Practice Test Incorrect Answers Flashcards
What is a positive SLR test?
Low back and radicular symptoms at less than 40 hip flexion
What are the 4 tests of the cervical radiculopathy test item cluster?
-Spurlings
-ULTT A
-<60 degrees rotation to affected side
-Pos Cervical Distraction
What are signs for cervical myelopathy?
-Babinski
-Hoffman
-Ataxic gait
-N/t in B LE
-Bowel and bladder changes
What would decrease the likelihood of mechanical thoracic pain?
Lack of symptom provocation with thoracic ROM
What does the lateral scapular slide test indicate?
Weakness of the scapular stabilizers
What is the fat pad sign and what does it indicate?
-Elbow joint effusion
-Elbow Fracture
What is Slocum’s test?
A modification of the Anterior Drawer Test
When to use a Slocum’s test instead of anterior drawer or Lachman’s?
When looking for rotational instability
What is a Reverse Segond Fracture?
An avulsion fracture of the medial tibial plateau
Determining the number of people who test positive for a special test based on the overall population prevalance is what value?
Positive Predictive Value
What are the terms included in the ICF framework?
-Health Conditin
-Body Functions and Structures
-Environmental Factors
-Personal Factors
-Participation Factors
-Activities
What would be the ionic solution used in iontophoresis for a calcium deposit in an achilles tendon?
Acetic Acid
What is the MOI for a syndesmotic ankle injury?
Rotational: A direct blow to the lateral knee with the foot remaining planted on the ground in relative external rotation
What do you not want to do with a person with a syndemotic ankle injury?
Gastroc/soleus stretching because it would force the mortise apart
What is the correct intervention for weeks 0-2 after an ankle syndemotic injury?
-PRICE
-Immediate non-weight bearing with crutches
-A posterior splint with the ankle position in 10 degrees ankle plantarflexion
What is a bipartite patella?
A patella that does not fuse and remains 2 separate bones
What image would be used to delineate a symptomatic from asymptomatic bipartite patella?
Bone Scan
The validity that deals with the degree to which the results of a trial can be generalized to different subjects and settings is called?
External Validity
What inidcates good reliability of kappa?
> 0.8
What are the types of validity?
-Internal
-External
What is internal validity?
-The instruments and procedures measured what they were supposed to measure
What is the Finkelstein test?
Pt makes a fist with their thumb between their palm and fingers and is then passively moved into ulnar deviation
What is the Scaphoid shift test?
Blocking the scaphoid and performing wrist flexion from an extended position; testing for instability
What is Froment’s sign?
A test for ulnar nerve palsy noted by bending the thumb when pinching a piece of paper
What motion would be most impacted by a posterior displaced distal radial fracture?
Forearm supination and pronation
What should be the highest priority after a distal radius surgical repair?
Extrinsic extensor tightness
What does not increase the risk for nonunion after a fracture?
Acetaminophen use
What raises the risk of nonunion after a fracture?
-Cox-1 inhibitors
-Cox-2 inhibitors
-NSAIDS
-Smoking
What is a valid assumption regarding patellar taping?
An assessment of patellar tracking is not critical prior to taping
Which diagnostic test is important after a dislocation that appears to have caused nerve damage? (weakness, tingling)
Plain Radiographs
What is the best initial course of action for an initial episode of anterior glenohumeral dislocation?
At least 1 week of immobilization
What is an appropriate manual therapy intervention 6 weeks after surgery for a distal radial fracture?
Grade IV mobilization of the proximal carpal row in a volar direction while holding the radius and ulna immobile
What is the appropriate imaging after finding a positive load-shift and active compression test?
Magnetic resonance arthrogram of the glenohumeral joint
Where is a Hill-Sach’s lesion on the humeral head?
Posterolateral
What is a Hill-Sachs lesion related to?
Anterior Shoulder Dislocation
What are Bankart repairs done for?
TUBS - Traumatic, Unidirectional- usually anterior, in conjuction with bankart lesions
When is an inferior capsular shift surgery indicated?
