Deck 12

Question 1

58M basketball coach slipped on a wet floor in the locker room and landed on his R knee. Immediate anterior/lateral knee pain and swelling, but was able to ambulate independently with antalgic gait pattern after the fall. The assistant coach drove him to urgent care for eval as he was unsure if he was safe to drive. In urgent care, the evaluating PT reported knee ROM 0-115˚ with ttp over patella and fibular head.

Based on the available info, is further dx imaging required?

A. No
B. Yes, plain film radiography is recommended
C. Yes, MRI recommended
D. Yes, CT scan recommended

Answer 1

B. Yes, plain film radiography is recommended

Question 2

58M basketball coach slipped on a wet floor in the locker room and landed on his R knee. Immediate anterior/lateral knee pain and swelling, but was able to ambulate independently with antalgic gait pattern after the fall. The assistant coach drove him to urgent care for eval as he was unsure if he was safe to drive. In urgent care, the evaluating PT reported knee ROM 0-115˚ with ttp over patella and fibular head.

Which of the patient findings are indicative of radiographs according to the Ottawa Knee rule?

A. Age and ttp to patella
B. Knee ROM loss and palpation to fibular head
C. Knee ROM loss and ttp over patella
D. Age and ttp over fibular head

Answer 2

D. Age and ttp over fibular head

Question 3

58M basketball coach slipped on a wet floor in the locker room and landed on his R knee. Immediate anterior/lateral knee pain and swelling, but was able to ambulate independently with antalgic gait pattern after the fall. The assistant coach drove him to urgent care for eval as he was unsure if he was safe to drive. In urgent care, the evaluating PT reported knee ROM 0-115˚ with ttp over patella and fibular head.

When comparing the diagnostic accuracy of the Ottawa Knee Rules (OKR) and Pittsburgh Decision Rules (PDR) for knee fractures, literature has shown that:

A. OKR and PDR had identical specificity, but the OKR had higher sensitivity vs. the PDR
B. OKR and PDR had identical sensitivity, but PDR had higher specificity than the OKR
C. OKR and PDR had identical sensitivity and specificity
D. OKR and PDR had identical sensitivity but the OKR had higher specificity than the PDR

Answer 3

B. OKR and PDR had identical sensitivity, but PDR had higher specificity than the OKR

Question 4

34M competitive soccer player who sustained a knee injury while pivoting on his LLE during a game. Noticed his knee was quite swollen, but not until approx. 12 hrs after the injury. When observing his squat, he reports a painful catch sensation with inc pain at depth of the squat, deviating toward uninvolved side. Amb with knee in slight flex and has inc pain with backwards walking.

Based off the given pt info, what dx is most likely?

A. Osteochondral fx
B. Meniscus tear
C. ACL tear
D. Patellofemoral pain

Answer 4

B. Meniscus tear

Question 5

34M competitive soccer player who sustained a knee injury while pivoting on his LLE during a game. Noticed his knee was quite swollen, but not until approx. 12 hrs after the injury. When observing his squat, he reports a painful catch sensation with inc pain at depth of the squat, deviating toward uninvolved side. Amb with knee in slight flex and has inc pain with backwards walking.

After 2 weeks of mod improvements in function, but no change in painful clicking, the pt was seen by ortho and a meniscal repair was performed. Regarding PO ambulation and WB restrictions, what is recommended in pts with meniscal repairs?

A. NWB x 2-4 weeks followed by axillary crutches weaning over 2 additional weeks
B. PWB 6 weeks
C. Early progressive WB
D. Full WB immediate PO

Answer 5

C. Early progressive WB

Question 6

16F gymnast fell while performing on the balance beam and landed on her thoracic spine. Mild bruising present just below inferior angle of scapula. Presents to PT clinic to complete intake paperwork prior to her eval. What pt reported outcome measure is most appropriate?

A. NDI
B. Thoracic pain and function scale
C. ODI
D. QuickDASH

Answer 6

C. ODI

Question 7

Pt referred for PO rehab after L fibular ORIF. She is 6 wks PO and has been ambulating in CAM boot. New since surgery, she has developed c/o hip discomfort and burning/tingling sensation of dorsal/lateral foot. Ankle ROM considerably reduced as expected, and ankle PF, DF, inv, ev strength all 4-/5. Diminished sensation over distal shin and majority of dorsal foot and toes. Ambulating into clinic in boot, you notice a significant list d/t LLD on the boot side but ID that it is symmetrical in standing out of boot. Lumbar AROM WNL and painfree with OP. (-) SLR. Slump with prickly sensation in above area but only when foot placed in PF/inversion

Based on the above listed info, what would explain her new distal paresthesia complaints?

