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OCS - Medbridge practice exam 2- 75 Questions
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Sutlive CPR for Dx of Hip OA in individuals with unilateral hip pain - ✓✓✓(1) self- reported squatting as an aggravating factor (2) active hip flexion causing lateral hip pain (3) scour test with adduction causing lateral hip or groin pain (4) active hip extension causing pain (5) passive internal rotation of less than or equal to 25° Renal pain referral - ✓✓✓- pelvis, low back, AND SHOULDER per wiki: "Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classic symptom of a ruptured spleen.[1] May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ruptured ectopic pregnancy." ankylosing spondylitis risk factor - ✓✓✓- Crohn's disease and IBS are high Hill-Sachs lesion - ✓✓✓- A Hill-Sachs lesion is a compression fracture or depression defect on the posterior humerus that can occur when the humeral head impacts the inferior rim of the glenoid during a shoulder dislocation. Intervention to reduce impact of bone mineral density loss - ✓✓✓There is moderate evidence to suggest that high intensity aerobic exercise may be the most appropriate intervention to either reduce the loss or reverse the loss of bone mineral density. (Dutton 2008)
Which of the following is most helpful in the diagnosis of cauda equina due to its high sensitivity? - ✓✓✓Urinary dysfunction is common in those who have cauda equina, but urinary retention is more common than urinary incontinence and has a 90% sensitivity. (Small 2005) Non-msk generator for lower abdomen, middle lumbar spine, and buttock region sx? - ✓✓✓Individuals who have involvement of the large intestine will exhibit most of their symptoms in the buttock, middle lumbar spine and the lower abdomen, with the symptoms located in the region of T11-L1. (Goodman and Snyder 2013) Lower GI pathology - ✓✓✓Yes:
- bloody diarrhea
- central lbp
- fecal incontinence
- melena No:
- Upper thigh pain is more closely related to reproductive or urinary tract pathologies than lower GI pathologies. (Goodman and Snyder 2013) What is the MCID for the Oswestry Disability Index for patients with chronic low back pain? - ✓✓✓Ten points or 20% is the MCID reported in the literature for patients with chronic low back pain. (Davidson 2002) S1 nerve root - ✓✓✓Individuals with nerve root involvement of S1 will often have difficulty with plantarflexion and great toe movement, as well as an inability to walk on their toes. In this case, the patient's atrophy of the gastroc/soleus also pointed to an S issue. (Cleland and Koppenhaver 2011) A physical therapist is performing an examination/evaluation on a patient with low back pain that radiates to the posterior thigh. During the active range of motion assessment, the patient has a replication of symptoms during lumbar flexion. What should the
gold standard for diagnosis of cervicogenic headaches - ✓✓✓The diagnostic gold standard for cervicogenic headaches is a nerve block of the C2 nerve root. This is because the C2 nerve root travels through the obliquus capitis, splenius capitis, and trapezius muscle before then traveling through the occipital notch and innervating the unilateral scalp. Note that sometimes this diagnostic standard also is accompanied with long-term resolution of symptoms for patients with cervicogenic headaches! (Anthony
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. (Califf 1996) cervical ligamentous instability, which tests should be assessed first - ✓✓✓Mintken et al. described the reasoning behind performing the Sharp Purser test first in JOSPT. The Sharp Purser test is an alleviation test, and should be utilized first to determine if there is excessive mobility. Provocative tests, such as the alar ligament stress test, anterior shear test and aspinall test, should only be performed after the Sharp Purser test if no symptoms were generated and no excessive mobility is sensed via the Sharp Purser test. (Mintken 2008) It is recommended (as demonstrated in the MedBridge cervico- thoracic videos) to perform the sharp purser test again after provocation tests to help alleviate any symptoms that were aggravated with testing. cervical myelopathy risk factors - ✓✓✓Asian > Hispanic Male > female up to 90% of people > 70 yo hickening of ligamentous tissue that extends into the spinal canal, along with infolds and loss of capsular flexibility, are commonly seen as risk factors for the development of cervical myelopathy.
