END - MED 1 Flashcards
- The most common causes of musculoskeletal pain are the following except:
A. Fibromyalgia
B. Rheumatoid arthritis
C. Trauma and fracture
D. Overuse syndromes such as tendinitis and bursitis
B. Rheumatoid arthritis
“Because trauma, fracture, overuse syndromes, and fibromyalgia are among the most common causes of musculoskeletal pain, these should be considered with each new encounter.”
- The most common masquerader with Musculoskeletal complaints is:
A. Ankylosing spondylitis
B. Fibromyalgia
C. Systemic lupus erythematosus
D. Dermatomyositis
B. Fibromyalgia
Rationalization: Fibromyalgia often presents with symptoms that can mimic other musculoskeletal disorders but is primarily a disorder of pain regulation and perception. This can lead to it being considered a “masquerader” as it mimics symptoms of other rheumatological conditions.
- CT, MRI or plain spinal x-ray is rarely indicated in the first month of symptoms.
A. True
B. Maybe
C. False
A. True
Rationalization: According to best practices, imaging such as CT, MRI, or plain spinal x-rays is not typically indicated in the first month of musculoskeletal symptoms unless severe or progressive neurological deficits are present. Early imaging may lead to unnecessary medical intervention without significant changes in management or outcomes.
- Possible advantages of early ambulation for acute low back pain:
A. Improve bone, cartilage and muscle strength
B. None of the above
C. All of the above
D. Increased endorphin levels
E. Cardiovascular conditioning
C. All of the above
Rationalization: Early ambulation can aid in improving bone, cartilage, and muscle strength, increasing endorphin levels, which are natural pain relievers, and contributing to cardiovascular conditioning. These factors help in the recovery from acute low back pain and may prevent chronic pain development.
5.An example of Inflammatory musculoskeletal disorder is:
A. Osteoarthritis
B. Pigmented villonodular synovitis
C. Fibromyalgia
D. Systemic lupus erythematosus
D. Systemic lupus erythematosus
Rationalization: Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disorder that affects multiple organ systems, including the musculoskeletal system, manifesting as arthritis or arthralgia. The other disorders listed, except for Pigmented villonodular synovitis which is also inflammatory but less common, do not primarily involve systemic inflammation as in SLE. Fibromyalgia, for example, involves pain perception without underlying inflammatory pathology, and osteoarthritis is primarily a degenerative, rather than inflammatory, disorder.
- True or false:
As we age, the uncinate process hypertrophies and contribute to the neural foraminal narrowing and result to radiculopathy in the cervical spine.
A. True
B. False
C. Maybe
A. True
Rationalization: As we age, changes in the spine’s anatomy, such as hypertrophy of the uncinate process, can contribute to narrowing of the neural foramen. This narrowing can impinge on the nerve roots, potentially leading to symptoms of radiculopathy in the cervical spine.
Uncovertebral joint = Luschka’s Joint
- The following are considered triggers for gout :
A. None of the above
B. Chemotherapy
C. All of the above
D. Renal insufficiency
E. Diuretics
C. All of the above
Rationalization: Common triggers for gout include factors that increase uric acid levels or decrease its excretion. Renal insufficiency and diuretics can impair uric acid excretion. Chemotherapy can also precipitate gout by causing rapid cell turnover and consequently increased uric acid production.
- Which of the following is considered part of the 4 most common SERIOUS causes of back pain:
A. Glucocorticoid use
B. IV drug use
C. Advanced age >70
D. Radiculopathy
D. Radiculopathy
Four most common serious causes:
* Radiculopathy - Permanent nerve damage that doesn’t heal.
* Tumor - Growth that may cause or exacerbate pain.
* Infection - Bacterial or viral infections affecting the spine.
* Referred pain from viscera - Pain originating from internal organs.
- True or false: The nerve roots exit a level above their respective vertebral bodies in the cervical region and follow a long intraspinal course before exiting.
A. Maybe
B. True
C. False
C. False
Rationalization: In the cervical spine, while it’s true that the nerve roots exit above their respective vertebral bodies, they actually follow a short intraspinal course before exiting, unlike in the thoracic and lumbar regions where the roots follow a long intraspinal course. This distinction is important for understanding the mechanics of spinal nerve compression and potential sites of radiculopathy.
