NMS 2 Final Flashcards
Multiple myeloma causes lytic lesions which puts a patient at risk of what?
A. Osteophytes formation
B. Pathological fractures
C. Cardiovascular complications
D. Hemorrhages
B. Pathological fractures
The meridian point large intestine 4, or L14 is a very common trigger point for gastrointestinal upset, headaches, pregnancy complaints, and low back pain. Where is it located?
A. Base of the 5th metatarsal
B. PSIS’s
C. Web of the thumb
D. Midway between the sacrum and greater trochanter
C. Web of the thumb
Bruxism, aka grinding teeth, can potentially cause what condition?
A. Bells Palsy
B. Osteoarthritis
C. Halitosis
D. TMJ Syndrome
D. TMJ Syndrome
Cervical strain/sprain is typically caused by what mechanism of injury?
A. Repetitive injury
B. Pathological injury
C.hyperflexion/hyperextension
D. Rapid rotation
A. Repetitive injury
Cramping and pain in the legs of a patient with a lumbar canal stenosis is called:
A. Vascular claudication
B. Neurogenic claudication
C. Intermittent claudication
B. Neurogenic claudication
Torticollis is when the neck is held in a ________ and/or _________ position.
A. Rotated, laterally flexed
B. Rotated, extended
C. Laterally flexed, extended
D. Rotated, flexed
A. Rotated, laterally flexed
Which of the following potential causes of intercostal neuralgia?
A. Trauma
B. Viral infections
C. Nerve entrapment
D. All of the above
D. All of the above
diffuse idiopathic skeletal hyperostosis patients should also be screened for what other condition?
A. Rheumatoid arthritis
B. Congestive heart failure
C. Diabetes mellitus
D. Graves’ disease
C. Diabetes mellitus
Papilledema is a warning sign for what type of headache?
A. Pathological headache
B. Cervicogenical headache
C. Migraine headache
D. Sinus headache
A. Pathological headache
A compressive lesion is related to:
A. The location of a herniation
B. The reaction of a herniation
C. The size of a herniation
D. The level of a herniation
C. The size of a herniation
The leading cause of disability in the elderly is _________.
A. Lumbar stenosis
B. Degenerative joint disease
C. Osteoarthritis
D. Diabetes mellitus
B. Degenerative joint disease
Would you adjust a patient with an acute cervical strain/sprain?
a) Yes, removing the subluxation will speed up the healing process
b) Yes, but using more gentle techniques
c) No, adjusting during the acute phase of this injury could cause further damage
d) No, the patient should be sent to an ER
c) No, adjusting during the acute phase of this injury could cause further damage
A “classic” migraine is classified as a migraine ___________.
A. With aura
B. Without aura
C. With nausea
D. Without nausea
A. With aura
At what degree of scoliotic curvature do we start to become concerned about cardiovascular complications?
a) 30
b) 40
c) 50
d) 60
d) 60
Which of the following is
NOT one of the symptoms needed to diagnose a cervicogenic headache according to the
International Headache Society?
a) Resistance or limited range of motion
b) Change in the contour, texture, and tone of the musculature of the neck
c) A headache lasting for more than 24 hours
d) Abnormal tenderness of the neck musculature
c) A headache lasting for more than 24 hours
A patient presents with saddle paresthesia and bowel/bladder incontinence.
What do you suspect the diagnosis to be?
a) Myelopathy
b) Cauda Equina Syndrome
c) Radiculopathy
d) Vascular Claudication
b) Cauda Equina Syndrome
A 77 year old male patient woke up this morning with a headache. As he got out of bed, he became dizzy and fell. He says that he frequently has headaches accompanied by dizziness almost every morning. What exam finding would you expect to be present?
a) Elevated CRP
b) Hypertension
c) Nuchal Rigidity
d) Sinus Pressure
b) Hypertension
“Bamboo spine,” “trolley track sign,” and “railroad sign” are all common radiographic findings of what condition?
a) Rheumatoid arthritis
b) Ankylosing spondylitis
c) Enteropathic arthritis
d) DISH
b) Ankylosing spondylitis
CASE STUDY: A 35 year old male presents to the clinic with an excruciating headache… runny nose. He states the pain is localized behind his left eye. He’s been experiencing… drooping. What is the most likely diagnosis?
a) Migraine headache
b) Cluster headache
c) Sinus headache
d) Stroke
b) Cluster headache
CASE STUDY: A 25 year old female presents with dull achy low back pain that radiates into her glutes… worsening for about 5 years. She used to be a competitive gymnast and stopped when the back pain… extension.
