AT 3312 Final
Which one of the following positive likelihood ratios would classify a special test for a lateral ankle sprain as an "Excellent" clinical test?
24.52
Intra-abdominal diagnosis
Blunt intra-abdominal injury Appendicitis Acure Cholecystitis (Gall bladder) Hepatomegaly (liver) Splenomegaly (Spleen)
The four cardinal signs of inflammation in Western medicine were first described by ___________________.
Celsus
Cobb angle >40 degrees
Hyperkyphosis
Negative likelihood ratio (-LR)
Indicates the likelihood that a negative test result was obtained in a person with the condition as compared to a person without the condition
The spinal cord ends at the _______ vertebral level to become the cauda equina.
L2
Patellar tendon reflex
L3-L4
Achilles Tendon reflex
S1-S2
Somatic Pain
Soma= bodyPain originates in muscle, soft tissue and skinSuperficial/ deep
yellow flags
Their presence likely suggest poor prognosis, but not serious pathology
The sensorimotor innervation to the rectus femoris muscle is provided by which one of the following peripheral nerves
femoral
Atypical slipped capital femoral epiphysis (SCFE) commonly occurs in overweight or obese boys who also have ____________________________. (Read this question carefully and indicate all the correct answers).
hypogonadism hypothyroidism
Which one of the following types of meniscal tears is most likely to be successfully repaired with arthroscopic surgery?
longitudinal
Which one of the following is the most appropriate diagnostic imaging technique to rule in/rule out an acetabular labral tear?
magnetic resonance imaging (MRI)
Which one of the following muscles is typically inhibited in patients who present in clinic with Janda's "lower crossed syndrome"?
rectus abdominis
When you perform a special ligament test on an injured patient with an acute Grade 2 sprain of her knee, the quality of the end feel you'll obtain is typically described as ________________
soft
Patient-reported outcome (PRO) measures, e.g., Roland-Morris Disability Questionnaire, as discussed in the Reiman (2016) text, are considered ____________________ if they measure what they are intended to measure.
valid
Functions of the Menisci
1) In high load, 70% of compressive load is absorbed by menisci. (Lateral meniscus= most) 2) Wedge-shaped assist in lubrication of the joint. Acts as a space-felling mechanism, increasing synovial fluid delivery to the surfaces of tibia and femur. 3) 20% increase in joint friction following meniscal removal (Total meniscectomy= rare)
Functions of the menisci of the knee
1) Load transmission- Transmits 50-60% of weight baring load in full extension, and approx 85-90% in flextion 2) Schock Absorption- Protect the articular surfaces of the knee under loads that can reach 6X body weight 3) Joint lubrication- Help drive the synovial fluid into the articular (hyaline) cartilage at the ends of femur and tibia 4) Joint stability- Deppen the articulating surface of the tibial plateau, particularly under valgus/ varus and axial stresses
In the skeletally immature child, there are ___________ movable vertebrae in the lumbo-sacral spine?
10
A typical computed tomography (CT) scan delivers the same amount of ionizing radiation to the patient as approximately ___________ standard X-rays?
100
During walking and running gait, approximately _______ of individuals make initial contact with the ground with a rear footstrike pattern.
85%
The anterior cruciate ligament (ACL) provides approximately ________ of the resistance to anterior tibial translation, while the posterior cruciate ligament (PCL) provides approximately _______ of the resistance to posterior tibial translation.
85%; 90%
Hip fracture from a fall is a major public health concern in the United States. Falls are responsible for ______ of the hip fractures in persons 65 years of age and older, and _________ of these patients will die within one year after fracturing their hip.
95%, 20%
Hyaline Articular cartilage (HAC)
A thin, dense covering of the ends of all bones that comprise the diarthorodial (freely movable) joints
Cardiovascular diagnosis
Acute Coronary Syndrome Congestive Heart failureDeep vein thrombosis (DVT) Peripheral arterial disease Abdominal Aortic Aneurysm
lumbar lordosis
An excessive anterior curvature of the lumbar spine
Neurological diagnosis
Cauda Equina Syndrome Meningococcal DiseaseMTBI/ post-concussion syndrome Primary brain tumor Parkinson's disease Myasthenia Gravis
Common Reg flags
Changes in bowel or bladder function Changes in muscle tone or ROM Changes in skin or skin lesions Chest pain with exertionIncreased urination with excessive thirst Unexplained weight loss (>10% in 10-21 days) Pain that has not improved with therapy
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 ________________________________.