For multidirectional instability of the shoulder
What is not an acceptable activity 1 day s/p lumbar total disc arthroplasty?
Repeated lumbar extension in standing
What are acceptable activities 1 day s/p lumbar total disc arthorplasty?
-TA contractions
-Ambulation with AD
-Supine knee to chest exercises to tolerance
What is normal lumbar-pelvic rhythm?
Initial flexion of the lumbar spine is followed by anterior rotation of the pelvis
What is the Mason Classification system?
-Naming of radial head fracture based on location and amount of comminution and displacement
What are the types of fractures of the Mason Classification System?
-Type 1: Fracture that has had a nondisplaced fissure of a peripheral fracture of the rim
-Type 2: A marginal sector fracture with displacement
-Type 3: Comminuted, displaced fracture involving the entire radial head
What direction should a glenohumeral glide be performed to improve external rotation?
Posterior
Johnson et al
What is the delphi technique
A Step-wise process to establish an expert consensus of the most important clinical indicators for diagnosis of a particular shoulder disorder
What lumbar zygoapophyseal joint position limit rotational movement potential?
Sagittal
For hip pain and limitation which indicates manual therapy and thrust manipulation, what technique do you choose?
Use long-axis distraction hip manipulation, starting in open-pack position and progressing to closed-pack position in the patient’s most restricted range
For calf pain radiating to the ankle sporadically with no injury and unable to provoke symptoms by changing position or activity; what is the most likely diagnosis?
Popliteal Artery Obstruction
What might lead you to think popliteal artery obstruction as a dx?
-Calf and/or ankle pain or discomfort
-Peripheral vascular disease
-Cold feet after exercise
What might indicate pericarditis?
-Substernal pain
-Left Shoulder Pain
-Relief with leaning forward
-Worse wtih cough, swallow, take deep breaths
What is the prognosis for swan neck deformity?
Can try splinting, but many end up with surgery
What are the 5 possible clinical presentations of psoriatic arthritis?
-Symptoms in the DIPs
-Assymetric oligoarticular: Sxs on one side, enthesitis, dactylitis (sausage fingers)
-Symmetric polyarthritis: B presentation
-Spondylitis: effects spine and pelvis, most common back
-Athritis mutilans: most severe, fusing of bones, joint pain/swelling, opera-glass hand, pencil-in-cup deformity
What is a derivation study for?
a proposed mechanism of diagnosis, intervention, or prognosis
usually in small groups and should be used with caution
What is the best intervention to use on somebody who fits into the traction subgroup?
Prone Press-Ups
Which direction should the C2 turn with passive head turning?
The opposite direction of the head turn
What age group has the highest risk of cervical radiculopathy?
40s and 50s
What is likely to be seen with upper cervical ligamentous instability?
-Occipital numbness with occipital headaches
-Significant range-of-motion limitations in all directions
-Signs and symptoms of cervical myelopathy
What has the best sensitivity for Carpal Tunnel Syndrome?
Wrist-ratio index greater than 0.67
What can the popliteus muscle do with an individual with a posterior cruciate tear?
-Reduce the potential for excessive posterior translation
-Assist with stability of the knee
What meniscal test has the best specificity for a lateral meniscal tear?
Joint line tenderness
What position to assess a posterolateral corner injury of the knee?
30 degrees of knee flexion
What are the grades of posterolateral corner injury based on tibial ER?
-Grade 1: <5 degrees
-Grade 2: 5-10 degrees
-Grade 3: >10 degrees
Which stages of adhesive capsulitis will have the same ROM actively and under anestesia?
Grades 2 and 3
What is stage one of Neer’s classification?
Edema and hemorrhage most common in younger, athletic populations
What is stage two of Neer’s classification?
Fibrosis and tendinitis, usually in thos 25-40 y/o and from repeated mechanical irritation
What is stage three of Neer’s classification?
Partial or complete tears usually in those >45 years old; also bone spurs and tendon rupture
Which might be causes of secondary knee OA?
-Acromegaly
-Hyperparathyroidism
-Rickets
What are the Kellgren-Lawrence classification grades of OA?
