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OCS: Practice Tests > Deck 14 > Flashcards

Deck 14 Flashcards

1
Q

58M presents to PT with c/o mod anterior and lateral hip pain during WB activities. Additionally he describes a morning stiffness that lasts roughly 40 minutes, improving with mat during his morning routine. Objective exam reveals PROM IR 20˚ on involved side with pain and 25˚ on uninvolved side, PROM 110˚ on involved side and 125˚ on uninvolved side. UA to extend hips past neutral B.

Based off the above info and in accordance with published CPG, which outcome measure would NOT be useful to track functional progress for this pt?

A. WOMAC
B. Hip disability and Osteoarthritis Outcome Score (HOOS)
C. Harris Hip Score (HHS)
D. Copenhagen Hip and Groin Outcome Score (HAGOS)

A

D. Copenhagen Hip and Groin Outcome Score (HAGOS)

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2
Q

58M presents to PT with c/o mod anterior and lateral hip pain during WB activities. Additionally he describes a morning stiffness that lasts roughly 40 minutes, improving with mat during his morning routine. Objective exam reveals PROM IR 20˚ on involved side with pain and 25˚ on uninvolved side, PROM 110˚ on involved side and 125˚ on uninvolved side. UA to extend hips past neutral B.

Which intervention has the best evidence in tx of mod hip OA for the above pt?

A. Long axis thrust manipulation and passive stretching into extension
B. Gait and balance training
C. Individualized prescription of therapeutic activities based on the pt’s needs (STS, step-ups, etc)
D. US and weight loss

A

A. Long axis thrust manipulation and passive stretching into extension

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3
Q

16F competitive swimmer with generalized R shoulder pain. No MOI but states pain has been present over the past year but has recently gotten worse as the vigor of her training has ramped up. Pt c/o pain when swimming freestyle and with OH movements during ADLs. The pt is RHD with no signifiant PMH.

Observation: mod FHP, R shoulder slightly lower than L
ROM: WNL UE/cervical
Strength: LUE 5/5 grossly, RUE 4/5* with ER, flex, abd, 4/5 with scap retraction
Sensation: intact and B symmetrical to light touch to both UEs
Palpation: ttp noted over R infraspinatus/teres minor mm bellies
Special tests: (-) crossbody adduction | (-) Empty can | (-) drop arm | (+) HK | (+) sulcus | (-) apprehension but painful | (+) relocation test for pain reduction

What is the best description of this pt’s primary dx?

A. Primary shoulder impingement
B. MDI
C. Secondary shoulder impingement
D. Scapular dyskinesia

A

C. Secondary shoulder impingement

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4
Q

24 yo recreational runner c/o buttock pain around the ischial tuberosity when running, especially uphill. After a few minutes of running symptoms generally improve, but persist following the run Additionally, sx worse with deep squat, lunging, and prolonged sitting i.e. driving and sitting on hard chairs. No sx with standing, lying, slow walking on a level surface.

Objectively the pt has (-) sacral thrust/thigh thrust/compression/distraction tests. Slight buttock pain with full lumbar flexion but no pain in lumbar flexion when knees are bent. (-) SLR/slump. Pt reported 2/10 pain with SL bridging and 3/10 pain during a SLDL/arabesque that subsides after completion.

What is a gait modification that may be introduced to reduce her symptoms while running?

A. Inc fwd trunk lean
B. Inc anterior pelvic tilt
C. Inc cadence
D. Inc stride length

A

C. Inc cadence

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5
Q

48M with hx of chronic episodic LBP referred for PT eval and tx by physician. The pt describes his pain as an “unrelenting, boring pain” that is constant regardless of movement or posture changes. It does vary with time of day Additionally, over the previous 3 weeks he noted inc difficulty getting comfortable in bed and more frequent awakening at night 2/2 LBP. ROS revealed no c/o recent wt loss, fever, chills, sweats, nausea, fatigue, dyspnea, cardiac dysfunction, no changes with b/b function, no personal hx of CA. He reports a 12 pack-years of cigarette smoking and hx of atherosclerotic disease. Leisure activities include jogging, water skiing, walking his dog.

Given the info provided from the pt hx, what sinister pathology must be ruled out?

A. Prostate metastatic cancer
B. Abdominal aortic aneurysm
C. Renal/urinary tract disorder
D. Osteomyelitis

A

B. Abdominal aortic aneurysm

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6
Q

50F with 3 mo hx of shoulder pain. C/o sharp pain when reaching OH and across her body to fasten her seatbelt. Objectively she has painful arc from 70-120˚ and inc pain with OP into flexion at 180˚. Upon evaluation, you decide to perform a PA HVLA thrust to upper, middle, and lower thoracic spine. Immediately following, you re-test shoulder flex and her painful arc has fully resolved with less pain into OP at 180˚.