Convey respect for adult patients by addressing them formally, e.g., "Mrs. Sanchez", "Mr. Kawamura". Use jargon-free terminology ("lay terminology") when talking with a patient. Target an eighth-grade level of comprehension when choosing your words when in conversation with a patient. If English is your primary language, determine the patient's level of fluency in the English language.
The screw home mechanism
Created by unequal sizes of the femoral condyles, and how the rotate ("spin") on the tibial plateau.
According to the Meyerding scale, an L4 vertebral body that has subluxed anteriorly 35% of the width of L5 vertebral body is classified as a ___________________ severity spondylolisthesis.
Grade 2
Of all the component parts of the physical exalm, the _________________ is the most important
History
Quadriceps angle (Q-angle)
Men= ~10 degrees or less Women= ~15 degrees or less
The knee is a "mechanical compromise" between.....
Mobility and stability
Ultimate goal of the orthopedic exam is?
Obtaining a clinical or working diagnosis
Largest diarthrodial joint in body
Tibiofemoral Joint (knee)
Visceral pain
Viscera= gutPain originates in internal organsAching/squeezing pain
Which of the following special tests are designed to evaluate the status of the anterior cruciate ligament (ACL)? (Please read this question carefully and identify all the correct answers).
anterior drawer test Lachman test
3. In Chapter 6, Reiman (2016) suggested that the main function of plain film radiography ("x-rays") is to rule out fractures and conditions such as ______________________________. (Read carefully, and select all the answers that you consider to be correct).
bone tumors hip osteoarthritis
Which of the following diagnostic imaging techniques expose the patient to ionizing radiation?
both CT and fluoroscopy
The _________________________ muscle group is located in the medial compartment of the thigh and is innervated by the _________________________ nerve.
hip adductors, obturator
The curve of the sacral spine is a ___________________ curve in the _____________________ direction.
primary, posterior
6 major static stabilizers of the tibiofemoral joint
1) MCL 2) LCL 3) ACL 4) PCL 5) Medial Meniscus 6) Lateral Meniscus
The statistic, negative likelihood ratio (-LR), is the ratio of a negative (-) test result in a people with the pathology to a negative test result in people without the pathology. Which one of the following values is the best -LR?
0.01
The perimeniscal capillary plexus creates the "red-red zone" by supplying blood to the outer ________________ percent of the medial and the lateral menisci.
25 to 30
How many of the cardinal planes of motion (or cardinal axes of motion) are possible at every lumbar zygoapophyseal ("facet") joint?
3
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 that was cited in both lecture and the Reiman (2016) 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
The stance phase accounts for about 60% of the gait cycle during walking, while the swing phase accounts for about 40%. According to the data from the classic study by Mann (1986) in the American Journal of Sports Medicine, what are the approximate proportions of the stance and swing phases during jogging, running and sprinting?
30% stance phase, 30% swing phase
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
when testing myotomes, each isometric contraction must be held for greater than ___ seconds in order to allow for myotomal weakness to become evident
5
We now understand that genetics are 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
The fibular collateral ligament (FCL) provides approximately ________ of the resistance to adduction stress when the knee is in a position of about 25 degrees flexion.
70%
. Reiman (2016) cites evidence that suggests that the medical history portion of the patient interview, if well done, can identify the correct diagnosis in approximately ________ of patients.
75%
Which of the following statements are TRUE regarding the condition of a lumbar herniated nucleus pulposus (HNP)? (Read carefully and be certain to indicate all correct answers).
A lumbar herniated nucleus pulposus (HNP) is one of the most common diagnoses made by orthopedic spine specialists. Disc herniation-associated radiculopathy is now considered to be a biochemical as well as mechanical problem. Diagnostic imaging studies reveal that persons over the age of 60 have a high incidence of bulging and herni
When assessing a patient for differences in true leg length, which of the following anatomical landmarks are used?
ASIS to distal medial malleolus
Structural/true leg length
ASIS to medial malleolus An actual difference in the length of the femur or the tibia of one leg compared to the othe
Yellow flag signs
Abnormal signs and symptoms Vilateral symptoms Symptoms that are peripheralizing Progressive weaknessMultiple inflamed jointsPsychosocial stresses
Blue flags
Also can affect prognosis because the client may feel unsupported by employer, which can negatively affect their motivation
Kyphosis
An excessive posterior curvature of the thoracic spine (Hunchback)
3 fascial (muscle) compartments of the thight
Anterior: Hip flexors and knee extensors ( FEMORAL N) Medial: Hip adductors and knee internal rotators (OBTURATOR N) Posterior: Hip extensors and knee flexors (SCIATIC N)
2 Bundles of the ACL
At 0 degrees (full knee extension) -Posterolateral(PL) bundle is taut -Anteromedial (AM) bundle is loose At 90 degrees (Flexion) - Posterolateral (PL) bundle is loose - Anteromedial (AM) bindle is taut
A 110-meter high sophomore hurdler on the high school track team comes to your clinic complaining of chronic pain in the popliteal fossa of his left leg. Which one of the following injuries/conditions ranks the highest on your differential diagnosis list?
