresis should never be used because it has no positive effects on heel pain and overall function
B.) Iontophoresis may or may not provide two to four weeks of pain relief and improved function in those with heel pain This is correct per the clinical practice guidelines produced by the Journal of Orthopaedic and Sports Physical Therapy. [Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., McDonough, C. M., & American Physical Therapy Association (2014). Heel pain-plantar fasciitis: Revision 2014. The Journal of Orthopaedic and Sports Physical Therapy, 44(11), A1-A33.] check_circle
Q46.) The patellofemoral joint is also at risk for the development of osteoarthritis. Which part of the patella is typically involved in knee osteoarthritis? A.) Knee B.) Lateral C.) Anterior D.) Posterior
B.) Lateral In almost 80 percent of individuals who have patellofemoral osteoarthritis, lateral patellofemoral involvement is common because of abnormal kinematics, such as a lateral patellar tilt. [Hunter, D. J., Zhang, Y. Q., Niu, J. B., Felson, D. T., Kwoh, K., Newman, A., Kritchevsky, S., Harris, T., Carbone, L., & Nevitt, M. (2007). Patella malalignment, pain and patellofemoral progression: The Health ABC Study. Osteoarthritis and Cartilage, 15(10), 1120-1127.] check_circle
Q53.) A physical therapist is implementing a stretching program for a patient with neck pain. Which of the following muscles should be included in the flexibility program? A.) Anterior scalene and middle trapezius B.) Medial scalene and upper trapezius C.) Levator scapulae and lower trapezius D.) Pectoralis major and middle trapezius
B.) Medial scalene and upper trapezius The anterior, medial, and posterior scalene, along with the upper trapezius and the levator scapulae and pectoralis muscles should be incorporated into a stretching program for a patient with neck pain. [Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34.] check_circle
Q43.) Which of the following knee pathologies puts an individual at the highest risk for developing knee osteoarthritis? A.) ACL tear B.) Meniscal tear C.) PFPS D.) PCL tear
B.) Meniscal tear Meniscal tears are linked to the development of knee osteoarthritis. [Heidari B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian Journal of Internal Medicine, 2(2), 205-212.] check_circle
Q29.) A physical therapist is working on strengthening with a patient who tore his posterior cruciate ligament two weeks ago. It was a full-thickness tear, but he has not had a surgery for the injury. Which of the following muscles can assist with stability of the knee and reduce the potential for excessive posterior translation? A.) Biceps femoris B.) Popliteus C.) Quadriceps femoris D.) Semimembranosus
B.) Popliteus The popliteus helps resist posterior forces on the tibia, and if there is a posterior cruciate ligament injury, the popliteus can assist in providing knee stability. So this is the muscle that should be strengthened. Note also that the quadriceps femoris muscle group can provide an anterior shear force on the knee but is not an overall good stabilizer of the knee alone. [Levangie, P. K., Norkin, C. C., & Levangie, P. K. (Eds.). (2011). Joint structure and function: A comprehensive analysis (5th ed.). F.A. Davis Co.] check_circle
Q8.) A physical therapist is working on narrowing down what she thinks is a particular type of arthritis. The patient has arthritic symptoms only in the distal interphalangeal joints of the fingers and toes. He has also reported a recent diagnosis of iritis, which has affected his ability to see. Which arthritic condition does this patient likely have? A.) Ankylosing spondylitis B.) Psoriatic arthritis C.) Reactive arthritis D.) Rheumatoid arthritis