Which is true regarding the immediate effect of thoracic SMT on shoulder pain in individuals with shoulder pain?

A. Inc RTC cross-sectional area
B. Change in thoracic kinematics
C. Inc LT strength
D. Altered scapular kinematics

A

C. Inc LT strength

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7
Q

Pt is an obese warehouse employee who has worked manual labor for the past 20 yrs. He is convinced his job of working with a forklift, and getting on/off the floor as well as loading through his back has resulted in disc degeneration seen on his recent spinal imaging. According to the best available evidence, the factor that is most likely to contribute to the development of disc degeneration is?

A. Vibration loading (forklift)
B. Genetics
C. Repeated spinal loading
D. Obesity

A

B. Genetics

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8
Q

Pt presents to PT with c/o 1 mo hx of LBP. Sx occurred immediately after picking up her 20# puppy and were described as sharp with certain movements. Sx have improved after approximately 1-2 weeks and are now stable and rated as 3-4/10 at worst. Back pain is primarily reproduced with fwd flex (while bending fwd and when returning upright), car txfrs, and lifting.

Based on the updated lumbar tx based classification system, this pt can be classified into what specific rehabilitation management category.

A. Symptom modulation
B. Movement control
C. Functional optimization
D. Specific exercise

A

B. Movement control

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9
Q

41 yo obese female who recently started jogging in an attempt to lower her weight. Prefers outdoor running on pavement and runs in flexible shoes, Nike Frees, that are comfortable on her feet while walking at work. Her primary complaint is medial ankle and heel pain that started roughly 1 mo prior.

Gait eval reveals excessive pronation. She has tenderness to palpation/tapping posterior to medial malleolus. Sensory exam reveals sensory loss to medial heel. Neurodynamic assessment reveals pain with slump test when foot is maximally DF/ev, otherwise symptom free in a pure sagittal plane testing position.

Based on the above info, what dx most accurately explains her symptoms?

A. S1 radiculopathy
B. Posterior tibialis tendinopathy
C. TTS
D. Plantar fasciitis

A

C. TTS

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10
Q

Which is NOT considered a poor prognostic indicator for pelvic girdle pain in the antepartum population?

A. Inc lumbar lordosis
B. Prior hx of pregnancy
C. Belief their prognosis will not improve with therapy
D. Inc BMI

A

A. Inc lumbar lordosis

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11
Q

What does HAGOS stand for?

A

Copenhagen Hip and Groin Outcome Score

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12
Q

HAGOS is an outcome score recommended for pts with

A

non-arthritic hip pain

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13
Q

level of evidence for hip OA: manual therapy

A

A

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14
Q

level of evidence for hip OA: exercise (strengthening/flexibility)

A

A

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15
Q

level of evidence for hip OA: gait/balance/functional activities

A

C

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16
Q

level of evidence for hip OA: weight loss

A

C

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17
Q

level of evidence for hip OA: ultrasound

A

B

18
Q

Secondary shoulder impingement occurs in the presence of

A

capsular laxity and RTC weakness

19
Q

Get improvement in isometric strength of ____ immediately after thoracic manipulation

A

lower trap

20
Q

Clinicians should use what risk factors in the prognosis of pelvic girdle pain

A
  • prior hx of pregnancy
  • orthopedic dysfunctions
  • inc BMI
  • smoking
  • work dissatisfaction
  • lack of belief of improvement
21
Q

35F competitive figure skater being seen for rehab following a sprained ankle. Today she comes in reporting of R sided neck pain following rearend MVC on her way to your office. She is feeling quite shaken up. She recalls the accident occurring while she was stationary at a stop light, heard a loud horn, looked up in her rearview mirror and saw the other vehicle as it hit her car from behind. She was able to drive directly to her appt with you. Denies paresthesias. Has essentially normal sitting posture in your office. When walking from the waiting room to your office she is able to follow you with her head as you walk back and forth in front of her.

At this point in the visit what action is most appropriate?

