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NBCE PART 3 EXAM 2024 ACTUAL
EXAM 200 QUESTIONS AND
CORRECT ANSWERS (PROFESSOR
VERIFIED) | ALREADY GRADED A+ |
LATEST EDITION
Goal of the Case Hx is to establish? -------CORRECT ANSWER------------ The how and why How/Why details which aspect of the HX?e -------CORRECT ANSWER------ ------Mech Of Injury-forces and energy dissipated to create trauma Trauma -------CORRECT ANSWER------------Singular or multiply "the framework" Other conditions must be detailed d/t -------CORRECT ANSWER------------ Directly/indirectly relate to the complaint or the well being of the pt. Understanding the whole patient, is best accomplished through the creation of -------CORRECT ANSWER------------Doing a clinical impression aka prioritized problems list Clinical impression:
Basis upon? Determines? Contents to ensure thoroughness (5) -------CORRECT ANSWER------------ Based on Hx alone and determines what further testing needs to be done.
- Describe subluxation
- Describe complaint with modifiers
- Describe co-morbid factors
- Describe diagnoses
- Describe complications Subluxation aka? What priority? -------CORRECT ANSWER------------aka intersegmental dysfunction, always number one Complaints with modifiers What dictates treatment plan? ? &? provide markers for improvement? -------CORRECT ANSWER---------- --Phase of injury dictates treatment plan Severity and Frequency provide markers for improvement Description of symptoms with location helps determine what tissues are involved a(quality & site) Phases of Injury (3) and duration? -------CORRECT ANSWER------------ Acute: 0-72 hours Subactue: 72 hrs-2 weeks Chronic: 2 weeks + acute exacerbation of a problem... responsablity of D.C -------CORRECT ANSWER------------MUST be properly documented
Co-morbid factors defined and examples (2) -------CORRECT ANSWER----- -------Presence of one or more conditions in addition to a primary conditions that has an effect on another Ddx or the overall well being Ex. High blood pressure, diabetes etc. Diagnoses -------CORRECT ANSWER------------Always subluxation, there are some allopathic diagnoses. Ex. osteoarthritis, AS, S/S, Fx, facet syndrome etc. This determines treatment Dejerene's Triad + has (?) steps, will increase pressure on ?, and is used to DDX? -------CORRECT ANSWER------------ 3 Nerve Root Disc, tumor, stenosis, severe trauma (fx) "Complications" include minimum (8) aspects name them -------CORRECT ANSWER------------demographics, lifestyle, occupation, social, age, sex, religion, ADL's #1 Hx predicts incidence LBP -------CORRECT ANSWER------------previous LBP Chief Complaint -------CORRECT ANSWER------------MNOOPPQRST PSOFMD Review of Systems -------CORRECT ANSWER------------SHITMD GREENCRUMS
Facet Referral -------CORRECT ANSWER------------just going somewhere Facet Syndrome -------CORRECT ANSWER------------had for a long time along with other signs and symptoms ARTHROSIS OF FACETS (DJD) Syndrome classified and name examples -------CORRECT ANSWER-------- ----Set of symptoms occuring together ex. facet syndrome, TOS, fibromyalgia, restless leg, chronic fatigue, Reiter's (ddx with AS and infx spondylitis), Late Effects of S/S -------CORRECT ANSWER------------recurring S/S in area of previous injury with NO NEW TRAUMA! EXACERBATION well documented S/S -------CORRECT ANSWER------------identifiable injury/incident causing present symptoms. Ddx fx Pain on active, active resisted, and passive ROM "Sclerotome" pain pattern Quality? DT - or + ORIGINate for what tissue? Dermatome? -------CORRECT ANSWER------------diffuse, non-specific ABSENCE DT
Muscle ache/pain DJD Pain Quality and Pattern? Law's Assoc? Aspect of case hx to consider? 3 assoc complication of DX? -------CORRECT ANSWER------------Diffuse, local, dermatomal Wolff's/Davis' Law Spondylosis VB Arthrosis facets Canal/IVF stenosis Think demographics Claudication (2) types? How to differentiate? -------CORRECT ANSWER---- --------Vascular-better when pt stops moving Neurogenic-better when pt bends forward or leans off it Hot/Cold extremities S/S may be global in the limb or limbs that are affected Postural Syndromes aka? To describe conditions/causative factors you use Hx to describe: (4) ------- CORRECT ANSWER------------Abnormal Posture To describe conditions/causative factors you use Hx to describe:
- cumulative trauma
- repetitive trauma
- Jandas crossed syndromes
- abnormal posture Spinal Anomalies and Varients: (2) classifications? m/c spinal region associated?