What do you suspect the diagnosis to be?
a) Lumbar strain/sprain
b) Piriformis syndrome
c) Lumbar disc herniation
d) Spondylolisthesis
d) Spondylolisthesis
What clinical finding is indicative of the cord being compromised?
a) Lower motor neuron lesion signs
b) Instability
c) Upper motor neuron lesion signs
d) Loss of range of motion
c) Upper motor neuron lesion signs
Which condition should be considered non-accidental in children?
a) Rib fracture
b) Costco Cartilaginous injury
c) Thoracic Costal facet sprain
d) Snapping scapula
a) Rib fracture
Which of the following would be an example of dysplastic spondylolisthesis?
a) DJD
b) Trauma
c) Spina Bifida
d) Scoliosis
c) Spina Bifida
Which of the following is not part of the METH acronym?
A. Exercise
B. Movement
C. Heat
D. Torsion
D. Torsion
The most common level for cervical radiculopathy is _____________?
a) C5-6
b) C6-7
c) C7-71
d) C4-5
b) C6-7
CASE STUDY: Patient presents after a car accident that occurred right outside your clinic. She is having difficulty walking through the door and when she’s filling out her paperwork you see she’s having difficulty holding the pen and writing. During your exam, you find multiple MSR discrepancies in both her arms and legs. What’s the most likely diagnosis?
a) Cervical radiculopathy
b) Cervical sprain/strain
c) Torticollis
d) Cervical myelopathy
d) Cervical myelopathy
Centralization when treating a disc herniation refers to:
a) Symptoms progressing farther peripherally
b) Symptoms disappearing
c) Symptoms worsening in intensity
d) Symptoms regressing closer to the site of injury
D. Symptoms regressing closer to the site of injury
DISH is characterized as the overproduction of what?
a) Cartilage
b) Adipose
c) Bone
d) Scar tissue
c) Bone
Vertebral artery dissection (VAD) is a cause of stroke in patients younger than ________?
a) 65
b) 55
c) 45
d) 35
c) 45
The proliferation phase of a healing refers to the formation of
a) Scar tissue
b) Bone
c) Muscle tissue
d) Pain receptors
a) Scar tissue
A patient with a lateral disc herniation will typically have antalgia.
a) In forward flexion
b) In extension
c) Toward the lesion
d) Away from the lesion
d) Away from the lesion
Postural syndrome demonstrates ___________ deep neck flexors, rhomboids, and lower traps; and ___________ pecs, SCM’s upper traps, and levator
a) Tight, tight
b) Tight, weak
c) Weak, weak
d) Weak, tight
d) Weak, tight
Case study. Patient presents with swelling and visible deformity in the bilateral hands. She used to work as a writer but has stopped the last few months due to pain and inability to type and write. She notes significant stiffness and decreased range of motion in both hands. She also recently had x-rays done and upon examination, you see that her ADI space is increased.
What is the most likely diagnosis?
a) DISH
b) Cervical myelopathy
c) Rheumatoid arthritis
d) cervical radiculopathy
c) Rheumatoid arthritis
Thoracic outlet syndrome (TOS) is caused by compression of what structures?
a) Brachial plexus
b) Subclavian artery
c) Subclavian vein
d) All of the above
d) All of the above
Which film view would you need to obtain if you wanted to assess the stability of the cervical spine?
a) AP open mouth view
b) Flexion/Extension motion view
c) Lateral cervical neutral view
d) AP lower cervical view
b) Flexion/Extension motion view
_______ usually have slower/longer healing times due to decreased vascularity of the affected issue
A. Sprains
B. Strains
C. Both sprains and strains
A. Sprains
A grade 3 sprain/strain has which of the following characteristics:
A. No bruising or swelling
B . No instability
C. Pain only at the end range of motion
D.Complete tearing of the muscle fibers/ligaments
D.Complete tearing of the muscle fibers/ligaments
Which of the following spondylolisthesis types is due to a boney pathology?
A. Type 5
B. Туре 4
C. Type 3
D. Type 2
E. Type 1
A. Type 5
Which of the following is NOT a potential cause of lumbar myelopathy?
