Review Q's Flashcards
A 28 y/o F presents w/ HA, nasal congestion, and sore throat x1week. On PE she is afebrile; cobblestoning of posterior oropharynx and tonsils are 1/4 w/o exudate. Which of the following findings could be addressed as part of tx targeting Zink’s compensatory pattern relevant to this pt?
A. OA F RL SR B. C4 E RR SR C. T4 F RL SL D. R rib 6 exhalation SD E. Pea-sized tender nodule in the 1st intercostal space near the sternum
A. OA F RL SR
A 56-year-old female presents to the primary care clinic with complaints of right low back pain for the past year. The pain is exacerbated by activity and improved with rest. Consequently, she has become increasingly sedentary. Even getting up from a chair is difficult due to pain. Physical exam reveals: Right hip flexor 4/5 strength, and; Left hip flexor, bilateral knee extensors, knee flexors, and plantar flexors 5/5 strength; patient perceives low back pain and experiences difficulty actively flexing at the right hip in the supine position, but none on the left. Patient perception of active hip flexion improves after applying a medial external force through the pelvis. Which of the following is the most likely cause of this patient’s clinical picture?
A. L2 nerve root impingement
B. L2 right paracentral disc herniation
C. Muscle imbalance between hip flexors and extensors
D. Muscle imbalance between hip adductors and abductors
E. Cauda equina syndrome at L2
C. Muscle imbalance between hip flexors and extensors
A 32-year-old female presents to the primary care clinic complaining of pain in her right foot that began two weeks ago after running a half marathon. Examination reveals somatic dysfunction in right tarsals. The pain is located on the plantar surface along the medial portion of the midfoot. Which of the following best describes Counterstrain positioning for this somatic dysfunction?
A. Patient lateral recumbent with pillow supporting leg, forefoot inverted, and calcaneus everted. B. Patient prone, apply eversion to the forefoot with calcaneus externally rotated.
C. Patient is supine, apply inversion force to the forefoot, ankle is placed in internal rotation.
D. Patient prone, dorsum of foot on physician’s thigh, translate calcaneus toward forefoot.
E. Patient is supine, with a pillow under the distal aspect of the tibia.
D. Patient prone, dorsum of foot on physician’s thigh, translate calcaneus toward forefoot.
A 14-year-old female presents to Urgent Care with mother and states she was tripped playing basketball 2 days ago and her back hurts and feels stiff. NSAIDs and ice packs have helped. She’s a shooting guard and every time she straightens up to take a shot, she feels the pain. She also states difficulty in getting up from the seated position. Physical examination reveals deep R sacral sulcus, posterior left ILA, Lumbosacral spring positive, positive Thomas test on L, Prone left leg active extension difficult and elicits pain. Which of the following would you recommend the pt perform first in her exercise Rx?
a. stretching left gluteus medius
b. retraining strength program for left gluteus medius
c. stretching for left iliopsoas
d. retraining strength program for the left iliopsoas
e. stretching the left gluteus medius
f. retraining strength program for left gluteus maximus
c. stretching for left iliopsoas
A 36-year-old female presents to the primary care physicians office with complaints of dizziness that started after a motor vehicle collision yesterday. She was rear-ended as the restrained driver waiting in the left-hand turn lane. Physical exam reveals cranial nerves 2-12 intact and C2 resisting anterior motion of the articular pillar on the right, which improves with flexion. Which of the following best describes the set-up position for and HVLA, sidebending emphasis treatment?
A. RR SL B. RL SL C. RR SR D. RL SR E. Flexed E Extended
A. RR SL
On exam, C2 does not translate from left to right, which improves with extension. Which of the following is the correct setup position for the pts head and neck to employ a sidebending emphasis HVLA tx?
A. RL SL B. RL SR C. RR SR D. RR SL E. F RL
D. RR SL
A 15-year-old 30-week multiparous female presents to the outpatient clinic with complaints of right lower back pain. Bending seems to make it worse and she feels like she cannot take a deep breath well. The pain started about 1-month ago and has been getting progressively worse. Physical examination reveals right ribs 8-12 preference for exhalation; L2 transverse process posterior on the right and improves with extension; right sacral sulcus posterior, left ILA superior; positive right seated flexion test; positive lumbosacral seated spring. Which of the following is the ending position in applying a supine Still technique with traction localized to the indicated rib?