B.) Psoriatic arthritis This patient's presentation of symptoms only in the distal interphalangeal joints of the fingers and toes is one of the five possible clinical presentations of this type of arthritis. Iritis is also seen in individuals with psoriatic arthritis, along with other possible inflammatory eye conditions. [Antony, A. S., Allard, A., Rambojun, A., Lovell, C. R., Shaddick, G., Robinson, G., Jadon, D. R., Holland, R., Cavill, C., Korendowych, E., McHugh, N. J., & Tillett, W. (2019). Psoriatic nail dystrophy is associated with erosive disease in the distal interphalangeal joints in psoriatic arthritis: A retrospective cohort study. The Journal of Rheumatology, 46(9), 1097-1102.] check_circle
Q41.) A 27-year-old masters swimmer comes into your clinic with R shoulder pain. She complains of chronic shoulder pain through college that has worsened over the last year. She states her pain is often a dull ache but she can get intermittent sharp pains in the anterior right shoulder by the end of practice, which usually consists of ~4,000 yards. The patient has seen her PCP and was referred to your clinic with a diagnosis of shoulder impingement. Given this information, at what stage of impingement would you classify her based on Neer's classification? A.) Stage 1 B.) Stage 2 C.) Stage 3 D.) Stage 4
B.) Stage 2 Stage 2 classification includes fibrosis and tendinitis. It usually occurs with repeated episodes of mechanical irritation. The patients are usually between the ages of 25 and 40, and there can be thickening or fibrosis of the subacromial bursa. check_circle
Q38.) In what stage(s) of adhesive capsulitis will patients under anesthesia who have adhesive capsulitis exhibit range of motion that is equal to the range of motion that is present when they are awake? A.) All stages B.) Stage 2 or 3 C.) Stage 4 D.) There is no stages where patients will show similar results under anesthesia or awake with regard to range of motion.
B.) Stage 2 or 3 Those in stages 2 and 3 of adhesive capsulitis will show nearly the exact same amounts of range of motion when awake or when tested under anesthesia. [Kelley, M. J., McClure, P. W., & Leggin, B. G. (2009). Frozen shoulder: Evidence and a proposed model guiding rehabilitation. The Journal of Orthopaedic and Sports Physical Therapy, 39(2), 135-148.] check_circle
Q40.) What is currently known in regard to stretching for patients with adhesive capsulitis? A.) Stretching at least two times per day will result in the most positive gains in range of motion B.) Stretching beyond limits of a patient's pain can result in poor overall outcomes C.) Stretching for sixty seconds with at least two repetitions per stretch will decrease pain and improve range of motion D.) Stretching should only be implemented in those who exhibit low irritability
B.) Stretching beyond limits of a patient's pain can result in poor overall outcomes It is important to respect tissue irritability when passively or actively performing stretching exercises because it can impact overall outcomes, so this is the correct answer. [Kelley, M. J., Shaffer, M. A., Kuhn, J. E., Michener, L. A., Seitz, A. L., Uhl, T. L., Godges, J. J., & McClure, P. W. (2013). Shoulder pain and mobility deficits: Adhesive capsulitis. The Journal of Orthopaedic and Sports Physical Therapy, 43(5), A1-A31.] check_circle
Q45.) A patient has recently been diagnosed with knee osteoarthritis via the Kellgren-Lawrence classification system. The patient reports knee pain after walking or standing for six to eight hours, as well as a significant increase in the amount of knee stiffness present over the last few months. Based on the radiograph, bone osteophytes are present, but the articular cartilage is still very healthy. Which of the following grades of osteoarthritis does this patient have? A.) Grade 1 B.). Grade 2 C.) Grade 3 D.) Grade 4
B.). Grade 2 Individuals with Grade 2 have mild knee osteoarthritis, but they will experience symptoms. [Kellgren, J. H., & Lawrence, J. S. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases, 16(4), 494-502.] check_circle
what are two signs of an Anterior interosseous nerve injury/entrapment?
