Deck 6 Flashcards
Pt referred for chronic neck pain. Wants to be seen bc of an incident that occurred last week at the hair salon. Hair washed in a sink with the back of her neck resting on the edge. Experienced an electrical shock down her back and paresthesia into her limbs. What is this phenomenon called?
Lhermitte’s sign
Lhermitte’s sign can be indicative of
- cervical myelopathy
- other neurologic pathologies
Froment’s sign is used to identify
ulnar nerve palsy
This sign is suggestive of meningitis
Kernig’s sign
Kernig’s sign is suggestive of meningitis and is characterized by
significant limitation when straightening the knee when the hip is flexed to 90˚
The dorsal scapular nerve innervates all of the following muscles except which of the choices below?
A. Rhomboid major
B. Rhomboid minor
C. Levator scapulae
D. Latissimus dorsi
D. Latissimus dorsi
What nerve innervates the latissimus dorsi?
thoracodorsal nerves
From medial to lateral, starting at the thoracic vertebrae spinous process, what is the correct order of muscles?
A. iliocostalis, spinalis, longissimus
B. longissimus iliocostalis, spinalis
C. spinalis, longissimus, iliocostalis
D. spinalis, iliocostalis, longissimus
C. spinalis, longissimus, iliocostalis
What nerve innervates BOTH the teres major and the subscapularis?
lower subscapularis nerve
The upper subscapularis nerve innervates ONLY what muscle?
subscapularis
What muscles are innervated by the axillary nerve?
- deltoid
- teres minor
The dorsal scapular nerve innervates which muscles?
- rhomboid major
- rhomboid minor
- levator scapulae
Brown-Sequard syndrome is characterized by what kind of spinal cord lesion?
A. Anterior SC lesion
B. Posterior SC lesion
C. Hemisection SC lesion
D. Complete SC lesion
C. Hemisection SC lesion
Brown-Sequard syndrome: What symptoms seen on the side of the lesion?
- loss of proprioception
- loss of motor function
Brown-Sequard syndrome: What is seen on the contralateral side of the lesion?
inability to sense pain or temperature
Brown-Sequard syndrome: (complete/incomplete) lesion
incomplete
How many true ribs?
7
How many false ribs?
5
What constitutes a “true” rib?
Attach directly to the sternum
While evaluating a pregnant patient in an OP ortho clinic, she developed sx’s of hypotension after laying supine for approximately 2 minutes. What structure is being compressed?
inferior vena cava
Compression of the inferior vena cava can cause symptoms of ____ in supine
hypotension
Compression of the vena cava in supine likely to occur when during a pregnancy?
late
You are providing medical coverage during a marathon when a runner comes up to your tent with sudden onset SOB and chest pain. You suspect pneumothorax of the R lung bc of trachial deviation. Which direction do you suspect to see the trachea shift?
A. Away from the R lung
B. Toward the R lung
C. Trachea stays midline
D. Depression of the trachea
A. Away from the R lung
The trachea shifts AWAY from the lung experiencing the pneumothorax. Why?
increase in pressure due to air filling the space between the lung and chest wall
30M presents via direct access with acute shoulder pain at the tip of the L shoulder. Denies any MOI, but shoulder pain is excruciating. What is the most likely dx?
A. L RTC tear
B. Ruptured spleen
C. Cervical radiculopathy
D. MI
B. Ruptured spleen
Kehr’s sign is indicative of
ruptured spleen
What is Kehr’s sign?
acute L shoulder pain at the tip
According to JOSPT neck pain CPG, which of the interventions has the highest grade?
A. Thoracic manipulation
B. Stretching
C. Centralization procedures
D. Traction
D. Traction
The inferior vena cava, esophagus and aorta all enter through openings in the diaphragm. These openings are at approximate levels in relation to the thoracic spine. The inferior vena cava enters the diaphragm at the ___ thoracic vertebra.
8th
The inferior vena cava, esophagus and aorta all enter through openings in the diaphragm. These openings are at approximate levels in relation to the thoracic spine. The esophagus enters the diaphragm at the ___ thoracic vertebra.