-Grade 0: normal
-Grade 1: Doubtful joint space narrowing
-Grade 2: Definite osteophytes, possible joint space narrowing
-Grade 3: Multiply osteophytes, definite joint space narrowing, sclerosis
-Grade 4: Large osteophytes, marked joint space narrowing, severe sclerosis
What does sclerosis of bone mean?
Thickening or hardening of bone under joint cartilage
Which part of the patella is typically involved in knee osteoarthritis?
Lateral (80%, from lateral patellar tilt)
What is grade 1 Kaltenborn traction?
neutralize joint pressure without any separation of joint surfaces
What is grade 2 Kaltenborn traction?
Separates articulating surfaces, taking up slack or eliminating play within the joint capsule
What is grade 3 Kaltenborn traction?
Stretch the joint capsule and soft tissues
What autonomic response may happen as a result of manual therapy?
Changes in skin temperature, skin conductance, cortisol levels, or heart rate
What is innervated by the axillary nerve?
-Deltoid
-Teres Minor
The triceps and anconeus are innervated by?
The radial nerve
What is related to the development of chronic neck pain
Weakness in the hands
What is the average deep neck flexor endurance test time found in individuals with neck pain?
24 seconds
What happens with ulnar nerve damage at the tunnel of Guyon?
The hand will be resting in wrist flexion, MCP extension, and PIP/DIP flexion
A sprain or strain of the cervical spine is what ICF diagnosis
Neck pain with movement coordination impairments
What muscles are impacted with Erb’s Palsy?
-Deltoid
-Biceps
-Brachialis
-Infraspinatus
-Supraspinatus
-Serratus Anterior
-C5-6
What muscles does Klumpke’s palsy impact?
-Intrinsic hand muscles
-Flexor carpi ulnaris
What is Parsonage-Turner syndrome?
An inflammatory or viral response causing neuritis of the brachial plexus and the upper trunk could be impacted
What cords to do the median nerve originate from?
The lateral and medial cords
When should a night splint be trialed with plantar fasciitis?
When they have had symptoms longer than six months
What is the best type of night splint for plantar fasciitis?
It doesn’t matter
What are 3 mobilizations that have been shown to reduce symptoms in those with plantar fasciitis?
-Cuboid Thrust manipulation
-Distal tibiofibular joint posterior nonthrust manipulation
-Proximal tibiofibular joint thrust manipulation
When might iontophoresis provide relief?
For heel pain, 2-4 weeks
What is one condition pulsed ultrasound might be useful for short-term improvement?
Calcific tendonitis
What pathology has pain with shoulder flexion, adduction, and internal rotation?
Coracoid impingement syndrome
(also impingement in general)
What is normal cervical flexoin, and side flexion ROM?
45 degrees
What is causalgic pain?
burning, and patients with causalgia have very significant amounts of pain
Can a Hill-sachs lesion be noted on an xray?
Yes
tient has ankle instability, what does the current evidence state regarding expected limited directions with the star excursion balance test
anterior and anteromedial directions
In what nerve injury is the nerve completely severed?
Neurotmesis
Crohn’s disease and irritable bowel syndrome are risk factors for?
Ankylosing Spondylitis
What means of exercise are beneficial for osteoporosis?
-High-load, low-repetition
-High-intensity aerobic exercise
Where are symptoms of the large intestine referred?
-Buttock
-Middle lumbar spine
-Lower Abdomen
Where will gall bladder symptoms refer?
-Right upper abdominal region
-Right scapular region
-Mid to lower thoracic spine
Where will the liver refer to?
-Right scapular region
-Mid to lower thoracic spine
-Right Cervical spine
(gall bladder won’t have cervical)
Where does the stomach refer?
-Upper abdominal
-Middle thoracic
-Lower thoracic
What muscles are innervated by the femoral nerve?
-Quadriceps
-Pectineus
-Iliacus
-Sartorius
-Articularis genus
What is the gold standard for cervicogenic headache dx?
C2 nerve block
What is an indicator for cervicogenic headache?