Benedictine sign cannot do the "OK" sign
Q94.) A 41-year-old male cyclist reports neck and arm pain. His pain diagram shows pain on the right side of his neck, down into the right triceps, with numbness and tingling present in the arm. With just the limited information from the pain diagram, which of the following diagnoses can be ruled out? A.) Brachial plexus neuritis B.) C7 disc herniation C.) Cubital tunnel syndrome D.) Pancoast tumor
C.) Cubital tunnel syndrome Although the ulnar nerve, which has innervation from C7, is involved with cubital tunnel syndrome, the symptoms in cubital tunnel syndrome do not begin in the neck and radiate to the right triceps region. Instead, these individuals have pain starting near the medial elbow and radiating distal from this region. They will also report numbness and tingling in the arm, but in the same pattern as where the pain begins. References: Netter, F. H. (2014). Atlas of human anatomy (6th ed.). Saunders/Elsevier. Magee, D. J. (2008). Orthopedic physical assessment (5th ed.). Saunders/Elsevier. Dutton, M. (2008). Orthopaedic examination, evaluation, and intervention (2nd ed.). McGraw-Hill Medical. check_circle
Q37.) Given the following sensitivity and specificity values, which of the following special tests would be most helpful in trying to rule in subacromial impingement? A.) Painful arc (sensitivity = 0.31,specificity = 0.81) B.) Empty can test (sensitivity = 0.88, specificity = 0.58) C.) Hawkins-Kennedy Test (sensitivity = 0.62, specificity = 0.99) D.) Neer Impingement Test (sensitivity = 0.79, specificity = 0.53)
C.) Hawkins-Kennedy Test (sensitivity = 0.62, specificity = 0.99) Since the Hawkins-Kennedy test has a specificity of 0.99, we can conclude that this would allow us to best rule-in a diagnosis of subacromial impingement. Please note that there are usually a wide variety of sensitivity and specificity values published for special tests, and so often test-item clusters are more valuable. In this instance, we can use the SPin/SNout rule and find the item that has the highest reported specificity to rule in the diagnosis. [Park, H. B., Yokota, A., Gill, H. S., El Rassi, G., & McFarland, E. G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. The Journal of Bone and Joint Surgery, American Volume, 87(7), 1446-1455.] check_circle
Q44.) Which of the following diagnoses is not a cause of secondary knee osteoarthritis? A.) Acromegaly B.) Hyperparathyroidism C.) Hypothyroidism D.) Rickets
C.) Hypothyroidism Current evidence suggests that hypothyroidism has no connection to the development of knee osteoarthritis. [Michael, J. W., Schlüter-Brust, K. U., & Eysel, P. (2010). The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Ärzteblatt International, 107(9), 152-162.] check_circle
Q55.) A patient with whiplash-associated disorder is referred to physical therapy and is wearing a soft collar. Which of the following is true regarding the use of soft collars in patients with neck pain after a motor vehicle accident? A.) A soft collar can improve function in patients after a motor vehicle accident, but only if worn for less than four hours per day B.) If patients wear a soft collar but also participate in strengthening exercises for the upper quarter, the outcomes are the same if they wear no collar but perform strengthening exercises C.) Individuals who wear a soft collar after a motor vehicle accident are more likely to take prolonged time off work D.) Patients who wear a soft collar for two weeks after a motor vehicle accident have decreased pain and improved disability levels when assessed at six months
C.) Individuals who wear a soft collar after a motor vehicle accident are more likely to take prolonged time off work Using a soft collar shows no benefit in functional recovery, and it also predisposes individuals to prolonged time off work, according to a study by Crawford et al. References: Crawford, J. R., Khan, R. J., & Varley, G. W. (2004). Early management and outcome following soft tissue injuries of the neck: A randomised controlled trial. Injury, 35(9), 891-895. Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34. check_circle
Q77.) Which of the following mobilizations has NOT been shown to improve heel pain symptoms in patients with plantar fasciitis? A.) Cuboid thrust manipulation B.) Distal tibiofibular joint posterior nonthrust manipulation C.) Midtarsal pronation/supination nonthrust manipulation D.) Proximal tibiofibular joint thrust manipulation
