LOWER MSK - Questions (MIDTERM)
MCID for Oswestry Disability Index (ODI)? 6 8 10 12
10
A 45 year old diagnosed with lumbar radiculopathy has pain which worsens with sitting and improves with standing and walking. Based on this information alone, which specific exercise category would be appropriate for this patient? - Extension - Flexion - Shift correction - Traction
10:45am (3/5/24)
A 25 year old female underwent a hip arthroscopy for right anterior groin pain secondary to a hip labral tear she suffered nearly 2 years ago. The patient is now 12 weeks post-op with no report of pain during all activities of daily living, presents with a normal and symmetrical gait pattern, and has completed 6 weeks of "late stage" rehab consisting of squats, lunges, and other lower body strengthening activities. Which of the following criteria need to be met prior to the patient initiating some type of running into her rehab? - Hip Outcome Score at least 80% for ADL subscale - Strength of hip and pelvic muscles at least 80% compared to opposite side - 30 second single leg stance without pain - 15 minutes fast walking
15 minutes fast walking
MCID for the Roland-Morris Disability Questionnaire? 5 10 15 20
5
Research shows that individuals performing the Y Balance Test are at 3x increased risk for injury if the composite score is below what threshold? 97% 94% 91% 89%
94% ????11:15am
Your patient is performing standing marches using the countertop for UE support. What are the correct arthrokinematics occurring at the right hip joint when performing the march? - Anterior roll and glide of the femur on the acetabulum - Posterior roll and glide of the femur on the acetabulum - Anterior roll and posterior glide of the femur on the acetabulum - Posterior roll and anterior glide of the femur on the acetabulum
Anterior roll and posterior glide of the femur on the acetabulum
A patient comes to outpatient PT for a pre-op visit. They are undergoing a total hip arthroplasty utilizing an anterior approach. You need to educate them on restricted motions post-op. Which of the following correctly identifies these? - Avoid: flexion >90, IR past neutral, ADDuction past midline - Avoid: flexion > 90, ER past neutral, ADDuction past neutral - Avoid: excessive extension, ABDuction, ER - Avoid: excessive extension, ADDuction, ER
Avoid: excessive extension, ABDuction, ER
A patient with left PSIS pain demonstrates centralization with repeated lumbar extension. Based on this information, which intervention is most appropriate? - Erector spinae soft tissue massage - SIJ mobilization - Directional preference exercises - SIJ manipulation
Directional preference exercises
Patient Education Alone Can Be Used as a treatment strategy for patients with chronic low back pain T/F?
False
According to the Lumbar CPGs, which pain location outcome score is most likely to require referral for cognitive behavioral therapy? - Generalized pain with high psychosocial scores (>50) - Referred lower extremity pain with FABQ<18 - Localized lumbar pain with Oswestry score > 50 - Sciatica with FABQ>18
Generalized pain with high psychosocial scores (>50)
A positive Trendelenburg sign implicates weakness of which of the following muscles? - Glute Max - Glute Medius - Glute min - TFL
Glute Medius
Which of the following is NOT a part of the Altman Clinical Criteria for the diagnosis of hip OA? - Age > 50 - Hip flexion < 115 deg - Morning stiffness > 60 minutes - Hip IR < 15 deg
Hip IR < 15 deg
The ovaries and testes may refer pain to which region? - Lower abdomen and sacral spine - Thoracolumbar spine and upper abdomen - Thoracolumbar spine and inferior angle right scapula - Upper sacral spine and suprapubic area
Lower abdomen and sacral spine
Which exercise would be best to improve stabilization of the lumbar spine? - Plank on knees and forearms - Upper Abdominal Curl - Bicycles Exercise (abs)
Plank on knees and forearms
Coupled motions of the spine: When you side-bend to the right, which direction do we expect rotation to occur? - Rotation to the right - Rotation to the left - No rotation
Rotation to the left
According to EMG studies, if you want to strengthen the glute med, which exercise should you do in order to maximize muscle activation? - SL squat - Sidelying clamshells - Sidelying hip ABDuction - Lateral band wall
Sidelying hip abduction
According to the evidence, what is the first line of treatment for patients with hip OA? - Supervised exercise, manual therapy, education - Supervised exercise, weight loss, education - Weight loss, education, rest - Manual therapy and modalities
Supervised exercise, weight loss, education
In terms of irritability, Level 1 pain is considered... - pain after specific activity - pain after specific activity that doesn't affect performance. - pain at start of activity which resolves after warm up. - intermittent pain that does not disturb sleep.
