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Advanced Spine > M1 Multiple Choice Quizzes > Flashcards

M1 Multiple Choice Quizzes Flashcards

1
Q

Which of the following is NOT an appropriate reason for using a classification approach to LBP?

A. Pt outcomes are improved
B. Tx approaches are more standardized
C. Clinic billing is simplified
D. Communication between PTs is improved

A

C. Clinic billing is simplified

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2
Q

Which of the following is most likely to ‘rule in’ lumbar spinal stenosis?

A. Walking worsens and sitting improves
B. Worsens with walking and sitting
C. Sitting worsens and walking improves
D. Improves with walking and sitting

A

A. Walking worsens and sitting improves

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3
Q

In a pt with significant back pain who has also used oral steroids long term, _______ should be assumed until proven otherwise.

A. Serious infection
B. Kidney problems
C. Fracture
D. Claudication

A

C. Fracture

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4
Q

A smoker with LBP is more likely to have which of the following?

A. Ankylosing spondylitis
B. Vascular claudication
C. Cauda equina
D. Serious infection

A

B. Vascular claudication

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5
Q

Morning stiffness for more than 30 minutes, waking in the second half of the night, and better with exercise than rest are indicative of

A. Ankylosing spondylitis
B. Spinal infection
C. Osteoarthritis
D. Rheumatoid arthritis

A

A. Ankylosing spondylitis

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6
Q

A pt who has been seen for a week for direction specific exercise now reports new tingling in her buttocks and vulva. There are no other new sensory or motor complaints. The best response to this is:

A. Do a thorough neuro exam during today’s visit and possibly make an immediate referral
B. Monitor this symptom closely and make an immediate referral if it doesn’t resolve in the next few visits
C. Call the referring physician and inform him/her of the new symptoms and ask if you can send the pt over immediately for evaluation
D. Stop today’s visit immediately and send the pt to the nearest emergency room for neuro evaluation

A

A. Do a thorough neuro exam during today’s visit and possibly make an immediate referral

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7
Q

A LBP pt who is appropriate for traction is most likely to also have which of the following?

A. Pregnancy
B. Core weakness
C. Stiffness
D. Leg pain

A

D. Leg pain

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8
Q

What two psychological conditions should a PT screen for early in an episode of care for LBP?

A. Fear avoidance and anxiety disorders
B. Anxiety disorders and depression
C. Depression and fear avoidance
D. Bipolar disorder and depression

A

C. Depression and fear avoidance

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9
Q

Bilateral swelling can be another clue that a pt may have

A. Spinal infection
B. Aortic aneurysm
C. Neurogenic claudication
D. Kidney problems

A

D. Kidney problems

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10
Q

A pt with an acute abdominal aortic aneurysm is most likely to NOT have which of the following characteristics?

A. Other vascular problems
B. Throbbing pain not related to movement
C. Female sex
D. Constant symptoms

A

C. Female sex

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11
Q

A sedentary job is _____ likely to cause LBP when compared to a job requiring lots of heavy lifting

A. Equally
B. Less
C. More

A

A. Equally

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12
Q

Your pt had 6/10 pain on admission and now 2 weeks later reports 4/10. Has he improved? Why or why not?

A

Yes

MCID ≥ 2

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13
Q

Your pt reports being stiff in the morning for 45 minutes. Which of the following is most likely to be the source of her pain?

A. Degenerative musculoskeletal
B. Systemic inflammatory
C. Mechanical LBP
D. Visceral referred pain

A

A. Degenerative musculoskeletal

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14
Q

Which of the following is NOT associated with long-term oral steroids?

A. AVN
B. OA
C. Higher risk of infection
D. Muscle weakness

A

B. OA

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15
Q

Your pt has a compression fx and severe pain. She is taking an opiate pain medication for the pain and it helps significantly. If you could only warn her about one common side effect, which one will you discuss with her? Why?