Baker's cyst
femoral triangle
Base: Inguinal ligament Medial border: Adductor longus Lateral border: Sartorius contents: femoral vein, artery and nerve
What is used to quantify the severity of both kyphosis and scoliosis
Cobb Angle
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)? (Read carefully and be certain to indicate all correct answers).
Cognitive
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? (Read carefully, and select all the answers that you consider to be correct).
EBM promotes critical thinking within the professions of physical and occupational therapy. 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. The application of EBM principles can improve the level of care delivered to our patients
Which of the following statements accurately characterize femoroacetabular impingement syndrome (FAI)? (Please read this question carefully and identify all the correct answers).
FAI commonly involves results in damage to the acetabular labrum In its early stages, FAI manifests as a deep, continuous pain during prolonged sitting. FAI is most commonly found among adolescent males, ages 13-21. The anterior impingement test has high sensitivity (0.90) and is a good clinical test for examining a patient for FAI.
Motor and sensory innervation of the knee extensor muscles located in the thigh is provided by the __________________ nerve?
Femoral
Knee joint (tebiofemoral) unites the two longest levers in the body....
Femur and tibia
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? (Read carefully and be certain to indicate all correct answers).
Forward leaning posture uncrossed arms and legs head nodding arm symmetry
With regard to the manual muscle testing (MMT) grading system, a female patient who, when asked by you, is able to actively flex her arthritic right hip joint through the full (normal) range of motion is described as having grade _______ muscle strength?
Grade 3
Dynamic stabilizers of the knee Knee Flexors
Hamstrings (primary) - Biceps Femoris - Semitendinosus - Semimembranosus Gastrocnemius (Secondary)
Major ligaments of the Hip joint
Iliofemoral ligament: Limits hip extension and hyperextension Pubofemoral ligament: Limits hip extension and abduction Ischiofemoral ligament: Limits hip internal rotation and extension
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? (Read carefully and be certain to indicate all correct answers).
Immediate evaluation of minor head injuries and suspected concussions in children. Immediate evaluation of acute abdominal pain in children.
Osteitis pubis is an inflammatory condition involving the pubic symphysis that is typically caused by repetitive motion or training errors. Which of the following are known sources of the overloading that can produce this condition? (Read this question carefully and indicate all the correct answers).
Increasing the duration of an exercise program too rapidly. Running on concrete or asphalt roads or surfaces. Running on uneven terrain. Increasing the intensity of an exercise program too rapidly.
Positive Likelihood Ratio (LR+)
Indicates the likelihood that a positive test result was obtained in a person with the condition as compared to a person without the condition
Scheuermann's Disease
Inflammation of the vertebrae and cartilage occurs around the ring apophysis of the vertebral body Idiopathic bit its present in approx 10% of populationCommonly occurs between T10-L2
Dynamic stabilizers of the knee Rotator
Internal rotators - Pes Anserinus - Sartorius - Gracilis - Semitendinosus - Semimembranosus - Popliteus
5 characteristics common to all diarthrodial (synovial) joints....
Joint cavity ligamentous joint capsule Synovial membrane Synovial fluid (lubricant)Articular (Hyaline) cartilage (on the ends of the long bones that form the joint)
The results of a 2018 study by Van Der Straeten et al. used which of the following patient-reported outcome measures (PROs) in their short-term and medium term results of artificial meniscal implants? (Please read this question carefully and identify all the correct answers).
KOOS Lysholm Scale VAS for pain IKDC
lumbar plexus
L1-L4
According to Reiman (2016), testing the patient's patellar tendon reflex, a component of the lower quarter screen, is actually a test of which one of the following spinal nerve roots?
L4
sacral plexus
L5-S2
Which ligament is the primary restraint to varus loads
LCL 55% at 5 degrees of flexion 69% at 25 degrees of flexion
Which of the following special orthopedic tests is/are appropriate for the diagnosis of an anterior cruciate ligament (ACL) tear? (Read this question carefully and be sure to indicate all the correct answers).