pain after specific activity
Which of the following center edge angle measurements would suggest decreased stability of the hip? 35 degrees 50 degrees 65 degrees 20 degrees
20 degrees
How long should a patient expect to be in physical therapy for rehabbing either FAI or a labral tear at a minimum? - 6 months - 5 months - 4 months - 3 months
3 months
Someone in their 40's should be able to balance in single leg stance with their eyes open for about how long? - 15 seconds - 20 seconds - 25 seconds - 30 seconds
30 seconds
Average single leg balance time (eyes open) for a 40 year old should be in what range? - 20ish seconds - 25ish seconds - 30ish seconds
30ish seconds
Targeted weight loss for patients with hip OA should be what percent of body weight?
5-7.5% (for pts BMI > 25)
Which test would be appropriate for a 72 year old patient with leg pain aggravated by standing and walking? - 6 minute walk test - SIJ provocation tests - Y balance test - Hop test
6 minute walk test
What is the MCID of the Focus of Therapeutic Outcomes (FOTO) measurement? a) 6 b) 8 c) 10 d) 12
8
What is the minimal detectable change score for the symptom subscale according to the Hip Disability and Osteoarthritis outcome score (HOOS)? 2 points 5 points 8 points 11 points
8 points
While performing the Thomas test, normal knee flexion should be approximately what value? You have not responded - 60 degrees of knee flexion - 70 degrees of knee flexion - 80 degrees of knee flexion - 90 degrees of knee flexion
90 degrees of knee flexion
A physical therapist administers the 40m Self Paced Walk Test. What gait speed places an individual at increased risk for falls? You have not responded
< 0.7 m/s
What is the cutoff walking speed to indicate a patient is at an increased falls risk? <0.9 m/s <0.8 m/s <0.7 m/s <0.6 m/s
<0.7 m/s
After performing the 40m self paced walk test, what is the reported cut point identifying individuals at increased risk for falls? <0.7m/sec <0.6m/sec <0.8m/sec <0.9m/sec
<0.7m/sec
Of the 230 subjects in the Long, Donelson et al (2004) clinical trial, what percentage of subjects demonstrated a directional preference? 10% 30% 50% >70%
>70%
A physical therapist receives a referral for a patient diagnosed with spondylolisthesis. Which of the following scenarios would be most consistent with the medical diagnosis? - A 13yo female gymnast with no significant medical history - A 17yo female tennis player with a 15 degree lateral curvature of the spine - A 28yo machinist with a history of recurrent low back pain - A 67yo male with a previous diagnosis of ankylosing spondylitis
A 13yo female gymnast with no significant medical history (lumbar spine loaded in hyperextension)
A patient presents with sudden onset of severe, sharp right hip pain and significant limp that started 2 months. The patient reports a history of AIDS and corticosteroid use. What is your initial hypothesis?
