SAER 2001 Flashcards
A 27-year-old female runner presents to your office with foot pain for the last 3 weeks. She reports
a severe pain on the bottom of her foot which is worse with the first few steps in the morning after
getting out of bed. She has no history of trauma and typically runs up to 5 miles per day. Her
running has been severely limited since this pain began. What is the best initial treatment option
for this patient’s pain?
(a) Walking cast for the affected foot
(b) Complete bed rest for several days
(c) Corticosteroid injection at the involved site monthly for 3 months
(d) Foot orthotic and stretching
(d)
This patient’s symptoms are most consistent with plantar fasciitis. Classically, this syndrome is most painful first thing in the morning upon arising and is aggravated by overuse or change in footwear. Stretching the plantar fascia, often before getting out of bed in the morning, and use of a heel cup or medial longitudinal arch orthotic are the initial treatments for this condition.
Corticosteroid injection may be indicated at the insertion of the fascia into the plantar aspect of the calcaneus; however, this is usually not required on a repeated basis. Relative rest from the aggravating activity may be useful, but bed rest is not indicated. A walking cast would not allow
stretch of the plantar fascia.
What magnetic resonance imaging findings would help to distinguish an acute from a chronic intracerebral hemorrhage? (a) T1 decreased, T2 increased (b) T1 decreased, T2 decreased (c) T1 increased, T2 increased (d) T1 increased, T2 decreased
(b) The T1 signal in an acute hemorrhagic event would be decreased. Magnetic resonance imaging can
be helpful in distinguishing acute from chronic hemorrhagic events. The pathology and subsequent
neuroimaging results are based on the stage of hemoglobin molecular breakdown. In acute
hemorrhagic states, deoxyhemoglobin predominates and T1/T2 images are both decreased. In
chronic hemorrhagic states (more than 2 weeks) methemoglobin
Which of the following synovial fluid findings is most specific for infection?
(a) White blood cell count of 5,000/mm3
(b) Transparent, straw-colored fluid
(c) Ninety-eight percent neutrophils on a differential leukocyte count
(d) Negatively birefringent crystals under a polarizing microscope
(c) All synovial fluid removed for diagnostic purposes should be sent for gram stain and cell count.
Noninflammatory synovial fluid typically has white blood cell counts of less than 2000/mm3, is
transparent or yellow colored, and has less than 50% neutrophils. Inflammatory fluid usually is
translucent or opaque, can have very high cell counts (up to 100,000/mm3), and usually has less
than 90% neutrophils. Synovial fluid that has cell counts over 100,000/mm3, is purulent and has
more than 95% neutrophils should be considered infected.
6. A withdrawal syndrome produced by abrupt medication dose reduction or the administration of an antagonist drug is referred to as (a) tolerance. (b) pseudoaddiction. (c) physical dependence. (d) addiction.
(c) Physical dependence is a pharmacologic property of many drugs caused by the body’s physiologic
acclimation to their presence. In the case of opioids, withdrawal will develop in tolerant patients if
the drug is not tapered.
A nurse working in a rehabilitation hospital is most likely to injure her back while
(a) assisting a patient to perform a sliding-board transfer.
(b) catheterizing a patient.
(c) performing a wheelchair-to-toilet patient transfer.
(d) helping a patient move up in bed.
(d) The difficulty in using proper posture and body mechanics and the forces required for pulling
patients up in bed are believed to be the reasons that this task most often causes back pain among
nurses.
The most useful clinical criterion to distinguish Becker muscular dystrophy from Duchenne
muscular dystrophy is
(a) creatine kinase values at the time of diagnosis.
(b) walking ability during the teen-age years.
(c) Gowers’ sign and calf enlargement.
(d) age at onset of diagnosis.
(b) The most useful clinical criterion to distinguish Becker muscular dystrophy (BMD) from Duchenne
muscular dystrophy (DMD) is the continued ability of the patient to walk into late teen-age years.