A. Nausea
B. Addiction
C. Dizziness
D. Constipation

A

C. Dizziness (immediate danger of fall)

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16
Q

Your pt has had an MRI that revealed “multilevel degenerative disc disease.” Which of the following is LEAST likely to be a NEGATIVE effect of this radiologic exam?

A. Less likely to believe PT dx if different
B. Increased fear avoidance and reduced participation in exercise
C. Inappropriate reduction in general physical activity
D. Scared into being more motivated to listen and improve

A

D. Scared into being more motivated to listen and improve

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17
Q

Your pt has a rapid onset of acute LBP and right calf pain. His _____ is likely to improve his px but his _____ is likely to worsen it.

A. Recent onset, leg pain
B. Leg pain, rapid onset
C. NA - he has an overall good px
D. NA - he has an overall poor px

A

A. Recent onset, leg pain

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18
Q

The Patient Specific Functional Scale is applicable only to spine pts

A. True
B. False

A

B. False

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19
Q

A high Oswestry score suggests a high level of function

A. True
B. False

A

B. False

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20
Q

During the subjective exam, a pt with recent onset LBP says her MRI shows a disc bulge at L4-5 disc. There do not appear to be any subjective neuro sx or red flags. The therapist should

A. As for a copy of the radiology report to verify accuracy of it before you begin tx
B. Finish their exam to see whether the findings are related to the MRI report
C. Ignore this info because MRI findings aren’t reliable or valid

A

B. Finish their exam to see whether the findings are related to the MRI report

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21
Q

A pt says that standing makes their LBP worse and sitting makes it better. Prone lying is

A. Likely to increased their pain
B. Not likely to increase their pain
C. Probably unpredictable

A

A. Likely to increased their pain

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22
Q

A pt says that extension makes his pain worse and flexion makes it better. He is most likely to have a _____ disc herniation

A. Anterior
B. Posterior

A

A. Anterior

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23
Q

A pt says that L side lying on a soft mattress increases her R LE pain. On a firm mattress, this position doesn’t increase her pain so much. This pt’s pain is likely to be related to

A. L lateral flexion
B. R lateral flexion

A

B. R lateral flexion

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24
Q

A pt says that sidelying WITH a pillow between his knees feels better than without a pillow. The pillow is probably ____ the amount of rotation that his lumbar spine is in

A. Decreasing
B. Increasing

A

A. Decreasing

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25
Q

A large disc herniation that is revealed by an MRI is _____ to be related to their LBP

A. Likely
B. Unlikely

A

A. Likely

26
Q

Pain from a chemical source is likely to be

A. Severe
B. Constant
C. Superficial
D. Deep

A

B. Constant

27
Q

Which of the following is least likely to help establish the relationship between two areas of pain?

A. Descriptors used for each
B. Duration of each
C. Onset of each
D. Effect of agg factor on each

A

A. Descriptors used for each

28
Q

If a pt who reports pain while sleeping, the PT should

A. Refer for further eval
B. Ask what it is that wakes him or her
C. Change his or her sleep position
D. Find out what kind of bed is being used

A

B. Ask what it is that wakes him or her

29
Q

Assessing 24-hour behavior means

A. Typing pain ratings to the past 24 hours
B. Asking about pain at various times of day
C. The PT is doing a pt centered interview
D. The PT will be able to set specific goals

A

B. Asking about pain at various times of day

30
Q

Why or when would tying pain ratings to the past 24 hours not be considered assessing 24-hour behavior?

A

Would ask about past 24 hours at reassessment, but not for someone who has had LBP for a few years

31
Q

Paresthesia

A. Means that numbness is present also
B. Indicates that a referral is necessary
C. Indicates that neurologic structures are involved
D. Is an example of a hard neuro sign

A

C. Indicates that neurologic structures are involved

32
Q

The neuromatrix theory of pain

A. Pain cannot occur in the absence of noxious stimulation
B. All pain actually arises from the CNS and not the PNS
C. Cognition, sensation, and motivation impact pain perception
D. Only applies to the development of chronic pain

A

C. Cognition, sensation, and motivation impact pain perception

33
Q

S.I.N.S.S.