A. Palpate rib 8, arm flexion B. Palpate rib 8, arm extension C. Palpate rib 10, arm flexion D. Palpate rib 10, arm extension E. Palpate rib 12, arm flexion F. Palpate rib 12, arm extension
A. Palpate rib 8, arm flexion
PE reveals L2 TP prominent on the right and becomes more symmetric with extension. Which of the following best describes the ending position for a seated Still’s technique?
A. E RR SR B. E RL SL C. F RR SR D. F RL SL E. N RR SL F. N RL SR
D. F RL SL
PE reveals significant TART findings in the lumbar spine, especially on the right at the lumbosacral junction; hypertonicity of the right QL; positive right standing flexion test; ASIS, PSIS, medial malleolus all superior on the right. Which of the following is the final step in a Still’s technique for this pt?
A. HVLA R leg inferior tug B. Low vel, medium amplitude right leg inferior tug C. IR of right hip D. ER of right hip E. Knee flexion F. Knee extension
B. Low vel, medium amplitude right leg inferior tug
A 66-year-old male presents to the primary care clinic with complaints of right low back pain for the past year. The pain is exacerbated by activity and improved with rest. Physical examination findings include fascial preference at the thoracolumbar junction for flexion and right rotation with motion resisting left sidebending. Which of the following would be the setup position for direct myofascial release of the thoracolumbar junction?
A. F RR SR B. F RL SL C. F RR SL D. F RL SR E. E RR SR F. E RL SL G. E RR SL H. E RL SR
F. E RL SL
Which of the following findings could be addressed as part of a treatment targeting Zink’s compensatory pattern relevant to this pt?
A. L2 E RR SR B. L4 E RR SR C. T4 F RL SL D. C4 F RL SL E. Pea-sized tender nodule in the 1st intercostal space near the sternum
A. L2 E RR SR
[L2 has the crus of both hemidiaphragms attached and therefore is intimately related to proper diaphragm function]
A 59-year-old female presents to her primary care physician with complaints of left lower back pain. The pain began while clearing out her mother’s home this past weekend with her sister to prepare it to be sold after her mother’s death 2-weeks ago. It is worse with movement and better with rest, but it will stiffen up. She has trouble transitioning from seated to standing and seems to take a few steps before she gets to her full upright posture. She’s had back pains before, but not like this one. She describes a sedentary lifestyle. Physical exam reveals: hypertonicity and bogginess of bilateral paraspinals (left worse than right). Which of the following is the most appropriate treatment to address the edema associated with this patient’s presentation?
A. HCTZ 25 mg PO B. Acetaminophen extra strength PO C. suboccipital release D. Doming the diaphragm E. Cyclobenzaprine PO
D> doming the diaphragm
A 15-year-old 30-week multiparous female presents to the outpatient clinic with complaints of right lower back pain. Bending seems to make it worse and she feels like she cannot take a deep breath well. The pain started about 1-month ago and has been getting progressively worse. Physical examination reveals right ribs 8-12 preference for exhalation; L2 transverse process posterior on the right and improves with extension; right sacral sulcus posterior, left ILA superior; positive right seated flexion test; positive lumbosacral seated spring. Which of the following is the target area to apply force to treat this patient with a supine BLT technique?
A. Right anterior sacral base B. Left anterior sacral base C. Right posterior sacral sulcus D. Left posterior sacral sulcus E. Right posterior ILA F. Left posterior ILA
F. Left posterior ILA
A 32-year-old G2P0010 female at 18 weeks gestation presents with progressive numbness, tingling, and pain in her right hand. It started approximately 6 weeks ago, and has grown in severity. Initially only present on occasion, it is now constant. She describes the pain as burning and feels like little pinpricks, rated 4/10. She works as a medical transcriptionist. Prolonged wrist flexion causes increased numbness. Musculoskeletal PE findings include: OA E RL SR, C6 F RLSL, Wrist extended. In applying a muscle energy treatment, which of the following areas and ending positions is most associated with a purely neurologic model?
