PMR 2 - musculoskeletal Flashcards
Which is the only carpal bone that crosses both the proximal and distal carpal rows?
a. Hamate
b. Scaphoid (navicular)
c. Trapezoid
d. Capitate
B) The scaphoid bone is the only carpal bone that crosses both carpal rows. This position not only provides stability, but also places the scaphoid at the greatest risk of injury.
Structures passing through the carpal tunnel into the hand include:
a. Five finger flexor tendons
b. The ulnar nerve
c. The median nerve
d. The radial nerve
C) There are nine finger flexor tendons that pass into the hand through the carpal tunnel (along with the median nerve). Five of the nine tendons are deep flexors tendons and the other four are superficial flexors.
Tests) to evaluate for shoulder impingement syndrome include:
a. Hawkins” sign
b. Speed’s test
c. Neer’s sign
d. Answers A and C
D) Neer’s impingement sign is performed by bringing the arm in extreme forward flexion with the humerus externally rotated. With Hawkins’ impingement sign, the arm is forward flexed to 90° and medially rotated. A positive sign elicits pain during movement. Speed’s test is used to assess for bicipital tendonitis.
O’Brien’s test evaluates for:
a. Labral abnormalities
b. Bicipital tendinitis
c. Stability of the glenohumeral joint
d. Thoracic outlet syndrome
A) O’ Brien’s test evaluates for labral abnormalities. The shoulder is flexed to 90° with the elbow fully extended. The arm is then adducted 15° and the shoulder is internally rotated with the patient’s thumb pointing down. Downward force is applied to the arm against resistance. The shoulder is then externally rotated with the palm facing up and the examiner applies downward force on the patient’s arm, which the patient is instructed to resist. A positive test is indicated by pain during the first part of the maneuver with the patient’s thumb pointing down. The pain is lessened when the patient resists a downward force with the palm facing up.
The test of choice when looking for labral pathology is:
a. MRI
b. CT scan
c. X-rays
d. Magnetic resonance (MR) arthrogram
D) MR arthrogram is the test of choice when evaluating for labral pathology.
Shoulder impingement may result from:
a. Extrinsic compression (bone spurring or tendon edema)
b. Loss of competency of the rotator cuff
c. Loss of competency of scapula stabilizing muscles
d. All of the above
D) Impingement can result from extrinsic compression or as a result of loss of competency of the rotator cuff and/or scapula stabilizing muscles. The biceps tendon also passes within the space. The impingement interval, which is the space between the undersurface of the acromion and the superior aspect of the humeral head, is maximally narrowed when the arm is abducted.
Mechanisms proposed for superior labrum anterior to posterior (SLAP)
lesions include:
a. Falling on an outstretched arm
b. Overhead throwing motion
c. Repetitive overhead reaching
d. Answers A and B
D) SLAP lesions occur as a result of falling on an outstretched arm causing a traction and compression injury related to the fall.
Overhead throwing motion in the deceleration phase causes traction on the superior labrum by the biceps muscle. The cocking phase of the overhead throw causes a torsional peeling-back stress to the glenoid labrum leading to a SLAP lesion.
Adhesive capsulitis or frozen shoulder:
a. Results from thickening and contraction of the capsule around the glenohumeral joint
b. Is more commonly seen in middle-aged women
c. Has risk factors including diabetes
d. All of the above
D) Frozen shoulder often follows a period of prolonged shoulder immobilization and 8. results in a decreased range of motion (ROM) of the shoulder. Thickening and contraction of the capsule occurs around the glenohumeral joint. Risk factors include diabetes. It is more commonly seen in middle-aged women.
The articulations of the elbow joint include:
a. Ulnohumeral
b. Radiocapitellar
c. Proximal radioulnar
d. All of the above
D) The elbow articulations allow the elbow two degrees of freedom: flexion-extension and pronation-supination. The normal elbow moves from 0 (full extension) to 135° to 150° of flexion. Pronation is approximately 70° to 90° and supination is approximately 80°to 90°.