Persons with BMD will typically remain ambulatory beyond 16 years. Outlier DMD cases
generally stop ambulating between 13 and 16 years of age. Creatine kinase values cannot be used
to differentiate DMD from BMD. Calf enlargement and the presence of Gowers’ sign are a
nonspecific findings. Studies have shown significant overlap in the observed age at onset between
DMD and BMD.
Dysesthesias on the plantar aspect of the foot may be associated with peripheral neuropathy or
tarsal tunnel syndrome. Which of the following would be most useful to help in distinguishing
between these?
(a) Reproduction of symptoms with compression inferior to the medial malleolus
(b) Sensory testing using a Semmes-Weinstein monofilament on the plantar aspect of the foot
(c) Plain anteroposterior and lateral radiographs of the foot, including the calcaneus
(d) Slowing of the medial and lateral plantar nerves on nerve conduction studies
(a) Both peripheral neuropathy and tarsal tunnel syndrome can present with painful dysesthesias. Plain
radiographs will not be helpful, as they can be normal with either of these conditions. Nerve
conduction studies may demonstrate slowing of the medial and lateral nerves with either condition,
and sensation on the plantar aspect of the foot may be decreased with either condition.
Compression over the tarsal tunnel should cause increased symptoms of numbness, tingling, or
burning in the plantar aspect of the foot.
A primary care physician started a relative of yours on donepezil (Aricept) for the treatment of
Alzheimer’s disease. This medication is used to modify
(a) expressive language skills.
(b) behavioral and cognitive symptoms.
(c) disease progression.
(d) restoring normalized sleep-wake cycles.
(b) Donepezil is a cholinesterase inhibitor (C1) with properties shown to address cognitive behaviors,
specifically behavioral disturbances. C1 has not been shown to slow or stop disease progression.
A 26-year-old woman presents with the new onset of lower extremity weakness and bladder
incontinence. Past medical history is remarkable for an episode of diplopia and blurred vision
which resolved spontaneously. The most likely diagnosis is
(a) multiple sclerosis.
(b) myasthenia gravis.
(c) myasthenic syndrome.
(d) amyotrophic lateral sclerosis.
(a) Clinically, multiple sclerosis is characterized by multiple lesions separated in time and location
within the central nervous system. Common presenting symptoms include diplopia, optic neuritis,
weakness, sensory loss, and ataxia. Women between the ages of 20 and 40 are the most commonly
affected population. Diplopia, though commonly associated with myasthenia gravis, is not seen in
myasthenia syndrome or amyotrophic lateral sclerosis.
The best possible expected functional outcome for a person with C7 ASIA A spinal cord injury is
(a) dependent with bladder, independent with bed mobility, and some assist with all transfers.
(b) dependent with bladder, independent with bed mobility, and independent with level transfers.
(c) independent with bladder, some assist with bed mobility, and independent with some
transfers.
(d) independent with bladder, independent with bed mobility, and independent with level
transfers.
(d) Expected functional outcomes after traumatic spinal cord injury have been delineated in the
clinical practice guidelines for health care professionals. A person who has sustained a C7-8-level
spinal cord injury can best be expected to need assistance in clearing secretions, may need partial
to total assistance with a bowel program, and may be independent with respect to bladder
management, bed mobility, and transfers to level surfaces. Adaptive equipment is listed in these
tables (FIM (functional independent measures) purists can argue that these persons really are only
modified independent).
Which of the following conditions is least likely to exacerbate preexistent lymphedema?
(a) Scuba diving in cold water
(b) Airplane travel
(c) Phlebotomy
(d) Sun exposure
(a) Conditions associated with decreased atmospheric pressure will cause lymphedema to progress.
Activities or situations that lead to increased blood flow in the affected extremity (eg, burns, heat,
physical exertion, trauma) exacerbate lymphedema. Atmospheric pressure increases during scuba
diving, therefore, it has the capacity to ameliorate lymphedema.
Functional recovery programs for the injured worker with chronic pain should
(a) be done on an inpatient basis to increase the likelihood of success.