Onset of pain with cervical motions
What should be done to perform optimal screening to rule out circulatory insufficiency for patients with head and neck pain
Stratify patients into high, medium, or low risk categories based on historical risk factors and results from special tests or the presence of prodromal symptoms.
What are risk factors for cervical myelopathy?
-Male
->70 y/o
-Thickening of ligamentous tissue in the spinal canal
Hypertrophy of the uncovertebral joints may cause?
Impingement leading to cervical radiculopathy
After a grade 3 posterior cruciate ligament injury, what is recommended regarding weight-bearing status?
Partial weight-bearing for 2–4 weeks after injury
What does the external rotation recurvatum test test?
posterior cruciate ligament and the posterolateral corner of the knee
What is consistent with posterolateral corner injury?
Sharp pain at terminal stance and push-off during gait
What is most likely to be limited after PCL injury?
High-speed running
WHat is the jobe relocation test?
A test for anterior stability of the GH joint
What is helpful for ruling out a SLAP tear?
Passive compression test (Sn)
What are helpful in ruling in a SLAP tear?
Primarily:
-Active compression test
-Jobe Relocation Test
Secondarily:
-Yergason test
-Anterior Slide Test
What is the order of OA development?
-Irreversible matrix degradation
-Synovitis
-Loss of cartilage
-Development of osteophytes
What are good interventions for those with high irritability adhesive capsulitis?
-Electrical stimulation
-Grade 1&2 GH mobes
-Pain-free active assisted ROM
What is a risk factor for poor outcome after knee arthroscopy?
History of knee OA >24 months
Who has higher rates of knee OA, white or african american women?
African American
What modalities help reduce pain in individuals with knee OA?
-Acupuncture
-Transcutaneous Electrical Nerve Stimulation
-Low-level laser therapy
What are 4 hip glides used to help with knee OA?
-AP
-Caudal
-PA
-PA with FABER
What are the five variables for using hip mobilizations with individuals with knee OA? (CPR)
-Anterior thigh pain
-Passive knee flexion <122 degrees
-PROM hip IR <17 degrees
-Hip/groin pain or paresthesia
-Pain with hip distraction
What is another neck pain outcome measure similar to the NDI?
SF-36
What muscle is deactivated with putting the tongue on the top of the mouth?
-Platysma
-Hyoids
What muscles are impacted by a spinal accessory muscle injury?
-Trapezius
-SCM
What are 3 treatments that can be helpful for lateral epicondylalgia?
-Cervicothoracic junction nonthrust manipulation
-Radioulnar joint nonthrust manipulation
-SNAGs
-Scaphoid thrust manipulation
What do the scores mean on the Patient Health Questionnaire for Depression and Anxiety (PHQ)
-3 to 5: mild anxiety/depression
-6-8: moderate
-9-12: severe
What is the course of Parsonnage-Turner syndrome?
-Intense pain which subsides within days to weeks
-Weakness/paralysis develops as pain subsides in upper extremity muscles
What muscle must not be activated before 6-8 weeks post open RTC repair?
Deltoid
A history of abdominal pain, and on the morning of the examination/evaluation, she feels cramping in her stomach that began the night before and comes in waves may indicate what?
Ectopic Pregnancy
Where is the inferior extensor retinaculum?
Tip of the malleolus to the sinus tarsi and lateral calcaneus
Where will individuals with a AAA experience symptoms?
Low back and groin.
“throbbing, pulsating, tearing, or ripping”
What are 4 potential results from manual therapy?
-Change in heart rate
-Increased muscle strength
-Hypoalgesia
-Improvement in depression scale score
What are lumbar traction protocols?
Static traction of 5-10 minutes first visit
12 minutes, 0:60 on/0:20 off at 40-60% BW in subsequent visits
What nerve roots innervate the abductor hallucis?
S2-S3
What nerve roots innervate the Adductor Longus?
L2-L4
What nerve roots innervate the gastroc?
S1-S2
What nerve roots innervate the peroneus longus?
L5
With symptoms below the knee, what is not recommended?