A. OA Extended, Rotated Left, Sidebent Right
B. OA Flexed, Rotated Right, Sidebent Left
C. C6 Extended, Rotated Right, Sidebent Right
D. C6 Flexed, Rotated Left, Sidebent Left
E. Wrist Extended
F. Wrist Flexed
C. C6 Extended, Rotated Right, Sidebent Right
A 35-year-old white female presents to your office with knee pain after running her first marathon of the season last weekend. She has noticed the pain getting progressively worse during her training. She describes it as a dull aching pain in the front of her knee, which gets worse with activity and repeated bending (ex., climbing stairs). She has also noticed when she gets up from sitting for 15 minutes or more, her knees are painful and make crackling sounds as she stands. She makes it very clear to you that she does not wish to stop running as it is her favorite stress reliever. Which of the following diagnoses could be a sequela of this acute presentation if left untreated?
A. Torn meniscus B. Chondromalacia C. Rheumatoid Arthritis D. Torn Anterior Cruciate Ligament E. Patellar Tendonitis
B. chondromalacia
A 24-year-old male presents to the primary care office with complaints of lower back pain. The pain began yesterday after slipping on the ice when stepping down from the curb to get into his friend’s car. He said it was quite comical because he pulled on the frozen door latch and slid right under the car landing with his back on the curb. Physical examination: L3 posterior transverse process on the right in neutral and extension, but it becomes symmetric with the left TP in flexion. Performing HVLA with the patient in the left lateral recumbent position would most likely include which of the following?
A. pulling left arm anterior to rotate the pt to the right; monitor L3 with right or left hand
B. pushing the right pelvis posteriorly to accentuate R rotation from below
C. Perform HVLA thrust on its inhalation
D. pull right arm inferiorly to accentuate right SB
A. pulling left arm anterior to rotate the pt to the right; monitor L3 with right or left hand
A 34-year-old female presents to the sports medicine office with complaints of right hip pain 1 week after participating in an Iron Man event (1.2-mile swim, 56-mile bike, 13.1-mile run). She states that it began a week before her first Iron Man event. She cut down her training routine a bit before the race, but still participated. She was very sore all over after the event and had a limp, but she thought it would get better with rest of her body. Workup with x-rays and MRI failed to divulge a specific pathological cause of her complaints. PROM recheck exam of the hip after OMT finds: diminished ROM in Ab/Adduction and IR/ER that is slightly improved by OMT. She would like to compete in another race in 6 weeks, but she cannot train secondary to her pain. Which of the following is the most likely next step in patient management?
A. referral to chiropractor B. referral for accupuncture C. referral for PT D. referral to neurologist for EMG E. referral for orthopedic surgery
C. referral to PT
A 31-year-old female presents to the primary care office with complaints of low back and right buttock and leg pain. She has been training for her first Iron Man and the pain started after a practice half Iron Man she did last weekend. The pain in her back feels mostly left sided and it seems to involve her left buttock and radiates down the back of her leg, but doesn’t go below the knee. Physical examination: Left SI joint TART, Tenderpoint midway between left greater trochanter and ipsilateral ILA with
underlying hypertonic muscle mass, External lower extremity rotation preference when hip in neutral. Which of the following stretches would most likely target and benefit this patient in an Exercise Prescription?
A. Quadriceps stretch B. Supine Rectus femoris + quadriceps stretch C. Prone Iliopsoas stretch D. Supine piriformis stretch E. Standing TFL stretch
D. Supine piriformis stretch
A 43 y/o male presents with c/o LBP. He just recently started running as a form of exercise after his primary care physician informed him of his high BMI and risk for cardiovascular disease. He describes the pain as an intermittent dull ache exacerbated by running. On physical exam, pelvic compression test is restricted on the right, iliac crest heights are even bilaterally, ASIS height inferior on left, PSIS height superior on left, and medial malleoli height superior on right. Which of the following best describes the physician-directed activating force vector for an HVLA technique?