(b) not be started until pain medications have been discontinued.
(c) focus on restoration of function.
(d) focus on reducing the patient’s pain symptoms.
(c) Functional recovery programs should focus on restoring functional ability, including return to
work.
Of the following, somatosensory studies would be the most useful in the diagnosis of
(a) tarsal tunnel syndrome.
(b) motor neuron disease.
(c) myasthenia gravis.
(d) multiple sclerosis.
(d) Somatosensory studies can be helpful in the diagnosis of multiple sclerosis. Standard nerve
conduction studies and electromyography are far more useful in the diagnosis of the other
disorders.
The leading cause of childhood disability is
(a) traumatic brain injury.
(b) spinal muscular atrophy.
(c) spina bifida.
(d) cerebral palsy.
(d) Cerebral palsy is the leading cause of childhood disability. The reported incidence is approximately
2-3 per 1,000 live births. The incidence of spina bifida is .5 per 1,000, of spinal muscular atrophy 1
in 25,000. The annual incidence for traumatic brain injury in children is 1-2 per 1,000. However,
the great majority of cases are minor and result in no long-term disability. Approximately 15% of
brain-injured children have moderate and severe injuries resulting in permanent impairment.
Which of the following orthoses or shoe modifications is used in the conservative management of plantar fasciitis? (a) Heel lift (b) Posterior night splint (c) Lateral heel wedge (d) Metatarsal bar
(b) A heel lift plantarflexes the foot and is used for Achilles tendinitis. A metatarsal bar is used for
metatarsalgia. A lateral heel wedge can be used for the conservative management of osteoarthritis
of the knee. A posterior night splint dorsiflexed to 5/ is the correct answer.
A 32-year-old woman with known multiple sclerosis has frequent bladder sensation and urgency
but very little urination amounts. Nursing informs you that her void amounts are low, her post-void
residual is high, and the combined voided plus catheter specimen amounts are on the low-normal
side. You order urodynamic testing to verify
(a) an areflexic bladder with sphincter dyssynergia (increased tone).
(b) an areflexic bladder with normal sphincter tone.
(c) a hyperreflexic bladder with sphincter dyssynergia.
(d) a hyperreflexic bladder with normal sphincter tone.
(c) Bladder dysfunction in patients with multiple sclerosis can be challenging from a diagnostic
perspective. The use of urodynamic testing provides useful information. Bladder function in this
scenario would be hyperreflexic, and with high residual volumes it would indicate that bladder
outlet pressure is high so as to block urine flow, as if squeezing on a water balloon and holding the
spout. This outlet pressure is called dyssynergia, and treatment is directed at bladder neck
relaxation.
Which of the following glucocorticoid preparations has the longest therapeutic action?
(a) Triamcinolone diacetate (Aristocort)
(b) Methylprednisolone acetate (Depomedrol)
(c) Hydrocortisone phosphate (Hydrocortone)
(d) Dexamethasone sodium phosphate (Decadron)
(d) The onset and length of symptomatic relief after steroid injection are related to the preparation
used. Dexamethasone sodium phosphate has an intermediate solubility and a fairly long biologic
half-life (36-72 hours). Methylprednisolone and triamcinolone have biologic half-lives of 12-26
hours. Hydrocortisone phosphate is not recommended for intraarticular use.
Outcomes of inpatient rehabilitation for neoplastic versus traumatic spinal cord injury reveal that
(a) indices for depression were significantly higher in patients with neoplastic injury.
(b) patients with neoplastic spinal cord injury had significantly shorter lengths of stay.
(c) rate of functional change was significantly better in the traumatic population.
(d) neoplastic spinal cord injury was associated with a significantly higher rate of discharge to
the community.
