Chap 22

Question 1

1. When the body is in an upright position, the line of gravity passes where in relation to the spinal column?
   a. Anterior to the spinal column
   b. Posterior to the spinal column
   c. Through the middle of the lumbar vertebrae
   d. Through the middle of the thoracic vertebrae

Answer 1

A

Question 2

2. A bilateral separation in the pars interarticularis that leads to anterior displacement of a vertebra is
   a. lordosis.
   b. spina bifida.
   c. spondylolisthesis.
   d. spondylolysis.

Answer 2

C

Question 3

3. A loss of ceretrospinal fluid around the spinal cord because of deformation of the spinal cord or a narrowing of the neural canal is called
   a. spina bifida.
   b. Scheuermann disease.
   c. spinal occlusion.
   d. spinal stenosis.

Answer 3

D

Question 4

4. When disk nuclear material moves into the spinal canal and impinges on adjacent nerve roots it is called a(n)
   a. extruded disk.
   b. herniated disk.
   c. prolapsed disk.
   d. sequestrated disk.

Answer 4

A

Question 5

5. If an individual has a diminished quadriceps reflex and weak ankle dorsiflexion, what nerve root is injured?
   a. L3
   b. L4
   c. L5
   d. S1

Answer 5

B

Question 6

6. A person with sciatica, with sensory and reflex changes, muscle weakness, and normal bowel and bladder function, may return to sports participation
   a. in 6 to 12 weeks.
   b. in 12 to 24 weeks.
   c. after surgical decompression and rehabilitation.
   d. probably never.

Answer 6

B

Question 7

7. Hard disk disease is associated with
   a. uncontrolled lateral bending of the neck.
   b. herniation of the nucleus pulposus through the posterior annulus.
   c. a diminished disk height and the formation of marginal osteophytes.
   d. physically active adolescents.

Answer 7

C

Question 8

8. The top of the iliac crest is the landmark for which vertebra?
   a. T12
   b. L2
   c. L4
   d. S1

Answer 8

C

Question 9

9. Which of the following is not a characteristic of facet joint pathology?
   a. Nonspecific low back pain of a deep and achy quality
   b. Visible flattening of lumbar lordosis
   c. Pain that radiates into the posterior thigh
   d. Pain that radiates into the posterior lower leg.

Answer 9

D

Question 10

10. Hip flexion tests which nerve root myotome segment?
    a. L1–L2
    b. L3
    c. L5
    d. S1

Answer 10

A

Question 11

11. Ipsilateral pain during the first 70° of a straight leg raising test indicates a possible
    a. herniated disk.
    b. irritation of the sacroiliac joint.
    c. sciatica.
    d. tight hamstrings.

Answer 11

C

Question 12

12. A patient with sciatica caused by an annular tear will report
    a. pain localized over a facet joint on spinal extension.
    b. back pain is greater than radiating leg pain.
    c. radiating leg pain is greater than back pain.
    d. pain that is not reproduced with straight leg raising.

Answer 12

C

Question 13

13. The condition in which the nuclear material bulges into the spinal canal and runs the risk of impinging adjacent nerve roots is termed
    a. prolapsed disk.
    b. extruded disk.
    c. sequestrated disk.
    d. sciatica.

Answer 13

B

Question 14

14. Lumbar facet pathology may involve
    a. subluxation or dislocation of the facet.
    b. facet joint syndrome.
    c. degeneration of the facet.
    d. All of the above

Answer 14

D

Question 15

15. A positive Spurling test suggests
    a. a nerve root impingement due to a narrowing of the neural foramina.
    b. hypomobility of the vertebrae.
    c. occlusion of the cervical vertebral artery.
    d. an herniated disk.

Answer 15

A

Question 16

16. In assessing lumbar spine disorders, the ______ test is used to determine if the patient is trying or may be a malingerer.
    a. Valsalva
    b. Milgram
    c. Hoover
    d. Slump

Answer 16

C

Question 17

17. Which of the following tests is not used to assess sacroiliac dysfunction?
    a. Approximation test
    b. FABER test
    c. Gaenslen test
    d. Oppenheim test

Answer 17

D

Question 18

18. The top of the iliac crest is the landmark for which vertebrae?
    a. T12
    b. L2
    c. L4
    d. S1

Answer 18

C

Question 19

19. Hip flexion consists of
    a. anteriorly directed sagittal plane rotation of the femur with respect to the pelvic girdle.
    b. posteriorly directed sagittal plane rotation of the femur with respect to the pelvic girdle.
    c. anteriorly directed movement of the anterior superior iliac spine with respect to the pubic symphysis.
    d. posteriorly directed movement of the anterior superior iliac spine with respect to the pubic symphysis.

