Clinical Evaluation and Diagnosis #2
During a track meet, you notice one of the runners appears somewhat disoriented. During your assessment of this athlete, you find he is complaining of being lightheaded, his skin is cool and clammy, he is sweating profusely, and his radial pulse is rapid. You take a rectal temperature and find it is mildly elevated (102F). You suspect the athlete is suffering from which of the following problems?
*Heat exhaustion
What is the average range of motion of knee flexion?
0 to 180 degrees
The maximal rate at which oxygen is consumed and utilized while exercising is known as the maximal oxygen consumption, or VO2 max. What is the normal range of VO2 max for an average college athlete?
45 to 60 mL/kg/min
While elevating a patient's shoulder, you note that the patient is unable to abduct through the full range of motion against gravity. When performing a manual muscle test, this finding would be assigned which of the following muscle grades?
A -⅗ muscle deontes an incomplete movement against gravity.
What is the usual mechanism of injury for a Colles' fracture?
A fall on an outstretched arm and hand:
With the patient sitting, the scapula stabilized, and the shoulder maximally flexed, the patient complains of pain and appears apprehensive. This is a positive _ test.
A positive Neer's test is indicative of shoulder impingement of the supraspinatus tendon or the tendon of the long head of the biceps.
The AT performs a cervical distraction test on a patient. A positive finding is observed. This is indicative of which of the following?
A positive cervical distraction test is indicative of a nerve root compression or facet dysfunction
What type of force typically causes injury to the medial collateral ligament, medial meniscus, and anterior cruciate ligament of the knee?
A valgus force with the tibia in external rotation
Which of the following is an example of a papule?
A wart
What position should the patient's shoulder be in to manually muscle test the deltoids?
Abducted to 90 degrees
What is the most common mechanism of injury for an anterior shoulder distraction?
Abduction and external rotation
You evaluate a basketball player who has sustained a finger injury while attempting to catch a ball. During your examination) you observe that the athlete is unable to extend the distal phalanx and the tip of his finger is positioned in approximately 30 degrees of flexion. You determine the athlete has a mallet finger. This injury is caused by which of the following?
An avulsion of the extensor tendon from its insertion
If a palpable "clunk" or shift at approximately 20 to 30 degrees of knee flexion is found during a pivot-shift test, this may be indicative of what?
Anterolateral rotary instability of the knee
A patient is brought to the ATF after sustaining a hard kick to the abdominal area. Which of the following symptoms is not a sign of a significant abdominal injury?
Ashen-colored skin: Altered vital signs, such as a rapid pulse; decreased blood pressure; ashen skin color; rapid, shallow respirations; and rebound tenderness are all signs of shock, indicating a significant internal injury.
When a patient reports to the AT complaining of lateral hip pain, all of the following conditions might be the source of pain except:
Avulsion of the ischial tuberosity: An avulsion of the ischial tuberosity will cause local acute pain deep in the proximal thigh/distal buttock area.
Speed's test is an evaluative test for which of the following problems?
Bicipital tendinitis
Which of the following tests is appropriate to perform if the AT suspects the patient has meningitis?
Brudzinski-Kernig test
The biceps brachii tendon reflex correlates to what spinal level?
C5
Changes in cognition and behavior and disorientation after a traumatic head injury are indicative of dysfunction of which part of the brain?
Cerebrum
During the inflammatory response, leukocytes are drawn to the site of injury by chemical mediators. This process is known as which the following?
Chemotaxis is the process by which leukocytes are drawn to the site of injury by chemical mediators during an inflammatory reaction
Which of the following are common complications of hepatitis C?
Cirrhosis and liver cancer
Lysosomes function to fo which of the following during the inflammatory process?
Contain enzymes that digest material brought into the cytoplasm of the cells during phagocytosis
How is cranial nerve VIII tested?
Crumpling paper near the ear
Which of the following diseases is the most commonly inherited disorder among White Americans?
Cystic fibrosis
After a severe head injury, an individual may posture as follows: extension of the lower limbs and flexion of the elbows, wrist, and fingers. This condition is called?
Decortication
Which of the following is the underlying cause of multiple sclerosis?
Demyelination of the neurons of the central nervous system
A leading cause of hypothyroidism is Hashimoto's thyroiditis, which is an autoimmune disorder. What is the primary symptom of this disease?