(b) Patients with neoplastic spinal cord compression tend to be older than their traumatic counterparts,
with a peak incidence between 50 and 70 years. Significant differences exist with regard to the
level of injury; tumors involving the spinal cord tend to involve the thoracic and lumbar regions
more than the cervical region. There was a shorter rehabilitation length of stay in patients with
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neoplasms. (This may allow patients to have more time at home with their families. These patients
had an increased percentage of paraplegia and incomplete injury.) Patients with tumors did
demonstrate a trend toward lower rate of discharge to the community, but this was not significant
During the initial reductive phase of decongestive physiotherapy for advanced lymphedema,
compressive bandaging should remain in place
(a) 1-2 hours per day.
(b) overnight.
(c) whenever patients are not bathing or being manually drained.
(d) only during exercise periods.
(c) During the initial phase of complete decongestive physiotherapy (CDP), compressive bandages
traditionally remain in place 20 - 21 hours per day. They are removed only to permit bathing and
manual lymphatic drainage. Once maximal volume reduction has been achieved, patients transfer
to phase II, or maintenance, CDP indefinitely. The purpose of phase II CDP is to prevent
reaccumulation of lymphedema. During phase II, patients apply compressive wrapping only at
night.
A 35-year-old fireman with a 3-month history of shoulder bursitis is referred to you for treatment.
Among the following, your initial management would include
(a) ice massage to the involved area.
(b) ultrasound to the involved area.
(c) transcutaneous electrical nerve stimulation.
(d) placing the arm in a shoulder sling.
(b) Ice massage is more effective for acute bursitis. Subacute or chronic bursitis may respond to deep
heating modalities such as ultrasound.
The earliest weakness seen in skeletal muscle in Duchenne muscular dystrophy is located in
(a) knee extensors.
(b) hip flexors.
(c) neck flexors.
(d) ankle plantar flexors.
(c) Neck flexor weakness occurs during preschool years. Weakness is generalized but is predominantly
proximal early in the disease course. Pelvic girdle weakness precedes shoulder girdle weakness by
several years. Weakness progresses steadily. Quantitative strength testing is more sensitive than
manual muscle testing.
During normal human locomotion, the center of gravity travels through a sinusoidal pathway that is
modified by 6 determinants of gait. Which of the following is not considered 1 of the 6
determinants?
(a) Pelvic extension
(b) Foot and ankle synchronization
(c) Knee flexion
(d) Lateral pelvic displacement
(a) The 6 determinants are as follows: lateral displacement that reduces horizontal excursion from 6”
down to 1.7”; knee flexion that reduces vertical excursion 7/16”; pelvic rotation that reduces
vertical excursion 3/8”; pelvic tilt that reduces vertical excursion 3/16”; and foot and ankle
synchronization as well as ankle and knee synchronization that both serve to smooth out the
sinusoidal curve but do not decrease excursion.
Clinical features of Friedreich’s ataxia include
(a) sparing of sensory function.
(b) onset in the fourth decade of life.
(c) a high incidence of scoliosis.
(d) ambulation into late adulthood.
(c) Friedreich’s ataxia is a spinocerebellar degenerative syndrome with onset in the first 2 decades of
life. Weakness, proprioceptive sensory loss, and ataxia dominate the clinical picture. The incidence
of scoliosis approaches 100%; it is typically more severe when onset occurs at a young age.
Ambulation is lost by early adulthood.
Five weeks after sustaining a T6 spinal cord injury, your patient is noted to have urinary
incontinence with intermittent catheterization volumes of less than 200mL. Urinalysis is
unremarkable. You consider starting
(a) sodium etidronate (Didronel).
(b) oxybutynin (Ditropan).
(c) urecholine (Bethanechol).
(d) terazosin (Hytrin).
(b) This patient is probably developing spontaneous detrusor contractions but is emptying
incompletely. You would consider using an anticholinergic agent to decrease detrusor (and hence
intravesical) pressures. Ideally, you would obtain urodynamic studies to delineate detrusorsphincter
coordination. One should not initiate a cholinergic agonist without knowing of possible
detrusor -sphincter dyssynergy.
A human resource firm working with a manufacturing company inquires about personal factors and
low back injuries. It is interested in matching individuals with work stations. Which of the
following was found to be most important in predicting injuries?