Answer 19

A

Question 20

20. The development of one or more wedge-shaped vertebrae in the thoracic or lumbar regions through abnormal epiphyseal plate behavior is called
    a. spondylolysis.
    b. spear tackler’s spine.
    c. spinal stenosis.
    d. Scheuermann disease.

Answer 20

D

Question 21

21. Lordosis is often associated with
    a. strong abdominal muscles and a posterior pelvic tilt.
    b. strong abdominal muscles and a forward pelvic tilt.
    c. weak abdominal muscles and a posterior pelvic tilt.
    d. weak abdominal muscles and a forward pelvic tilt.

Answer 21

B

Question 22

22. A fracture of the pars interarticularis is termed
    a. spondylolysis.
    b. spear tackler’s spine.
    c. spinal stenosis.
    d. spondylolisthesis.

Answer 22

A

Question 23

23. The focus of a rehabilitation program following spondylolisthesis should be
    a. flexibility of the quadriceps and gluteal muscles; strengthening of the abdomen.
    b. flexibility of the quadriceps and gluteal muscles; strengthening of the back extensors.
    c. flexibility of the hamstrings and gluteal muscles; strengthening of the abdomen and back extensors.
    d. flexibility of the hamstrings and gluteal muscles; strengthening back extensors.

Answer 23

C

Question 24

24. Which of the following signs and symptoms is not related to neurological deficits or damage?
    a. Radiating pain
    b. Loss of bladder control
    c. Referred pain
    d. Weakness in myotomes

Answer 24

C

Question 25

24. Which of the following signs and symptoms is not related to neurological deficits or damage?
    a. Radiating pain
    b. Loss of bladder control
    c. Referred pain
    d. Weakness in myotomes

Answer 25

C

Question 26

26. If an athlete has a diminished patellar reflex and weak ankle dorsiflexion, which nerve root is injured?
    a. L3
    b. L4
    c. L2
    d. S1

Answer 26

B

Question 27

27. Compression loads on the lumbar spine are greatest during
    a. walking.
    b. back hyperextension.
    c. trunk flexion.
    d. sitting in a slouched position.

Answer 27

D

Question 28

28. During spondylolysis and spondylolisthesis, muscle spasms often occur in the
    a. rectus abdominis.
    b. erector spinae and hamstrings.
    c. erector spinae and quadriceps.
    d. rectus abdominis and quadriceps.

Answer 28

B

Question 29

29. The stress/function test where the clinician preforms flexion, adduction, and internal rotation is known as?
    a. Single-leg stance test.
    b. FADDIR test.
    c. Hoover test.
    d. FAIR test.

Answer 29

B

Question 30

30. If nerve root L5 is irritated or damaged, myotome weakness will be found in
    a. toe flexion.
    b. toe extension.
    c. ankle dorsiflexion.
    d. ankle plantar flexion.

Answer 30

B

Question 31

31. True or False? The sacral curve is convex posteriorly.
    a. True
    b. False

Answer 31

A

Question 32

32. True or False? The lumbar region permits the largest cumulative range of motion in flexion/extension with 46°, compared with 16° in the thoracic region.
    a. True
    b. False

Answer 32

B

Question 33

33. True or False? Spinal rotation capability is greatest in the lower lumbar region.
    a. True
    b. False

Answer 33

B

Question 34

34. True or False? Axial compression loading has been identified as the leading mechanism of injury for severe cervical spine injuries.

Answer 34

T

Question 35

35. True or False? Approximately 70% to 90% of all cases of scoliosis can be directly linked to overdevelopment of muscles on the dominant side of the thorax or to a leg length discrepancy.
    a. True
    b. False

Answer 35

B

Question 36

36. True or False? When lifting a heavy weight, it is important to inhale deeply as the lift is initiated and exhale forcefully throughout the lift until the end.
    a. True
    b. False

Answer 36

A

Question 37

37. True or False? Large compressive loads, such as those sustained during weight lifting, can cause fractures of the vertebral end plates, leading to a wedge fracture in the cervical area.
    a. True
    b. False

Answer 37

B

Question 38

40. True or False? An individual with lumbar spinal stenosis develops back and leg pain after walking a limited distance, which concomitantly increases as distance increases.
    a. True
    b. False

Answer 38

A

Question 39

41. True or False? The most commonly herniated disks are the lower two lumbar disks, with ruptures occurring on the anterior or anterolateral aspect of the disk.
    a. True
    b. False