C.) Midtarsal pronation/supination nonthrust manipulation Midtarsal pronation and supination nonthrust manipulations were used in a study by Shashua et al., and it was found that the addition of these manual techniques did not improve overall heel pain/symptoms in patients with plantar fasciitis. References: Cleland, J. A., Abbott, J. H., Kidd, M. O., Stockwell, S., Cheney, S., Gerrard, D. F., & Flynn, T. W. (2009). Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: A multicenter randomized clinical trial. The Journal of Orthopaedic and Sports Physical Therapy, 39(8), 573-585. Shashua, A., Flechter, S., Avidan, L., Ofir, D., Melayev, A., & Kalichman, L. (2015). The effect of additional ankle and midfoot mobilizations on plantar fasciitis: A randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 45(4), 265-272. check_circle
Q56.) A 35-year-old male patient is referred to physical therapy for an acute insidious onset of symptoms three weeks prior to referral. The patient only has symptoms in his neck, with no radiating symptoms. Objective findings reveal limited cervical range of motion in all planes, both actively and passively. Which diagnosis from the International Classification of Functioning, Disability and Health (ICF) does this patient have based on the findings provided? A.) Cervicalgia B.) Neck pain with headaches C.) Neck pain with mobility deficits D.) Spondylosis without radiculopathy
C.) Neck pain with mobility deficits This patient is less than 50 years of age, his duration of symptoms is less than twelve weeks, the pain is isolated to the neck, and he has reduced cervical range of motion. All of these findings correlate to the ICF diagnosis of neck pain with mobility deficits. [Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34.] check_circle
Q64.) Which of the following diagnoses could cause the development of Erb's palsy? A.) Cervical radiculopathy of C7-C8 B.) Long thoracic nerve injury C.) Parsonage-Turner syndrome D.) Spinal accessory nerve injury
C.) Parsonage-Turner syndrome An inflammatory or viral response causing Parsonage-Turner syndrome could cause the development of Erb's palsy since Parsonage-Turner syndrome is a neuritis of the brachial plexus and the upper trunk could be impacted. [Vath, S. A., Owens, B. D., & Stoneman, P. (2007). Insidious onset of shoulder girdle weakness. The Journal of Orthopaedic and Sports Physical Therapy, 37(3), 140-147.] check_circle
Q14.) Based on current evidence, what are the two variables that help clinicians determine which patients with low back pain will benefit the most from mechanical traction? A.) Centralization with extension and a positive crossed straight-leg raise test B.) Centralization with extension and a positive straight-leg raise test C.) Peripheralization with extension and a positive crossed straight-leg raise test D.) Peripheralization with extension and a positive straight-leg raise test
C.) Peripheralization with extension and a positive crossed straight-leg raise test In a study by Fritz et al. in 2007, it was found that those who peripheralized with extension and had a positive crossed straight-leg raise test finding were the subgroup of individuals who were most likely to have successful outcomes with mechanical traction. [Fritz, J. M., Cleland, J. A., & Childs, J. D. (2007). Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. Journal of Orthopedic Sports Physical Therapy, 37, 290-302.] check_circle
Q67.) A 23-year-old male patient is referred to physical therapy with an insidious onset of pain on the radial side of the palm. He also reports paresthesia in the thumb, index, and middle finger. The patient plays a lot of tennis, and the symptoms increase with tennis or any other type of activity. He also feels that his forearm is "heavy" at times, and this is not dependent on activity. Based on the patient's symptoms, which diagnosis is most likely? A.) Anterior interosseous nerve entrapment B.) Posterior interosseous nerve entrapment C.) Pronator teres syndrome D.) Radial tunnel syndrome
C.) Pronator teres syndrome These symptoms are common to pronator teres syndrome and would be expected. [Nigst, H., & Dick, W. (1979). Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome). Archives of Orthopaedic and Traumatic Surgery. Archiv für Orthopädische und Unfall-Chirurgie, 93(4), 307-312.] check_circle Parathesia is the key here versus AIN entrapment. AIN entrapment is pure motor and no sensation deficits.