(a) Age greater than 40
(b) Obesity
(c) Psychologic factors
(d) Poor physical fitness
(c) Other than a history of previous back injury, psychologic factors were found to be more important
than physical factors in predicting injuries.
You are treating a 48-year-old man who has had two lumbar laminectomies for what you suspect is
a recurrent right L5 radiculopathy. You perform an electromyogram to confirm the diagnosis, and
it reveals 2+ positive waves and fibrillations with decreased recruitment in the right anterior
tibialis. The patient informs you that he can only tolerate the examination of one more muscle. Of
the following you would choose
(a) extensor hallucis longus.
(b) L5 paraspinals.
(c) vastus medialis.
(d) flexor digitorum longus.
(d) The history is suggestive of an L5 radiculopathy. Given the previous laminectomies, examining a
single level of paraspinals would provide limited information. Although you cannot form any firm
conclusions based on such a limited examination, study of the flexor digitorum longus will provide
findings outside the peroneal distribution and could lend support to the clinical diagnosis
The most common complication after amputation in the immature child is
(a) phantom limb pain.
(b) diffuse edema.
(c) terminal overgrowth.
(d) painful neuroma.
(c) Terminal overgrowth at the transected end of a long bone is the most common complication after
amputation in the skeletally immature child. It occurs most frequently in the humerus, fibula, tibia,
and femur, in that order. The oppositional growth may be so vigorous that the bone pierces the
skin. The treatment of choice is surgical revision.
A 79-year-old cachetic woman with coronary artery disease and unstable angina sustains a right hip
fracture after a fall. After an open-reduction internal fixation of the hip joint with the use of a
dynamic hip screw, the orthopedic surgeon determines that the patient is 25% partial weight
bearing to the right side. She has weak upper body strength and good balance. Which of the
following assistive devices is most appropriate?
(a) Standard walker
(b) Rolling walker
(c) Axillary crutches
(d) Quad cane
(b) Standard walkers require good standing balance and good upper body strength. Crutches require
good upper body strength and have an increased energy expenditure of 40%-60%, which would be
contraindicated in unstable angina. Quad canes are not appropriate when significant weight-bearing
relief is required. Rolling walkers are most appropriate for patients who lack upper body strength
and provide safer gait than crutches or canes.
A 16-year-old boy presents 2 days after being injured during a weekend football game. He reports
receiving a direct blow on the right side from the helmet of a player. He had immediate pain in the
right lower part of the posterolateral trunk. On exam, you note ecchymosis and tenderness to
palpation just superior to the right iliac crest. Which of the following signs would be expected on
subsequent examination?
(a) Severe pain with internal rotation of the right hip
(b) Pain on the right side with left lateral bending of the trunk
(c) Numbness in the right femoral nerve distribution
(d) A positive Gillet test
(b) This scenario is classic for a contusion of the iliac crest or “hip pointer.” It occurs as a result of a
direct blow to an unprotected iliac crest. Tenderness with swelling and ecchymosis is common, as
is pain on the affected side with lateral bending away from the side of contact. This is not a hip
injury, and internal rotation of the hip should be normal. The Gillet test is used to evaluate
sacroiliac mobility. Numbness can be seen on the ipsilateral side because the T12-L3 lateral
cutaneous nerve branches are often injured.
A 75-year-old man with a recent anterior communicating artery aneurysm, treated by neurosurgical
clipping is admitted to the inpatient rehabilitation unit for poststroke care. Deep vein thrombosis
prophylaxis should include
(a) heparin 5,000 units BID.
(b) warfarin doses based on INR values.
(c) pneumatic compression stocking (ankle or calf).
(d) continuous passive motion devices.
(c) Venous thromboembolic events can occur in as many as 75% of untreated patients with after
stroke. Prophylaxis is typically pharmacologic or manual venous compression. In patients with
documented intracerebral bleeding, anticoagulation is not recommended, and alternating pneumatic
compression derives are best used.