compressive cause for cervical radiculopathy - ✓✓✓Hypertrophy of the uncovertebral joints idiopathic carpal tunnel syndrome, what is the most common cause? - ✓✓✓Increased pressure in the carpal tunnel that leads to compression of the median nerve Reason: Because of a mismatch between the size of the median nerve and the carpal tunnel themselves, there is an increase in pressure in the carpal tunnel, which can lead to the pathology, when there is an idiopathic cause of carpal tunnel syndrome. (Uchiyama 2010) PS, Amyloid deposition often occurs in those who have long term dialysis for kidney pathologies. However, this is a secondary cause of carpal tunnel syndrome, not an idiopathic cause. carpal tunnel syndrome treatment options. Based on current evidence, which is true? - ✓✓✓- Surgical treatment is more effective than splinting Reason: Although it is unclear if this statement is true for those with mild symptoms, the studies included in a recent Cochrane Review revealed that surgical treatment is more effective than splinting. (Verdugo 2008) UNCLEAR IF SURGERY IS BETTER THAN CSI pain with third digit proximal interphalangeal flexion, resisted elbow flexion, and forearm supination. There is mild weakness seen with the strength assessment of the same muscles. Which pathology? - ✓✓✓Pronator teres syndrome Reason: Pronator teres syndrome, or compression of the median nerve between the two heads of the pronator teres muscle, would cause the symptoms seen with this patient. (Netter 2014 and Magee 2014) Motions to avoid with posterolateral corner injury - ✓✓✓- tibia ER
- hyperextension
- knee varus
activity is most likely to be limited in the long term after a posterior cruciate ligament injury - ✓✓✓Reason: In those who had posterior cruciate ligament tears, high speed running was the activity most affected in the long term as reported by Logerstedt et al in the APTA's clinical practice guidelines on knee ligament sprains. (Logerstedt 2 2010) ruling in a posterior cruciate ligament tear - ✓✓✓Reason: The posterior drawer test has a specificity of 99% as discussed by Logerstedt et al in the clinical practice guidelines for ligament sprains from the orthopaedic section of the APTA. However, the posterior sag sign has a specificity of 100%. What is the percentage of individuals who have a rotator cuff lesion, but are asymptomatic? - ✓✓✓67% Reason: Two thirds of individuals with small rotator cuff tears are asymptomatic per Fermont et al. (Fermont 2014) If a patient had which of the following, what would be helpful in ruling in adhesive capsulitis? - ✓✓✓(x)History of shoulder dislocation (x)Patient's age is 72 years Reproduction of symptoms with (o) end range glenohumeral motions Reason: With passive range of motion, patients with adhesive capsulitis regularly show end range limitations and reproduction of symptoms, depending on which stage they are in of the pathology (Kelley 2013). (x)Weakness of the supraspinatus, infraspinatus, and biceps brachii combination of tests would be most appropriate in determining if a SLAP lesion is present? - ✓✓✓Active compression test and Jobe relocation test Reason: Powell et al found that a combination of the active compression test and the Jobe relocation test or a second combination of the Jobe relocation test and the anterior apprehension maneuver was most helpful in ruling in a SLAP lesion. (Powell 2008)
What intervention is often deferred in patients who are highly irritable? - ✓✓✓euromuscular re-education exercises Reason: Neuromuscular re-education is often only incorporated in those who exhibit moderate and low irritability, as those who are highly irritable may have significant difficulty with the types of interventions used for neuromuscular re-education. It is better to wait until a patient is less irritable before integrating this into the plan of care (Kelley 2013). pain as 5/10 on average throughout the day...what level of irritability does this patient fall into? - ✓✓✓Moderate irritability Reason: This patient's pain of 5/10 falls into the average level of moderate pain (4-6/10) as discussed by Kelley et al, so this patient would be moderately irritable. (Kelley 2009 and Kelley 2013) In the pathogenesis of knee OA, which of the following occurs last? - ✓✓✓Development of osteophytes Reason: As discussed by Hackenbroch, sclerosis, subchondral cysts and osteophyte development occurs right before misalignment or loss of congruency in the joint, which is the last step in progressive osteoarthritis. (Hackenbroch 2002) irreversible matrix degradation > synovitis > cartilage loss > development of osteophytes Poor prognosticating factor after knee arthroscopy - ✓✓✓Spahn et al studied the factors that led to poor outcomes after arthroscopy for medial compartment osteoarthritis of the knee, and if an individual had a history of knee osteoarthritis for greater than 24 months, they were more likely to have poorer outcomes. (Spahn 2006) Knee OA prevalence - ✓✓✓African American women have knee osteoarthritis more often than white women. (Anderson 1998)
- patients in a supervised physical therapy group and patients in a home exercise program group had equal maintenance of improvements
- those who received supervised physical therapy were less likely to be taking medication at one year after intervention Cleland CPR for use of thoracic spine manipulation for neck pain - ✓✓✓▪ Symptoms <30 d ▪ No symptoms distal to the shoulder ▪ Looking up does not aggravate symptoms ▪ FABQPA score < ▪ Diminished upper thoracic spine kyphosis ▪ Cervical extension ROM <30° Tongue on roof of mouth deactivates - ✓✓✓Activation of the platysma and the hyoid muscles will be decreased if the patient places their tongue on the roof of their mouth. (Childs 2008 and Netter 2014) neck pain with radiating pain should be treated with - ✓✓✓- Mechanical Intermittent Traction Reason: For patients with chronic neck pain and radiating pain, clinicians should provide mechanical intermittent traction combined with other interventions based on the 2017 Neck Pain CPG.
