Module 2

Question 1

MRIs utilize magnetic energy to create a magnetic field that is 90,000 times stronger than the earths magnetic field to create an image based on the molecular content of tissues within the body (True/False)

Answer 1

True

Question 2

MRI does not involve radiation (True/False)

Answer 2

True

Question 3

Does T1 or T2 provide better anatomical detail?

Answer 3

T1

Question 4

Does T1 or T2 have higher signal intensity for fat?

Answer 4

T1

Question 5

Does T1 or T2 have higher signal intensity for water?

Answer 5

T2

Question 6

On a T2 image, would inflammation appear whiter or darker than other tissues?

Answer 6

Whiter

Question 7

On a T1 image is bone or fattier tissue darker or lighter?

Answer 7

Lighter

Question 8

On a T2 image is bone or fattier tissue darker or lighter?

Answer 8

Darker

Question 9

What are the two mnemonics for a T2 image?

Answer 9

World war 2 (white water type 2)

H2O (white water type 2)

Question 10

What is gadolinium?

Answer 10

IV injection on imaging

Question 11

What does gadolinium do to T1?

Answer 11

Increases signal of T1

Question 12

What does gadolinium do to T2?

Answer 12

Decreases signal of T2

Question 13

What are the contraindications of getting an MRI?

Answer 13

Pacemakers

Claustrophobia

Obesity

Question 14

What are the characteristics to get an MRI?

Answer 14

Soft tissues (ligament, tendon, muscles, cartilage)

Vascular demyelinating disease

Neoplasm, infection, inflammation, or seizure

Post-acute CVA, TIA, or dementia

Question 15

What are the characteristics to get a CT scan?

Answer 15

Cortical bone (chest, abdomen, pelvis)

Fractures or loose bodies

Bony stenosis

Occult fractures in patients with osteoporosis

Initial evaluation CVA, trauma, or hemorrhage

Question 16

A CAT scan is another name for a CT scan (True/false)

Answer 16

True

Question 17

A CT scan generates 3-D images (True/False)

Answer 17

True

Question 18

What are the advantages of a CT scan compared to a MRI?

Answer 18

Evaluates osseus structures very well

Evaluates soft tissues moderately well

Evaluates cortical bone better than MRI

Lower expense and time than MRI

Question 19

Why is the risk of a CT scan potentially greater than a radiograph or MRI?

Answer 19

Due to radiation exposure

Question 20

What is the relationship between ultrasound frequency, penetration, and image resolution?

Answer 20

With higher frequency there is poorer penetration but high image

With lower frequency there is higher penetration but low image

Question 21

What is therapeutic ultrasound?

Answer 21

Treatment in heating (1930s)

Question 22

What is diagnostic ultrasound?

Answer 22

Imaging using reflection (1950s)

Question 23

What are the challenges of ultrasound with image generation?

Answer 23

Principles of sound wave propagation

Effects of different tissue densities

Effect of frequency on penetration and resolution

Question 24

What is Anechoic seen as on an ultrasound?

Answer 24

Black (fluid)

Question 25

What is Hypoechoic seen as on an ultrasound?

Answer 25

Grey (muscle, synovial tissue, or peripheral nerves)

Question 26

What is Hyperechoic seen as on an ultrasound?

Answer 26

Grey/white (bone, tendons, or fascia)

Question 27

What is a 2-5 MHz curved array used for in imaging?

Answer 27

Abdominal wall Multifidus Bladder images Diaphragm

Question 28

What is a 5-10 MHz linear array used for in imaging?

Answer 28

Transverse abdominus Multifidus Diaphragm

Question 29

What does the curved probe produce in imaging?

Answer 29

A wider and more in depth view

Question 30

What does a linear probe produce in imaging?

Answer 30

Square image with a good near field view but poor far view

Question 31

What can the orientation of the probe influence?

Answer 31

The plane of view

Question 32

What can ultrasound imaging be used for?