AVN
Which of the following is considered a Red Flag in the 2012 Lumbar CPG? - Abdominal aneurysm (>4 cm) - Lumbar disc herniation - Pain rated 12/10 - Lumbar synovial cysts
Abdominal aneurysm (>4 cm)
The Agency for Health Care Policy and Research (1994) and the Flynn Clinical Prediction Rule study (2003) both recommend manipulation for patients in which stage ? - acute - chronic - subacute - improving
Acute
How would you bias the straight leg raise test to see if there is peroneal nerve involvement? - Ankle plantarflexion and eversion - Ankle dorsiflexion and eversion - Ankle dorsiflexion and inversion - Ankle plantarflexion and inversion
Ankle plantarflexion and inversion
During normal, open-chain hip extension, in which direction would you expect the femur to glide? - Inferior - Posterior - Anterior - Lateral
Anterior
A 21-year old, female lacrosse player with no significant past medical history presents to your clinic with intermittent right lower quadrant pain for the last 3-4 weeks. The patient states that they think they might have been hit during a lacrosse game, but they do not recall a particular episode of trauma. They describe the pain now as constant and sharp, such that they have missed their college classes and the last few lacrosse practices. Which red flag pathology is most likely with this patient presentation? - Femoral Neck Fracture - Slipped Capital Femoral Epiphysis - Colon CA - Appendicitis
Appendicitis
A 78 year old male presents to the clinic 3 days postoperative a cemented right total hip arthroplasty (THA). The physical therapist notes in the operating report that the surgeon utilized a posterolateral incision. Which of the following is the most appropriate acute precaution to reinforce with this patient? - Avoid hip extension past neutral - Avoid hip external rotation beyond neutral - Avoid hip internal rotation past neutral - Avoid hip abduction past midline
Avoid hip internal rotation past neutral
Target weight loss is recommended in patients with hip OA if BMI is greater than what value? - BMI > 20kg/m2 - BMI > 25kg/m2 - BMI >30kg/m2 - BMI >35kg/m2
BMI > 25kg/m2
What sign/symptom would lead you toward a diagnosis of lateral femoral cutaneous neuropathy vs hip OA or Hip flexor strain? - Anterior hip pain - Symptoms worse with walking - Burning type pain - Constant pain
Burning type pain
Your Patient Presents to Physical Therapy with severe low back pain, bowel/bladder incontinence, and sensory/motor loss to BLE. Which syndrome/condition would be on your radar? - Lumbar Radiculopathy - Pelvic Girdle Pain - Spinal Stenosis - Cauda Equina
Cauda Equina
Based on the CPG's, which grade are support belts and exercise given for the treatment of Pelvic Girdle Pain? (Note: Exercise and Support Belts have the same grade). - A - B - C - D
D
Which of the following describes the resting position of the hip? A) Full extension, full internal rotation, full abduction B) 30 degrees of flexion, 30 degrees of adduction, slight medial rotation C) 90 degrees of flexion, 45 degrees of abduction, and slight lateral rotation D) 30 degrees of flexion, 30 degrees of abduction, slight lateral rotation
D) 30 degrees of flexion, 30 degrees of abduction, slight lateral rotation
Which intervention is most appropriate for a patient with pelvic pain who has a central mechanism? - Manual therapy procedures directed toward the pelvic floor muscles - Diaphragmatic breathing - Pelvic support belts - Manual therapy procedures directed toward the lumbar spine
Diaphragmatic breathing
A patient with an acute right lateral shift of the trunk has a positive SLR at 45 degrees on the left and has weakness of left ankle DF. Which of the following best describes this patient's condition? - Discogenic with left L4 nerve root compression - Discogenic with left S1 nerve root compression - Central stenosis with left L4 nerve root compression - Left facet pathology with left L4 nerve root compression
Discogenic with left L4 nerve root compression (L4 myotome: DF)
A 45 year old male with a diagnosis of lumbar radiculopathy has leg symptoms which worsen with repeated lumbar extension and decrease with flexion. Based on this presentation, which intervention is most appropriate? - Double knees to chest therapeutic exercise - Extension SNAG - Sacroiliac region manipulation - Traction in the prone position
Double knees to chest therapeutic exercise
A 65 year old male is diagnosed with lumbar degenerative changes. In the repeated end range movement examination it was noted that the patient's leg symptoms decreased with flexion. Based on this information, which intervention is most appropriate? - Double knees to chest therapeutic exercise - Extension SNAG - Manipulation directed at the zygoapophyseal joints - Traction in the prone position
Double knees to chest therapeutic exercise
Which of the following is described in the 2021 Lumbar clinical practice guidelines? - Evidence is emerging for dry needling to be performed in conjunction with other interventions. - Directional preference exercises are indicated for low back pain with mobility deficit. - Chronic low back pain responds best to spinal manipulation - Lumbar traction is indicated for low back pain with radiating pain.
Evidence is emerging for dry needling to be performed in conjunction with other interventions.