Answer 39

B

Question 40

42. True or False? A lumbar fracture at the L5 level could be catastrophic if a bony fragment pierces the spinal cord and could result in total nerve disruption distal to that site.

a. True
b. False

Answer 40

B

Question 41

43. True or False? Weak ankle plantar flexion and a reduced Achilles tendon reflex indicate an L5 nerve root injury.
    a. True
    b. False

Answer 41

B

Question 42

44. True or False? The sciatic nerve can be palpated midway between the ischial tuberosity and the greater trochanter.
    a. True
    b. False

Answer 42

A

Question 43

45. True or False? During the straight leg raising test, pain that occurs opposite the leg lifted indicates a herniated disk.
    a. True
    b. False

Answer 43

A

Question 44

46. True or False? Lifting with the trunk erect minimizes the tension requirement for muscles of the lumbar spine.
    a. True
    b. False

Answer 44

A

Question 45

47. True or False? Because the spinal cord ends at about L1 or L2 level, fractures of the lumbar vertebrae below this point do not pose a serious threat but should be handled with care to minimize potential nerve damage to the cauda equina.
    a. True
    b. False

Answer 45

B

Question 46

48. Match the following nerves with the appropriate myotome.
49. L1–L2 a. toe extension
50. L3 b. knee flexion
51. L4 c. plantar flexion, foot eversion, hip extension
52. L5 d. hip flexion
53. S1 e. knee extension
54. S2 f. ankle dorsiflexion

Answer 46

Answer: 1-d, 2-e, 3-f, 4-a, 5-c, 6-b

Question 47

50. What signs and symptoms are associated a lumbar fracture or dislocation?

Answer 47

Answer: Signs and symptoms include localized, palpable pain that may radiate down the nerve root if a bony fragment compresses a spinal nerve.

Question 48

51. Identify six possible causes of low back pain.

Answer 48

Answer: The causes include:
a. Muscle strains and sprains
b. Sciatica
c. Protruded or herniated disk
d. Pathological fracture
e. Disk space infections
f. Spinal infections (tuberculosis)
g. Neoplastic tumor (primary or metastatic)
h. Ankylosing spondylitis (arthritis of the spine)
i. Benign space-occupying lesions
j. Abdominal aortic aneurysm

Question 49

52. Differentiate spondylolysis and spondylolisthesis.

A

Answer 49

nswer: Spondylolysis
a. A fracture involving the pars articularis
b. May be congenital but may be caused by mechanical stress
c. May range from hairline to complete separation of the bone
Spondylolisthesis
a. A bilateral separation in the pars interarticularis
b. Results in the anterior displacement of a vertebra with respect to the vertebra below it
c. Most common site for this injury is the lumbosacral joint (L5–S1)

Question 50

53. Identify five signs or symptoms of an acute low back injury that should be recognized as “red flags” and warrant immobilization and immediate referral to a physician?

Answer 50

Answer: The “red flags” include:
a. Severe pain, point tenderness, or deformity along the vertebral column
b. Loss or change in sensation anywhere in the body
c. Paralysis or inability to move a body part
d. Diminished or absent reflexes
e. Muscle weakness in a myotome
f. Pain radiating into the extremities
g. Trunk or abdominal pain that may be referred from the visceral organs
h. Any injury in which you are uncertain about the severity or nature

Question 51

54. What are the signs and symptoms of sciatic caused by an annular tear?

Answer 51

Answer: Radiating leg pain is greater than back pain; pain increases with sitting and leaning forward, coughing, sneezing, and straining; neurological deficits are usually present; positive ipsilateral straight leg raising test

Question 52

55. What is sciatica? Explain the four classifications of sciatica and their management.

Answer 52

Answer: The classifications and their management are as follows:
a. Sciatica only
i. No sensory or muscle weakness
ii. Modify activity appropriately, and develop rehabilitation and prevention program
iii. Any increased pain requires immediate reevaluation
b. Sciatica with soft signs
i. Some sensory changes, mild or no reflex change, normal muscle strength, normal bowel and bladder function
ii. Remove from participation in sport and physical activity for 6 to 12 weeks
c. Sciatica with hard signs:
i. Sensory and reflex changes; muscle weakness caused by repeated, chronic, or acute condition; normal bowel and bladder function
ii. Remove from participation for 12 to 24 weeks
d. Sciatica with severe signs
i. Sensory and reflex changes, muscle weakness, and altered bladder function
ii. Consider immediate surgical decompression