A. Spinal tumor
B. Herniated disc
C. Bone spurs
D. All of these are potential causes of myelopathy
D. All of these are potential causes of myelopathy
Cauda equina syndrome is usually caused by:
A. an autoimmune disorder
B. a massive lumbar disc prolapse
C. diabetes mellitus
D. a large compression fracture
B. a massive lumbar disc prolapse
Most lumbar discs resolve spontaneously within
A. 6 weeks
B. 12 weeks
C. 1 year
D. 6 months
D. 6 months
Exercises for piriformis syndrome are aimed at:
A. strengthening the core
B. relaxing the piriformis
C. stretching the low back musculature
D. strengthening the pelvic floor
B. relaxing the piriformis
Which of the following can cause neurological changes?
A. Diabetes mellitus
B. Pernicious anemia
C. Alcoholism
D. B12 deficiency
E. Heavy metal toxicity
F. All the above
F. All the above
A low back brace should be used:
A. during the acute phase
B. throughout the entirety of treatment
C. if there is a fracture
D. only for the first 24 hours
A. during the acute phase
If a patient has symptoms of vascular claudication, x-rays may show:
A. lumbar stenosis
B. cauda equina syndrome
C. pars fracture
D. arteriosclerosis
D. arteriosclerosis
Segmental instability is:
A. chronic
B. genetic
C. highly unstable
D. reversible
D. reversible
Which of the following conditions would you want to obtain motion films (such as flexion extension views) before treating conservatively?
A. Lumbar strain/sprain
B. Lumbar instability
C. Piriformis syndrome
D. Coccygodynia
B. Lumbar instability
The nucleus pulposis has migrated beyond the dimensions of the vertebral body but the nuclear fibers are still intact it is called:
A. protrusion
B. subannular extrusion
C. transannular extrusion
D. sequestered
B. subannular extrusion
If L5 has completely slipped of the sacrum it is called:
A. spondyloptosis
B. spondylolisthesis
C. spondylosis
D. spondylarthritis
A. spondyloptosis
A 25-year-old female presents with dull achy low back pain that radiates into her glutes. She states it has been progressively worsening for about 5 years. She used to be a competitive gymnast and stopped when the back pain developed. The pain is worse with extension. What do you suspect the diagnosis to be?
A. Lumbar strain/sprain
B. Piriformis syndrome
C. Lumbar disc herniation
D .Spondylolisthesis
D .Spondylolisthesis
A 29-year-old female presents with intense coccygeal pain following labor and delivery. She delivered the first child 4 months prior and has had progressively worsening discomfort since. She has difficulty sitting for prolonged periods and difficulty with transitioning from sitting to standing. What do you suspect the initial injury was?
A. Coccygeal fracture
B. Sacral fracture
C. Pelvic ligament sprains
D. Hemorrhoids
A. Coccygeal fracture
What is the best system ot evaluate the degree of slippage for a spondylolisthesis?
A. George’s line
B. Ullman’s line
C. Meyerding’s scale
D. Cobb’s angle
C. Meyerding’s scale
The most common type of L4 spondylolisthesis is
A .Traumatic
B. Isthmic
C.Dysplastic
D. Degenerative
D. Degenerative
Which of the following would be an example of a dysplastic spondylolisthesis?
A.DJD
B. Trauma
C. Spina Bifida
D. Scoilsis
C. Spina Bifida
Most common segment for a spondylolisthesis to occur is
A. L2
B. L3
C. L4
D. L5
D. L5
Patient presents with saddle paresthesia and bowel/bladder incontinence. What should your next step in treatment be?
A. Adjust with focus on the low back and pelvis
B. Electrical stimulation for 10 minutes
C. Core rehabilitation program
D. Refer to the ER for emergency decompression
D. Refer to the ER for emergency decompression
A patient presents with saddle paresthesia and bowel/bladder incontinence. What do you suspect the diagnosis to be?
A. Myelopathy
B. Cauda Equina Syndrome
C. Radiculopathy
D. Vascular Claudication
B. Cauda Equina Syndrome
Gait disturbances, pathological reflexes, muscle weakness, and numbness in the extremities are all signs of ________ compromise.
A. vascular
B. peripheral nerve
C. Cord
C. Cord
Which imaging modality is considered the gold standard for diagnosing disc herniations?
