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OCS: Practice Tests > Deck 8 > Flashcards

Deck 8 Flashcards

1
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

The pt’s symptoms a week after the first visit are suggestive of what pathology?

A. Disc herniation producing radiculopathy
B. Spinal stenosis
C. Cauda equina syndrome
D. Myasthenia gravis

A

C. Cauda equina syndrome

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2
Q

With CES, will likely have (hypo/hyper)reflexive stretch reflexes

A

hyporeflexive

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3
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

What is the maximum time the pt can wait before undergoing surgery for this pathology?

A. < 12 hrs
B. < 48 hrs
C. < 72 hrs
D. < 96 hrs

A

C. < 72 hrs

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4
Q

Why does surgery need to be performed within 72 hrs for CES?

A

decrease risk for permanent neuro comopromise

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5
Q

Best timeframe for surgery with CES within ___ hrs

A

48 hrs

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6
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

All of the following items are suggestive of the pathology in this vignette except for what?

A. Inc in anal sphincter tone
B. Perianal sensation deficit
C. No anal wink or cremasteric reflex
D. Urinary retention

A

A. Inc in anal sphincter ton

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7
Q

Cauda equina is (UMN/LMN) disorder

A

LMN

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8
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

Once the pathology from this vignette is identified, which imaging modality is most recommended?

A. Dx US
B. Radiographs
C. CT scan
D. MRI

A

D. MRI

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9
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

What would be the most appropriate referral for the pt in this vignette?

A. PCM
B. Urgent care
C. ED
D. Neurosurgeon

A

D. Neurosurgeon (or orthopedic spine surgeon)

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10
Q

45M presents via direct access. Intermittent LBP worsened recently after picking up a box from the ground. (+) radicular symptoms into R thigh to above the knee. No red flags present and his sx improved with repeated AROM lumbar extension. Sx’s worsen with repeated flexion and appear to be d/t disc pathology. A week later, reports to PT with worsening constant LBP and c/o sx’s suggestive of urinary retention. Has B radiculopathy along posterior aspect of his thighs. Exam reveals hypo reflexive PF muscle stretch reflexes and dec sphincter tone.

Which surgical procedure is most indicated for the pathology in this vignette?

A. Ablation of sacral nerves
B. Laminectomy and discectomy
C. L4-5 fusion
D. L5-S1 fusion

A

B. Laminectomy and discectomy

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11
Q

Which are the most common levels for a disc herniation to occur?

A. L1-2 and L3-4
B. L2-3 and L4-5
C. L4-5 and L5-S1
D. L2-3 and L5-S1

A

C. L4-5 and L5-S1

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12
Q

Of 40,000 operations, (%) of disc herniations were at L4-5/L5-S1

A

95%

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13
Q

Which nerve innervates the adductor longus and gracilis, and provides sensation to the medial thigh?

A. Anterior branch of obturator nerve
B. Posterior branch of obturator nerve
C. Femoral nerve
D. Sciatic nerve

A

A. Anterior branch of obturator nerve

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14
Q

The posterior branch of the obturator nerve innervates which muscles?

A
  • obturator externus

- adductor magnus

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15
Q

The posterior branch of the obturator nerve has no (sensory/motor) innervation

A

sensory

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16
Q

The anterior branch of the obturator nerve innervates which muscles

A
  • adductor longus

- gracilis

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17
Q

Does the anterior branch of the obturator nerve contain sensory fibers?

A

yes

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18
Q

You have been treating 33F for L knee pain that started 5 weeks ago after beginning half marathon training. Pt is new to running and wears tight fitting compression pants. Though knee pain is improving, she reports sensation of numbness in her anterolateral thigh. What is the most likely dx?

A. Femoral neuropathy
B. L2-3 disc extrusion
C. Meralgia paresthetica
D. ITBS

A

C. Meralgia paresthetica

19
Q

26M presents with new onset LBP and radicular sx to posterior aspect of R thigh after deadlifts. Sx centralize to lower buttock with REIL. Pt has low fear and PROM IR greater than 35˚. What is the best intervention for this pt today?

A. REIL
B. Sidelying lumbar manipulation
C. Isometric trunk stabilizer strengthening
D. Nerve tensioners with sciatic nerve bias

A

A. REIL

20
Q

If you have to choose between repeated motions vs. manipulation, should do what first?

A

repeated motions (exhaust directional preference), then manipulation - use hierarchy

21
Q

35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive. What is the most likely dx and best mgmt for this pt?

A. Central sensitization. Multidisciplinary mgmt is recommended.
B. Renal infection. Refer to ED
C. Kidney stone. Refer to ED
D. Transverse myelitis. Refer to ED

A

C. Kidney stone. Refer to ED

22
Q

35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive.

If we were to consider renal infection, what would likely be present?

A

fever

23
Q

35M presents via direct access with sudden sharp LBP that comes and goes. Reports it radiates to R testicle. He does not have a fever. Lumbar exam is inconclusive.

If we were to consider transverse myelitis, what would likely be present?

A

weakness

24
Q

Middle aged pt presents with LBP and a Later sign. Denies radicular symptoms and reports inc morning stiffness that improves with movement. What is the most likely dx?

A. Lumbar stenosis
B. Ankylosing spondylitis
C. Chronic LBP
D. L3 spondylolisthesis

A

B. Ankylosing spondylitis

25
Q

What it the Later sign?