A. Verify the subjective exam is complete
B. Decide whether or not a limited objective exam is needed
C. Determine whether a referral is needed
D. Organize the components of an efficient subjective exam

A

B. Decide whether or not a limited objective exam is needed

34
Q

A pt seems to have a great deal of anxiety about her first episode of LBP. It is out of proportion to the severity and duration of her sx, but she does not have any hx or other indicators of an overall anxiety disorder. This is an example of a

A. Red flag which suggests a referral is needed for further diagnoses
B. Orange flag which suggests that further psychiatric screening is needed
C. Yellow flag which negatively impacts her px for recovery
D. Blue flag which suggests that specific workplace interventions will be needed

A

C. Yellow flag which negatively impacts her px for recovery

35
Q

A pt seems to have a great deal of anxiety about her first episode of LBP. It is out of proportion to the severity and duration of her sx, but she does not have any hx or other indicators of an overall anxiety disorder. This is an example of a

Why is this a yellow flag?

A

She doesn’t have any other indications of a psychiatric disorder

36
Q

Which of the following is NOT an example of a black flag?

A. A pt is reliant on transportation which is so unreliable that many treatments have been missed
B. A pt is self-employed and unable to modify work duties or schedule to accommodate his injury
C. A pt has had to change providers multiple times for the same problem because he does transient work in two different states
D. A pt’s clinical depression has been exacerbated by the onset of LBP and she is having trouble adhering to HEP recommendations

A

D. A pt’s clinical depression has been exacerbated by the onset of LBP and she is having trouble adhering to HEP recommendations

37
Q

A pt reports constant bilateral posterior pelvic pain that is worst at night, especially when prone and which makes it difficult to fall asleep. He also has stiffness in the morning that doesn’t resolve until he gets to work and is a couple hours into a shift.

A. ThePT should finish a limited exam but consider referring for further eval
B. This suggests inflammation which is a MSK problem so no referral is needed
C. The PT should take his temperature because this would determine whether a referral is indicated or not
D. The PT should proceed with a full exam because a referral isn’t likely to be needed

A

A. The PT should finish a limited exam but consider referring for further eval

38
Q

A pt reports constant bilateral posterior pelvic pain that is worst at night, especially when prone and which makes it difficult to fall asleep. He also has stiffness in the morning that doesn’t resolve until he gets to work and is a couple hours into a shift.

Is bilateral pelvic pain necessarily a red flag? Why is it a potentially a red flag in this case?

A
  • Not necessarily a red flag
  • Combo of severe B night pain and the fact that the stiffness takes several hours to go away is excessive
  • Sounds more like AS
39
Q

Which of the following statements is most true?

A. Insidious onset of LBP almost always necessitates referral for further diagnostic evaluation
B. Insidious onset of LBP is more likely than sudden onset to suggest a referral is needed
C. Follow up questions

A

B. Insidious onset of LBP is more likely than sudden onset to suggest a referral is needed

40
Q

A pt reports constant but variable right sided deep achy LBP that has recently gotten more severe and has expanded to include the posterior right hip. The pain increases with certain movements and eases with others. Which of the following is most true?

A. His back pain is likely to be local somatic pain but his hip pain is radicular at referred
B. The ‘spreading’ of his LBP is probably a function of worsening of his somatic pain
C. The low back and hip pain can both be from a somatic source but because his is constant, the pain is probably the result of infection
D. This pain has a mechanical pattern of agg and ease, therefore the pain could not be originating from a tumor pressing on a spine structure

A

B. The ‘spreading’ of his LBP is probably a function of worsening of his somatic pain

41
Q

A pt says she has local lumbar pain and also calf pain. There is no thigh pain. These two areas _____ related to the same problem

A. Are
B. Are not
C. May be

A

C. May be

42
Q

What is the best reason for planning the objective exam?