Q15.) After completing a round of mechanical traction for a patient who fits into the traction subgroup, which of the following is the most appropriate therapeutic exercise intervention? A.) Abdominal curl B.) Abdominal draw-in C.) Prone press-ups D.) Single knee to chest stretch
C.) Prone press-ups Prone press-ups are the best intervention to perform after mechanical traction for an individual who fits into the traction subgroup because the traction will be performed in a prone position with the patient ultimately in a neutral or extended position. [Fritz, J. M., Cleland, J. A., & Childs, J. D. (2007). Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. Journal of Orthopedic Sports Physical Therapy, 37, 290-302.] check_circle
Q96.) During the objective examination of a patient's shoulder, a physical therapist observes atrophy within the infraspinatus fossa when compared to the uninvolved side. Which of the following conditions is most likely to be the cause of the atrophy? A.) C7 radiculopathy B.) Subscapularis tear C.) Suprascapular nerve palsy D.) Dorsal scapular nerve palsy
C.) Suprascapular nerve palsy The Suprascapular nerve innervates the infraspinatus muscle. check_circle
Q39.) When integrating the use of manual therapy into an intervention plan for a patient with adhesive capsulitis, a physical therapist uses joint mobilization. The patient is moderately irritable, so the physical therapist is deciding what type of techniques to use. Which of the following is appropriate regarding manual therapy use with patients who exhibit moderate irritability? A.) End-range techniques into tissue resistance can be integrated, but only low amplitude should be employed B.) Only low-intensity techniques should be used, and there should be no movement into tissue resistance C.) Techniques that progress into tissue resistance can be incorporated as long as there is not pain after the intervention D.) Until the patient is in the low irritability classification, very little joint mobilization should be incorporated; instead, passive range of motion is appropriate
C.) Techniques that progress into tissue resistance can be incorporated as long as there is not pain after the intervention With patients who are moderately irritable, progressing the amplitude and duration of procedures into tissue resistance is recommended as long as they do not have increased inflammation or pain after the treatment is complete. References: Kelley, M. J., McClure, P. W., & Leggin, B. G. (2009). Frozen shoulder: Evidence and a proposed model guiding rehabilitation. The Journal of Orthopaedic and Sports Physical Therapy, 39(2), 135-148. Kelley, M. J., Shaffer, M. A., Kuhn, J. E., Michener, L. A., Seitz, A. L., Uhl, T. L., Godges, J. J., & McClure, P. W. (2013). Shoulder pain and mobility deficits: Adhesive capsulitis. The Journal of Orthopaedic and Sports Physical Therapy, 43(5), A1-A31. check_circle
Q58.) If the ulnar nerve is damaged at the tunnel of Guyon, what would you expect to see in the presentation of the hand? A.) Flexor digitorum profundus is weak due to the ulnar nerve damage, and therefore the hand will be in a hyperextended position of the fourth and fifth digits at the MCP B.) Wrist flexion with MCP flexion and PIP/DIP extension in an intrinsic plus position C.) The hand will be resting in wrist flexion, MCP extension, and PIP/DIP flexion D.) The wrist and first and second MCP, PIP, and DIP joints will be in an extended position
C.) The hand will be resting in wrist flexion, MCP extension, and PIP/DIP flexion This answer describes the intrinsic minus position of the hand. This position will occur when the deep branch of the ulnar nerve is impacted and the intrinsic muscles are weak but the extrinsic muscles are unaffected. check_circle An ulnar claw, also known as claw hand, is a deformity or an abnormal attitude of the hand that develops due to ulnar nerve damage causing paralysis of the lumbricals.
What is causalgic pain?