10th
The inferior vena cava, esophagus and aorta all enter through openings in the diaphragm. These openings are at approximate levels in relation to the thoracic spine. The aorta enters the diaphragm at the ___ thoracic vertebra.
12th
When a pt elevates their arm past 120˚ of elevation, what muscles primarily facilitate upward rotation of the scapula?
A. serratus anterior, upper trapezius
B. lower and middle trapezius
C. upper and lower trapezius
D. lower trapezius and serratus anterior
D. lower trapezius and serratus anterior
Trunk stabilizer endurance hold times are commonly used for establishing benchmarks. Which of the following has the best sensitivity, specificity, and predictive value of LBP?
A. Iso hold in a crunch position with inferior angles just above table
B. Prone DL SLR test
C. Sorensen test
D. Prone iso chest raise test
B. Prone DL SLR test
Which of the following can commonly develop in marathon runners?
A. Atrial fibrillation
B. Pre-ventricular contractions
C. Hypertrophic cardiomyopathy
D. Sudden cardiac death
A. Atrial fibrillation
Frequent PVC’s can be indication of
underlying heart pathology
Hypertrophic cardiomyopathy can lead to
sudden death
What nerve provides motor innervation to the diaphragm??
A. Accessory nerve
B. Lower intercostal nerve
C. Phrenic nerve
D. Upper intercostal nerve
C. Phrenic nerve
The phrenic nerve provides (motor/sensory) innervation to the diaphragm
motor
Pt in OP setting with complete SCI at C2 a year ago. What muscles does the pt use in order to breathe?
A. Diaphragm
B. Upper trapezius
C. TrA
D. External and internal obliques
B. Upper trapezius
The diaphragm is innervated by which nerve
phrenic
The diaphragm is innervated by the phrenic nerve, which receives contributions from
ventral rami of C3, 4, 5
While assessing static position of the scapula, you measure distance between T4 and medial border and notice distance to the R is greater than the L. What could be the reason for this discrepancy?
A. T4 syndrome
B. Shoulder impingement
C. L long thoracic nerve injury
D. R long thoracic nerve injury
D. R long thoracic nerve injury
What dermatome is associated with the nipples?
T4
What dermatome is associated with the umbilicus?
T10
What will yield better results for a pt with neck pain?
A. Cervical manipulation
B. Thoracic manipulation
C. Thoracic mobilizations
D. Shoulder girdle strengthening
A. Cervical manipulation
Which of the following TOS syndrome tests should be utilized to confirm compression of brachial plexus by the scalenes?
A. Adam’s test
B. Adson’s test
C. Wright test
D. Costoclavicular test
B. Adson’s test
What is the Adson’s test procedure?
- Assessing radial pulse
- Pt turns head toward affected arm
- Therapist extends and externally rotates the arm.
Adson’s test: what is a positive result?
any reduction of pulse
The costoclavicular test is similar to which test?
Adson’s
The costoclavicular test is similar to the Adson’s test except for
the pt’s head is looking straight forward
(+) costoclavicular test would indicate TOS secondary to
compression between the first rib and clavicle
What orientation are the facet joints of the 6th thoracic vertebrae?
A. Sagittal plane
B. Frontal plane
C. Transverse plane
D. Vertical axis
B. Frontal plane
The demi-facets of the mid-thoracic vertebrae are located on which aspect of the vertebrae?
A. Vertebral body
B. Transverse process
C. Lamina
D. Rib
A. Vertebral body
The demi-facets are concave surfaces located on the vertebral body and articulate with the
convex rib head
The costotransverse facet is located where?
on the transverse process
The costotransverse facet is located on the transverse process and articulates with
rib
The vertebrae of what region of the spine have the smallest disc height and nucleus pulposus?
Thoracic spine
T4 syndrome is characterized by which of the following?
A. Paresthesias into 4th/5th digits B
B. Unilateral sensation of coolness in the R hand
C. Non-dermatomal paresthesias and hypomobility of lower cervical spine and upper thoracic spine
D. Localized upper thoracic pain
C. Non-dermatomal paresthesias and hypomobility of lower cervical spine and upper thoracic spine
A sense of unilateral coolness in the R hand presents as this type of pathology
vascular