- The primary source of infection leading to vertebral osteomyelitis is from:
A. skin and urinary tract
B. endocarditis
C. poor dentition
D. pulmonary disease
A. skin and urinary tract
Rationalization: The most common sources of infection leading to vertebral osteomyelitis are typically via hematogenous spread from distant sites. Common primary sources include the skin, especially in cases of skin infections or procedures, and the urinary tract, which can be sources of bacteria that may seed to the vertebral column.
- The duration for chronic musculoskeletal disorder is:
A. Greater than 4 weeks
B. Greater than 6 weeks
C. Greater than 2 weeks
D. Greater than 1 week
B. Greater than 6 weeks
Rationalization: Chronic musculoskeletal disorders are generally defined as those persisting for more than 6 weeks. This duration helps differentiate chronic from acute conditions, reflecting a prolonged inflammatory or degenerative process that requires different management strategies compared to acute conditions.
Acute (symptom duration <6 weeks)
Acute arthropathies are usually due to infections, crystal-induced reactions, or reactive causes.
Chronic (>6 weeks).
Chronic conditions encompass noninflammatory and immunologic arthritides (like OA and RA) and nonarticular disorders (such as fibromyalgia).
- The Part of the spine responsible for a quarter of the total length of the spine is:
A. Intervertebral discs
B. Anterior ligaments
C. Posterior spine
D. Vertebral bodies
A. Intervertebral discs
Rationalization: The intervertebral discs contribute significantly to the length of the spinal column. They account for about one-quarter of the total length of the spine, acting as cushions between the vertebral bodies and allowing for flexibility and absorption of shocks.
- Cardinal signs of inflammation except:
A. Crepitations
B. Warm to touch
C. Swelling
D. Erythema and pain
A. Crepitations
Rationalization: The classical cardinal signs of inflammation include warmth, swelling, erythema (redness), and pain.
Crepitations, or crackling sounds typically heard in the joints, are not a classic sign of inflammation but are often more associated with structural changes in the joints such as those seen in osteoarthritis.
- Cancer-related back pain most commonly affects:
A. Thoracic spine
B. Lumbar spine
C. Sacrum
D. Cervical spine
A. Thoracic spine
Rationalization: Cancer-related back pain most commonly affects the thoracic spine. This area is a frequent site for metastatic disease due to the rich vascular supply and the presence of the vertebral venous plexus, which can harbor metastatic cells from primary cancers located elsewhere in the body.
- Bed rest is recommended to a maximum of 2 days even for relief of severe symptoms of acute low back pain.
A. True
B. Maybe
C. False
A. True
Rationalization: Current guidelines generally recommend limiting bed rest during episodes of acute low back pain. Extended bed rest can lead to muscle atrophy and deconditioning, worsening recovery outcomes. Limiting bed rest to no more than 2 days can help maintain physical conditioning and potentially reduce recovery time.
- Articular disorders may be characterized by the following except:
A. Swelling or deformity
B. Pain aggravated by active and passive range of motion
C. Pain aggravated by active range of motion
D. Crepitus
C. Pain aggravated by active range of motion
Rationalization: In articular disorders, pain typically increases with both active and passive range of motion due to joint involvement. Option C suggests pain only with active movement, which is more characteristic of periarticular or musculotendinous conditions where the pain primarily arises from muscle activity rather than joint movement itself.
17 A 42 year old diabetic, with an HBA1c 11%, sought consultation due to intense neck pain. This started after he noted some vesicular rashes at the neck. This is due to:
A. Measles
B. Cervical angina syndrome
C. Herpes zoster
D. Chicken pox
C. Herpes zoster
Rationalization: A diabetic patient with an HBA1c of 11% presenting with intense neck pain and vesicular rashes likely has Herpes zoster (shingles), which is caused by reactivation of the varicella-zoster virus. The description of vesicular rashes localized to a specific area is typical of shingles, which can cause severe pain.
- Bedside maneuver/s used to diagnose Carpal Tunnel syndrome:
A. All of the above
B. Only Tinel’s sign and Phalen’s test
C. Phalen’s test
D. Tinel’s sign
E. Finkelstein’s test
B. Only Tinel’s sign and Phalen’s test
Rationalization: Tinel’s sign and Phalen’s test are specific bedside maneuvers used to diagnose Carpal Tunnel Syndrome. Tinel’s sign involves tapping over the median nerve at the wrist to elicit a tingling sensation in the fingers, and Phalen’s test involves flexing the wrist for about a minute to provoke symptoms. Finkelstein’s test is used for diagnosing De Quervain’s tenosynovitis, not Carpal Tunnel Syndrome.