Lachman test anterior drawer test anterior drawer test with a KT-1000 arthrometer
anatomical movements that the clinician knows will be painful are done ___ to avoid an overflow of symptoms
Last
An 11-year old physically-active boy who comes to your clinic complaining of anterior hip pain must be evaluated to rule out which of the following injuries and/or conditions? (Please read this question carefully and identify all the correct answers).
Legg-Calvé-Perthes disease psoas muscle strain slipped capital femoral epiphysis
Which of the following statements accurately describe Legg-Calvé-Perthes disease? (Please read this question carefully and identify all the correct answers).
Legg-Calvé-Perthes disease occurs in boys 4 times more frequently than in girls.
Black flags
Mat affect clients prognosis due to limitations with insurance
The patient's subjective experience of pain can be made more objective using which of the following instruments? (Read carefully, and select all the answers that are correct).
McGill Pain Questionnaire Universal Pain Assessment Tool Numeric Pain Rating Scale (NPRS)
The patient's subjective experience of pain can be made more objective using which of the following instruments? (Read carefully and be certain to indicate all correct answers).
McGill Pain Questionnaire Visual analogue scale (VAS) Numeric pain rating scale (NPRS)
Myotomes
Motor function
Which of the following statements accurately describe non-enzymatic glycation (NEG), a biochemical phenomenon associated with the ageing process. (Read carefully and be certain to indicate all correct answers).
NEG mostly affects human tissues with a low metabolic rate and a high content of collagen. NEG is a slow degenerative process that reduces the capacity of the affected tissue to absorb compressive loading and impacts.
Which one of the following is NOT a physical sign of injury?
Nausea
Functional/Apparent Leg Length Discrepancy
Navel to medial malleolus Leg-length difference that is attributed to something other than the length of the tibia or femur
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? (Read carefully and be certain to indicate all correct answers).
Neurological testing indicates a motor and/or sensory loss. Active range of motion testing reveals a third degree muscle tear. Diminished posterior tibial arterial pulse Ligamentous testing ("special tissue tests") reveals gross joint instability. An absent or diminished patellar tendon reflex.
Screw- home mechanism
Open Kinematic Chain - In non-weight bearing situations, the tibia externally rotates on the fixed femur Closed Kinematic Chain - In weight- bearing situations, the femur internally rotates on the fixed tibia
__________________________________ is an adolescent condition that involves the inflammation of the patellar tendon at its insertion onto the tibial tubercle.
Osgood-Schlatter's disease
Strongest ligament in the knee
PCL Provides 90% resistance to posterior tibial translation
Dynamic stabilizers of the knee Knee extensors
Quadriceps Femoris - Rectus Femoris ( Acts at both hip and knee) -Vastus Lateralis -Vastus Intermedius - Vastus Medialis
Which of the following statements reflect current clinical management strategies for the posterior cruciate ligament (PCL)? (Please read this question carefully and identify all the correct answers).
Quite commonly, clinicians recommend a "wait and see" (nonsurgical) approach to patients who have moderate to severe PCL sprains.
Zones of meniscal Vascularity
Red-on red zone - Vascularized outer 1/3rd of the meniscus - BEST healing potential Red-on- white Zone - Transitional Zone 3mm-5 from meniscosynovial junction - Intermediate healing potential White-on- white Zone - Avascular inner 2/3rd of the meniscus - Nutrition comes from synovial fluid - Poor healing potential
The functional characteristics of the menisci at the tibiofemoral joint include which of the following? (Please read this question carefully and identify all the correct answers).
Reducing joint pressure by increasing the contact area between the femur and tibia Increasing tibiofemoral joint lubrication through movement of the synovial fluid. Improving joint stability due to their concave shapes, helping to keep the "ball" (femoral condyles) on the "table" (tibial plateau).
Pediatric pelvic avulsion fractures are essentially ____________________ fractures that commonly occur at the ASIS, AIIS or ischial tuberosity apophyses.
Salter-Harris Type I
Pediatric pelvic avulsion fractures are essentially __________________________________ fractures that commonly occur at the ASIS, AIIS, or ischial tuberosity apophyses.
Salter-Harris Type I
Red flags
Signs and symptoms suggestive of serious pathology and very poor prognosis in orthopedic clients
Which of the following statistical values is/are helpful for the clinician to know when choosing a special orthopedic test in the evaluation of a lower extremity injury? (Read carefully, and select all the answers that you consider to be correct).