Name (6) common examples -------CORRECT ANSWER------------Born with it-congenital, otherwise acquired Common lumbars-spondy Scralization, lumbarization Tropism Spina Bifida Knife Clasp Syndrome Scoliosis Thoracolumbar Subluxation 3 complications? Involves? Common areas affected? -------CORRECT ANSWER-------------pain that will not resolve
- prolonged postural distortion
- internal compression
- involves segments above and below
- common insertion point for diaphragm, lower - trap, iliopsoas
- area of pivot from upper to lower extremity arm and leg swing Lumbar Subluxation Pain Pattern/distribution m/c seen? M/C etiology? m/c involved spinal segments/locations? Orthopedic test used to isolate/DDX? Soft tissue presentation? Pt. presentation? -------CORRECT ANSWER------------unilateral pain
- traumatic event
- SI joint PE usually L4-L
- belt test, goldthwaites, SLR
- muscle spasm
- edema
- presence of later/anterior antalgia with acute trauma with unknown etiology
- last 6 months to a year
- thoroughly documented
- deconditioned musculature along with fibrosis and adhesions
- Ligament laxity with coupling segments and hypo/hyperlordosis Lumbar Fx MOI? PE used? Imaging result? -------CORRECT ANSWER-------------traumatic event
- PE possible tuning fork and reflex hammer findings
- acute sensitivity on motion/palp
- x-ray fx or callous formation with minor break Sacral ord Coccyx fx -------CORRECT ANSWER------------Same as lumbar fx Postural Syndromes Causes? Presentation upon PE, Imaging? Vertebral malpositon? Classification? What is need for a DX? -------CORRECT ANSWER------------
- sustained postural distortion, repetitive/cumulative trauma, late effects S/S, subluxation
- distortion visible on inspection, palp, x-ray
- lateral shifting and rotation
- It's a complication and co-morbid factor (NOT diagnosis)
- need other following qualifiers for diagnosis Lower Cross Syndrome Class? Hypertonic mms?
Hypotonic mms? Postural presentation? -------CORRECT ANSWER-------------postural/again this is NOT diagnosis
- tightening iliopsoas, rectus femoris, and spinal erectors
- weaking transverse abdominus, internal obliques, external obliques, rectus abdominus, and glute max
- Forward head translation
- change cervical curve
- protracted shoulders
- increased thoracic kyphosis
- increased lumbar lordosis
- anterior pelvic tilt Abnormal Posture defined? -------CORRECT ANSWER-------------deviates from classic neutral biped stance in all four directions
- CBP Cumulative/? trauma? MUST document? -------CORRECT ANSWER------- ------repetitive
- document MOI Repetitive motion becomes? MUST document? -------CORRECT ANSWER-------------becomes accumulated trauma
- document MOI Prolonged postural distortion is caused when pt? -------CORRECT ANSWER-------------primary MOI
- pt trauma holding body in one position for long periods of time with little or no movement
SI Joint referral -------CORRECT ANSWER-------------Hx of pain with/without trauma that is local to joint or referring into thigh and possibly down to the foot
- S/S from joint articulation and tissues and may have sclerotomal on coupled motion
- x-ray may have pathology Lumbopelvic trigger point referral HPI considerations? referral? Pt. presentation? -------CORRECT ANSWER-------------pt pain scenario that started local or diffuse; maybe insidious (ie) repetitive motion or sustained postural distortion
- maybe peripheral referral into one or both lower etremities
- soft tissue spasm, edema
- antalgia
- altered lordosis or pelvic torque Muscle Spasm defined and classes (2) -------CORRECT ANSWER------------ Sudden involuntary contraction. Acute/subactute Myofascitis defined and classed? -------CORRECT ANSWER------------ pain/tenderness in muscle and related CT. Chronic nature (fibromalgia) NOT fibroMYalgia Visceral Referral quality? -------CORRECT ANSWER------------diffuse symptoms related to organs ex. lower GI tract, kidney, bladder, sex organs
SOLS- L2/L3 Spinal N. Root (L1 Disc) MOI? AGE? DT =/-? mm test? Dermatomal levels? Reflex? -------CORRECT ANSWER-------------trauma/tumor
- <
- DT +
- iliopsoas test
- dermatomes L1, L2, L