Causalgia is technically known as complex regional pain syndrome type II (CRPS II). It's a neurological disorder that can produce long-lasting, intense pain. CRPS II arises after an injury or trauma to a peripheral nerve. Peripheral nerves run from your spine and brain to your extremities. The most common site of CRPS II pain is in what's called the "brachial plexus." This is the bunch of nerves that run from your neck to your arm. CRPS II is rare, affecting slightly fewer than 1 person out of 100,000
Q25.) A physician has diagnosed a patient with cervical myelopathy and referred her to physical therapy. The physical therapist is asking some follow-up questions and gathering his own objective findings. Which of the following findings would be most helpful for diagnosis? A.) Blood pressure greater than 160/95 B.) Dizziness or light-headedness related to neck movement C.) Unexplained weight loss D.) Abnormal gait pattern
D.) Abnormal gait pattern Ataxia is part of a test-item cluster by Cook et al. (2010) describing common findings in patients with cervical myelopathy. [Cook, C., Brown, C., Isaacs, R., Roman, M., Davis, S., & Richardson, W. (2010). Clustered clinical findings for diagnosis of cervical spine myelopathy. Journal of Manual & Manipulative Therapy, 18(4), 175-180. https://doi.org/10.1179/106698110X12804993427045] check_circle
Q87.) If a patient has atrophy in the infraspinous fossa along with weak and pain-free abduction, which of the following is likely the cause of the patient's atrophy? A.) Accessory movement involvement B.) Contractile tissue involvement C.) Inert tissue involvement D.) Nervous tissue involvement
D.) Nervous tissue involvement Weak and pain-free findings with shoulder abduction implicate the suprascapular nerve. Also, the atrophy in the infraspinous fossa means the nerve innervating the infraspinatus is involved, and that is also the suprascapular nerve. [Magee, D. J. (2008). Orthopedic physical assessment (5th ed.). Saunders/Elsevier.] check_circle
Which of the following special tests is included as a variable in the clinical prediction rule for the diagnosis of carpal tunnel syndrome? A.) Carpal compression test B.) Phalens test C.) Tinel test for median nerve D.) None of the above
D.) None of the above No special tests ended up being a part of the diagnostic clinical prediction rule for carpal tunnel syndrome, even though they were a part of the comprehensive examination/evaluation to determine those variables. [Wainner, R. S., Fritz, J. M., Irrgang, J. J., Delitto, A., Allison, S., & Boninger, M. L. (2005). Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation, 86(4), 609-618.] check_circle
Q27.) A patient who originally was thought to have carpal tunnel syndrome was correctly diagnosed as having anterior interosseous nerve entrapment. Which of the following muscles will be weak with anterior interosseous nerve entrapment, but not weak with carpal tunnel syndrome? A.) FDP B.) FDS C.) FPL D.) Pronator Quadratus
D.) Pronator Quadratus The pronator quadratus, along with the flexor pollicis longus and flexor digitorum profundus (lateral half), would be weak with anterior interosseous syndrome. [Netter, F. H. (2014). Atlas of human anatomy (6th ed.). Saunders/Elsevier. check_circle
Q86.) If this patient had come to physical therapy with a diagnosis of calcific tendinitis, which of the following interventions would have been the most beneficial for the patient, based on current evidence? A.) Isometric strengthening for shoulder flexors and external rotators B.) PROM for shoulder flexion and abduction C.) Pulleys for AAROM shoulder flexion and abduction D.) Pulsed ultrasound
D.) Pulsed ultrasound For short-term improvement, Ebenbichler et al. found ultrasound therapy to be beneficial for calcific tendinitis. [Ebenbichler, G. R., Erdogmus, C. B., Resch, K. L., Funovics, M. A., Kainberger, F., Barisani, G., Aringer, M., Nicolakis, P., Wiesinger, G. F., Baghestanian, M., Preisinger, E., Weinstabl, R., & Fialka-Moser, V. (1999). Ultrasound therapy for calcific tendinitis of the shoulder. New England Journal of Medicine, 340(20), 1533-1538.] check_circle
Q65.) A 36-year-old welder sustains a peripheral nerve injury to the ulnar nerve at the wrist. A splint is required for intervention. What position should the hand be splinted in? A.) Splint the interphalangeal joints in extension B.) Splint the interphalangeal joints in flexion C.) Splint the metacarpophalangeal joints in extension D.) Splint the metacarpophalangeal joints in flexion