Specificity Accuracy Reliability Answer validity Answer sensitivity
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? (Read carefully and be certain to indicate all correct answers).
The application of EBM principles can improve the level of care delivered to patients 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. EBM promotes critical thinking within the professions of physical and occupational therapy.
Which of the following statements are true regarding providing culturally competent care for your patients? (Read carefully and be certain to indicate all correct answers).
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. 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. The clinician should respect the patient's perspective(s) on complementary and/or alternative medical approaches.
When evaluating a suspected knee joint injury, an important consideration for a meniscal injury being present is the fact that _______________________________________________. (Please read this question carefully and identify all the correct answers).
The medial meniscus has an attachment to the deep medial collateral ligament (joint capsule) and is commonly injured when valgus stress is the mechanism of injury (MOI).
Which of the following are considered to be anatomical and/or biomechanical functions of the menisci at the tibiofemoral joint? (Read this question carefully and be sure to indicate all the correct answers).
The menisci aid joint lubrication by driving the synovial fluid into the avascular hyaline articular cartilage on the ends of the femur and tibia. The menisci deepen the articulation between the femur and the tibia, thus improving joint stability The menisci serve as effective shock absorbers, distributing compressive loads that can be as high as six times body weight and more.
Which of the following statements are correct regarding the clinician's utilization the patient's contralateral (normal) limb when conducting your orthopedic examination?
The patient's contralateral limb serves as a reference for what is normal for that patient The patient's contralateral ("normal") limb is used to determine whether bilateral symmetry exists for sensory and motor functions. both A and B The patient's contralateral ("healthy") limb should be used as a comparator when observing for the cardinal signs of inflammation ALL THE ABOVE
Which of the following are basic competencies that Reiman (2016) says are expected of physical medicine clinicians regarding diagnostic imaging? (Read carefully and be certain to indicate all correct answers).
Understanding the radiographic report from the referring radiologist as well as the terminology used to describe the findings. Being able to explain imaging findings to patients and discuss diagnostic imaging with other professionals. Being able to recognize precautions and contraindications to treatment and modify the plan of care accordingly, based on the results of the imaging report.
Which of the following principles apply to the physical examination portion of the orthopedic assessment of a patient? (Read carefully and be certain to indicate all correct answers).
Unless bilateral movement is required, the normal (uninjured) side is tested first. Answer 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. 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.
Which of the following statements correctly describe the medical history, physical signs, and symptoms associated with Sinding-Larsen-Johansson syndrome? (Please read this question carefully and identify all the correct answers).
Upon palpation, the distal pole of the patella will be point tender. The patient will typically demonstrate a weakness in manual muscle testing of the knee extensor muscles in the involved limb. The patient is typically a pre-adolescent boy or girl who participates in sports and physical activities that involve running and jumping.
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 ________________________________.
Use jargon-free terminology ("lay terminology") when talking with the patient. Determine the patient's level of fluency in the English language both A and B Convey respect for adult patients by addressing them formally, e.g., "Mrs. Garcia". ALL THE ABOVE
MCL injury MOI
Valgus loading of weight bearing knee
Regarding palpation of a patient, the clinician should take particular note of which of the following? (Read carefully, and select all the answers that are correct).
Varying tissue densities in the quadriceps femoris The presence of one or more trigger points in the posterior calf Crepitus near a suspected fibular fracture Increased skin tissue temperature when compared to the contralateral normal ankle
Factors increasing the Q-angle
Width of hips Genu Valgum Poorly positioned tibial tubercle Tibial rotation ('tibial torsion") Pes Planus ('Flat Feet")
The specificity of a clinical or diagnostic test is defined as the percentage of patients with ___________________________________________
a positive diagnostic test result who have the suspected disease or injury.
In the human body, fibrocartilage is __________________________________________. (Read very carefully, as only one (1) answer is correct)
a specialized type of cartilage found only in some synovial/diathrodial joints
Which of the following are modifiable risk factors for knee osteoarthritis, a condition that affects more than one-third of the 65 and older population in the United States? (Please read this question carefully and identify all the correct answers).
activity level body weight
The medial border of the femoral triangle is comprised of the _____________________________.
adductor longus
Which of the following contribution to the static stability of the tibiofemoral joint? (Read this question carefully and be sure to indicate all the correct answers).
anterior and posterior cruciate ligaments medial and lateral collateral ligaments negative intraarticular (joint) pressure
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
With sacroiliac nutation, the superior aspect of the sacrum moves ____________________ and stress is put on the _______________________ ligament.