Which statement accurately describes anteversion and retroversion in regards to toeing in and out? - Excessive anteversion = toeing out - Excessive anteversion = toeing in - Excessive retroversion = toeing in
Excessive anteversion = toeing in
Your patient presents to Physical Therapy with LBP and radiating symptoms to R calf. Their pain centralizes after performing 10 repetitions of prone press ups on elbows. What is the patient's most likely Directional Preference? - Flexion - Sidebending - Lateral Rotation - Extension
Extension
A patient with right sided low back pain is limited in extension and ipsilateral sidebending and there is limited passive accessory motion at L4-5. This describes which clinical pattern? - Facet syndrome - Muscle strain - SIJ sprain - Stenosis
Facet syndrome
Symmetry tests are the most reliable for ruling in SIJ Dysfunction T/F?
False
You should never recommend a cane for a patient with hip OA as you want them to return to normal gait ASAP T/F?
False
Patient is 12 weeks s/p hip arthroscopy for a torn labrum. Patient is progressing well throughout PT and is ready to initiate running. Which of the following would need to be met in order to initiate running? - SL wall sit > 30 secs - Able to complete > 15 repetitions during 5x STS - Fast walking 15 minutes - SL balance > 1 min
Fast walking 15 minutes
Which nerve is being tensioned in this picture? (Well's: pt prone, knee flexed back) - Femoral - tibial - sciatic - peroneal
Femoral
Your patient presents to Physical Therapy with complaints of R anterior thigh pain, numbness, and tingling. Their symptoms are reproduced when you flex/bend the RLE in prone. Which nerve is most likely involved? - Sciatic Nerve - Tibial Nerve - Femoral Nerve - Sural Nerve
Femoral Nerve
65-year-old female underwent a L total hip arthroplasty utilizing a posterior approach 3 days ago. During evaluation, which motions should you educate them on avoiding? - Flexion > 90, Excessive ER, hip -abduction - Extension past neutral, hip IR, Hip ER - Flexion > 90, Hip IR, Hip adduction crossing midline - Extension past neutral, hip ER, hip abduction
Flexion > 90, Hip IR, Hip adduction crossing midline
A 72yo pt with spinal stenosis will most likely benefit from: - core strengthening - lumbar grade I-II PA mobilizations - flexion exercises - repeated extension
Flexion exercises
A positive Trendelenburg sign implicates weakness of which of the following muscles? Select the BEST answer. Gluteus Medius Gluteus Maximus Gluteus Minimus Superior gemellus
Gluteus Medius
An X-ray showing definite osteophytes, definite narrowing of joint space, and slight sclerosis would be classified under which grade according to the Kellgren-Lawrence scale?
Grade 2
Your patient with R hip OA has difficulty achieving full hip extension at terminal stance during gait. You determine in your evaluation that this is due to joint hypomobility. Which joint mobilization would be MOST beneficial to improve their gait? - Grade I-II Posterior glide of the femur on the acetabulum - Grade I-II Anterior glide of the femur on the acetabulum - Grade III-IV Posterior glide of the femur on the acetabulum - Grade III-IV Anterior glide of the femur on the acetabulum
Grade III-IV Anterior glide of the femur on the acetabulum
A 35 year old female presents to your clinic with a 5 year history of intermittent left anterior hip and groin pain. She reports the pain at best at 0/10 and at worst 8/10 which wakes her up at night about 3x/week. She describes the pain as a general dull ache but at times reports a sharp/pinching/catching pain. She reports playing multiple sports (basketball, softball, track) throughout high school and has been a recreational runner (15-20 miles per week) for the past 15 years. Pain is typically worse with prolonged sitting and in the evenings on days she has gone for longer (> 5 mile) runs. The chronic tight hip flexor is often mistaken for an underlying problem we refer to as: - Hip Microinstability - Slipped Capital Femoral Epiphysis - Marfan's Syndrome - Dr. D Syndrome
Hip Microinstability
Older age, achy pain, stiffness, weakness. What is your best guess at diagnosis? - Hip OA - Chronic athletic groin pain - Piriformis syndrome - Femoroacetabular Impingement Syndrome
Hip OA
There is good evidence for the use of nonthrust and thrust manual therapies for which population? - Hamstring strain - Hip OA - Groin injury - Hip flexor strain
Hip OA
The Hip Outcome Score has been validated in which patient population?