A. L4 radiculopathy
B. L5 radiculopathy
C. Saphenous nerve entrapment
D. Superficial fibular nerve entrapment
E. Deep fibular nerve entrapment

Answer 7

D. Superficial fibular nerve entrapment

Question 8

60M semi truck driver presents to PT with c/o hand numbness and pain while driving his truck. Drives in 4x 6 hour bouts before switching with his driving partner. He has been having a difficult time driving d/t pain/numbness, esp with involved hand on top of the steering wheel. When bothersome, he will shake his hands for relief of paresthesias, which are primarily in digits 1-3. When observing the pt, you notice a significant FHP. Cervical spine exam elicits local mid-cervical pain with OP into extension.

Neurological: dermatomes reduced sensation of digits 1 and 2, myotomes WNL, DTR WNL

Special tests: (-) ULTTA, (+) Phalens, (-) Tinels, Wrist ratio index 0.70

Based off the above information, which dx is most likely?

A. Cervical radiculopathy
B. Pronator syndrome
C. CTS
D. TOS

Answer 8

C. CTS

Question 9

60M semi truck driver presents to PT with c/o hand numbness and pain while driving his truck. Drives in 4x 6 hour bouts before switching with his driving partner. He has been having a difficult time driving d/t pain/numbness, esp with involved hand on top of the steering wheel. When bothersome, he will shake his hands for relief of paresthesias, which are primarily in digits 1-3. When observing the pt, you notice a significant FHP. Cervical spine exam elicits local mid-cervical pain with OP into extension.

Neurological: dermatomes reduced sensation of digits 1 and 2, myotomes WNL, DTR WNL

Special tests: (-) ULTTA, (+) Phalens, (-) Tinels, Wrist ratio index 0.70

What evidence-based intervention is best indicated at this time for the pt?

A. Phonophoresis and median n. glide
B. Superficial heat and IFC
C. Wrist flexor stretching
D. Short-term, neutral positioned wrist orthosis worn at night

Answer 9

D. Short-term, neutral positioned wrist orthosis worn at night

Question 10

60M semi truck driver presents to PT with c/o hand numbness and pain while driving his truck. Drives in 4x 6 hour bouts before switching with his driving partner. He has been having a difficult time driving d/t pain/numbness, esp with involved hand on top of the steering wheel. When bothersome, he will shake his hands for relief of paresthesias, which are primarily in digits 1-3. When observing the pt, you notice a significant FHP. Cervical spine exam elicits local mid-cervical pain with OP into extension.

Neurological: dermatomes reduced sensation of digits 1 and 2, myotomes WNL, DTR WNL

Special tests: (-) ULTTA, (+) Phalens, (-) Tinels, Wrist ratio index 0.70

What manual therapy intervention is recommended for this pt?

A. Median n. neurodynamic mobilizations
B. Cervical lateral glides and carpal mobilizations
C. STM of transverse carpal ligament
D. Elbow manipulation

Answer 10

B. Cervical lateral glides and carpal mobilizations

Question 11

2018 CPG update: position for meniscal repair and WB restrictions

Answer 11

May consider early progressive WB in pts with meniscal repairs

Question 12

ODI is preferred for thoracic pain below (level)

Answer 12

T4

Question 13

What is the preferred outcome measure for thoracic pain above T4?

Answer 13

NDI

Question 14

Use of short-term neutral positioned wrist orthosis worn at night for CTS: level of evidence

Answer 14

B

Question 15

53F referred for tx of L shoulder. Referral includes recs for stretching exercises. Symptom onset 4 mos ago and has progressively worsened to the point where she has lost considerable ROM with pain ratings of 8/10 during certain movements. She is no longer able to fasten her bra, touch her back pocket, put her hair in a ponytail, or reach into cupboards. Pt states last week, her husband tossed her the car keys and she reflexively reached out to grab them, which resulted in 48 hrs of inc shoulder pain and difficulty sleeping. Pain levels in clinic are reported as constant 6-7/10 at rest and have been keeping her up at night, even when lying on the uninvolved shoulder. Pt has PMH of obesity and DM.

AROM: 80˚ flex | 75˚ abd | 18˚ ER
PROM: 90˚ flex | 80˚ abd | 20˚ ER

Based off the above info and your knowledge of the current evidence for her shoulder condition, what intervention is best recommended?

