Clin lecture exams

Starkey and Brown (2015) recommend that certain clinical findings warrant the termination of your orthopedic evaluation and immediate physician referral. Which of these findings are identified below?

A. Active range of motion testing reveals a third degree muscle tear. B. Neurological testing indicates a motor and/or sensory dysfunction. C. both A and B D. Ligamentous testing ("special tissue tests") reveals gross joint instability. E. all of the above (A, B and D)***

Which of the following represent information that would typically be obtained by the clinician from the patient during the "O" phase of the HOPS injury examination process?

-Asymmetry -presence of surgical scars -both -skin color or appearance -all of the above***

Lumbar lordosis is known to be caused by which of the following?

-weak core (ab) muscles -pregnancy -both***

A typical computed tomography (CT) scan delivers the same amount of ionizing radiation to the patient as approximately ___________ standard X-rays?

100

15. The four cardinal signs of inflammation in Western medicine were first described by ___________________.

Celsus

A patient who presents with a calcaneal gait has weak or paralyzed _________________ muscles.

plantar flexor

The lumbar curve is a _____________________ curve that develops as the result of _________________________.

secondary, the infant progresses from sitting to crawling to walking

Which of the following are included among the 33 "red flag findings" identified by Reiman (2016) that warrant immediate referral of the patient to physician?

-chest pain with exertion -neurological signs and symptoms -both -pain unchanged by movement or rest -all of the above ***

Reiman (2016) suggests that the main function of plain film radiography ("x-rays") is to rule out fractures and conditions such as:

-hip osteoarthritis -exostoses -Both ***

When performing a clinical assessment of a patient's posture, which of the following are anatomical landmarks commonly used to evaluate her/him for anatomical asymmetry?

-iliac crests -lateral malleoli -both -patellae -all of the above***

The patient's subjective experience of pain can be made more objective using which of the following instruments?

-numeric pain rating scale (NPRS) -visual analogue scale (VAS) -both A and B***

Which of the following have been recognized as YELLOW flag findings that warrant referral of a patient to a physician?

-symptoms that are peripheralizing -progressive weakness -both -bilateral symptoms -all of the above***

Reiman (2016) described nonverbal communication as a vital part of the patient interview, said to comprise 55% to 97% of all communication. Which of the following are examples of effective forms of nonverbal behaviors?

-uncrossed arms and legs -forward leaning posture -both -positive reinforcement -all of the above***

In the skeletally immature child, there are ______ moveable vertebrae in the lumbo-sacral spine.

10

The statistic, positive likelihood ratio (+LR), is the ratio of a positive test result in a people with the pathology to a positive test result in people without the pathology. Which one of the following values is the best +LR?

20.0

Good listening skills are essential for success in patient interviews and obtaining accurate medical histories from patients. We have discussed the tendency of physicians in the United States to interrupt patients while they were giving their opening statements. One study cited in both lecture and the Reiman text indicated that in order for patients to divulge their primary concern ("chief complaint"), they needed at least __________________ of uninterrupted speaking time to do so.

30 seconds

Hyperkyphosis is defined as a kyphotic angle greater than ___________ degrees between T4 and T12 vertebral bodies that is obtained from a lateral x-ray using the Cobb method.

40

We now understand that genetic inheritance is responsible for as much as _________ percent of all the cases of intervertebral disc degenerative disc disease (DDD), irrespective of the patient's sex.

50 to 75

Infants up until about 18 months of age will demonstrate slight genu varum, followed by genu valgum until about age 3. However, by the age of __________, most children's lower leg alignment will naturally straighten.

6 years

Which of the following statements are TRUE regarding the condition of a lumbar herniated nucleus pulposus (HNP)?

A. A lumbar herniated nucleus pulposus (HNP) is one of the most common diagnoses made by orthopedic spine specialists. B. Diagnostic imaging studies reveal that persons over the age of 60 have a high incidence of bulging and herniated lumbar discs, and in some cases, with no symptoms. C. both A and B D. Disc herniation-associated radiculopathy is now considered to be a biochemical as well as mechanical problem. E. all of the above (A, B and D)***

Which of the following are basic competencies that Reiman (2016) says are expected of physical medicine clinicians regarding diagnostic imaging?

A. Being able to explain imaging findings to patients and discuss diagnostic imaging with other professionals. B. Understanding the radiographic report from the referring radiologist as well as the terminology used to describe the findings. C. both A and B D. Being able to recognize precautions and contraindications to treatment and modify the plan of care accordingly, based on the results of the imaging report. E. all of the above (A, B and D)***

Steves & Hootman (2004) believed that evidence-based medicine (EBM) was important to the practice of physical medicine. Which of the following statements accurately describe their perspective?

A. EBM promotes critical thinking within the professions of physical and occupational therapy. B. The application of EBM principles can improve the level of care delivered to patients C. both A and B D. Having strong evidence that supports the efficacy of a treatment will facilitate third party reimbursement for physical therapists, occupational therapists, and other physical medicine providers. E. all of the above (A, B and D)***

In 2013, the American Academy of Pediatrics launched the "Choosing Wisely" campaign to inform health care providers about the dangers of the unnecessary use of computed tomography (CT) in making which of the following diagnoses, particularly in emergency department/emergency room care?

A. Immediate evaluation of minor head injuries and suspected concussions in children. B. Immediate evaluation of acute abdominal pain in children. C. both A and B***

Which of the following statements accurately describe non-enzymatic glycation (NEG), a biochemical phenomenon associated with the ageing process.