A. X-ray
B. MRI
C. CT
D. PET scan
B. MRI
If a disc herniation is classified as contained, it means:
A. the annular fibers are disrupted
B. the nucleus pulposis is sequestered
C. the nucleus pulposis is extruding
D. the annular fibers are intact
D. the annular fibers are intact
A disc herniation at L2 will affect what nerve root?
A. L1
B. L2
C. L3
D. L4
C. L3
A patient with a lateral disc herniation will typically have antalgic _________
A. in forward flexion
B. in extension
C. toward the lesion
D. away from lesion
D. away from lesion
Myelopathy and cauda equina syndrome are caused by compression in the:
A. IVF
B. vertebral canal
C. transverse foramen
D. inguinal canal
B. vertebral canal
True or False:
An inflammatory lesion and a compressive lesion can occur together.
True
An inflammatory lesion is related to:
A. the location of a herniation
B. the reaction of a herniation
C. the size of a herniation
D. the level of a herniation
B. the reaction of a herniation
A compressive lesion is related to:
A. the location of a herniation
B. the reaction of a herniation
C. the size of a herniation
D .the level of a herniation
C. the size of a herniation
Multidirectional instability is likely due to
A. Genetic factors
B. muscle imbalance
C. surgery
D. congenital structural anomalies
B. muscle imbalance
Would you adjust a patient with lumbar instability?
A. Yes, but avoiding the unstable segments.
B. Yes, full spine adjusting is fine in patients with this condition.
C. Yes, but only using activator protocol.
D. No, adjusting is contraindicated in these patients.
A. Yes, but avoiding the unstable segments.
Surgery to relieve pressure on the cord for those with lumbar canal stenosis is typically a
A. fusion
B. disc replacement
C. laminectomy
D. bone graft
C. laminectomy
Lumbar canal stenosis is generally worse with
A . rotation
B . lateral flexion
C . extension
D . flexion
C . extension
Cramping and pain in the legs of a patient with lumbar canal stenosis is called
A. Vascular claudication
B. Neurogenic claudication
C. Intermittent claudication
B. Neurogenic claudication
Which of the following substances are affecting by aging and lead to decreased tensile strength and diminished nutrient supply to cartilage?
A. Collagen
B. Proteoglycan
C. Elastin
D. A and B
E. A and C
F. All of the above
D. A and B
Degenerative joint disease is most common inwhich of the following joints?
A.Axial skeletal joints
B. Appendicular skeletal joints
C. Weight bearing joints
D. non-weight bearing joints
C. Weight bearing joints
The leading cause of disability in the elderly is:
A. Lumbar stenosis
B. Degenerative joint disease
C. Osteoarthritis
D. Diabetes mellitus
B. Degenerative joint disease
Rarely, surgery may be required for patients with piriformis syndrome to release the
A. tendinous bands of the piriformis
B. tight fibers of the Sacro tuberous ligament
C. compressed sciatic nerve
D. tight fibers of the sacroiliac ligament
A. tendinous bands of the piriformis
A 35-year-old female presents to the clinic with chronic tingling and pain down the back of her right leg. She works as a receptionist and has difficulty sitting during work. During your exam you note she has a significant internal rotation restriction of her right hip. What is the most likely diagnosis?
A.Piriformis syndrome
B.Lumbar spinal stenosis
C. Sciatica
D .Lumbar myelopathy
A.Piriformis syndrome
Primary sciatica affects the sciatic nerve via __________ where secondary sciatica affects the sciatic nerve via ____________?
A.direct irritation, muscle tension
B. underlying neurologic changes, direct irritation
C . muscle tension, underlying neurologic changes
D . direct irritation, muscle tension
B. underlying neurologic changes, direct irritation
Myofascial pain syndrome is characterized by:
A. Pain
B. neurological changes
C. fibromyalgia
D. trigger points
D. trigger points
What chiropractic treatment is very beneficial in preventing progression of disease in patients with lumbar facet syndrome?
A. Flexion distraction
B. Early manipulation
C. TENS therapy
D. Core rehabilitation
A. Flexion distraction
A 44-year-old male presents to your clinic following an injury at work. He was picking up a box and didn’t bend his Knees. He states he “moved too quickly” and had spasming immediately in his lower back. Now he can barely move due to intense muscle spasm pain. He states that heat has made ti better. What is the most likely diagnosis?
A.Lumbar facet syndrome
B. Lumbar stenosis
C. Lumbar sprain/strain
D. Sciatica
C. Lumbar sprain/strain