Hip OA patients
A physical therapist is evaluating a patient diagnosed with FAI syndrome. Which of the following outcome measures is most appropriate and specific for this patient population? - Hip Outcome Score - Copenhagen Hip and Groin Outcome Score - Hip Disability and Osteoarthritis Outcome Score - SF-12
Hip Outcome Score
According to the Zurich Consensus Statement for the treatment of FAI/labral tears, best practice regarding treatment includes gentle ROM, activity modification/movement pattern retraining, and what other treatment (per Zurich guidelines)? - Hip strengthening - Core strengthening - Patient education and hip focused strengthening - Hip and trunk strengthening
Hip and trunk strengthening
A 55 year old male presents to the clinic with complaints of left sided anterior, groin pain. He reports his pain as a constant dull ache that has been present for nearly 20 years with a gradual worsening over the past 6 months that finally made him seek treatment. He reports his pain as a constant, dull ache and morning stiffness that typically subsides within an hour.Which of the following examination findings would help you confirm your clinical diagnosis of hip OA? Hip internal rotation <24 degrees Hip extension <15 degrees Hip external rotation <30 degrees Hip internal rotation <35 degrees
Hip internal rotation <24 degrees
A physical therapist is evaluating a patient diagnosed with hip OA. During the ROM exam where would you expect to find the GREATEST limitation?
IR
The strongest ligament of the hip joint is the: - Iliofemoral Ligament - Transverse Ligament - Pubofemoral Ligament - Ischiofemoral Ligament
Iliofemoral Ligament
The Well leg raise test is used for: - Neural tension - Indicating disc disorders - Hamstring length - Quad length
Indicating disc disorders
Which nerve innervate the gluteus maximus musculature? - Nerve to Obturator Internus - Superior Gluteal Nerve - Inferior Gluteal Nerve - Nerve to Piriformis
Inferior Gluteal Nerve
The 2021 updates to the Lumbar CPG included: - Treatment based classifications - Interventions - Bracing - Manual therapy
Interventions
What is the focus of the 2021 lumbar clinical practice guidelines? - Interventions - Diagnostic imaging - Interprofessional collaboration - Mechanical Diagnosis and Therapy
Interventions
Which of the following impairments justifies spinal stabilization as an intervention? - 3/5 erector spinae strength - Joint hypermobility - Pain with provocation and limited mobility of the involved segments - Pelvic asymmetry in the structural exam
Joint hypermobility
Which of the following is true regarding LBP? - LBP is a leading cause of disability - The cause of LBP can be identified 50% of the time - Although costs are increasing, LBP outcomes are improving - Yearly direct and indirect costs of LBP are $100 million
LBP is a leading cause of disability
A 6-year-old male presents to PT with complaints of hip pain. He ambulates into the clinic with an antalgic gait. During AROM, he is limited and painful into hip abduction and hip IR. Which red flag pathology do you need to rule out? - Legg-Calve-Perthes - Slipped Capital Femoral Epiphysis - Avascular Necrosis
Legg-Calve-Perthes
A 6-year-old boy presents to physical therapy with a hip pathology. Based on patient age, which of the following conditions is most likely? Legg-Calve-Perthes Disease Slipped capital femoral epiphysis Rheumatoid arthritis Labral tear
Legg-Calve-Perthes Disease
According to the LBP CPG, treatment based classifications for acute LBP is what level of evidence? - Level A - Level B - Level C - Level D
Level B
Which tissue structure do we expect to be the most hypertrophied in a 72-year-old patient with spinal stenosis? - Anterior longitudinal ligament - Ligamentum Flavum - Posterior Longitudinal ligament - Multifidi
Ligamentum Flavum
What clinical findings differentiate a hip flexor strain from adductor related groin pain from inguinal related groin pain from pubic related groin pain?