anteriorly; sacrotuberous
PCL Bundles (2)
anterolateral bundle is taut in flexion posteromedial bundle is taut in extension
Which of the following surgical procedures for femoral articular cartilage injury have outcomes that are described as "restorative"? (Please read this question carefully and identify all the correct answers). Correct!
autogenous chondrocyte implantation osteochondral allografts osteochondral autografts
An apophyseal avulsion of the ischial tuberosity involves which one of the following muscles?
biceps femoris
Which of the following muscles act concentrically to cause external rotation at the knee? (Please read this question carefully and identify all the correct answers).
biceps femoris
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? (Read carefully and be certain to indicate all correct answers).
congestive heart failure deep vein thrombosis peripheral arterial disease abdominal aortic aneurysm acute coronary syndrome
The posterior portion of the vertebral motion segment is classified as a/an __________________________ type of joint.
diarthrosis
The ligamentum flavum has a higher concentration of ___________________ than any other ligament in the human body.
elastin
The iliofemoral ligament at the hip limits which of the following anatomical movements at the hip? (Please read this question carefully and identify all the correct answers).
extension and hyperextension
An accentuated lumbar lordotic curvature, often associated with Janda's "lower crossed syndrome", is commonly due to _______________________________________.
facilitated iliopsoas muscles and inhibited abdominal muscles
The screw-home mechanism increases the stability at the tibiofemoral joint at terminal extension. To achieve this in closed kinetic chain (CKC) mode, the _________________ __________________ rotates on the fixed ________________________
femur, internally, tibia
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
Which one of the following surgical techniques is most effective for repair of large (~8 cm squared) hyaline articular cartilage lesions on the medial or lateral femoral condyle?
fresh osteochondral allograft
Which of the following muscles, when acting concentrically, produce external rotation at the hip? (Please read this question carefully and identify all the correct answers).
gemellus superior quadratus femoris piriformis obturator internus gemellus inferior obturator externus
A patient who demonstrates a Trendelenburg gait indicates that they have a weakness or paralysis of which one of the following muscles?
gluteus medius
A positive Trendelenburg test indicates a significant weakness or paralysis of which of the following muscles? (Please read this question carefully and identify all the correct answers).
gluteus medius
Which of the following are dynamic stabilizers that act(s) as an agonist(s) to the anterior cruciate ligament (ACL) and help(s) resist anterior tibial translation? (Please read this question carefully and identify all the correct answers).
hamstrings
Which one of the following is NOT a physical sign of injury?
headache
The _________________________ muscle group is located in the medial compartment of the thigh and is innervated by the _________________________ nerve
hip adductors, obturator
For the past two weeks, a 32-year old female recreational runner has had pain on the lateral aspect of her left knee near Gerdy's tubercle. She typically runs 3 to 5 miles per workout, 4 days per week, but hasn't increased or decreased her mileage for 4 months. On palpation, she is point tender in this area, but has full range of motion at both the left hip and knee joints. Her symptoms are most likely due to:
iliotibial band friction syndrome
Which of the following factors is/are associated with the pathogenesis (onset) of osteitis pubis? (Please read this question carefully and identify all the correct answers).
increasing the intensity of an exercise program too quickly walking or running on hard surfaces such as sidewalks beginning an exercise program after a long period of physical inactivity
Which of the following are anatomical motions produced by muscles in the pes anserine group? (Read this question carefully and be sure to indicate all the correct answers).
knee flexion Knee internal rotation
The _________________________ muscle group is located in the posterior compartment of the thigh and is innervated by the _________________________ nerve.
knee flexor, sciatic
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? (Read carefully and be certain to indicate all correct answers).
lateral malleoli Answer greater trochanters patellae Answer inferior angle of the scapulae iliac crests
Which of the following are static stabilizers of the patellofemoral joint? (Please read this question carefully and identify all the correct answers).
lateral patellofemoral ligament trochlear groove of the femur medial patellofemoral ligament
In patients with patella alta, the length of their patellar tendon is significantly _________________ than the length of their patella, which in turn _____________________ the patellofemoral contact forces at the knee.
longer, increases
According to Reiman (2016), scoliosis is a postural dysfunction that can involve which of the following? (Read carefully and be certain to indicate all correct answers).
lumbar region of the spine both the thoracic and lumbar regions of the spine (two curves) thoracic region of the spin
According to Reiman (2016), which one of the following diagnostic imaging techniques is recommended for adolescent patients who present with low back pain and suspected stress reactions involving the lumbar pars interarticularis?
