Deck 13 Flashcards
68M presents to PT with c/o R shoulder/scapular pain and B hand tingling in digits 1-3. Currently managing pain with use of Acetaminophen without improvement. Shoulder pain does not vary with positioning or movement of his neck or arms which has made you as the therapist suspicious of a non-MSK origin of symptoms. Upon performing a thorough medical screen, the pt reveals his stool is light colored, almost white, and is having moderate abdominal pain. When taking a BP recording, you notice irregular flex/ext movements of the pt’s wrist. When asking the pt to actively hyperextend the wrist and hand with the arms in front, irregular flex/ext movements of the wrist and fingers also occur.
At this point, what sinister pathology is a likely dx and source of shoulder pain?
A. Pancreatitis
B. Hepatobiliary disease
C. Gastric ulcer
D. NSAID induced gastropathy
B. Hepatobiliary disease
68M presents to PT with c/o R shoulder/scapular pain and B hand tingling in digits 1-3. Currently managing pain with use of Acetaminophen without improvement. Shoulder pain does not vary with positioning or movement of his neck or arms which has made you as the therapist suspicious of a non-MSK origin of symptoms. Upon performing a thorough medical screen, the pt reveals his stool is light colored, almost white, and is having moderate abdominal pain. When taking a BP recording, you notice irregular flex/ext movements of the pt’s wrist. When asking the pt to actively hyperextend the wrist and hand with the arms in front, irregular flex/ext movements of the wrist and fingers also occur.
What observable sign is c/w irregular flex/ext movements of the wrist and fingers as described above?
A. Dysdiadochokinesia
B. Asterixis
C. Ataxia
D. Involuntary tremor
B. Asterixis
What is the most sensitive hx and/or physical exam data for ruling out cauda equina syndrome in a pt who presents with sudden, severe onset of LBP?
A. Urinary retention
B. Fecal incontinence
C. Saddle anesthesia
D. Sensory or motor deficits in the feet (L4, L5, S1 areas)
A. Urinary retention
55M presents via direct access 5 days s/p fall in shallow water while fishing. States he fell out of his boat and hit the R side of his head resulting in L lateral flex and axial compression. Denies any LOC, HA, vertigo, dizziness, paresthesias, dysarthria, dysphagia, or nausea. Pt states he was able to shake it off and return to sailing the following day. Pt reports persistent 3-7/10 pain on the NPRS in mid-lower cervical region. Reports mild reduction in cervical ROM compared to normal.
Based on the above info, your next action should be:
A. Proceed with full exam of his cervical spine
B. Measure cervical rotation ROM and then make decisions on need for imaging
C. Perform a sharp-purser exam to assess for upper cervical instability
D. Referral out for cervical spine imaging
D. Referral out for cervical spine imaging
25M professional ice hockey player presents for eval of acute groin pain that began 3 days ago during NHL competition. No hx of groin or abdominal injury prior to this incident. Pt describes MOI while he was turning L, skating in the 3rd period when an opposing player pushed him in the back His trunk extended, hip abducted and extended and he felt immediate pain in the groin region and was unable to continue playing the remainder of the game.
Today, pt experience lower abdominal/groin pain with most ADLs such as supine to sit txfr, walking, STS, coughing. Trunk ROM limited by pain. Also having sharp pain with PROM hip ext and resisted hip flex/hip add. Resisted double hip adduction painful and unchanged with pelvic stabilization belt.
What dx most clearly matches this pt presentation?
A. Sports hernia
B. Pubic symphysis instability
C. Adductor strain
D. Inguinal hernia
A. Sports hernia
25M professional ice hockey player presents for eval of acute groin pain that began 3 days ago during NHL competition. No hx of groin or abdominal injury prior to this incident. Pt describes MOI while he was turning L, skating in the 3rd period when an opposing player pushed him in the back His trunk extended, hip abducted and extended and he felt immediate pain in the groin region and was unable to continue playing the remainder of the game.
Today, pt experience lower abdominal/groin pain with most ADLs such as supine to sit txfr, walking, STS, coughing. Trunk ROM limited by pain. Also having sharp pain with PROM hip ext and resisted hip flex/hip add. Resisted double hip adduction painful and unchanged with pelvic stabilization belt.
The above pt underwent laparoscopic hernia repair for his abdominal/groin pain and reported approximately 90% improvement in pain. Returns to clinic several months later for eval of his ongoing chronic groin pain, which is sensitive to palpation at the pubic tubercle and just lateral to this. PE reveals pain exclusively with resisted hip flex and resisted hip adduction when hip positioned to 90˚flex.
What dx most clearly matches this pt’s current presentation?
A. Psoas tendinopathy
B. RA tendinopathy
C. Pectineus tendinopathy
D. Adductor longus tendinopathy
C. Pectineus tendinopathy
65F presents to clinic with c/o medial elbow and hand pain. Your top ddx include ulnar neuropathy and C8-T1 radiculopathies. Which of the following muscles are likely to be weak in a pt with C8-T1 radic but intact in a pt with ulnar neuropathy at the elbow?
A. Medial lumbricals
B. Opponens pollicis
C. Dorsal interossei
D. Opponens digiti minimi
B. Opponens pollicis
42 yo obese woman presents to PT with severe acute LBP and RLE pain/numbness extending into the foot. During a quick functional screen, pt was able to heel walk, but struggled to maintain PF on the R side when asked to walk on her toes. Lumbar flexion increases both LBP and leg pain, extension increases both LBP and leg pain. When performing a side glide, the L side glides increase LBP/leg pain while R side glides reduce leg pain.
Based off the info above, you determine she meets the symptom modulation subgrouping of the TBC proposed by Alrwaily et al.
What tx subgrouping is best used to help guide treatment initially?
A. Manipulation
B. Specific exercise
C. Traction
D. Active rest
B. Specific exercise
42 yo obese woman presents to PT with severe acute LBP and RLE pain/numbness extending into the foot. During a quick functional screen, pt was able to heel walk, but struggled to maintain PF on the R side when asked to walk on her toes. Lumbar flexion increases both LBP and leg pain, extension increases both LBP and leg pain. When performing a side glide, the L side glides increase LBP/leg pain while R side glides reduce leg pain.
Based off the info above, you determine she meets the symptom modulation subgrouping of the TBC proposed by Alrwaily et al.
When performing sensory testing as a component of her neuro screen, where would you anticipate to find her “numbness” during sensory testing?
A. Medial malleolus
B. Web space between toes 1 and 2
C. Lateral border of 5th metatarsal
D. Posterior knee
C. Lateral border of 5th metatarsal
What 2 clinical findings would lead you to consider use of mechanical traction for a pt presenting with acute LBP and s/s of nerve root compression
A. Absence of a directional preference and (+) xSLR
B. Peripheralize with ext and leg pain more severe than LBP
C. Sx reduction with manual traction and leg pain > back pain
D. Peripheralization with extension and (+) xSLR
D. Peripheralization with extension and (+) xSLR
Light colored (almost white) stools indicate an inability of the liver or biliary system to excrete
bilirubin
Liver dysfunction results in increased
serum ammonia
urea
Nerve function can be impaired with liver dysfunction and is a potential cause of B ___
CTS
Any pt with sx of B CTS should be screened for
liver impairment
Asterixis aka
liver flap
What is asterixis?
pt extends arms, spreads finger, extends the wrist
abnormal flapping tremor at the wrist