Tennis elbow typically:
a. Is an acute lesion, lasting less than a few weeks
b. Presents with pain and tenderness over the medial epicondyle
c. Does not affect grip strength
d. Can occur as a result of a tennis backhand stroke
D) Tennis elbow is commonly known as lateral epicondylitis. Patients present with pain and tenderness over the lateral epicondyle as well as over the extensor tendon. There is pain with resistance to wrist and third digit extension. Occasionally, grip strength testing elicits pain. Acutely, there will be inflammatory responses to tension overload placed in the tendon-bone junction. Lateral epicondylitis typically lasts longer than a few weeks. It is caused by a poor backhand stroke in tennis, although this is not always the cause.
Hill-Sachs lesion of the shoulder:
a. May be associated with posterior dislocations
b. May cause shoulder instability if it accounts for 10% of the articular surface
c. Is a compression fracture of the posterolateral aspect of humeral head caused by abutment against the anterior rim of the glenoid fossa
d. Is evaluated by Speed’s test
C) Anterior glenohumeral stability is evaluated by the apprehension test. Hill-Sachs lesion accounting for greater than 30% of the articular surface may cause shoulder
L instability. A notch occurs in the posterior lateral aspect of humeral head due to recurrent impingement.
Rotator cuff tears are characterized by:
a. Symptoms similar to rotator cuff tendinitis
b. Pain at night with side-lying on the affected side
c. Examination findings of supraspinatus weakness, external shoulder rotator weakness, and positive drop arm test
d. All of the above
D) A full thickness tear can cause immediate functional impairments. The pain quality can be described as dull and achy, and symptoms are similar to those of rotator cuff tendinitis. The greatest limitation is difficulty performing overhead activities.
Scapula winging is caused by an injury to which one of the following nerves?
a. Radial nerve
b. Suprascapular nerve
c. Long thoracic nerve
d. Axillary nerve
C) Injury to the long thoracic and spinal accessory nerves causes weakness of the serratus anterior and trapezius muscles and is most commonly associated with scapular winging. Patients present with symptoms of pain in the upper back or shoulder, muscle fatigue and weakness with the use of the shoulder. Initial management includes immobilization to prevent overstretching of the weakened muscle.
The differential diagnosis of trigger finger includes:
a. Dupuytren’s disease
b. Ganglion of the tendon sheath
c. Rheumatoid arthritis
d. All of the above
D) Trigger finger is defined as the triggering, snapping, or locking of the finger as it is flexed and extended. This is due to localized inflammation or nodular swelling of the flexor tendon sheath, which inhibits the normal tendon glide. Typically, the thumb, middle, and ring fingers of the dominant hand and middle-aged women are most commonly affected.
The diagnosis of aseptic
noninflammatory olecranon bursitis is:
a. Based on plain radiographs, demonstrating an olecranon spur in all cases
b. Requires aspiration of bursal fluid in all cases
c. Usually straightforward and based on characteristic appearance on physical examination
d. Made only with MRI
C) Additional studies are not usually necessary. If crystal-induced or septic bursitis is suspected, aspiration of the bursal fluid is usually indicated. Plain radiographs may demonstrate an olecranon spur in about one-third of cases.
Which of the following constitutes the largest tissue mass in the body (40%-45% of the total body weight)?
a. Bone
b. Muscle
c. Skin
d. None of the above
B) Muscle comprises 40% to 45% of the total body weight.
The primary function of tendon is to!
a. Transmit the force generated by a muscle to bone
b. Attach bone to bone
c. Be primary joint stabilizers
d. Provide nutrition to bone
A) Tendons consist of dense, regularly arranged collagen fibers meshed with elastin and a proteoglycan/glycosaminoglycan ground substance. The primary function of the tendon is to transmit the force generated in muscle to the bone allowing for the generation of movement of the extremities.
Identify the final treatment phase of sports rehabilitation:
a. Resolving pain and inflammation
b. Restoring ROM
c. Strengthening
d. Sports/task-specific activities
D) There are five treatment phases in sports rehabilitation. The first phase is to resolve the pain and inflammation. The second phase is to restore ROM. The third phase is strengthening. The fourth phase is proprioceptive training. The last phase involves sports/taskspecific activities.