Location of pain and palpation, aggravating factors
A patient with right sided low back pain is limited in active lumbar extension. If there is also limited joint passive accessory motion, which category best describes the presentation? - Low back pain with mobility deficit - Low back pain with power deficit - SIJ sprain - Lumbar stenosis
Low back pain with mobility deficit
Which of the following interventions is most appropriate for a person with right sided low back and right leg pain who centralizes with lumbar extension? - Lumbar extension - Right lumbar U/L accessory manipulation - Lumbar strengthening exercises - Sacroiliac joint regional manipulation
Lumbar extension
Which spinal movement is most likely to provoke symptoms in a 70 year old patient with right leg pain who is better sitting? - Lumbar flexion - Lumbar extension - Lumbar sideglide left - Lumbar sidebending left
Lumbar extension
If a patient's symptoms are centralizing with lumbar extension in the sagittal plane, which manual procedure is indicated to further the centralization process? - Lumbar extension mobilization (central accessory mobilization) - Lumbar sidelying rotation in neutral mobilization/manipulation - Lumbar U/L accessory mobilization - Sacroiliac joint regional manipulation
Lumbar extension MOBS (central accessory mobilization)
Based on pathophysiology, which intervention is typically beneficial for patients who have signs and symptoms consistent with spinal stenosis? - Lumbar flexion exercise - Lower extremity strengthening exercises - Inversion traction - Lumbar sidelying rotation in neutral mobilization/manipulation
Lumbar flexion exercise
A patient with acute low back pain, low fear avoidance, and no pain below the knee. According to Flynn (2003), this patient may have a favorable outcome with which intervention? - lower abdominal strengthening - lumbar mobilization/manipulation - traction in the supine position - transversus abdominus training
Lumbar mobilization/manipulation
Pt. is a 65-year-old male with complaints of LBP. Notes numbness and tingling into the legs; no pattern. He has decreased extension and rotation bilaterally. What's #1 hypothesis? - Sciatica - Lumbar strain - Lumbar stenosis - Lumbar instability
Lumbar stenosis (No pattern, bilateral ROM issues)
Which procedure involves partial removal of a lumbar disc? - Microdisectomy - Lumbar Fusion - Disc Arthroplasty
Microdisectomy
With a diagnosis of gluteus medius tendinopathy, which of the following treatment options has reported the most favorable results? - Modification of activity, FABER stretch - Recommend corticosteroid injection and rest - Modification of activity, Stretch and soft tissue mobilization of IT band - Modification of activity, hip abduction strengthening
Modification of activity, hip ABD strengthening
Co-activation of the transversus abdominus, mutlifidi, and rotatores muscles in a neutral position best describes which of the following exercise interventions? - Global muscle strengthening - Motor control - Dynamic muscle training - Directional preference
Motor control
A patient describes left lumbar and left lower extremity pain and the physical exam reveals a left foot drop. Based on this information, which additional tests/measures are indicated? - Hip AROM - Lumbar prone instability test - SIJ provocation tests - Neural tension testing
Neural tension testing
Which of the following test cluster has the greatest sensitivity for sacroiliac joint involvement?? - Pain over the PSIS with pelvic asymmetry - Pain over the PSIS with leg length discrepancy - Pain referred to the buttock with positive seated flexion and standing flexion tests - Pain over the PSIS and positive SIJ provocation tests
Pain over the PSIS and positive SIJ provocation tests
What differentiates inguinal related groin pain from adductor, iliopsoas, or pubic related groin pain? - Pain with resisted adduction - Pain with Valsalva/cough/sneeze - Pain with passive hip extension - Tenderness to infrainguinal iliopsoas palpation
Pain with Valsalva/cough/sneeze
Which of the following impairments supports lumbar manipulation as an intervention? - Erector spinae weakness - Joint hypermobility - Pain with provocation and limited mobility of the involved segments - Pelvic asymmetry in the structural exam
Pain with provocation and limited mobility of the involved segments
What would help you differentiate between inguinal related groin pain from adductor, iliopsoas, or pubic related groin pain? - Tenderness to palpation - Pain with passive hip extension - Pain with resisted adduction - Pain with valsalva/cough/sneeze
Pain with valsalva/cough/sneeze (inguinal has pain with these)
First line treatment for most patients with hip OA includes the combination of which of the following? - Prescription of NSAIDs, patient education - Patient education, supervised exercise, weight loss - Group exercise, orthotics, ultrasound - Movement pattern retraining, activity modification, range of motion
Patient education, supervised exercise, weight loss
Which factor is consistent with the category of chronic low back pain with cognitive or affective tendencies? - Presence of yellow flags - Flexion directional preference - Low fear avoidance - Presence of red flags
Presence of yellow flags
What is the clinician's next course of action if a patient in the subacute stage has intermittent low back pain, and describes leg pain that is worse with sitting? - Proceed cautiously in the movement exam while documenting patient response. - Discontinue the exam immediately and call the referring physician. - Discontinue the exam immediately and refer the person for a lumbar x-ray. - Discontinue the exam immediately and refer the person for cognitive behavioral therapy.