Answer 32

Biofeedback, neuromuscular reeducation, and performance testing

Question 33

Be able to recognize an image of the Multifidus and long head of biceps tendon on an ultrasound

Question 34

What is another name for Scintigraphy?

Answer 34

Bone scan

Question 35

What is a hot spot?

Answer 35

A darker region indicating an increase in uptake

Question 36

What is a cold spot?

Answer 36

Decreases in Boney metabolism

Question 37

What are health conditions associated with increased uptake on a bone scan?

Answer 37

Healing fractures Open growth plates Primary bone tumors Metastatic tumors Stress fractures Area of inflammation Areas of infection Increased vascularity

Question 38

What are health conditions associated with decreased uptake on a bone scan?

Answer 38

Avascular bone Certain metastases Areas of infection

Question 39

What assumption is made with respect to fMRI and cerebral blood flow?

Answer 39

That cerebral blood flow and neuronal activation or coupled

Question 40

What areas of physical therapy research have utilized fMRI in research based on this lecture?

Answer 40

Brain in pain Mechanisms of manual therapy

Question 41

What does electrophysiological testing assess?

Answer 41

Function and structural integrity of the PNS

Question 42

What does NCS/EMG provide?

Answer 42

Information regarding chronicity of nerve injury and longitudinal data for charting course

Question 43

What does NCS/EMG identify?

Answer 43

Combined multi-site injury, avoiding missed diagnoses and more global neuromuscular injury with focal onset

Question 44

What does NCS/EMG detect?

Answer 44

Dynamic and functional injury missed by MRI

Question 45

What does NCS/EMG clarify?

Answer 45

Clinical scenarios when one disorder mimics another

Question 46

What are the two things that NCS/EMG highly is?

Answer 46

Localizing and a sensitive indicator of early nerve injury

Question 47

What are the limitations of NCS/EMG?

Answer 47

Only assess large myelinated nerve fibers (temp and pain fibers not assessed)

Question 48

What are many nerves not amendable to?

Answer 48

NCS

Question 49

What is the only thing that is assessed with needle EMG?

Answer 49

Type 1 muscle fibers

Question 50

What is a motor unit?

Answer 50

An axon and all the muscle fibers it innervates

Question 51

What is evoked potential?

Answer 51

When the electrical event approaches, passes under and then passes past one recording electrode and one reference electrode

Question 52

What does SNAP mean?

Answer 52

Sensory nerve action potential

Question 53

What does CMAP mean?

Answer 53

Compound muscle action potential

Question 54

What is latency?

Answer 54

Time lapse from stimulation to the response

Question 55

What is amplitude?

Answer 55

Sum total of all the fibers recorded (gives info about number of axons functioning)

Question 56

What is duration?

Answer 56

Initial deflection of the negative phase to the return of the positive phase

Question 57

What is velocity?

Answer 57

Speed at which an action potential is conducted along a nerve

Question 58

Increased insertions activity at rest is associated with axonal degeneration? (True/False)

Answer 58

True

Question 59

Slowed nerve conduction velocity is most suggestive of demyelination (True/False)

Answer 59

True

Question 60

What is decreased recruitment suggestive of?

Answer 60

Axonal injury where motor units may have been lost

Question 61

What are the reasons for referring a patient for an EMG study?

Answer 61

When the diagnosis is unclear or when pathology is worth revealing and evidence dictates a different management strategy

Question 62

What is not a reason for referring a patient for an EMG study?

Answer 62

When the diagnosis is obvious Before a good history and clinical exam has been completed If the results won’t change your management For screening purposes

Question 63

How is neuritis different from neuropathy?

Answer 63

Neuritis is only nerve irritation whereas neuropathy is nerve pathology

Question 64

How do you know when demyelination is present?

Answer 64

Prolonged distal latency Decreased amplitude of SNAP or CMAP Slowed NCV

Question 65

What is demyelination?

Answer 65

Damage to the myelin sheath around nerves