A. NEG mostly affects human tissues with a low metabolic rate and a high content of collagen. B. NEG is a slow degenerative process that reduces the capacity of the affected tissue to absorb compressive loading and impacts. C. both A and B***

Which of the following principles apply to the physical examination portion of the orthopedic assessment of a patient?

A. Unless bilateral movement is required, the normal (uninjured) side is tested first. B. When individual myotomes are being tested with manual muscle testing, the patient should hold each isometric contraction for at least 5 seconds to determine if any myotomal weakness becomes evident. C. both A and B D. When evaluating the integrity of ligaments, stress is applied gently and repeated several times; the stress is gradually increased (up to the point of pain) in order that maximum instability can be demonstrated without causing muscle spasm. E. all of the above (A, B and D)***

Clear communication between patient and clinician is critical for obtaining an accurate medical history. In order to practice culturally competent care in this process, clinicians should ________________________________.

A. Use jargon-free terminology ("lay terminology") at about an eighth grade level of understanding when talking with a patient. B. Convey respect for adult patients by addressing them formally, e.g., "Mrs. Sanchez", "Mr. Kawamura". C. both A and B D. If English is your primary language, determine the patient's level of fluency in the English language. E. all of the above (A, B and D)***

Which of the following statements are true regarding providing culturally competent care for your patients?

A. When performing the orthopedic examination of a patient, the clinician must respect the patient's religious beliefs and not include or perform techniques that will offend her/him. B. The clinician should be alert and look for nonverbal cues that his/her patient is anxious and/or uncomfortable with the way that medical care is being provided. C. Both***

Which of the following types of information can be obtained with a dual energy X-ray absorptiometry (DEXA) scan?

A. bone mineral density B. body fat percentage C. both A and B D. severity of osteoporosis E. all of the above (A, B and D)***

Which of the following are included among the "red flag findings" identified by Reiman (2016) that warrant immediate referral of the patient to physician?

A. chest pain with exertion B. neurological signs and symptoms C. both A and B D. pain unchanged by movement or rest E. all of the above (A, B and D)***

Reiman (2016) describes the patient screening process for non-musculoskeletal related pain and dysfunction as complicated and time consuming. That said, which of the following is/are key factors that create the need for this screening include?

A. comorbidities B. side effects of prescribed medications C. both A and B D. the presence of visceral pain E. all of the above (A, B and D)***

According to Reiman (2016), which of the following represent cardiovascular conditions that the physical medicine clinician must be watchful for being present in her/his patient while performing the medical screening examination?

A. deep vein thrombosis B. congestive heart failure C. both A and B D. peripheral arterial disease E. all of the above (A, B and D)***

Which of the following are causes of regional mechanical low back pain with associated neurogenic leg pain?

A. spondylolisthesis B. spinal stenosis C. both A and B D. herniated nucleus pulposus E. all of the above (A, B and D)***

According to Reiman (2016), scoliosis is a postural dysfunction that can involve which of the following?

A. thoracic region of the spine B. lumbar region of the spine C. both A and B D. both the thoracic and lumbar regions of the spine (two curves) E. all of the above (A, B and D)***

When assessing a patient for differences in true leg length, which of the following anatomical landmarks are used?

ASIS to distal medial malleolus

The curve of the thoracic spine is a ___________________ curve in the _____________________ direction.

Primary, posterior

In the basic systematic "ABCs" approach to evaluating conventional radiographs described in Reiman (2016), the "s" in the mnemonic represents ________________________.

Soft tissue

Scheuermann's disease is an idiopathic condition that affects approximately 10% of the general population. This inflammatory, degenerative condition leads to _________________ wedging of multiple vertebrae, and creates an exaggerated __________________ curvature of the spine.

anterior, posterior

A patient's coping skills, previous treatment, and attitudes and beliefs are considered to be components of which "dimension of pain" as identified by Magee (2014)?

cognitive

Which of the following diagnostic imaging techniques delivers ionizing radiation to the patient when the image is being obtained?

computed tomography

An accentuated lumbar lordotic curvature, often associated with Janda's "lower crossed syndrome", is commonly due to _______________________________________.

facilitated iliopsoas muscles and inhibited abdominal muscles

According to the Loudon chapter in the Reiman (2016) text, the loading response subphase of the stance phase of gait is marked by which one of the following visible events?

foot flat

A patient who demonstrates a Trendelenburg gait indicates that they have a weakness or paralysis of which one of the following muscles?

gluteus medius

According to the Meyerding scale, an L4 vertebral body that has subluxed anteriorly 58% of the width of L5 vertebral body is classified as a ___________________ severity spondylolisthesis.

grade 3

Which one of the following is NOT a physical sign of injury?

headache

Which one of the following diagnostic imaging techniques is the most appropriate for identifying the presence of a herniated nucleus pulposus (HNP) correctly?

magnetic resonance imaging (MRI)

A herniated nucleus pulposus (HNP) in the lower lumbar region that is extruded or sequestered in the __________________ direction most often results in unilateral sciatica.

posterolateral

Which one of the following muscles is typically inhibited in patients who present in clinic with Janda's "lower crossed syndrome"?

rectus abdominis

The cervical curve is a ______________________ curve that begins to develop ________________.

secondary, at 3 months of age

How many of the cardinal planes of motion (or cardinal axes of motion) are possible at every lumbar zygoapophyseal ("facet") joint?

three

Patient-reported outcome (PRO) measures, e.g., the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, as discussed in the Reiman (2016) text, are considered ____________________ if they measure what they are intended to measure.

valid