Deviated trachea
All of the following are symptoms of caffeine withdrawal except:
Diaphoresis: Caffeine withdrawal may cause fatigue, headache, irritability, restlessness, anxiety, yawning, and a runny nose.
_ and _ are signs of diabetic coma
Drowsiness, acetone-smelling breath
Which of the following diagnostic tests is considered the "gold-standard" for detecting signs of hypertrophic cardiomyopathy?
Echocardiogram
A patient has been diagnosed with bulimia and has a known history of laxative abuse. Complications of chronic laxative use include which of the following?
Electrolyte imbalance and dehydration
An athlete sustains a neck injury during an ice hockey game and is complaining of numbness and tingling along the ulnar border of his forearm and fourth and fifth fingers. Which of the following roentgenograms would not be most appropriate in detecting nerve root compression?
Electromyography or nerve root conduction velocity test
An athlete sustains a blow to the head with a temporary loss of consciousness. He appears to have a lucid period in which he seems to be normal for a period of a couple of hours and then becomes significantly lethargic. What type of medical emergency would the AT suspect?
Extradural hemorrhage: he cardinal symptoms of an extradural hemorrhage include a lucid interval usually lasting for a few minutes up to a couple hours, followed by a period of lethargy, which may precede a seizure and coma. This is a true medical emergency, and the pt must receive tx immediately in order to survive.
The contact phase of the running gait is divided into which components?
Foot strike, mid support, and take-off
The adrenal glands release all of the following hormones except:
GH: The adrenal glands release aldosterone, cortisol, epinephrine, and norepinephrine. GH produced in the pituitary-hypothalamus.
Which of the following conditions often contributes to shoulder impingement?
Glenohumeral instability: Glenohumeral instability allows increased movement of the humeral head within the glenoid fossa, which in turn may lead to microscopic damage to the tissues that lie beneath the coracoacromial arch. Resultant edema and microhemorrhage cause a reduction in the joint space and impingement, most commonly of the supraspinatus tendon.
A _ is a device used to measure joint range of motion
Goniometer
A tennis player comes to the AT complaining of medial thigh pain. He is limping and has pain with resisted hip adduction and hip flexion. There is diffuse tenderness and ecchymosis along the proximal aspect of the medial thigh. What is the probably cause of the pain?
Groin strain
A patient reports having had a recent upper respiratory infection 2 weeks ago and is now having rapidly evolving bilateral muscle weakness of unknown origin. He is afebrile. What should the AT suspect?
Guillain-Barre syndrome is an acute autoimmune syndrome manifesting as a rapid, diffuse, demyelinating disorder of the spinal roots and peripheral nerves.
How is cranial nerve IX tested?
Having the patient swallow
Mast cells release which of the following chemicals to initiate the inflammatory response?
Histamine
Which of the following signs is tested for when a deep vein thrombosis is suspected after a traumatic incident occurs involving the lower leg?
Homan's sign: Homan's sign is used to screen for suspected deep vein thrombosis. It is performed by passively dorsiflexing the ankle, stretching the gastrocnemius. The sign is positive if this maneuver causes leg pain.
Which of the following conditions is also known as Graves' disease?
Hyperthyroidism
A patient comes to the ATF after being kicked in the lower leg by an opponent during a football game. He is complaining of decreased sensation in the L4 dermatome. What is this change in sensation called?
Hypoesthesia
All of the following injuries might be associated with a "popping" sensation of the knee joint except:
Iliotibial band friction syndrome
A second-degree medial collateral ligament sprain is characterized by all of the following except:
Immediate, severe pain following the feeling of a "pop" in the knee; the pain quickly subsides and the athlete is left feeling a dull ache in the knee joint: Most often a 'pop' is associated with an anterior cruciate ligament injury and less frequent with a subluxed patella.
A patient reports to the AT with the presence of lesions on his upper lip and mouth area that look like blisters with a crusted yellow appearance and a red, weeping base. What is the probably cause of these lesions?
Impetigo
What is the proper position to manually muscle test the anterior deltoid?
In order to expose the anterior deltoid to resistance in an antigravity position, the shoulder must be in 90 degrees abduction and in full external rotation. The forearm must be in full supination.
What is the hallmark sign of peripheral arterial disease?
Intermittent claudication: The hallmark sign of peripheral vascular disease is intermittent claudication, which manifests as cramping, weakness, numbness, and pain of the lower extremities and is provoked by exercise of a given intensity and duration.