- The term that refers to the inflammation of the tendinous or ligamentous insertions on bone is:
A. Subluxation
B. Contracture
C. Epicondylitis
D. Enthesitis
D. Enthesitis
Rationalization: Enthesitis refers to inflammation at the site where tendons or ligaments insert into the bone. It is commonly associated with conditions like ankylosing spondylitis or psoriatic arthritis. Epicondylitis refers specifically to inflammation of the tendon attachments at the elbow, and while related, is not as broad a term as enthesitis.
- The reverse straight-leg raising sign indicates which damaged nerve at:
A. All of the above
B. Contralateral side of the pain
C. Ipsilateral side of the pain
D. None of the above
C. Ipsilateral side of the pain
The reverse straight-leg raising sign involves passive extension of the leg backwards, which stretches the L2-4 nerve roots, the lumbosacral plexus, and the femoral nerve passing anterior to the hip. If this maneuver results in reproducing the patient’s usual back or limb pain, it indicates a nerve or nerve root lesion on the same side (ipsilateral) as the pain.
- Pain at the medial arm and axilla indicates damage to:
A. C5 nerve root
B. C7 nerve root.
C. C6 nerve root
D. C8 nerve root
E. T1 nerve root
E. T1 nerve root
Rationalization: Pain at the medial arm and axilla is indicative of damage to the T1 nerve root. This nerve root innervates areas that include the inner forearm down to the hand, and symptoms in this distribution suggest involvement of this lower cervical nerve root.
- The following are considered triggers for gout :
A. None of the above
B. Chemotherapy
C. All of the above
D. Renal insufficiency
E. Diuretics
C. All of the above
Rationalization: Triggers for gout can include chemotherapy, renal insufficiency, and diuretics. Chemotherapy can increase uric acid production; renal insufficiency can decrease its excretion; diuretics can alter kidney function, affecting uric acid levels as well.
- Pain at the anterolateral thigh, medial calf and knee indicates damage of:
A. L4 nerve root
B. S1 nerve root
C. L2 nerve root
D. L5 nerve root
A. L4 nerve root
Rationalization: Pain in the anterolateral thigh, medial calf, and knee typically indicates damage to the L4 nerve root. This nerve root affects these specific areas, and symptoms there would suggest its involvement.
Additional Notes:
Straight Leg-Raising Sign: Present for L5 and S1 nerve roots, indicating sciatic nerve irritation or damage when pain is reproduced by lifting the leg.
Reverse Straight Leg-Raising Sign: Also relevant for assessing lower back pain and potential nerve root issues.
LUMBOSACRAL NERVE ROOTS (PAIN DISTRIBUTION):
* L2: Pain in the anterior thigh.
* L3: Pain in the anterior thigh and knee.
* L4: Pain in the anterolateral thigh, knee, and medial calf.
* L5: Pain in the lateral calf, dorsal foot, posterolateral thigh, and buttocks.
* S1: Pain in the posterior calf, posterior thigh, bottom foot, and buttocks.
- Carpal tunnel syndrome results from compression of which nerve?
A. Superficial branch of the radial nerve
B. All of the above
C. None of the above
D. Ulnar nerve
E. Median nerve
E. Median nerve
Rationalization: Carpal tunnel syndrome results from the compression of the median nerve as it travels through the carpal tunnel in the wrist. This nerve primarily provides sensation to the thumb, index, middle, and part of the ring finger, and controls some small muscles at the base of the thumb.
- Pain at the anterolateral thigh, medial calf and knee indicates damage of:
A. L4 nerve root
B. S1 nerve root
C. L2 nerve root
D. L5 nerve root
A. L4 nerve root
Rationalization: Pain in the anterolateral thigh, medial calf, and knee typically indicates damage to the L4 nerve root. This nerve root affects these specific areas, and symptoms there would suggest its involvement
LUMBOSACRAL NERVE ROOTS (PAIN DISTRIBUTION):
* L2: Pain in the anterior thigh.
* L3: Pain in the anterior thigh and knee.