D.) Splint the metacarpophalangeal joints in flexion Splinting the metacarpophalangeal joints in flexion prevents overstretching of the volar surface soft tissues and forces the extrinsic finger extensors to provide interphalangeal joint extension and allow for finger extension. [Colditz J. C. (2002). Plaster of Paris: The forgotten hand splinting material. Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists, 15(2), 144-157.] check_circle
Q7.) A physical therapist is treating a patient with rheumatoid arthritis, and the patient has developed a swan-neck deformity. The patient noticed an onset of this deformity six months prior to referral from her physician to physical therapy. It has become rather painful and has started to limit hand mobility in the past six weeks. Which of the following interventions will be most effective for this patient's condition, based on the progression of the deformity? a.) joint mobilization B.) strengthening C.) Stretching D.) Surgical intervention
D.) Surgical intervention Many patients do not need treatment for a swan-neck deformity, but in the case of this patient, the symptoms ultimately affected hand mobility, and treatment is necessary. Splinting could be trialed with the patient, but ultimately many patients end up having surgical intervention on the deformity. [Cooper, C. (2007). Fundamentals of hand therapy: Clinical reasoning and treatment guidelines for common diagnoses of the upper extremity. Elsevier.] check_circle
Q11.) A 52-year-old female presents to physical therapy with low back pain and right leg pain extending to the posterior Achilles tendon region that started approximately two weeks prior. The patient does not exhibit a lateral shift. There is a loss of AROM in both flexion and extension, and the symptoms increase into the posterior Achilles tendon region with both flexion and extension. Other findings include a positive prone instability test and positive straight-leg raise, slump, and crossed straight-leg raise tests. Lastly, there is diminished sensation in the posterior heel region on the right. The FABQ work subscale score is 16, and the physical activity subscale score is 8. Which of the following subgroups should this individual be placed into from the treatment-based classification? A.) Lumbopelvic joint manipulation B.) Specific exercise C.) Stabilization D.) Traction
D.) Traction This individual has several findings that would place her into the mechanical traction subgroup. She has peripheralization with extension, neurological sensory deficits, and a positive crossed straight-leg raise. All of these are objective findings that should point a physical therapist to classifying the patient into the mechanical traction subgroup. [Fritz, J. M., Cleland, J. A., & Childs, J. D. (2007). Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. Journal of Orthopedic Sports Physical Therapy, 37, 290-302.] check_circle
Q17.) Of the following, which may be seen in migraine and cervicogenic headaches, but not in tension headaches? A.) Female predominant B.) Intense pain C.) Radiating pain the back to front D.) Unilateral headache
D.) Unilateral headache Tension headaches are bilateral headaches, whereas migraine headaches and cervicogenic headaches are isolated to one side. [Headache Classification Subcommittee of the International Headache Society (2004). The International Classification of Headache Disorders (2nd ed.). Cephalalgia. 24 Suppl 1, 9-160.] check_circle
Q21.) A patient presents with a six-week history of occipital headaches with associated intermittent numbness in the occipital region and significant limitations with AROM in all planes of motion in the cervical spine. Over the last week, the patient has started to notice some clumsiness with gait. Which of the following diagnoses is most likely for this patient? A.) Atlas fracture B.) Cervical myelopathy C.) VBI D.) Upper cervical ligamentous instability
D.) Upper cervical ligamentous instability In those who have upper cervical ligamentous instability, one is likely to see occipital numbness with occipital headaches, significant range-of-motion limitations in all directions, and signs and symptoms of cervical myelopathy, which here include clumsiness with gait. Refer to Childs et al. (2008) on cervical treatment-based classification for further explanation of red-flag screening in the cervicothoracic region. References: Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34. Kerry, R., & Taylor, A. J. (2006). Cervical arterial dysfunction assessment and manual therapy. Manual Therapy, 11(4), 243-253. Kerry, R., & Taylor, A. J. (2009). Cervical arterial dysfunction: knowledge and reasoning for manual physical therapists. The Journal of Orthopaedic and Sports Physical Therapy, 39(5), 378-387. check_circle