A

gross limitation of SB

26
Q

6 yo M referred to PT by his pediatrician for hip pain and strengthening. His mother tells you he has been limping for 2 weeks. Based on the limited info, what is the most likely dx?

A. LCPD
B. SCFE
C. Femoral neck fx
D. Anterior labral tear

A

A. LCPD

27
Q

7 yo M reports with L hip pain radiating into groin, limp with ambulation, and a fever. Pt denies any MOI. Sx have been ongoing x 15 days. You decide to refer to urgent care. Blood work revealed ESR of 45 mm/hr and WBC of 12,000. What is the most likely dx?

A. LCPD
B. SCFE
C. Transient synovitis
D. Septic arthritis

A

D. Septic arthritis

28
Q

A hockey player is referred by sports med physician for LBP and Gilmore groin. What best describes Gilmore groin?

A. Tear in external oblique aponeurosis and conjoint tendon
B. Extrusion of L2-3 disc referring pain to the groin
C. Anterior labral tear of the hip
D. Hip OA Tonnis grade II referring to the hip

A

A. Tear in external oblique aponeurosis and conjoint tendon

29
Q

Gilmore groin is a type of

A

athletic pubalgia

30
Q

A 16 yo track athlete referred with hx of LBP and new onset R hip pain. Hip pain has gradually worsened. Reports no MOI, started training for track season last month. BMI = 18 and pt has amenorrhea. Which special test needs to be performed to screen for pathology?

A. Fulcrum test
B. Thigh thrust test
C. Patellar pubic percussion test
D. Repeated motions testing of lumbar spine

A

C. Patellar pubic percussion test

31
Q

30 yo pregnant female referred for LBP by PCM. When you call from the waiting room, you see she uses a walker to ambulate. Exam shows normal PF reflexes B, but absent Achilles reflex. What dx should you be most suspicious of?

A. Cervical myelopathy
B. Central thoracic disc herniation
C. CES
D. Primary lateral sclerosis

A

C. CES

32
Q

Primary lateral sclerosis is (UMN/LMN) pathology

A

UMN

33
Q

Central thoracic disc herniation would present as (UMN/LMN)

A

UMN

34
Q

Pt referred with new onset LBP and burning pain in R upper lateral thigh. Previously seen for LBP and sciatica of RLE 5 years ago since giving birth to 3 kids and 50# weight gain. Exam shows no myotomal or dermatomal deficits. Burning pain increases during periods of prolonged sitting. What is the likely cause of her concordant pain?

A. Anterior labral cyst compressing the sciatic nerve
B. L3-4 lumbar radiculopathy
C. Femoral nerve entrapment
D. Lateral femoral cutaneous nerve entrapment

A

D. Lateral femoral cutaneous nerve entrapment

35
Q

15M presents with acute onset LBP and upper buttock pain. UA to fully extend his lumbar spine d/t sharp pain. When in lumbar flexion, c/o dull sensation in the low back. His hamstrings appear tight bilaterally and spasm during PROM SLR. You decide to refer the pt back to PCM for imaging. What is the most likely vertebrae causing his pain?

A. L3
B. L4
C. L5
D. S1

A

C. L5

36
Q

15M presents with acute onset LBP and upper buttock pain. UA to fully extend his lumbar spine d/t sharp pain. When in lumbar flexion, c/o dull sensation in the low back. His hamstrings appear tight bilaterally and spasm during PROM SLR. You decide to refer the pt back to PCM for imaging.

Based on this case, the PT should suspect compromise of what?

A

posterior elements of the lumbar vertebrae

37
Q

An extension based injury in a youth athlete can cause what in the lumbar spine?

A

spondylolysis of the pars interarticularis, which could also lead to a spondylolisthesis

38
Q

58M marathon runner presents with c/o decreased speed and weakness that started insidiously. Reports L THR last year. Observation revealed a more muscular R buttock compared to the L. MMT demonstrated 3+/5 strength for L hip ext and 5/5 for R. Hip abd 5/5 B. Injury to which nerve is likely causing this impairment?

A. Iliohypogastric nerve
B. Superior gluteal nerve
C. Inferior gluteal nerve
D. Obturator nerve

A

C. Inferior gluteal nerve

39
Q

All of the following nerves supply the posterior lateral thigh except which of the following answer choices?

A. Obturator nerve
B. Lateral cutaneous nerve of the thigh
C. Posterior cutaneous nerve of the thigh
D. Inferior medial and lateral cluneal nerves

A

A. Obturator nerve

40
Q

What ROM findings would you suspect in a young boy with a SCFE?

A. increased hip flexion
B. increased hip abduction
C. increased hip IR
D. Increased ER

A

D. Increased ER

41
Q

Pts with SCFE will likely present with limitations in which hip motions?

A

IR
abd
flex

42
Q

SCFE: ER will likely be increased due to

A

slippage

43
Q

A pt referred after radio frequency ablation failed to relieve her lumbar facet arthropathy. What nerve innervates the facet jt?

A. medial branch of dorsal rami
B. lateral branch of dorsal rami
C. dorsal root ganglion
D. primary ventral ramus

A

A. MEDIAL branch of dorsal rami

44
Q

What is the most specific dx test for ruling IN cauda equina syndrome?

A. Urinary retention
B. Unilateral or bilateral sciatica
C. Unilateral or bilateral motor/sensory deficits
D. Sensory deficit of perianal region

A

A. Urinary retention

OCS: Practice Tests (25 decks)

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