A. Proceed with evaluation of her neck
B. Evaluate her neck and refer for imaging
C. Refer for immediate imaging
D. Manipulate her cervical spine

A

A. Proceed with evaluation of her neck

22
Q

35F competitive figure skater being seen for rehab following a sprained ankle. Today she comes in reporting of R sided neck pain following rearend MVC on her way to your office. She is feeling quite shaken up. She recalls the accident occurring while she was stationary at a stop light, heard a loud horn, looked up in her rearview mirror and saw the other vehicle as it hit her car from behind. She was able to drive directly to her appt with you. Denies paresthesias. Has essentially normal sitting posture in your office. When walking from the waiting room to your office she is able to follow you with her head as you walk back and forth in front of her.

Considering prognosis for this pt, you recall a CPR established to predict prognostic factors for ongoing mod/severe disability after acute WAD. Which of the following is NOT considered a prognostic factor of ongoing disability?

A. over 35
B. NDI > 40%
C. Presence of hyperarousal of sx
D. Neck flexor endurance of 24 seconds or less

A

D. Neck flexor endurance of 24 seconds or less

23
Q

What has the best evidence regarding use of modalities post-operatively for ACL-R patients?

A. Cryocompression is useful for reducing PO swelling in pts presenting with PO edema and/or effusion
B. NMES is useful to augment mm strengthening exercises to inc quad strength
C. Cryotherapy should be used immediately after ACL-R to reduce PO knee pain
D. Low level laser therapy helps reduce pain and activity limitation in individuals post ACLR

A

B. NMES is useful to augment mm strengthening exercises to inc quad strength

24
Q

72M c/o progressively worsening nocturnal and early morning thoracic pain. Sx generally improve with activity during the day but are always present, even at rest. In the past week, has begun having a band-like pain wrapping around his rib cage that is brought on with WB and relieved by lying down. On his intake paperwork you see he checked the box for hx of cancer, leading to concern about potential metastatic spinal tumor.

Which of the below cancers is LEAST likely to spread to the spine?

A. Lung
B. Breast
C. GI
D. Prostate

A

C. GI

25
Q

33 yo overweight female presents to your clinic for eval of acute LBP x 1 week. First recalls having pain when attempting to start her snow blower with a pull string. States it felt like a sharp tweak in central lower back and was rated as 3-4/10. Unfortunately the snow blower would not start. She then proceeded to shovel her driveway which further exacerbated her pain up to 5-6/10 at worst. Sx have calmed some over the past week and are no 1-2/10 at rest and spike up to 5/10 with particular movements. Denies b/b changes, denies n/t, denies LE symptoms

Lumbar AROM: flexion 100%, (+) Gower’s sign | ext WNL | SB 50% reduced with 3/10 back pain on CL side
Hip: flex WNL | 95˚ with knee extended
Accessory mobility: hypermobility and pain with PA spring L3-5
Palpation: ttp R QL
Special tests: (-) SLR, (+) prone instability

Based on the above subjective and objective info, what initial treatment is NOT recommended on day 1 for this pt?

A. lumbar HVLAT
B. Lumbar stabilization exercises
C. Lumbar AROM exercises
D. DN for QL

A

D. DN for QL

26
Q

58F with c/o R sided jaw pain and tension x 10 yrs. Jaw pain aggravated by singing, chewing, and eating. Has hx of clicking for many years, but no jt sounds currently with opening or closing. When opening, the pt’s jaw deflects toward R side with 30mm of movement. Protrusion 4 mm with R sided deflection as well. Masseter painful to palpation. When biting down on a firm object placed on her L molars, there is an increase in pain, but not on R side.

What specific TMD does she have?

A. Anterior DDWR
B. Anterior DDWOR
C. Masticatory mm dysfunction
D. Temporomandibular joint capsulitis

A

B. Anterior DDWOR

27
Q

20M college student who experienced traumatic injury to ring finger when playing flag football. Dove to grab his opponent’s flag, but caught his jersey instead, feeling a snap sensation in his finger with immediate pain. Has not yet seen a physician regarding this but came directly to you for consultation. Clinical exam reveals inability to actively flex at the DIP with preservation of normal flexion of PIP. Finger extension is normal.

After completion of your objective exam, what tx is recommended?

A. Immediate surgical consult
B. 6-8 weeks of orthotic placing DIP into ext 24 hrs/day
C. Cast DIP into ext for 2-3 weeks
D. Buddy tape digits 3 and 4 together until AROM restored

A

A. Immediate surgical consult

28
Q

48F with chronic thoracolumbar, B hip, shoulder, and LE pain. Hx of fibromyalgia. Pt scores +2 on PHQ 2, and 35 on FABQW and 20 on FABQPA. Due to severity of her widespread pain she has refrained from exercising, avoids participating in social events, and spends most of her time at home. States even short walks to her mail box are excruciating. She has attempted to manage her pain with massage therapy but experienced a flareup in pain x 3 days following her last massage. She presents for evaluation of her symptoms with primary goal of pain relief.