A. Gentle passive joint mobilization and ROM exercises
B. Modalities and pendulums
C. Education and passive stretching
D. Corticosteroid injection

Answer 15

D. Corticosteroid injection

Question 16

53F referred for tx of L shoulder. Referral includes recs for stretching exercises. Symptom onset 4 mos ago and has progressively worsened to the point where she has lost considerable ROM with pain ratings of 8/10 during certain movements. She is no longer able to fasten her bra, touch her back pocket, put her hair in a ponytail, or reach into cupboards. Pt states last week, her husband tossed her the car keys and she reflexively reached out to grab them, which resulted in 48 hrs of inc shoulder pain and difficulty sleeping. Pain levels in clinic are reported as constant 6-7/10 at rest and have been keeping her up at night, even when lying on the uninvolved shoulder. Pt has PMH of obesity and DM.

AROM: 80˚ flex | 75˚ abd | 18˚ ER
PROM: 90˚ flex | 80˚ abd | 20˚ ER

Based off the above info, what HEP is most appropriate for this pt?

A. Wall slides and wrist/elbow AROM
B. Shoulder isos and AAROM with dowel OH in supine
C. Pendulums and table slides
D. Doorway pec stretch, IR AAROM with towel behind back

Answer 16

C. Pendulums and table slides

Question 17

53F referred for tx of L shoulder. Referral includes recs for stretching exercises. Symptom onset 4 mos ago and has progressively worsened to the point where she has lost considerable ROM with pain ratings of 8/10 during certain movements. She is no longer able to fasten her bra, touch her back pocket, put her hair in a ponytail, or reach into cupboards. Pt states last week, her husband tossed her the car keys and she reflexively reached out to grab them, which resulted in 48 hrs of inc shoulder pain and difficulty sleeping. Pain levels in clinic are reported as constant 6-7/10 at rest and have been keeping her up at night, even when lying on the uninvolved shoulder. Pt has PMH of obesity and DM.

AROM: 80˚ flex | 75˚ abd | 18˚ ER
PROM: 90˚ flex | 80˚ abd | 20˚ ER

If this pt underwent an arthroscopic exam under anesthesia, what would most likely be observed?

A. Moderate synovitis/angiogenesis, capsuloligamentous fibrosis resulting in loss of the axillary fold and reduced PROM
B. Diffuse synovial rxn without adhesions or contracture
C. Aggressive synovitis/angiogenesis and some loss of motion
D. Capsuloligamentous complex fibrosis and moderate minimal synovitis

Answer 17

C. Aggressive synovitis/angiogenesis and some loss of motion

Question 18

38F endurance athlete presents to clinic with groin pain during WB. Pain originally began as dull ache present only at the end of a run > 8 milds. Symptoms have worsened over the past several weeks to the point where she how has constant groin pain while walking.

Which special test is most specific for ruling IN a femoral stress fx?

A. Patellar pubic percussion test
B. Fulcrum test
C. Tuning fork vibration test
D. Hop test

Answer 18

A. Patellar pubic percussion test

Question 19

A pt presents via direct access with c.o lower thoracic/abdominal pain. Although most causes of abd pain have a visceral origin, the MSK system must be considered when the cause is not obvious.

Which 2 questions are most useful to assist with differential dx in ruling in a MSK cause of abdominal pain?

A. “Does taking a deep breath aggravate your sx?” and “Does twisting your back aggravate your sx?”
B. “Does lifting heavy objects aggravate your sx?” and “Does taking a deep breath aggravate your sx?”
C. “Does eating foods aggravate your sx?” and “Has there been any weight change since onset of sx?”
D. “Does twisting your back aggravate your sx?” and “Does coughing/sneezing aggravate your sx?”

Answer 19

A. “Does taking a deep breath aggravate your sx?” and “Does twisting your back aggravate your sx?”

Question 20

76F with acute lateral waist/flank pain. Reports onset of back pain beginning 2 days ago without clear MOI. Reports pain with sneezing and moderately strenuous activity. Admits to a very sedentary lifestyle and states she does not like to exercise. When asked to lie down on the exam table, UA due to severe pain.

Based off the given intervention, what dx is most likely?