A. Avoid unnecessary pain
B. Make a dx
C. Plan your exam
D. Save examination time

A

A. Avoid unnecessary pain

43
Q

A sedentary job is _____ likely to cause LBP when compared to a job requiring lots of material handling

A. Equally
B. Less
C. More

A

A. Equally (remember the U curve)

44
Q

Your pt reports being stiff in the morning for about 45min. Which of the following is most likely to be the source of her pain

A. Degenerative musculoskeletal
B. Systemic inflammatory-
C. Mechanical LBP
D. Visceral referred pain

A

A. Degenerative musculoskeletal

45
Q

Stiffness after rest is evident of:

A

inflammatory component

46
Q

Your pt reports being stiff in the morning for about 45min. Which of the following is most likely to be the source of her pain

Systemic inflammation would be likely if stiffness lasted:

A

an hour or longer

47
Q

Which of the following is NOT associated with long term oral steroids?

A. AVN
B. OA
C. Higher risk of infection
D. Muscle weakness

A

B. OA

48
Q

What are some of the issues seen with long term corticosteroid use?

A
  • AVN of femoral head
  • OP
  • Immunosuppression
  • Steroid-induced myopathy
49
Q

Your pt has compression fracture and severe pain. She is taking an opiate pain med for the pain and it helps significantly. If you could only warn her about one common side effect, which one will you discuss with her and why?

A. Nausea
B. Addiction
C. Dizziness
D. Constipation

A

C. Dizziness

*inc risk of falls (immediate potential problem, this could happen today, could potentially lead to life-threatening side effects when she already has hx of fx)

50
Q

Your pt has had and MRI that revealed “multilevel degenerative disc disease”. Which of the following is LEAST likely to be a NEGATIVE effect of this radiologic exam?

A. Less likely to believe PT dx if different
B. Increased fear avoidance and reduced participation in exercise
C. Inappropriate reduction in general physical activity
D. Scared into being more motivated to listen and improve

A

D. Scared into being more motivated to listen and improve

51
Q

Your pt has rapid onset of acute LBP and right calf pain. His ___ is likely to improve his prognosis but his ____ is likely to worsen it.

B. Leg pain, rapid onset
C. NA- he has an overall good prognosis
D. NA- he has an overall poor prognosis

A

A. Recent onset, leg pain

52
Q

The Patient Specific Functional Scale is applicable only to spine patients

A. True
B. False

A

B. False

53
Q

A high Oswestry score suggests a high level of function

A. True
B. False

A

B. False

54
Q

With a disability index, a higher score =

A

higher disability

55
Q

During the subjective exam, a pt with recent onset LBP says her MRI shows a disc bulge at their L4-5 disc. There do not appear to be any subjective neuro symptoms or red flags. The therapist should

A. Ask for a copy of the radiology report to verify accuracy of this report before you begin treatment
B. Finish your exam to see whether the exam findings are related to their MRI report
C. Ignore this info bc MRI findings aren’t reliable or valid

A

B. Finish your exam to see whether the exam findings are related to their MRI report

56
Q

A pt says that standing makes their LBP worse and sitting makes it better. Prone lying is

A. Likely to increase their pain
B. Not likely to increase their pain
C. Probably unpredictable

A

A. Likely to increase their pain

57
Q

A pt says that standing makes their LBP worse and sitting makes it better. Prone lying is likely to increase their pain. Why?

A

puts them into extension, similar to standing

58
Q

A pt says that extension makes his pain worse and flexion makes it better. He is most likely to have ____ disc herniation.

A. Anterior
B. Posterior

A

A. Anterior

59
Q

A pt says that left sidelying on a soft mattress increases her right LE pain. On a firm mattress, this position doesn’t increase her pain so much. This pt’s pain is likely to be related to

A. L lateral flexion
B. R lateral flexion

A

B. R lateral flexion

60
Q

A pt says that sidelying with a pillow between her knees feels better than without a pillow. The pillow probably ____ the amt of rotation that his lumbar spine is in.

A. Decreasing
B. Increasing

A

A. Decreasing

61
Q

A large disc herniation that is revealed by an MRI is ____ to be related to their LBP

A. Likely
B. Unlikely

A

A. Likely

Advanced Spine (50 decks)

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