Mallet finger is:
a. A rupture of the terminal extensor tendon of the distal phalanx
b. Identified by a loss of active extension of the proximal interphalangeal (PIP) joint of the finger
c. Caused by forced extension of the distal phalangeal joint
d. Occurs more commonly in ice hockey than in basketball or baseball
A) Mallet finger is a rupture of the terminal extensor tendon of the distal phalanx causing loss of active extension of the distal interphalangeal joint. It is usually caused by forced flexion of the distal phalangeal joint as can occur when a ball hits the end of the finger. It occurs most commonly in sports like basketball or baseball.
De Quervain’s is a tenosynovitis involving which two tendons?
a. Extensor pollicis longus (EPL) and fl exor digitorum superficialis (FDS)
b. Abductor pollicis brevis (APB) and flexor digitorum profundus (FDP)
c. Flexor carpi radialis (FCR) and palmaris longus (PL)
d. Extensor pollicis brevis (EPB) and abductor pollicis longus (APL)
D) De Quervain’s is a tenosynovitis of the first dorsal compartment of the hand/wrist. The APL and EPB tendons are involved.
Finkelstein’s test is usually positive (pain is elicited along the radial aspect of the wrist when the wrist is forced into ulnar deviation with the thumb in a closed fist).
Scaphoid fractures can be ruled out if the patient:
a. Reports falling with an outstretched hand
b. Complains of pain over the anatomical snuff box
c. Has negative initial x-rays
d. Has point tenderness localized to the ulnar aspect of the wrist
D) Scaphoid fractures are the most common carpal bone fractures. They often occur due to a fall on an outstretched hand.
Snuff box tenderness may be noted. If initial plain films are negative, then wrist should be immobilized and films repeated in approximately 2 weeks. There is a high incidence of nonunion and vascular necrosis.
Gamekeeper’s thumb involves an injury to the following structure:
a. Medial collateral ligament
b. Ulnar collateral ligament
c. Transverse carpal ligament
d. Triangular fibrocartilage complex
B) Injuries caused by forcible abduction of the thumb are associated with injury to the ulnar collateral ligament of the first metacarpophalangeal joint (MCP). Skiers are at risk due to falling while holding a ski pole.
Boxer’s fractures involve a fracture of which metacarpal bone?
a. First metacarpal
b. Second metacarpal
c.Third metacarpal
d. Fifth metacarpal
D) Boxer’s fractures involve a fracture of the fifth metacarpal and are the most common fractures occurring in the metacarpals. They usually occur after the patient strikes a hard object with a closed fist. Treatment typically involves closed reduction and casting.
The rotator cuff muscles include all of the following, except:
a. Teres minor
b. Supraspinatus
c.Rhomboids
d. Infraspinatus
C) The rotator cuff muscles include the teres minor, supraspinatus, infraspinatus, and subscapularis muscles. These muscles are dynamic stabilizers of the shoulder.
Writer’s cramp;
a. Is the least common type of dvstonia.
b. Is a task-specific focal dystonia
c. Improves after attempts to perform a specific task such as writing
d. Has a poor prognosis
B)Writer’s cramp is the most common type of dystonia. Patients with dystonia have simultaneous contraction of agonist and antagonist muscle groups. Initial complaints present as poor coordination, cramping, and aching of the hand with task-specific movements. Prognosis for recovery is good.
Which of the following is not true regarding steroid injection for carpal tunnel syndrome (CTS)?
a. It is indicated for mild to moderate CTS
b. It can be used in conjunction with splinting and physical therapy
c. Caution should be used when injecting patients with diabetes
d. Is preferable to surgery in patients with severe CTS
D) Steroid injection can be considered in patients diagnosed (by NCV/EMG) with mild to moderate CTS. Care is taken to avoid piercing the median nerve. The needle is directed at an angle of 30 degrees. Surgery is usually required in severe CTS, especially if abnormal spontaneous potentials are noted in the APB muscle.
Intrinsic factors contributing to the development of tendinitis include all of the following, except:
a. Age
b. Genetic predisposition
c. Poor training technique
d. Muscle imbalance/weakness
C) Age, muscle imbalance (weakness), anatomic malalignment, and genetic predisposition are all intrinsic factors that contribute to the development of tendinitis.
Extrinsic variables include training errors, environmental factors, and equipment.