What intervention approach is best recommended for this pt?

A. Directionally specific lumbar mobility exercises
B. Lumbopelvic manipulation and general mobility exercises
C. Low intensity, sub maximal fitness exercises
D. Moderate-high intensity progressive endurance exercises

A

C. Low intensity, sub maximal fitness exercises

29
Q

48F with chronic thoracolumbar, B hip, shoulder, and LE pain. Hx of fibromyalgia. Pt scores +2 on PHQ 2, and 35 on FABQW and 20 on FABQPA. Due to severity of her widespread pain she has refrained from exercising, avoids participating in social events, and spends most of her time at home. States even short walks to her mail box are excruciating. She has attempted to manage her pain with massage therapy but experienced a flareup in pain x 3 days following her last massage. She presents for evaluation of her symptoms with primary goal of pain relief.

What reasonable conclusion can be made regarding her FABQPA score?

A. FABQPA score indicates she may benefit from lumbar manipulation
B. FABQPA score suggests a poor treatment outcome/negative prognostic variable
C. FABQPA and W sub scales have little impact on tx direction/outcomes in PT
D. FABQ scores are somewhat concerning, but do not meet cutoffs for elevated scores

A

B. FABQPA score suggests a poor treatment outcome/negative prognostic variable

30
Q

37F referred to PT with dx of myofascial pain syndrome. Pt is a medical receptionist at a doctor’s office and lives a rather sedentary lifestyle. Prior to PT referral she has been treated by acupuncturists and Reiki practitioners with only minor transient benefit. Prior hx includes MVA 10 yrs ago resulting in neck pain for several months that resolved with rehab.

Describes 1 yr hx of upper back pain, B arm pain, neck pain, HA, and B paresthesias in UEs. Hand complaints described as full, sweaty, numbing, and achy and typically involve the entire hand and occasionally forearms. When asked to rate the pain on a scale from 0-10, reported range from 5 at least and 9 at worst.

Cervical ROM: restricted RR and ext with local neck pain, all others WNL
Thoracic ROM: 20% ext with diffuse thoracic pain and dysesthesias into BUEs | 50% flex and pain inc with neck in flexion | 50% SB limited with CL thoracic pain | 50% rotation with ipsilateral thoracic pain
Neuro: 2+ C5-7 | myotomes WNL | dermatomes: no overt loss of sensation but altered sensation bilaterally at radial aspect of thenar eminence, dorsal digit 3, and ulnar aspect of hypothenar eminence | Babinski (-) | Clonus (-)
Palpation: significant ttp throughout UQ musculature
Accessory mobility testing: significant hypomobility T2-3 to T6-7. Familiar symptoms reproduced with testing of each hypo mobile segment

Which diagnoses/syndromes is most likely?

A. Parsonage turner
B. Thoracic discogenic pain
C. Cervical myelopathy
D. T4 syndrome

A

D. T4 syndrome

31
Q

Neck flexor endurance time of < 24 seconds has been shown in pts with ____ but not associated with poor prognosis in acute WAD

A

neck pain

32
Q

PB KTLL

A 
prostate
breast
kidney
thyroid
lung

lymphoma

33
Q

Lumbar manipulation has been shown to improve activation of which muscles and reduce….

A

improve lumbar multifidus activation

reduce aberrant motions

34
Q

In anterior DDWOR, where is the disc displaced?

A

in front of the condyle

35
Q

In anterior DDWOR, the disc is displaced in front of the condyle resulting in

A

no clicking noise with opening or closing

36
Q

With anterior DDWOR, what movements are typical?

A
  • ipsilateral deviation

- reduced contralateral excursion

37
Q

Anterior DDWOR: this test implicates joint over muscle

A

Cotton roll test

38
Q

Anterior DDWOR: The Cotton roll test implicates joint over muscle due to the compressive loading with

A

contralateral bite

39
Q

FABQPA score of > ___ has been suggested as an indicator of poor tx outcomes in pts with LBP

A

14

40
Q

A suggested FABQW cutoff score of > ___ has been suggested as an indicator of poor RTW status in pts receiving PT for acute occupational LBP

A

29

41
Q

A suggested FABQW cutoff score of > ___ has been suggested as an indicator of poor RTW status in pts receiving PT for acute LBP in non-working populations

A

22

OCS: Practice Tests (25 decks)

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