* L4: Pain in the anterolateral thigh, knee, and medial calf.
* L5: Pain in the lateral calf, dorsal foot, posterolateral thigh, and buttocks.
* S1: Pain in the posterior calf, posterior thigh, bottom foot, and buttocks.
- Chronic low back pain is defined as:
A. Duration of more than 6 months
B. Duration of more than 1 month
C. Duration of more than 12 weeks
D. Duration of more than 8 weeks
C. Duration of more than 12 weeks
Rationalization: Chronic low back pain is commonly defined as pain that persists for more than 12 weeks. This duration helps differentiate it from acute back pain, suggesting ongoing pathological processes or failed healing that requires more extensive management.
- The most common cause of cauda equina syndrome is:
A. Tumor compression
B. Lumbosacral spine fracture
C. Large ruptured lumbosacral intervertebral disc
D. Hematoma in the spinal canal
C. Large ruptured lumbosacral intervertebral disc
Rationalization: The most common cause of cauda equina syndrome is a large ruptured lumbosacral intervertebral disc. This condition causes compression of the nerve roots below the level of the spinal cord termination, resulting in severe back pain, neurological deficits, and bladder and bowel dysfunction.
- A positive Crossed straight leg-raising sign is a specific indicator for:
A. Femoral nerve damage
B. L2-L4 nerve root damage
C. Lumbosacral plexus damage
D. Disc herniation
D. Disc herniation
Rationalization: A positive Crossed Straight Leg Raising (CSLR) test, which involves lifting the unaffected leg and producing pain in the affected leg, is a specific indicator for lumbar disc herniation. This test increases intrathecal pressure and tension on the nerve roots, typically those compressed by a herniated disc.
- Diseases affecting the UPPER lumbar spine refer pain to which location:
A. Anterior thighs
B. Calves
C. Buttocks
D. Posterior thighs
A. Anterior thighs
Rationalization: Diseases affecting the upper lumbar spine (such as L1-L2) often refer pain to the anterior thighs. This region is innervated by nerves originating from the upper lumbar segments, and pathologies in these areas can lead to pain being felt in this specific location.
- Breakaway weakness is due to:
A. None of the above
B. Inattention
C. All of the above
D. Pain
E. Lack of effort during examination
C. all of the above
- Focal muscle atrophy reflect injury to:
A. None of the above
B. Peripheral nerve
C. Anterior horn cells of the spinal cord
D. All of the above
E. Nerve root
D. All of the above
Rationalization: Focal muscle atrophy can result from injury to the peripheral nerve, nerve root, or anterior horn cells of the spinal cord. Each of these components plays a crucial role in neuromuscular transmission and muscle innervation. Damage to any can lead to decreased stimulation and subsequent muscle atrophy.
- Crossed straight leg raising maneuver points to the affected nerve root at the:
a. All of the above
b. Ipsilateral side of the pain
c. None of the above
d. Contralateral side of the pain
d. Contralateral side of the pain
Rationalization: The Crossed Straight Leg Raising (CSLR) maneuver is specific for disc herniation compressing a nerve root and elicits pain in the contralateral leg. This maneuver increases the intrathecal pressure and tension on the nerve roots, typically those pinched by a herniated disc on the opposite side of where the leg is raised.
The regular SLR and the Reverse SLR signs are indicative of an issue on the ipsilateral side of the pain.
The Crossed SLR sign indicates an issue on the contralateral side of the pain.
- Pain at the posterior thigh, posterior calf and bottom of the foot indicates damage to:
A. L4 nerve root
B. S1 nerve root
C. L5 nerve root
D. L2 nerve root
B. S1 nerve root
Rationalization: Pain that radiates to the posterior thigh, posterior calf, and bottom of the foot typically indicates damage to the S1 nerve root. This nerve root affects these specific areas, and symptoms there would suggest its involvement.
LUMBOSACRAL NERVE ROOTS (PAIN DISTRIBUTION):
* L2: Pain in the anterior thigh.
* L3: Pain in the anterior thigh and knee.
* L4: Pain in the anterolateral thigh, knee, and medial calf.
* L5: Pain in the lateral calf, dorsal foot, posterolateral thigh, and buttocks.
* S1: Pain in the posterior calf, posterior thigh, bottom foot, and buttocks.