The most common cause of upper limb pain in long-standing tetraplegia is
(a) shoulder pain of radicular origin.
(b) shoulder pain of musculoskeletal origin.
(c) elbow pain of radicular origin.
(d) elbow pain of musculoskeletal origin.
(b) In patients with quadriplegia, 55% reported pain in at least one region of the upper extremity. The
shoulder was reported as painful in 46% of subjects; the most frequent diagnoses for shoulder pain
were orthopedically related—tendinitis, bursitis, and osteoarthritis. Referred pain of cervical origin
accounted for 33% of shoulder pain. In patients with paraplegia, symptoms of carpal tunnel
syndrome were the most common complaint (66%).
A patient with metastatic lung cancer presents to the emergency department with new-onset back
pain and lower extremity weakness suspected to be due to spinal metastases. Initial management
should include
(a) observation for 24 hours and careful reexamination for progressive neurologic deficits.
(b) emergent irradiation prior to imaging.
(c) empiric administration of high-dose dexamethasone in the absence of contraindications.
(d) alteration of the patient’s chemotherapy regimen.
(c) A randomized controlled trial of high-dose steroids (96mg dexamethasone) versus placebo
concluded that steroid-treated patients with spinal cord compression from malignant epidural
disease were more likely to retain or regain ambulation. Surgery and radiation may be indicated,
contingent on tumor location and type and on prior radiation history. Dexamethasone should be
administered to patients before imaging in order to alleviate pain and to optimize neurologic
recovery.
A 63-year-old man was in a car accident 3 days ago. Cervical radiographs performed in the
emergency department demonstrate multilevel degenerative disc disease. He is currently
asymptomatic but is concerned about the radiographic findings. You inform him that
(a) this is diagnostic of central spinal stenosis.
(b) further neuroimaging is required.
(c) cervical spine immobilization with a soft collar is recommended.
(d) no evaluation or treatment is necessary until symptoms occur.
(d) Cervical spine degenerative changes in males over 60 are commonly seen in asymptomatic
patients.
In children hospitalized with acute burns, early management should include
(a) avoidance of sedation.
(b) positioning for comfort to reduce severe pain.
(c) use of a pressure garment over areas of full-thickness burns.
(d) administration of narcotics and anesthetic agents.
(d) Although opiates should be considered the most important part of acute pain management
nonopiates should be used when possible. As the needs become more chronic, other agents should
be instituted to minimize the problems seen with opiates. Behavioral management and relaxation
therapy should also be used when possible. Typically, the position of comfort for a burned child is
the position that promotes deformity and, therefore, should be avoided. Garments are fitted later in
the course of treatment.
A 77-year-old woman is admitted to the rehab inpatient unit with a diagnosis of general debility
after urosepsis and dehydration. Clinical exam reveals impaired memory, diminished abstract
reasoning, gait ataxia, and peripheral distal extremity numbness. Past medical/surgical history is
positive for coronary artery disease and poor nutrition. Lab data include Na 135, K 3.5, Cl 95, C02
24, WBC 7.4, Hgb 9.5, MCV 101, urinalysis negative, RPR negative, Cobalamin assay 200 pg/mL
(normal 170-900). You believe her neurologic abnormalities are attributable to
(a) normal-pressure hydrocephalus.
(b) latent neurosyphyilis.
(c) postdehydration cerebral infarction.
(d) pernicious anemia.
(d) Pernicious anemia can account for significant cognitive and motor disturbances in patients
typically more than 60 years old. The most frequent clinical findings are paresthesias, numbness,
gait ataxia, focal incontinence, leg weakness, memory disturbance, and acute dementia. Workup for
cobalamin levels, intrinsic factor antibodies, and Shilling’s test are useful in making a correct
diagnosis. Treatment consists of cobalamin replacement.
Use of continuous passive motion after total knee replacement surgery
(a) is associated with increased knee flexion at 6 months.
(b) decreases the risk of joint infection.
(c) facilitates knee flexion within the hospital stay.
(d) obviates deep vein thrombosis prophylaxis.