magnetic resonance imaging
. Which one of the following is the most appropriate diagnostic imaging technique to rule in/rule out a lateral meniscus tear in a 12-year old female soccer player?
magnetic resonance imaging (MRI)
According to Reiman (2016), 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)
The anomaly in which there is a posterior defect in the spine that allows the protective coverings of the spinal cord to form a fluid-filled sac outside the body, spine is known as ________________________.
meningocele
When reading published research in physical medicine, which one of the following types of studies is considered to yield/produce the "best" (highest quality) evidence?
meta-analysis
The component of the stance phase of gait that occurs then the body's center of gravity is directly over the foot and the whole foot is in contact with the ground is known as __________________________.
midstance
In Chapter 20, Reiman (2016) notes that pelvic girdle pain (PGP) is a condition that occurs in patients who present in clinic with which of the following conditions? (Read this question carefully and indicate all the correct answers)
obesity rheumatoid arthritis osteoarthritis second or third trimester of pregnancy
Which of the following is/are considered a primary anatomical component of the posterolateral corner (PLC) of the tibiofemoral joint? (Read this question carefully and be sure to indicate all the correct answers).
oblique popliteal ligament fibular collateral ligament popliteus tendon popliteofibular ligament
PCL MOI
often from fall on flexed knee, blow to anterior knee, posterior loading PCL provides 90% of the resistance against posterior tibial translation
Reiman (2016) suggested that the main function of plain film radiography ("x-rays") is to rule out fractures and conditions such as _______________________________________. (Read carefully and be certain to indicate all correct answers).
osteoarthritis exostoses neoplasms
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? (Read carefully, and select all the answers that you consider to be correct).
pain that is not improved with therapy treatment night sweats increased urination with excessive thirst no discernible pattern of symptomsre bound tenderness
Compression of the S1 nerve root might manifest in the lower extremity as which of the following signs and/or symptoms? (Please read this question carefully and identify all the correct answers).
paresthesia in the posterior thigh, lateral lower leg and plantar aspect of the foot weakness during resisted knee flexion diminished Achilles tendon reflex
Total Musculoskeletal Assessment
patient history observation examination of movement special tests reflexes and cutaneous distribution joint play movements palpation diagnostic imaging
Patellofemoral pain syndrome (PFPS), sometimes referred to anterior knee pain syndrome (AKPS), is a prevalent condition among _________________________________________. (Please read this question carefully and identify all the correct answers).
people who also have chondromalacia of the patella Answer individuals who often have an imbalance between their vastus lateralis and vastus medialis muscles resulting in lateral tracking of the patella women who typically have Q-angles greater than 15 degrees people participating in repetitive motion activities such as bicycling and running.
A patient who presents in your clinic with a calcaneal gait has weak or paralyzed _________________ muscles.
plantar flexor
Following an acute left quadriceps femoris strain, a 20-year old intercollegiate track sprinter is unable to extend his knee actively beyond 30 degrees without assistance from the examiner. Using the manual muscle test (MMT) grading format presented below, you would classify his quadriceps muscle strength as:
poor = grade 2
Regardless of open kinetic chain (OKC) or closed kinetic chain (CKC) positioning, the ___________________ unlocks the extended tibiofemoral joint by initiating knee flexion and rotation.
popliteus
If a positive Godfrey test is observed, which one of the following structures has been damaged to some degree?
posterior cruciate ligament
Which one of the following is considered to be the "strongest" (greatest tensile strength) ligament in the knee?
posterior cruciate ligament
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 of the following types of information would typically be obtained by the clinician during the "O" phase of the HOPS or SOAP injury examination process?
posture gait both gait and posture muscle atrophy ALL THE ABOVE
You have a 46-year old male patient who is employed as a tile floor installer for a large national company. He has come to your clinic about the pain and swelling he now has on the anterior aspects of both of his patellae. From your history you learn that he doesn't wear any knee pads or use a kneeling cushion while at work. You suspect he has a case of chronic bilateral bursitis at the knee, most likely involving the _____________________ bursa.
prepatellar
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? (Read carefully and be certain to indicate all correct answers).
presence of surgical scars impaired gait skin color or appearance fascial expression asymmetry soft tissue contours
Which of the following are risk factors associated with slipped capital femoral epiphysis in an adolescent patient? (Please read this question carefully and identify all the correct answers).