All the following are benefits of ice in the treatment of acute tendinitis except:
a. Local vasoconstriction
b. Decreased metabolic rate
c. Decreased swelling
d. Local vasodilatation
D) Ice is used more frequently in the acute stages of inflammation, particularly during the first 72 hours. It is a very effective anti-inflammatory modality. Benefits of ice include vasoconstriction, decreased swelling, and relief of pain and muscle spasm.
Myofascial pain syndrome is characterized by:
a. Widespread tenderness
b. Tender points
c. Trigger points
d. No change in muscle tension
C) Trigger points can develop due to a S variety of factors, including direct or indirect trauma, overuse, or stress. A trigger point is an area of tautness, which on compression can cause local or referred manifestations.
Trigger points can refer symptoms to more remote regions. In contrast, palpation of a tender point causes local discomfort without referred pain.
Little League elbow:
a. Involves the lateral elbow region
b. Is an acute dislocation of the elbow
c. Occurs most commonly between the ages of 13-15
d. Occurs in athletes complaining of medial elbow pain
D) Little League elbow is suspected in a throwing athlete between the ages of 9 and 12 with medial elbow pain and a recent history of throwing. There is tenderness over the medial epicondyle and pain with resisted flexion of the wrist and valgus stress testing of the elbow. There may also be a slight elbow flexion contracture. The pathology is irritation and inflammation of the growth plate on the medial epicondyle.
Which bone articulates with the first metacarpal bone in the form of a saddle joint?
a. Trapezium
b. Trapezoid
c. Triquetrum
d. Scaphoid
A) Synovial joints come in multiple types.
Ball and socket joints (e.g., hip joint [multiaxial], provide the most ROM). The saddle joint is a biaxial joint that provides the second most ROM. Other types of synovial joints include the hinge (elbow-uniaxial), pivot (atlanto-axial joint uniaxial), condyloid joints (metacarpophalangeal joints-biaxial), and plain joints (acromioclavicular).
A fall or blow on a hyperextended (dorsiflexed) wrist can cause osteonecrosis of which bone?
a. Scaphoid
b. Lunate
c. Triquetrum
d. Pisiform
A) The scaphoid is the most commonly fractured carpal bone (70%). It is subject to osteonecrosis due to its poor blood supply.
Clinical features of a scaphoid fracture include tenderness in the anatomical snuff box.
Complications include collapse of carpal bones, especially scapholunate instability.
Kienböck’s disease involves which of the following features?
a. Osteonecrosis of the scaphoid
b. Pencil-in-cup deformities
c. Heberden’s and Bouchard’s nodules
d. Osteonecrosis of the lunate
D) Clinical features of Kienböck’s disease include pain over the dorsal aspect of the wrist, directly over the lunate. The mechanism is hypothesized to be an idiopathic loss of blood supply to the lunate, causing avascular necrosis. The disease is correlated with repetitive stress or fracture. Risk factors include short ulnar variance and poor vascular supply. In later stages, the collapse of the lunate results in multiple degenerative changes at the wrist.
Shoulder flexion involves the use of which muscle?
a. Anterior deltoid
b. Biceps brachi
c. Coracobrachialis
d. All of the above
D) Shoulder flexion involves the use of the anterior deltoid, pectoralis major, biceps brachii, and coracobrachialis.
Shoulder extension involves the use of which muscle?
a. Pectoralis major, sternocostal portion
b. Teres major
c. Posterior deltoid
d. All of the above
D) Shoulder extension involves the use of the posterior deltoid, latissimus dorsi, teres major, long head of triceps, and sternocostal portion of the pectoralis major.
All of the following muscles are involved in shoulder adduction, except:
a. Pectoralis major
b. Teres major
c. Coracobrachialis
d. Biceps brachi
D) The biceps brachi is not involved in shoulder adduction. In addition to the pectoralis major, teres major and
coracobrachialis, shoulder adduction involves the latissimus dorsi, infraspinatus, anterior and posterior deltoid, and the long head of the triceps.
The glenohumeral joint (shoulder girdle complex involves articulation of the humeral head with the glenoid fossa and the labrum. Approximately what percentage of humeral head articulates with the glenoid fossa?
a. 15%
b. 30%
C. 50%
d. 70%
B) Approximately 30% of the humeral head articulates directly with the glenoid fossa. A fibrocartilaginous complex called the labrum surrounds the glenoid fossa, effectively increasing the total contact of the humeral head with the glenoid to 70%. This allows for the stabilization of the glenohumeral joint and prevents anterior and posterior humeral head dislocation.