Foot pronation results in _ of the tibia during mid support in the running gait.
Internal rotation: The tibia internally rotated during mid support, following pronation of the subtalar joint.
One of the hormones that the pancreas produces is glucagon. What is the function of this hormone?
It stimulates the release of glucose from the liver into the blood
What problem might the AT see if the L4 nerve root was compressed?
Knee extension weakness
The patellar tendon reflex correlated to what spinal level?
L2-4
During your examination of a football player who has sustained a low back injury during a tackle, you find that he is reporting dulled sensation along the dorsum of his right foot, he has difficulty walking on his heels, and his patellar tendon reflex is diminished. You suspect which of the following nerve root(s) is affected?
L5: Decreased sensation over the dorsum of the foot, inability to dorsiflex the great toe/ankle, and a diminished patellar reflex are suspect of L5 nerve root irritation or injury.
Which of the carpal bones is most commonly dislocated?
Lunate
Which of the following tests is used to detect a possible meniscal tear in the knee?
McMurray's test
Which of the following is an indirect method of monitoring oxygen consumption?
Measuring heart rate: Measuring the heart range of VO2 max for the average college patient is 45 to60 mL/kg/min
A patient has just been diagnosed with plantar fasciitis. All of the following would be appropriate measures to provide support/relief to the affected area except:
Metatarsal pad
If the patient whom an AT is working with has a history of asthma, what daily test should they use to monitor the patient's condition?
Metered-dose inhaler
Which of the following structures is affected in an individual who has been diagnosed with amyotrophic lateral sclerosis?
Motor neuron
A basketball player reports to the ATF complaining of a "burning" pain along the lateral aspect of his right knee during and after running. No edema or ecchymosis is found during the exam, but he is tender to palpation of the affected area. Which of the following special tests might be positive?
Ober's test
When evaluating a patient for Sinding-Larsen-Johansson disease, the AT should be sure to do the following:
Palpate the inferior patellar pole with the patient's knee extended and the patellar tendon relaxed
Mumps is a contagious viral disease that is primarily manifested by:
Parotitis
Tenderness and pain with induration and swelling of the pretibial musculature following overexertion is indicative of which syndrome?
Periostitis: Periostitis, myositis, tendonitis or a combination of conditions may cause tenderness and pain with induration and swelling of the pretibial musculature of the pt's lower leg. They may be classified as anterior or post medial "shin splints", depending on which group structures are involved.
One of your female gymnasts has been complaining of feeling generally fatigued on a constant basis. After being examined by the team physician, he orders a complete blood count. This blood test assess all of the following except:
Plasma volume: complete blood count is a test that assesses the red and white blood cell amount, hemoglobin and hematocrit levels and platelet count.
Signs and symptoms of Sever's disease include which of the following?
Point tenderness at or just anterior to the insertion of the achilles tendon along the posterior border of the calcaneus
While training in a high-altitude climate (9000 to 10,000), a rock climber experiences acute dyspnea, cough, headache, and weakness. What is the probable cause of these symptoms?
Pulmonary edema: Signs of pulmonary edema include acute dyspnea, cough, headache, and weakness. The symptoms can occur in athletes who train at high altitudes.
A patient presents with loss of strength at the L3 and L4 nerve root levels. What muscle should the AT test to confirm an injury at this level?
Quadriceps
A wrestler comes into the ATF after sustaining a major elbow injury. There is intense pain, and the area is grossly swollen. The athlete is unable to straighten his elbow, and the forearm appears shortened. The AT suspects an acute dislocation. Which 2 areas would the AT check for possible vascular impairment?
Radial pulse and color of the nail beds after compression
A young gymnast sustains a fracture/dislocation of the right talus and is immobilized in non weight bearing for 6 weeks. After the cast is removed, she beings to complain of skin hypersensitivity, pain that is disproportional to the injury, and a significant resistance to move her ankle or toes. The AT recognizes this to be the initial symptoms of which of the following disorders?
Reflex sympathetic dystrophy
What is the greatest concerns and primary life threatening effect of rhabdomyolysis?
Renal failure
How is the strength of the pes anserine musculature manually tested?
Resistance to knee flexion and internal rotation of the lower leg
A soccer player sustains a mild head injury during a game. The AT administers a Romberg's test on the sideline, assessing which of the following?
Resisting a shoulder shrug
How is cranial nerve XI tested?