- no reflex L3 spinal N. Root (SNR) inervates which mm group? -------CORRECT ANSWER------------adductors L3/L4 SNR (L3 disc) HX MOI SITE AGE MM Dermatome site Reflex? -------CORRECT ANSWER-------------previous back pain
- twist with bending
- below knee
- <
- Tib ant M. test (inversion)
- dermatome lower medial thigh to calf/or medial foot
- patellar reflex
- muscle girth difference (medial hamstring reflex)
SITE
Associated complication MM Dermatome site Reflex? MM girth affected? -------CORRECT ANSWER-------------previous LBP
- twist with bend, below knee
- bilateral
- weakness legs
- bowel/bladder dysfunction
- dermatome perineum, both legs,
- ankle and/or knee jerk, anal tone
- muscle girth difference Lumbar Canal stenosis & accompanied? aka? AGE? HX? ONSET/PROV/PALL? SITE/SYMPTOMS? Associated NEURO/Dermatome complication? X-RAY METHODS AND MEASUREMENT for DX? -------CORRECT ANSWER-------------accompanied psuedo-claudication (neuroclaudication)
- 50+ yrs
- Hx LBP
- onset pain with walking, staying in postion, relief bending forward
- "sensory march" symptoms in feet travel up the legs to lumbopelvic region
- deficits cross nerve root boundaries
- x-ray Eisenstein or Beuler methods (>15mm relative, >10mm absolute) Cauda Equina Syndrome MECH/DEFINED ASSOCIATED COMP NEUROLOGICAL S/S DDX W/DERMATOME EXAM -------CORRECT ANSWER-------------acute or chronically worsening from injury to multiple nerve roots
- Loss bowel, bladder, groin fx
- bilateral leg symptoms-->numnbness and tingling in multiple dermatomes=canal stenosis, central disc, or tumor Others "SOLS" (2) -------CORRECT ANSWER------------IVF stenosis, Spinal cord tumor PNE: Piriformis Syndrome MOI? INSPECTION CLUES? HX? DERMATOME PE CAN MIMIC? YEAH OR NAH WITH MYOTOME OR DTR? PALPATION OF? REVEALS INVOLVEMENT? -------CORRECT ANSWER-------------non-traumatic
- short leg, pelvic rotation, pronation
- hx injections
- PE can mimic radiculopathy in dermatomes
- NOT myotome or DTR
- palpable gluteal involvement Sciatica Entrapment in? ligament, deep? mm's &? hamstrings? -------CORRECT ANSWER------------Entrapment in sacrotuberous ligament, deep rotators and proximal hamstrings DISH aka? osseous presentation? R.O.M? RESEMBLES? S/S? -------CORRECT ANSWER------------aka Ankylosing vertebral hyperostosis
QUALITY
COMMON X RAY FINDINGS -------CORRECT ANSWER-------------Hx accompanies scenarios under subluxation
- local/diffuse
- older pt with Hx of trauma, previous pain, surgery
- PE x-ray evidence or arthrosis and spondylosis
- with/without lordosis or pelvic torque Lumbosacral Arthrosis X RAY FINDINGS ASSOC LIGAMENTOUS COMP. -------CORRECT ANSWER------------- enlargment of facet articulations that bridge one vertebra to another
- may have calcified ligaments Sway Back WHO? MUSCULAR ETIOLOGY -------CORRECT ANSWER------------AKA Functional or structural hyperlordosis
- gymnasts/weight lifters
- overactive iliopsoas for a period of time Other altered spinal curvatures -------CORRECT ANSWER------------ Acquired (hyper) lordosis, postlaminectomy (hyper) lordosis, laterality of lumbar spine less than 20 degrees, unspecified curvature of the spine Multiple Myeloma AGE? C.C? TIMING? XRAY? ONCOLOGY? URINE?
ELECRO/IMMUNO PHORESIS?
MARROW ASPIRATION= >? % PLASMA CELLS -------CORRECT
ANSWER-------------50+ years
- unexplained persistent LBP
- vague symptoms worse at NIGHT
- unrelieved by rest
- x-ray-punched out rat bite lesions in skull, ribs, spine
- anemia with normal erythrocyte morphology
- Bence Jones ptn in urine
- electrophoresis monoclonal spiking
- immunoelectrophoresis increase IgG
- bone marrow aspiration >20% plasma cells Prostate cancer AGE? C.C? TIMING? URINE? ONCOLOGY? EXAM? DX W? -------CORRECT ANSWER-------------65+ man
- asymptomatic then insidious LBP and or pelvic pain
- pain on urination
- PE blood in urine
- palpable hard nodule near prostate
- biopsy for diagnosis
- PSA in blood with higher levels of dx or enlargement Metastatic Carcinoma HPI HX TIMING X RAY (2) -------CORRECT ANSWER-------------Hx weight loss, fatigue
- prior cancer diagnosis
- worse at NIGHT
- x-ray-osteolytic missing pedicle