A. Acute kidney infection
B. Acute vertebral fx
C. Pancreatitis
D. Thoracic zygapophyseal joint dysfunction

Answer 20

B. Acute vertebral fx

Question 21

33M “weekend warrior” presents to PT in orthopedic urgent care setting. States that while playing flag football tournament, he felt as if someone kicked him in the back of the calf. Pt turned around and yelled “who did that?” but saw that he had stepped awkwardly in a hole in the field. Rapid inc in pain and swelling just above the heel. Presents now with difficulty during push-up phase of gait and UA to perform heel raise. In prone, you feel a palpable gap in the Achilles Tendon, approximately 4 cm proximal to calcaneus. Thompson test reveals inability to PF with squeeze of GSC.

What is true regarding psychometric properties of the Thompson test?

A. High sensitivity and high specificity
B. High sensitivity and poor specificity
C. Poor sensitivity and high specificity
D. Poor sensitivity and specificity

Answer 21

A. High sensitivity and high specificity

Question 22

33M “weekend warrior” presents to PT in orthopedic urgent care setting. States that while playing flag football tournament, he felt as if someone kicked him in the back of the calf. Pt turned around and yelled “who did that?” but saw that he had stepped awkwardly in a hole in the field. Rapid inc in pain and swelling just above the heel. Presents now with difficulty during push-up phase of gait and UA to perform heel raise. In prone, you feel a palpable gap in the Achilles Tendon, approximately 4 cm proximal to calcaneus. Thompson test reveals inability to PF with squeeze of GSC.

Which of the following is NOT true regarding acute Achilles tendon ruptures?

A. Occur more often in males than females
B. Most commonly occur between 40-60 yo
C. Prior hx of Achilles tendon steroid injections is a risk factor
D. Will have no ability to PF in objective exam

Answer 22

D. Will have no ability to PF in objective exam

Question 23

60F with chronic R sided upper neck pain and HA for the past 9 mos. Reports HA present 4 days per week that typically last 5 hrs at a time.
Objective exam: RR 55˚ | LR 65˚ | R flex/rot 28˚ | L flex/rot 40˚

Day 1 tx: C1-2 rotary thrust technique followed by SNAGs for HEP. After manual therapy for neck, FRT improved to 36˚ R and after SNAGs improved to 38˚

What can be concluded about the initial flexion rotation testing and what can be concluded about the effect of tx on her FRT impairment?

A. (+) FRT to the R; improvements after manual therapy represent real, detectable change
B. (+) FRT to the R; improvements after manual therapy may be due to measurement error
C. (-) FRT to the R; improvements after manual therapy and SNAGs may be d/t measurement error
D. (-) FRT to the R; improvements after manual therapy represent real, detectable change

Answer 23

A. (+) FRT to the R; improvements after manual therapy represent real, detectable change

Question 24

Which of the following cluster(s) of symptoms is the most sensitive in screening for cancer/back-related tumor as a cause of low back pain?

A. Age ≥ 50, unexplained weight loss, previous hx of CA, failure to improve over 1 mo
B. Unexplained weight loss, insidious onset, neurological sx, failure to improve after 1 mo
C. Prior hx of CA, myotomal weakness in B LEs, failure to improve after 1 mo
D. Age > 50, hx of abdominal surgery, prior IV drug use

Answer 24

A. Age ≥ 50, unexplained weight loss, previous hx of CA, failure to improve over 1 mo

Question 25

In pts with adhesive capsulitis, intra-articular steroid injections combined with shoulder mobility and stretching exercises are more effective in providing short term (how long) pain relief and improved function compared to shoulder mobility and stretching alone

Answer 25

4-6 weeks

Question 26

These questions have significant positive indication of abdominal symptoms of MSK origin.

Answer 26

Does taking a deep breath aggravate your symptoms?

Does twisting your back aggravate your symptoms?

Question 27

A combination of these questions gave (%) specificity of indication of abdominal pain with MSK origin

Does taking a deep breath aggravate your symptoms?
Does twisting your back aggravate your symptoms?

Answer 27

96%

Question 28

In post-menopausal women with back pain, the presence of ______ were found to be at increased risk for vertebral fx

Answer 28

lateral waist pain

Question 29

In post-menopausal women with back pain, the presence of lateral waist pain were found to be at increased risk (how much?) for vertebral fx

Answer 29

4.5x more likely

Question 30

What is the supine sign?

Answer 30

unable to lie down on the table d/t severe pain

Question 31

This test has high sensitivity and specificity and can be used to rule in or out the dx of Achilles tendon rupture

Answer 31

Thompson test

Question 32

Positive flexion rotation test defined as

Answer 32

10˚ asymmetry

Question 33

MDC for flexion rotation test

Answer 33

7˚

Question 34

Best single question for screening for cancer/back related tumor

Answer 34

inability to obtain relief with bed rest