(c) Patients treated with continuous passive motion obtain greater early knee flexion (and thus
experience fewer hospital days and manipulations). These devices might exacerbate flexion
contractures and extension lags. Their use has no effect on rates of infection or deep vein
thrombosis.
A typical clinical finding in patients with alcoholic cerebellar disease is
(a) gait ataxia out of proportion to extremity ataxia.
(b) benign positional vertigo.
(c) severe upper extremity dysdiadochokinesia.
(d) vertical nystagmus.
(a) Alcoholic cerebellar disease preferentially affects the superior vermis of the cerebellum, resulting
in gait instability, poor trunk control, and lower greater than upper extremity ataxia.
Functional outcomes after the use of methylprednisolone in persons with penetrating spinal cord injury as compared with blunt injury are (a) markedly improved. (b) better. (c) unchanged. (d) worse.
(c) The administration of methylprednisolone did not significantly improve functional outcomes in
patients with gunshot wounds to the spine or increase the number of complications experienced by
patients during their hospitalization.
A 45-year-old colon cancer patient presents with new urinary incontinence and dull pain radiating
into the right buttock. Physical examination fails to reveal evidence of lower extremity motor or
sensory deficits. Of the following, the MOST appropriate next step in the patient’s evaluation
would include
(a) pelvic computed tomography with contrast.
(b) lower extremity electromyogram.
(c) positron-emission tomography scan.
(d) urodynamics studies.
(a) The sacral plexus is usually involved by tumor from the colon, prostate, bladder, or uterus.
Presenting symptoms usually begin as a dull, aching, midline pain, which may radiate into the
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buttocks. The pain may be associated with numbness in the perianal region. Numbness and
aresthesias may extend to involve the buttock and posterior aspect of the thigh. Bowel and bladder
function are often compromised. Computed tomography and magnetic resonance imaging scans of
the pelvis are excellent tools for detecting presacral masses and sacral destruction.
In considering selection of a lower limb prosthesis for a child with a congenital transfemoral
amputation, a knee joint should be included
(a) at initial fitting.
(b) between 3 to 5 years of age.
(c) when sports activities are anticipated.
(d) when the child pulls to stand.
(b) The lower limb deficient child should be fitted with a prosthesis when he or she is ready to pull up
to a standing position, usually between 9 and 12 months. A knee joint is added between 3 and 5
years.
Which one of the following cervical orthoses is the most restrictive to range of motion in flexion,
extension, axial rotation, and lateral bending, both actively and passively?
(a) Soft collar
(b) Philadelphia collar
(c) Philadelphia collar with thoracic extension
(d) Sternal-occipital-mandibular immobilizer collar
(d) Measurements of the range of motion in flexion, extension, axial rotation, and lateral bending (both
actively and passively) using a computerized motion analyzer for four orthoses—soft collar,
Philadelphia collar, Philadelphia collar with thoracic extension, and a Sternal-occipital-mandibular
immobilizer (SOMI)—found that the SOMI was most restrictive.
You are asked to see a 35-year-old woman with systemic lupus erythematosus who has severe left
groin pain. She underwent a cadaveric renal transplant 4 years ago. She has a Trendelenburg gait
and pain upon internal rotation of the hip. There is reproduction of the groin pain with hip flexion.
Your diagnosis is
(a) L5 radiculopathy.
(b) trochanteric bursitis.
(c) avascular necrosis.
(d) femoral neuropathy.
(c) The patient has aseptic necrosis of the femoral head. Her symptoms will be resolved with a hip
replacement. Before surgery, a program of isometric strengthening and endurance exercise is
appropriate. Trochanteric bursitis presents as lateral hip pain extending down the leg, worse with
walking or lying on that side. There is tenderness over the greater trochanter and pain with endrange
adduction or resisted abduction. Femoral neuropathy presents with weakness of the knee
extensors. An L5 radiculopathy typically presents with leg pain that extends to the dorsum of the
foot and is not worsened with hip rotation.
