Planning the Objective exam

Question 1

Think
Plan
Prove

Answer 1

framework for hypothesizing your hypotheses. THinking of predisposing, precipitating factors and perpetuating factors

Planning the physical exam to test

Proving your hypothesis and rule out others as needed

Question 2

Check list to reduce errors

Answer 2

WHat is in front of me?
What else could this be?
IS it more than one thing?
WHat is the worst possible thing this could be?

Question 3

Comparable sign-

Answer 3

The test or movement that reproduces the symptoms for which the patient is seeking tx

Question 4

Planning the objective exam

Answer 4

WHat, how and how much?

Question 5

WHen to progress forces

Answer 5

-condition not severe or irritable
-nature warrants no caution
-condition chronic and stable
-Aggravating factors suggest that comparable sign may be difficult to reproduce
-Symptoms not produced with standard testing

Question 6

Way to progress AROM forces

Answer 6

Overpressures,
Sustained OP
Repeated motions
combined motions
increase speed
movement under load

Question 7

Response to forces
Red light
Green light
Amber light

Answer 7

red- produced or increased and remains worst

Green-
-derangement pain decreased or abolished or better
-dysfunction- produced at end range and then reduced

Amber-
dereangement- pain produced but not worsened/improved

Question 8

how to plan for OE

Answer 8

Area under symptoms, visceral, structures immediately above or below

-any clinical syndromes

-Think of primary and secondary hypotheses

-Any contraindications

Question 9

Stenosis cluster

Answer 9

Age over 48
Better with sitting
Worse with standing and walking
Bilateral leg pain
Leg pain>back pain

Question 10

Cervical myelopathy cluster

Answer 10

Age over 45
+hoffman
+inverted supinator sign
+babinski
Gait deviations

1/5= rule out myelopathy

3-4/5- 94-100%

Question 11

P1 in OE

Answer 11

Where patient just starts to experience pain

Higher irritability- go to just here and then wait to see jow long they take to disappear

Question 12

L in OE

Answer 12

FOr patients who are not severe or irritable

Goes to the limit of the range

Question 13

When to not reproduce symptoms and what to do instead

Answer 13

-high severity and high irritability with latency

Perhaps go to P1 or just shy of P1

Question 14

WHat to do when distal symptoms difficult to produce ex- lateral shin pain that occurs only after hours

Answer 14

Examine above and local

Question 15

How to progress neurodynamics

Answer 15

Seated knee extension to SLR to Slump

Question 16

If patient has red flags how should exam be adjusted

Answer 16

perform the exam clearing or assessing red flags first

ex clear canadian c spine rules, VBI or upper cervical instability in trauma cases before moving to neuro testing

Question 17

lower cross syndrome

Answer 17

increased lumbar lordosis, TL hypomobility, midlumbar hypomobility, low lumbar hypomobility and tight hip flexors

Question 18

Treating lower cross syndrome

Answer 18

facilitate abs and glutes

-inhibit and stretch erector spinae, iliopsoas and hamstrings

Question 19

Upper cross syndrome

Answer 19

tight SO muscles, weak DNF, tight pecs and weak posterior periscapular musculature