Resisting a shoulder shrug
During exercise, the body's oxygen stores are greatly diminished. The recovery O2 is used for all of the following except:
Returning the catecholamine level in the blood to normal: The O2 consumed by the pt during the recovery phase of exercise replenished the o2 levels in the tissue fluids, increases the myoglobin in the muscles to pre activity levels, and restores the venous oxyhemoglobin to pre-exercise levels.
A lacrosse player comes limping into the ATF with assistance from a coach. He is holding his leg in slight hip and knee flexion. There is a large bulge in the proximal thigh. During the exam, the AT requests the athlete to extend his knee as he sits on the edge of a taping table. He is able to partially straighten his leg, although there is pain down the anterior thigh area with the attempt to move it. What does the AT suspect is wrong?
Ruptured rectus femoris muscle
Submaximal exercise tests, which evaluate physical working capacity by measuring heart rate increases with exercise, include all of the following except:
Saltin-Astrand VO2 debt test: Progressive pulse rate test, the Harvard step test, and the Cooper 12 minute run-walk test are all classified as submaximal stress tests.
What is an excessive lateral curvature of the vertebral column called?
Scoliosis
During your evaluation of a patient's shoulder, you notice their left scapula is " winging". What does this indicate?
Serratus anterior weakness
What is one of the most common symptoms of a lumbar discogenic injury?
Sharp, radiating pain down the back of the leg: The most common symptom of lumbar discogenic injury is a sharp, radiating pain down one or both legs legs. This is caused by a bulging or herniated disc impinging on a nerve root in the lumbar spine.
Woldd-Parkinson-White Syndrome is characterised by which of the following?
Short PR interval and prolonged QRS complex: WPW syndrome is characterized interval, a prolonged QRS complex, and early depolarization of the heart.
What position is the "recommended" position for manual muscle testing the gluteus medius muscle?
Side-lying, with the affected limb on top
In what position should the patient be to manually muscle test the hip flexors, and where should the AT's force be directed during testing?
Sitting, with the force directed down onto the anterior aspect of the thigh
What are the most 3 commonly affected organ systems in Marfan syndrome?
Skeletal, ocular, cardiovascular
The AT trainer asks a patient to shrug his shoulder after a neck and shoulder injury. He has difficulty performing this movement, even though it is not painful. What nerve is injured?
Spinal Accessory
"Spearing" in football is a dangerous technique. Football coaches have discontinued this practice when teaching tackling techniques because it may cause severe head and neck injuries. What is the resulting force on the cervical spine when a football player spears an opponent?
Sudden neck hyperflexion with rotation: Spearing occurs when a football player uses the top of his head as a ram, making contact with an opponent. The force is transmitted axially through the cervical spine, causing injury. Most cervical spine injuries result from forced hyperflexion, often with a combined rotation movement.
If the calcaneofibular ligament of the ankle is torn, which of the following would be positive?
Talar tilt test
True leg-length discrepancy is measured between which 2 points?
The anterior superior iliac spine to the medial malleolus
What is spina bifida occulta ?
The incomplete formation of the posterior vertebral arch without herniation of the meninges or spinal cord
What is the incubation period for HIV and human papillomavirus?
The incubation period for HIV and human papillomavirus is 1 to 6 months.
Allen's test is used to test what?
The integrity of the radial and ulnar arteries of the hand
When testing for paresthesia of the C5 nerve root, where should the AT perform pinprick testing?
The lateral aspect of the upper arm over the middle deltoid
When evaluating the inert structures of a joint, passive range of motion is used to determine all of the following except:
The patient's willingness to move
Sickle-cell anemia may cause rhabdomyolysis in the athlete. Which of the following is a cardinal sign of rhabdomyolysis?
The presence of myoglobin in the urine
A football quarterback is sacked during a game. He comes off the field holding his throwing arm and complains of chest and anterior shoulder pain. After evaluating the athlete, the AT suspects a torn pectoralis major muscle. Which of the following physical findings will be seen if the AT is correct?
Weakness in adduction, flexion, and internal rotation of the affected arm
When the AT places their thumb over the patient's distal bicep tendon and strikes the thumb with the reflex hammer, which nerve is being evaluated?
When the biceps brachii reflex is tested, it correlates with the function of the C5 nerve root.
When taking a history during a physical examination of a patient, all of the following information is pertinent except:
Whether the patient has medical insurance or not
Which dermatome correlates to the T7 nerve root?
Xiphoid process, costal margin