Q52.) Of the following objective findings, which is related to the development of chronic neck pain? A.) Hyporeflexia of any upper extremity deep tendon reflex(es) B.) Positive upper limb tension test for median nerve C.) Significant loss of active range of motion D.) Weakness in the hands
D.) Weakness in the hands Those who have weakness in the hands are predisposed to chronic neck pain, according to a study by Bot et al. (2005). References: Bot, S. D., van der Waal, J. M., Terwee, C. B., van der Windt, D. A., Scholten, R. J., Bouter, L. M., & Dekker, J. (2005). Predictors of outcome in neck and shoulder symptoms: A cohort study in general practice. Spine, 30(16), E459-E470. Childs, J. D., Cleland, J. A., Elliott, J. M., Teyhen, D. S., Wainner, R. S., Whitman, J. M., Sopky, B. J., Godges, J. J., Flynn, T. W., & American Physical Therapy Association (2008). Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. The Journal of Orthopaedic and Sports Physical Therapy, 38(9), A1-A34. check_circle
Q24.) A physical therapist knows the criteria for the clinical prediction rule for the diagnosis of carpal tunnel syndrome. However, the therapist wants to know which of the criteria has the best sensitivity. Of the following, which has the best sensitivity? A.) Gender B.) Median nerve sensation of the thumb C.) Symptom Severity Scale score greater than 1.9 D.) Wrist-ratio index greater than 0.67
D.) Wrist-ratio index greater than 0.67 The sensitivity of the wrist-ratio index greater than 0.67 is 93%. [Wainner, R. S., Fritz, J. M., Irrgang, J. J., Delitto, A., Allison, S., & Boninger, M. L. (2005). Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation, 86(4), 609-618.] check_circle
What is the action for the Masseter?
It is responsible for the elevation of the mandible and some protraction[1], and also the chewing movement of the mandible at the temporomandibular joint (TMJ).
What is Neurapraxia?
Neuropraxia is the mildest form of traumatic peripheral nerve injury. It is characterized by focal segmental demyelination at the site of injury without disruption of axon continuity and its surrounding connective tissues. This condition results in blockage of nerve conduction and transient weakness or paresthesia.Oct 24, 2022
What is the cannot do the "OK" sign?
On a physical examination, the patient will show weakness of the FLP and FDP to the index finger with a positive Pinch Grip test (Froment's sign); rather than making the "OK" sign, the patient will clap the sheet between the index finger and an extended thumb. [1]
According to Park Et al. What are the 3 tests to rule in a full thickness rotator cuff tear?
The combination of the painful arc sign, drop-arm sign, and infraspinatus muscle test produced the best post-test probability (91%) for full-thickness rotator cuff tears.
What is the action for medial pterygoid?
The primary action is to elevate the mandible and laterally deviate it to the opposite side.
What is Type 4 for Neers classification of lessions in impingement syndrome?
The type IV acromion does not exist in the classification system from Bigliani et al., but some references have indicated the type IV acromion is a convex acromion. [Bigliani, L. U., Ticker, J. B., Flatow, E. L., Soslowsky, L. J., & Mow, V. C. (1991). The relationship of acromial architecture to rotator cuff disease. Clinics in Sports Medicine, 10(4), 823-838.]
What is the action for medial temporalis?
This muscle's action is to move the mandible up, back, and side-to-side.
What is the TUBS classification of shoulder instability?
Traumatic Anterior Shoulder Instability, also referred to as TUBS (Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery), are traumatic shoulder injuries that generally occur as a result of an anterior force to the shoulder while its abducted and externally rotated and may lead to recurrent anterior shoulder instability.
What is axonotmesis?
Type II nerve injury Disruption of not only the myelin sheath but the axon as well The epineurium and perineurium remains intact, meaning that there is still some continuity within the nerve
What is Neurotmesis?
Type III nerve injury The most severe form of nerve injury, is associated with complete nerve division and disruption of the endoneurium. The axon, myelin sheath, and connective tissue components are damaged, disrupted or transected. As with axonotmesis, neurotmesis initiates Wallerian degeneration, but the prognosis for nerves is poor.
What is the Benedictine sign?
is seen when the patient is asked to make a fist and the ring and little finger flex but the index and middle finger can not flex at the metacarpal-phalangeal joint or interphalangeal joint.