Proceed cautiously in the movement exam while documenting patient response.
Based on what you know about Femoroacetabular Impingement Syndrome, during what portion of your examination would you expect to find the greatest limitations?
ROM
What is a differentiating feature of Greater Trochanteric Pain Syndrome and Hip OA? ~ Lateral Hip Pain ~ Resisted External Derotation Test ~ Hip abductor weakness ~ (+) Trendelenburg sign
Resisted External Derotation Test
Cluster of tests for SIJ involvement?
SIJ distraction, SIJ compression, thigh thrust, sacral thrust (highly sensitive!)
Most appropriate intervention for a pt with acute/localized SIJ pain? - core strengthening - SIJ manipulation - lumbar grade I-II PA mobilizations - repeated extension
SIJ manipulation
Patient presents with lumbar pain and numbness and tingling into the R leg. Slump test and SLR are positive and are concordant sign. Which of the following interventions would be most appropriate? - Lumbar extension - Sidelying lumbar manipulation - Sciatic neuromobilization - SIJ Manipulation
Sciatic neuromobilization
What would be an appropriate intervention for a patient with lumbar and leg symptoms who has impairments of a concordant seated slump test and no directional preference? - Lumbar extension exercise - Lumbar sidelying in neutral manipulation - Sciatic neuromobilization - Sacroiliac regional mobilization/manipulation
Sciatic neuromobilization
A 15-year-old male presents to PT with a hip pathology. Solely based on demographics, which condition do you suspect? - Legg-Calve-Perthes Disease - Slipped Capital Femoral Epiphysis - Rheumatoid Arthritis - Labral Tear
Slipped Capital Femoral Epiphysis
According to the TBC System, which intervention is indicated for patients with a directional preference? - Traction - Stabilization - Specific Exercise - Manipulation
Specific Exercise
A 45 year old patient is referred for treatment of lumbar radiculopathy and symptoms are found to centralize with repeated lumbar extension. According to the TBC, the patient would be classified into which category? - Manipulation - Specific exercise - Stabilization - Traction
Specific exercise
According to the Treatment Based Classification System (TBC), which intervention is indicated for patients who demonstrate a directional preference? - Specific exercise - Lumbar sidelying rotation in neutral mobilization/manipulation - Stabilization exercises - Traction
Specific exercise
Which LBP diagnosis is associated with segmental narrowing of disc heights between vertebrae, with increased prevalence after age 60, and decreased symptoms upon performing lumbar flexion? - Disc Herniation - Spondylolysthesis - Spinal Stenosis
Spinal Stenosis
Which of the following interventions is most appropriate for a patient 4 weeks following a lumbar fusion with instrumentation? - Spine stabilization - Lumbar sidelying rotation in neutral mobilization/manipulation grade III - Lumbar U/L accessory mobilization grade IV - Directional preference exercise
Spine stabilization
Which of the following pathophysiologies is characterized by a forward slippage of a vertebrae? - Spondylolisthesis - Spondylosis - Spondylolysis - Spinal stenosis
Spondylolisthesis
Which of the following pathophysiologies is characterized by a defect in the pars intarticularis? - Spondylosis - Spondylolysis - Spondylolisthesis - Ankylosis Spondylitis
Spondylolysis
Pt. is a 12-year-old female who complains of LBP. She is a competitive gymnast. Pain started within the last week after a 30 hour week of training. Observation shows increased lumbar lordosis. What's your #1 hypothesis? - Lumbar strain - Spondylolysis - Spondylolysthesis - Spondylitis
Spondylolysthesis (Lordosis)
Which Category do Motor Control Exercises (MCE's) fall under in the Low Back Treat Based Categories? - Stabilization - Manipulation - Specific Exercise - Traction
Stabilization
A physical therapists receives a referral for a patient diagnosed with spondylolisthesis. Which of the following scenarios would be most consistent with the medical diagnosis? - Step deformity with palpation - LBP worse with repeated lumbar flexion - Pain aggravated by sitting - Kyphotic lumbar spine
Step deformity with palpation