- Which bedside maneuver is done by asking the patient to bend the thumb across the palm and bend the fingers down over the thumb, then ask the patient to bend the hand towards the middle finger. Pain at the base of the thumb is positive for de Quervain’s tenosynovitis.
A. None of the above
B. All of the above
C. Finkelstein’s test
D. Phalen’s sign
E. Tinel’s sign
C. Finkelstein’s test
Rationalization: Finkelstein’s test is specifically designed to diagnose de Quervain’s tenosynovitis. It involves the patient making a fist with the thumb tucked inside the fingers, then ulnar deviating the wrist, which stresses the tendons affected in de Quervain’s and can elicit pain if the condition is present.
35 Examples of chronic musculoskeletal conditions are the following except:
A. Gouty arthritis
B. Fibromyalgia
C. Osteoarthritis
D. Rheumatoid arthritis
A. Gouty arthritis
Rationalization: Gouty arthritis, although it can have chronic implications, is primarily characterized as an episodic and acute inflammatory response to urate crystal deposition rather than a continuously persistent musculoskeletal condition like fibromyalgia, osteoarthritis, or rheumatoid arthritis. These latter conditions are marked by chronic progression and persistent symptoms.
36 Radiographic test that is best for imaging the lateral recess of the spinal canal and define body abnormalities:
A. CT scan
B. CT myelography
C. X-ray of the spine
D. MRI
B. CT myelography
Rationalization: CT myelography is particularly effective for imaging the lateral recess of the spinal canal and defining bony abnormalities. While MRI provides excellent detail of soft tissue structures, CT myelography combines the use of a contrast dye with CT imaging to give a detailed view of both bone and nerve structures, making it superior for certain types of spinal diagnostics, particularly in complex cases where bony architecture is involved.
- Pain at the posterolateral thigh, lateral calf and dorsal foot indicates damage to:
A. L2 nerve root
B. L4 nerve root
C. L5 nerve root
D. S1 nerve root
C. L5 nerve root
Rationalization: Pain that radiates to the posterolateral thigh, lateral calf, and dorsal foot typically indicates damage to the L5 nerve root. This pattern of pain distribution aligns with the sensory innervation provided by the L5 nerve root.
LUMBOSACRAL NERVE ROOTS (PAIN DISTRIBUTION):
* L2: Pain in the anterior thigh.
* L3: Pain in the anterior thigh and knee.
* L4: Pain in the anterolateral thigh, knee, and medial calf.
* L5: Pain in the lateral calf, dorsal foot, posterolateral thigh, and buttocks.
* S1: Pain in the posterior calf, posterior thigh, bottom foot, and buttocks.
- Non-articular disorders are characterized by:
A. Swelling or deformity
B. Pain aggravated by active and passive range of motion
C. Pain aggravated by active but not passive range of motion
D. Crepitations
C. Pain aggravated by active but not passive range of motion
Rationalization: Non-articular disorders are characterized by pain that is typically aggravated by active movements but not by passive movements. This indicates that the disorder affects the muscles or tendons rather than the joints themselves. Passive movement causing no pain helps differentiate non-articular from articular conditions, where both types of movement would typically cause pain.
- Sarcoidosis and SLE more commonly affects:
A. Whites
B. Asians
C. African Americans
D. Ethnic groups
C. African Americans
Rationalization: Sarcoidosis and Systemic Lupus Erythematosus (SLE) are more commonly seen in African Americans than in other ethnic groups. Both conditions show a higher prevalence and often more severe manifestations in African American populations compared to Whites and other races.
- An example of non-inflammatory musculoskeletal disorder is:
A. systemic lupus erythematosus
B. osteoarthritis
C. gouty arthritis
D. rheumatoid arthritis
B. osteoarthritis
Rationalization: Osteoarthritis is an example of a non-inflammatory musculoskeletal disorder. It is primarily a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone, typically due to wear and tear, rather than driven by systemic inflammation as seen in conditions like rheumatoid arthritis or gouty arthritis.
- Drug prescribed for dyslipidemia that causes drug-induced musculoskeletal complaints:
A. All of the above
B. Fish oil
C. Fenofibrate
D. HMG-CoA reductase inhibitors (statins)
D. HMG-CoA reductase inhibitors (statins)
Rationalization: Statins, or HMG-CoA reductase inhibitors, are well-documented for causing musculoskeletal complaints, including myalgia, muscle weakness, and in rare cases, rhabdomyolysis. This class of drugs is used widely in the treatment of dyslipidemia to reduce cholesterol levels but can have these adverse effects due to their impact on muscle tissue.