previous family history of this condition metabolic disorders body weight above the 95th percentile endocrine disorders
The curve of the thoracic spine is a ___________________ curve in the _____________________ direction.
primary, posterior
For the majority of patients who elect not to have ACL reconstructive surgery, the "natural history" of their injury includes which of the following? (Please read this question carefully and identify all the correct answers).
progressive deterioration of the knee joint meniscal tears osteoarthritis
Which of the following have been recognized as YELLOW flag findings that warrant referral of a patient to a physician? (Read carefully and be certain to indicate all correct answers).
progressive weakness symptoms that are peripheralizing multiple inflamed joints bilateral symptoms
With regard to the evidence-based practice of physical medicine, which one of the following experimental designs is considered to be the "gold standard" (best) in medical research?
randomized controlled trial
Which of the following are included among the "red flag findings" identified by Reiman (2016) that warrant immediate referral of the patient to physician? (Read carefully and be certain to indicate all correct answers).
rebound tenderness fatigue or malaise increased urination or thirst night sweats shortness of breath
Which of the following muscles, when acting concentrically, flex the hip? (Please read this question carefully and identify all the correct answers).
sartorius rectus femoris psoas iliacus
The cervical curve is a ______________________ curve that begins to develop ________________.
secondary, at 3 months of age
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 types of information can be obtained with a dual energy X-ray absorptiometry (DEXA) scan? (Read carefully and be certain to indicate all correct answers).
severity of osteoporosis body fat percentage presence of osteopenia bone mineral density
3 key factors that create need for non-musculoskeletal related pain
side effects of medications Comorbidities Visceral pain mechanisms
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? (Read carefully and be certain to indicate all correct answers).
side effects of prescribed medications comorbidities the presence of visceral pain
Due to the incongruence in length of the femoral condyles compared to the tibial condyles, the arthrokinematics of the tibiofemoral joint include which of the following? (Please read this question carefully and identify all the correct answers).
sliding (gliding) Rolling
In the basic systematic "ABCs" approach to evaluating conventional radiographs described in Reiman (2016), the "s" in the mnemonic represents ________________________.
soft tissue
Which of the following are known causes of regional mechanical low back pain that also results in neurogenic leg pain? (Read carefully and be certain to indicate all correct answers).
spondylolisthesis spinal stenosis herniated nucleus pulposus
With regard to pathological gait patterns presented in Lecture 6, during swing phase of ______________________ , the affected limb demonstrates increased knee and hip flexion to avoid toe dragging, producing a "high-step" pattern.
steppage gait
Which of the following are possible causes of effusion at the tibiofemoral joint? (Please read this question carefully and identify all the correct answers).
synovitis bacterial infection, e.g., MRSA Grade III ACL injury hemarthrosi
Which of the following diagnostic imaging techniques delivers ionizing radiation to the patient when the image is being obtained? (Read carefully and be certain to indicate all correct answers).
technetium-99 bone scan fluoroscopy
Which one of the following knee ligaments is the primary restraint against valgus stress that is applied to a knee that is flexed to 30 degrees?
tibial collateral ligament
The "unhappy triad" injury at the knee involves which of the following combinations of anatomical structures?
tibial collateral ligament, medial meniscus, anterior cruciate ligament
With regard to standing posture, Janda's lower crossed syndrome involves weakness and/or inhibition of which of the following muscles? (Read carefully, and select all the answers that you consider to be correct).
transversus abdominis rectus abdominis gluteus maximus
* CATEGORIES OF POSSIBLE HIP PAIN
trauma (17) Infections (5) Neurologic (3) Degenerative (2) Inflammatory (19) Metabolic (2) Neoplastic (5) Vascular (5) 58 total
. 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? (Read carefully and be certain to indicate all correct answers).
unusual menstrual cycle or symptoms unexplained weight loss pain unchanged by movement or rest chest pain with exertion neurological signs and symptoms
The _____________________________________ is the most appropriate test to specifically evaluate the status of the fibular collateral ligament of the knee.
varus stress test at 30 degrees of knee flexion
According to Reiman (2016), which of the following are characteristics demonstrated by "good diagnosticians" during the history-taking interview with patients, and are typically observable within the first 3 minutes of the encounter? (Read carefully and be certain to indicate all correct answers).
verifying information obtained from the patient thoroughness of inquiry regarding the chief complaint establishing a rapport with patient
Lumbar lordosis is known to be caused by which of the following? (Read carefully and be certain to indicate all correct answers).
weak core (abdominal) muscles tight hip flexor muscles pregnancy obesity