Your patient presents to Physical Therapy with lower calf/leg pain. Upon further assessment, your patient says their pain is reproduced with a SLR, with the foot biased towards inversion and dorsiflexion. Which nerve may be involved? - Femoral Nerve - Tibial Nerve - Sural Nerve - Common Peroneal/Fibular Nerve
Sural Nerve
Which patient symptom would lead you to the decision to NOT perform a lumbar manipulation? - Recent onset ( < 16 days) - Low FABQ (< 19) - Symptoms below the knee - Lumbar stiffness - Good hip IR (> 35º)
Symptoms below the knee
With regards to special tests, which of the following has the strongest +LR for ruling IN Femoroacetabular Impingement Syndrome? - FABER test - FADIR test - Thomas Test - Scour Test
Thomas Test
What was the purpose of the Baker et al (2017) article on the SCRIPT tool? - To illustrate how the SCRIPT tool can be used by PTs to guide clinical reasoning - To describe how an examination can lead to prescriptive exercises - To describe how PT practice evolved from prescription to direct access - To analyze the differences in schools of thought in PT practice
To illustrate how the SCRIPT tool can be used by PTs to guide clinical reasoning
The center edge angle measures the extent to which the acetabulum covers which portion of the femoral head? Top Bottom Medial Lateral
Top
When treating any patient, it is important to prioritize their impairments T/F?
True
You should rule out the lumbar spine before examining the SI Joint? T/F?
True
PTs should NOT use mechanical traction for patients with chronic LBP with LE pain T/F?
True Well it can be used, but BETTER to use MANUAL TRACTION
Which of the following modalities, in conjunction with exercise, has been shown to improve pain and function in patients with hip OA? - TENS - Massage - Ultrasound - Kinesiotaping
Ultrasound
According to the clinical prediction rule for spinal manipulation, which criteria will have the most favorable response? - Sx. radiating below the knee - acute LBP - (+) SLR - muscle tightness
acute LBP
According to the Flynn (2002) clinical prediction rule for manipulation, which criteria is most predictive of a favorable response? - Acute low back pain - Pain consistent with muscle strain - Positive leg length tests - Pain that radiates below the knee
acute low back pain
Which of the following descriptors are typical of visceral disease? - deep, dull, diffuse - deep, nagging, dull - cramping, dull, achy - sharp, shooting
deep, dull, DIFFUSE (non-specific)
Which intervention is the most effective for a patient with LBP with a central mechanism? - TA bracing - diaphragmatic breathing - reverse hyperextensions - cat-cow exercise
diaphragmatic breathing
Which of the following best differentiates L3-4 and L5-S1 disc disorders? - location of symptoms and neurological testing - symptom duration - symptom intensity - X-ray findings
location of symptoms and neurological testing
A patient with right sided low pain of 6 weeks duration states that is symptoms are rated as 5/10 and increase to 8/10 with prolonged sitting. Based on this information, how would you rate the severity of his condition? - minimal to moderate - moderate - moderate to severe - severe
moderate to severe
Which is the most common location of a lumbar disc herniation? - posteriolateral - far lateral - posterior - anterior
posteriolateral
Forward flexion of the lumbar spine causes the nuclear material of the disc to migrate in which direction? - anterior - anterolateral - posterior - posterolateral
posterior
Which of the following interventions is most appropriate for a who has localized pain and pain reproduction with SIJ provocation tests? - Sacroiliac joint regional manipulation - Lumbar flexion SNAG - Lumbar sidelying rotation in neutral mobilization/manipulation - Lumbar U/L accessory mobilization
sacroiliac joint regional manipulation
According to EMG studies looking at muscle activation patterns, which of the following exercises demonstrates the STRONGEST gluteus medius muscle activation? - clamshell with 30o hip flexion - sideways lunge - sidelying hip abduction - lateral band walk
sidelying hip abduction
Forward slippage of a vertebrae and step deformity characterize which lumbar condition? - spondylosis - spondylolysis - spondylolisthesis - stenosis
spondylolisthesis