- Cause of inflammatory musculoskeletal disorders:
A. Infection
B. All of the above
C. Reactive immune-mediated
D. None of the above
B. All of the above
Rationalization: Inflammatory musculoskeletal disorders can be caused by a variety of factors including infections (such as septic arthritis), and reactive immune-mediated responses (like rheumatoid arthritis or reactive arthritis). These conditions are characterized by inflammation of joints and other musculoskeletal structures, often leading to pain, swelling, and impaired function.
- Pain-sensitive structures of the spine except:
A. Annulus fibrosus
B. Facet joints
C. Dura
D. Nucleus pulposus
D. Nucleus pulposus
Rationalization: The nucleus pulposus itself is not pain-sensitive; it is the gel-like center of the intervertebral disc that, when herniated, can impinge on nearby pain-sensitive structures such as the annulus fibrosus, nerve roots, and facet joints. The annulus fibrosus, facet joints, and dura mater surrounding nerve roots are pain-sensitive and can cause significant pain when diseased or injured.
- Pain involving the posterior arm, dorsal forearm and dorsal hand indicates damage to:
A. T1 nerve root
B. C6 nerve root
C. C8 nerve root
D. C7 nerve root
E. C5 nerve root
D. C7 nerve root
CERVICAL NERVE ROOTS (PAIN DISTRIBUTION):
* C5:Pain in the lateral arm and medial scapula.
* C6: Pain in the lateral forearm and thumb/index fingers.
* C7:Pain in the posterior arm, dorsal forearm, and dorsal hand.
* C8:Pain in the fourth and fifth fingers, medial hand, and forearm.
* T1:Pain in the medial arm and axilla.
- The nerve roots exit below their respective vertebral bodies in the thoracic and lumbar regions and follow a short intraspinal course before exiting.
A. False
B. True
C. Maybe
A. False
Rationalization: In the thoracic and lumbar regions, the nerve roots do exit below their respective vertebral bodies, but they follow a longer intraspinal course before exiting. This is different from the cervical spine where nerve roots exit above their respective vertebral bodies.
- Pain at the lateral forearm, thumb and index finger indicates damage to:
A. C8 nerve root
B. T1 nerve root
C. C6 nerve root
D. C7 nerve root
E. C5 nerve root
C. C6 nerve root
Rationalization: Pain at the lateral forearm, thumb, and index finger typically indicates damage to the C6 nerve root. This nerve root innervates the areas including the thumb and index finger, and its impairment can result in sensory disturbances and pain in these specific regions.
CERVICAL NERVE ROOTS (PAIN DISTRIBUTION):
* C5:Pain in the lateral arm and medial scapula.
* C6: Pain in the lateral forearm and thumb/index fingers.
* C7:Pain in the posterior arm, dorsal forearm, and dorsal hand.
* C8:Pain in the fourth and fifth fingers, medial hand, and forearm.
* T1:Pain in the medial arm and axilla.
- The thoracic outlet syndrome (TOS) that does not respond to treatment even with multidisciplinary pain management:
A. Arterial TOS
B. True neurogenic TOS
C. Venous TOS
D. Disputed TOS
D. Disputed TOS
Rationalization: Disputed thoracic outlet syndrome (TOS) is a controversial diagnosis because it lacks clear diagnostic criteria and objective tests. Patients with this condition often present with nonspecific symptoms that don’t clearly fit arterial, venous, or true neurogenic TOS, and they may not respond well to treatment, even with multidisciplinary approaches.
- Part of the spine that protects the spinal cord and nerve roots:.
A. Anterior ligaments
B. Posterior ligaments
C. Posterior spine
D. Anterior spine
C. Posterior spine
Rationalization: The posterior spine (including the vertebral arches and processes) plays a crucial role in protecting the spinal cord and nerve roots by forming the vertebral canal, where the spinal cord is housed. The bony structure of the posterior elements of the spine, including the laminae and pedicles, offers mechanical protection against injuries from the back.
- True or false:
Focal muscle atrophy reflect atrophy of disuse.