Joint Manipulation
Pregnancy demonstrates a higher risk of what cervical pathology?
Cervical arterial dissection
What nerve innervates the tips of fingers 2 and 3?
Median
Which nerve does not innervate the tips of the fingers?
Radial
Which ACL bundle provides the most rotational stability?
Posterolateral
What is the arcuate ligament responsible for providing stability to?
The posterolateral knee capsule
What does the arcuate ligament attach to?
Head of the fibula, over the popliteus muscle to the intercondylar area of the tibia and to the lateral epicondyle of the femur blending with the head of the gastrocnemius
What are tests for the posterolateral knee?
-External Rotation Recurvatum
-Varus Stress at 30
-Dial test at 30
-Dial test at 90
-Posterolateral drawer
-Reverse pivot shift
What is the bounce home test for?
Meniscus
What are test for posteromedial corner injury?
-Valgus Stress
-Anteromedial Drawer
-Hughston’s Drawer
Which ligament does provide rotational stability and which doesn’t with posterolateral corner injury?
-Arcuate doesn’t
-Popliteofibular ligament does
What are dynamic stabilizers of the posterolateral corner?
-Biceps Femoris
-Iliotibial Band
-Popliteus
Who might have right arm pain with MCI?
Women, right biceps region
If what is present may rule out adhesive capsulitis?
GH OA on Xray
What test has the highest specificity for ruling in RTC full-thickness tears?
External rotation lag sign (94%)
Internal Rotation Lag Sign (84%)
Drop Arm Sign (77%)
What are 3 modalities that have been advocated to reduce pain and improve ROM in patients with adhesive capsulitis?
What is one that has NOT been advocated?
-Electrical Stimulation
-Shortwave Diathermy
-Ultrasound
-Thermotherapy
What is the exercise bike beneficial for with knee OA?
increasing ROM
What type of shoe insert might help offload the medial compartment of the knee?
Lateral wedge insole
Which head of the pectoral muscle is innervated by the lateral pec n.?
Upper head, which inserts into the anterior border of the medial half of the clavicle
Which head of the pectoral muscle is innervated by the medial pec n.?
The sternal/lower head, which inserts onto the sternum
What are the 6 factors that demonstrate responder to cervical thrust manipulation?
-Not feeling worse with extension
-NDI <11.5
-Bilateral Symptoms
-Not performing sedentary work >5 h/day
-Feeling better while moving the neck
-Dx of spondylosis without radiculopathy
> 4 = 89% success
For chronic neck pain, which is better, strengthening or endurance?
Neither, no difference in outcomes
Is the upper trapezius or lower trapezius important to train in those with cervicogenic headache?
Lower Trap
What changes in muscle will be present in those with chronic whiplash associated disorder?
Increased cross-sectional area due to fatty infiltrates
What are recommended interventions for neck pain with radiating pain?
-Nerve mobilization
-Traction
-Thoracic manual therapy
-NOT coordination, strengthening, and endurance
What is the motion of the carpals with ulnar deviation?
Extension of the proximal row and flexion of the distal row
What is the motion of the carpals with radial deviation?
Extension of the distal row and flexion of the proximal row
What are findings of a suprascapular nerve injury?
-Vague shoulder pain
-Weakness in shoulder abduction and external rotation
What are the ULNTT numbers representative of?
1 - median
2A - median
2B - Radial
3 - Ulnar
Why is lateral epicondylalgia a difficult pathology to treat?
There are very few cases of patients who have lateral epicondylalgia where the structures of the lateral elbow are directly involved and instead distal or proximal structures are causing the symptoms
What are the sizes of RTC tears?
> 1 cm - Small
1-3 cm - Medium
3-5 cm - large
5 cm - massive
Are there dorsal horns of nerve roots?
No
Where would fasiculations/muscle twitches injury originate?
Ventral horn of the spinal cord
What are muscles innervated by the Ulnar nerve?
-flexor digitorum profundus
-flexor carpi ulnaris
-adductor pollicis
-palmaris brevis
What nerve roots do the tricep reflex represent?
C7 and C8