A. Physician rolls the patient posteriorly to gap the sacroiliac joint.
B. Physician exerts a posterior force with the cephalad hand to patient’s anterior shoulder.
C. Physician exerts a force through the caudad forearm towards the patient’s umbilicus.
D. Physician exerts a force through the cephalad forearm towards the patient’s distal femur.
E. Physician exerts an anterolateral traction to the dysfunctional ASIS and PSIS.
C. Physician exerts a force through the caudad forearm towards the patient’s umbilicus.
A 42 y/o male commercial truck driver presents to your clinic with low back pain for the past week. He states that the pain started when he jumped down out of his truck after a 10-hour period of driving. Physical exam shows L1 FRrSr, L2-4 NRlSr, and a positive Thomas test on the right. After appropriate treatment, he reports moderate resolution of his symptoms and you decide to teach him a home stretch to continue to manage his main somatic dysfunction. Which of the following is part of the stretching component of the Exercise Rx for the indicated muscle?
A. Contract his gluteal mm.
B. Place hands behind him and straighten back
C. Place hand on lateral knee and pull closer to his body
D. Fully abduct ipsilateral arm over his head
E. Dorsiflex his foot
A. Contract his gluteal mm.
A 38-year-old male presents to the primary care office with complaints of right hip pain. The pain began 4 months ago after his second week of P90X training. He thought it would go away, but it hasn’t. Severity = 5/10 (0=nothing, 10=totally interfering with life). It bothers him when he walks or exercises and is better with rest. He’s really bummed because he wants to get in shape for summer. Physical examination: 4/5 right hip abduction strength; positive trendelenburg when weight bearing on the right; PROM right hip abduction 45 degrees when compared to left hip 60 degrees. Which of the following stretches would most likely target and benefit this patient in an Exercise Prescription?
A. Standing quadriceps stretch B. Seated stretch for hypertonic LE adductors C. Prone iliospoas stretch D. Supine piriformis stretch E. Standing hamstring stretch
B. Seated stretch for hypertonic LE adductors
A 22-year-old male presents to your office with complaints of ankle pain after rolling his ankle in a basketball game 2 hours ago. He jumped to shoot the ball, but landed on the lateral aspect of his foot, rolling it medially. On examination, you find moderate tenderness and swelling around the ankle, a positive anterior ankle drawer test, and point tenderness over the posterior edge of the lateral malleolus. When you ask him to walk across the room, he is unable to bear weight for more than two steps. What grade ankle sprain does this patient have, and does he qualify for radiographs according to the Ottawa Ankle Rules?
A. Grade 1, No Radiographs B. Grade 1, Yes Radiographs C. Grade 2, No Radiographs D. Grade 2, Yes Radiographs E. Grade 3, No Radiographs F. Grade 3, Yes Radiographs
D. Grade 2, Yes Radiographs
A 27 y/o G4P3 F presents to her OB for her 36-week appt. the pt complains of LBP for several months and has become progressively worse. The pain worsens with activity and is alleviated by rest. The pain is generally localized to her low back, but at times radiates down the back of her thighs to just above her knees b/l. Her sleep has progressively deteriorated d/t pain becoming worse at night, especially w/ turning. Which of the following is the most likely etiology?
A. Mechanical postural stress B. Herniated L4 disc C. Vascular compromise d/t compression D. Osteoarthritis of lumbar spine E. Sacroiliitis
A. Mechanical postural stress
A 45-year-old female presents to the primary care office with complaints of back pain and right hip pain. The pain began about 2-weeks ago when she started coaching her 12-year-old son’s soccer team. She thought she was just out of shape and it would go away, but it hasn’t.
Severity = 5/10 (0=nothing, 10=totally interfering with life). It bothers her when she walks or exercises and is better with rest. She’s really bummed because she didn’t think she was that out of shape and now feels old. Physical examination: positive right standing flexion test, right ASIS superior, left PSIS superior, iliac crests even. Which of the following describes the physician directed counterforce introduced through the lower extremity in a muscle energy technique for this patient?
A. Flexion B. Lateral C. Medial D. Extension E. IR F. ER
D. Extension