A. Maybe
B. False
C. True
B. False
Rationalization: Focal muscle atrophy can indeed reflect disuse, but it can also be caused by nerve damage, not just disuse. Therefore, stating that it only reflects atrophy of disuse is incorrect. Focal muscle atrophy can also result from nerve injury or disease affecting the muscles or nerves supplying them, making the statement too narrow.
- Diseases affecting the LOWER lumbar spine tend to produce pain at which location:
A. Lumbar region
B. Posterior thighs
C. Anterior thighs
D. Groin
B. Posterior thighs
- Causes of non-inflammatory musculoskeletal disorders except:.
A. Repetitive use
B. Trauma
C. Crystal-induced
D. Degeneration
C. Crystal-induced
Rationalization: Crystal-induced disorders, such as gout and pseudogout, are considered inflammatory conditions because the presence of crystals in the joint space induces an inflammatory response. Repetitive use, trauma, and degeneration typically cause non-inflammatory musculoskeletal disorders such as osteoarthritis (which is primarily degenerative rather than inflammatory), making crystal-induced disorders the exception among the options given.
63 The thoracic outlet syndrome (TOS) that presents with weakness and wasting of the intrinsic muscles of the hand accompanied by numbness on the palmar aspect of the fifth digit:
A. Disputed TOS
B. Arterial TOS
C. Venous TOS
D. Neurogenic TOS
D. Neurogenic TOS
Rationalization: The presentation of weakness and wasting of the intrinsic muscles of the hand accompanied by numbness on the palmar aspect of the fifth digit is characteristic of neurogenic thoracic outlet syndrome (TOS). Neurogenic TOS involves compression of the brachial plexus, leading to neurological symptoms in the areas innervated by the affected nerves.
- Straight leg-raising maneuver points to the affected nerve root at the:
A. Ipsilateral side of the pain
B. Contralateral side of the pain
C. None of the above
D. All of the above
A. Ipsilateral side of the pain
Rationalization: The straight leg-raising (SLR) maneuver is typically used to identify lumbar nerve root irritation, particularly the L5 and S1 nerve roots. Pain elicited on the side of the leg being raised (ipsilateral side) suggests nerve root compression or irritation on that same side.
- The largest intervertebral discs are located in the:
A. Cervical and lumbar
B. Thoracic and lumbar
C. Cervical and thoracic
D. Lumbar and sacral
A. Cervical and lumbar
Intervertebral discs
Largest in areas of greatest movement, specifically in the cervical and lumbar regions.
- Pain at the lateral arm and medial scapula indicates damage to:
A. C8 nerve root
B. C6 nerve root
C. C7 nerve root
D. C5 nerve root
E. T1 nerve root
D. C5 nerve root
- The straight-leg raising (SLR) maneuver stretches which nerve?
A. L5 and S1
B. Sciatic nerve and L5-S1 only
C. L2 and L4
D. Sciatic nerve
B. Sciatic nerve and L5-S1 only
Rationalization: The Straight Leg-Raising (SLR) maneuver specifically stretches the sciatic nerve along with the L5 and S1 nerve roots. This maneuver involves passive flexion of the leg at the hip while the patient is in a supine position, aiming to elicit pain that replicates sciatica, typically indicating the presence of lower lumbar nerve root irritation or compression, particularly at the L5 or S1 levels. This method is used to evaluate lumbar radiculopathy and can be a valuable diagnostic tool in assessing conditions affecting the lower spine.
- Red flag conditions to be considered for acute mono-articular disorder except:
A. Carpal tunnel syndrome
B. Rheumatoid arthritis
C. Gout
D. Septic arthritis
B. Rheumatoid arthritis
Consider “red flag” condition
* Gout
* Septic arthritis
* Fracture
* Vascular ischemia
* Carpal tunnel syndrome
- Part of the spine that absorbs shock from walking and running:
A. Posterior ligaments
B. Anterior spine
C. Anterior ligaments
D. Posterior spine
B. Anterior spine
- Depression and insomnia are associated comorbities for fibromyalgia.
A. True
B. Maybe
C. False
A. True
Rationalization: Depression and insomnia are indeed commonly associated comorbidities with fibromyalgia. Fibromyalgia is characterized by chronic widespread pain, fatigue, and sleep disturbances. These symptoms can significantly impact psychological health, often leading to depression and chronic insomnia, complicating the management of the disease.