- PS on the 2008 neck pain clinical practice guidelines, upper quarter and nerve mobilization procedures have moderate evidence; however this has been updated in the 2017 guidelines and are no longer recommended for patients with neck pain with radiating pain. neck pain with radiating pain, would not expect? - ✓✓✓Neck pain that radiates during cervical flexion
Reason: It is highly unlikely to see neck pain that radiates during cervical flexion. Instead, it would typically radiate during cervical extension, side bending and rotation (Childs 2008). which TFCC ligament should be taught in supination? - ✓✓✓palmar radiolunar ligament (dorsal should be taut in pronation) Long thoracic nerve injury - ✓✓✓cardinal sign is winging of the scapula/serratus weakness Spinal accessory n injury - ✓✓✓- trapezius and SCM are very weak
- may present with; depressed shoulder girdle, scapular winging during shoulder abduction, decreased shoulder flexion and abduction ROM
- commonly seen with blunt trauma injuries Accessory/secondary muscles for radial deviation - ✓✓✓APL, EPL, EPB Manual therapy for DeQuervain's tenosynovitis sx - ✓✓✓- would involve first CMC, intercarpals, and radiocarpal joints
- NOT radioulnar Heel pain and calcaneal spurs - ✓✓✓Radiographs that show a calcaneal spur in patients with heel pain does not confirm the diagnosis of plantar fasciitis Reason: Per clinical practice guidelines provided by the Journal of Orthopaedic and Sports Physical Therapy, any evidence of a calcaneal spur on a radiograph is not a key feature necessary to make a diagnosis. (Martin 2014) Self mobilization for patients with heel pain - ✓✓✓- Self mobilization for ankle eversion
- A mobilization with movement to improve dorsiflexion was a part of the Cleland et al study for improving heel pain symptoms, but it was not included in the home exercise program.
- Negative Neer test
- Not taking medications for their shoulder pain
- Symptoms less than 90 d Parsonage-Turner syndrome features - ✓✓✓- severe pain of insidious onset (shoulder radiating into neck and ue) is hallmark, but it improves days to weeks after initial sx while weakness persists
- is self-limiting (in months or years??)
- weakness occurs in a peripheral nerve distribution, sometimes a single peripheral nerve or other times a combination of peripheral nerves, cervical nerve roots or even different branches of the brachial plexu Clinical prediction rule: determining cervical radiculopathy (Wainner 2003) - ✓✓✓1) positive upper limb tension test A (ULTTa)
- involved-side cervical rotation range of motion less than 60 degrees
- positive distraction test
- positive Spurling's test A Pancoast tumor presentation - ✓✓✓- unilateral neck pain
- numbness/tingling down arm into pinky
- atrophy of anterior forearm musculature
- A pancoast tumor will present with all of the objective information provided in this case. The diagnosis may mimic a C8 radiculopathy, so atrophy in the anterior forearm muscles is possible due to long term involvement of that nerve root. Also, those with a pancoast tumor will not be able to change position or activity level and impact symptoms, like is present in this case. (Goodman and Snyder 2013) pt with l shoulder pain reports 100.9 deg fever. BP, RR, and HR are normal. What now?
- ✓✓✓Document the 100.9 degrees Fahrenheit temperature, as well as the normal findings from blood pressure, respiratory and pulse rate and continue to monitor the patient's symptoms at each visit
Reason: This patient is exhibiting a body temperature greater than 100 degrees, which is a red flag. However, the patient's other vital signs of blood pressure, pulse and respiratory rate are all within the normal range. With only one of four vital signs being abnormal, it is wise to document the information and continue to monitor for any changes at consequent visits.(Goodman and Snyder 2013) What muscle, if used actively before 6-8 weeks after surgery, can lead to a failure of an open rotator cuff repair? - ✓✓✓- Deltoid Reason: During an open rotator cuff repair, there is splitting and detachment of the deltoid and reattachment of this muscle to the acromion is a significant part of the surgical procedure. Because of the extent of involvement of the deltoid, it is imperative to not use this muscle actively for a relatively long period of time after surgery, and if used, could lead to a failure of the procedure. (Ghodadra 2009) Erb and Klumpke's palsy - ✓✓✓- Klumpke's palsy: inferior trunk injury of the brachial plexus (claw hand?)
- erb's: upper trunk (waiter's tip?) Ectopic pregnancy - ✓✓✓- An ectopic pregnancy is a medical emergency, and something that could potentially cause death if not managed immediately.
- can lead to abdominal pain, pelvic pain, and vaginal bleeding
- The fertilized egg can't survive outside the uterus. If left to grow, it may damage nearby organs and cause life-threatening loss of blood. Wet Point ankle sprain grading system - ✓✓✓- Grade I: ATFL tenderness, slight edema and ecchymosis, full or partial weight-bearing ability, stretched ligament, no instability
- Grade II: ATFL and CFL tenderness, moderate edema and eccyhmosis, difficutly weight-bearing without assistive device, partial ligament tear, no or slight instability
- Grade III: ATFL, CFL, and PTFL tenderness, significant and diffuse edema and ecchymosis, impossible to weight-bear without significant pain, complete ligament rupture, instability present