- Cancer is a comorbidity for myositis.
A. Maybe
B. False
C. True
C. True
Rationalization: Cancer is recognized as a significant comorbidity for myositis, particularly for certain types, such as dermatomyositis. There is a well-established association known as paraneoplastic syndrome, where myositis can be a manifestation of an underlying malignancy.
- Pain at the anterior thigh indicates which nerve root damage:
A. L5 nerve root
B. L2 nerve root
C. L4 nerve root
D. S1 nerve root
B. L2 nerve root
LUMBOSACRAL NERVE ROOTS (PAIN DISTRIBUTION):
* L2: Pain in the anterior thigh.
* L3: Pain in the anterior thigh and knee.
* L4: Pain in the anterolateral thigh, knee, and medial calf.
* L5: Pain in the lateral calf, dorsal foot, posterolateral thigh, and buttocks.
* S1: Pain in the posterior calf, posterior thigh, bottom foot, and buttocks.
- The thoracic outlet syndrome (TOS) caused by an anomalous band of tissue connecting the transverse process of C7 to the first rib :
A. Venous TOS
B. Disputed TOSC
C. True neurogenic TOS
D. Arterial TOS
C. True neurogenic TOS
Rationalization: True neurogenic TOS is caused by compression of the brachial plexus, often due to anatomical abnormalities such as an anomalous band of tissue connecting the transverse process of C7 to the first rib. This condition results in neurological symptoms including pain, numbness, and muscle weakness in the affected arm.
- The thoracic outlet syndrome (TOS) that presents with decrease blood pressure in the affected arm, signs of emboli but absent neurologic deficits is:
A. True neurogenic TOS
B. Arterial TOS
C. Venous TOS
D. Disputed TOS
B. Arterial TOS
Rationalization: Arterial thoracic outlet syndrome (TOS) presents with vascular symptoms such as decreased blood pressure in the affected arm and signs of emboli but typically lacks neurologic deficits. This form of TOS involves compression of the subclavian artery, which can lead to these specific vascular manifestations.
- The most common thoracic outlet syndrome (TOS) is:
A true neurogenic TOS
B arterial TOS
C disputed TOS
D venous TOS
C. Disputed TOS
Rationalization: Disputed TOS is the most common type of thoracic outlet syndrome, characterized by chronic pain in the absence of clear neurovascular compression that can be definitively diagnosed through imaging or electrophysiological studies. Patients often have nonspecific symptoms that do not meet the criteria for true neurogenic or vascular TOS.
- The duration of acute low back pain is:
A. Less than 4 weeks
B. Less than 5 months
C. Less than 3 months
D. Less than 6 months
C. Less than 3 months
Acute low back pain is defined as pain of less than 12 weeks duration, which equates to approximately 3 months. This timeframe is critical for distinguishing between acute and chronic back pain conditions.
- True or false:
Diabetes is a comorbidity of carpal tunnel syndrome.
A. True
B. Maybe
C. False
A. True
Rationalization: Diabetes is indeed a comorbidity of carpal tunnel syndrome. Individuals with diabetes are at an increased risk for carpal tunnel syndrome due to factors like glycosylation of tissues which can lead to thickening and stiffness, thereby increasing susceptibility to nerve compression within the restricted space of the carpal tunnel.
- Non-Inflammatory musculoskeletal disorders are characterized by:
A. Articular stiffness of prolonged duration (hours) and improves with activity
B. Systemic symptoms may be present such as fever, weight loss and rash
C. Intermittent stiffness or gel phenomenon exacerbated by activity
D. Profound fatigue
E. All of the above
C. Intermittent stiffness or gel phenomenon exacerbated by activity
Rationalization: Non-inflammatory musculoskeletal disorders are typically characterized by intermittent stiffness or a gel phenomenon that gets worse with activity. These conditions generally do not include systemic symptoms like fever or weight loss, nor do they exhibit articular stiffness of prolonged duration that improves with activity, which are more indicative of inflammatory conditions.
- Absence of ankle reflexes can be a normal finding in patients older than 60 years old
A. False
B. True
C. Maybe
B. True
Absent ankle reflexes can be normal in persons over 60 years or may indicate bilateral S1 radiculopathies.