Among the rotator cuff muscles, a tear primarily occurs in which of the following:
a. Supraspinatus
b. Infraspinatus
c. Teres minor
d. Subscapularis
A) The supraspinatus is the primary muscle implicated in rotator cuff tears. The supraspinatus tendon has a poor blood supply and is susceptible to chronic subacromial impingement–a mechanism which is rarely seen in people younger than 40 years of age.
The proximal row of carpal bones from a radial to ulnar direction include:
a. Scaphoid, lunate, trapezoid, pisiform
b. Trapezium, trapezoid, capitate, hamate
c. Scaphoid, lunate, triquetrum, pisiform
d. Trapezium, trapezoid, triquetrum, capitate
C) The proximal row of carpal bones (from a radial to ulnar direction) include the scaphoid, lunate, triquetrum, and pisiform. The distal row of carpal bones (from a radial to ulnar direction) include the trapezium, trapezoid, capitate, and hamate. A common acronm to remember these bones is “Some Lovers Try Positions That They Cannot Handle.”
All of the following muscles involved in wrist and finger flexion receive innervation from the median nerve except:
a. Flexor carpi radialis (FCR)
b. Flexor carpi ulnaris (FCU)
c. Palmaris longus (PL)
d. Flexor pollicis longus (FPL)
B) The flexor carpi ulnaris is innervated by the ulnar nerve. All of the other choices are muscles that are innervated by the median nerve. The median nerve also innervates the flexor digitorum superficialis. The flexor digitorum profundus is dually innervated by the median (second and third digit) and the ulnar nerve (fourth and fifth digit).
All of the following muscles involved in wrist and finger extension receive innervation from the radial nerve except:
a. Extensor carpi radialis longus
b. Extensor carpi radialis brevis
c. Extensor digiti minimi
d. Extensor indicis
C) The extensor digiti minimi muscle is innervated by the ulnar nerve. All of the other choices are muscles that are innervated by the radial nerve. Other muscles innervated by the radial nerve include the extensor carpi ulnaris, the extensor digitorum communis, and the extensor pollicis longus.
Ulnar deviation (also known as wrist adduction) includes paired contraction of which of the following muscle groups?
a. Flexor carpi ulnaris (FCU) and extensor carpi ulnaris (ECU)
b. ECU and palmaris longus (PL)
c. ECU and extensor pollicis longus (EPL)
d. Extensor carpi radialis (ECR) and flexor carpi radialis (FCRY
A) Paired contraction of the flexor carpi’ ulnaris and extensor carpi ulnaris causes ulnar deviation of the wrist.
Finger flexors (to digits 2-4) include all of the following except:
a. Dorsal and palmar interos sei
b. Flexor digitorum superficialis (FDS)
c. Lumbricals
d. Palmaris longus (PL)
D) The palmaris longus muscle is primarily a wrist flexor. Although it is absent in about 14% of the population, its absence does not have any known effects on grip strength. All the other choices are finger flexors, including the flexor digitorum profundus (not listed).
Finger extensors (to digits 2-4) include all of the following except:
a. Extensor pollicis longus (EPL)
b. Extensor digitorum communis
c. Extensor indices (proprius)
d. Extensor digiti minimi
A) All of the above muscles are digit 2 to 4 extensors, except the extensor pollicis longus, which is a thumb extensor.
Shoulder ROM involves 180° of flexion, 180° of abduction, 60°of extension, and
60° of adduction. A balance exists between the glenohumeral and scapulothoracic motion during shoulder abduction. How many degrees of scapulothoracic motion is involved in shoulder abduction?
а. 30°
b. 60°
C. 900
d. 120°
B) Overall, there is 2° of glenohumeral motion for every 1° of scapulothoracic motion during shoulder abduction (120° of
glenohumeral motion to 60 ° of scapulothoracic motion). However, in a normal shoulder, the majority of the initial ROM occurs at the glenohumeral joint when the arm is supinated.
Sensory information to the area of skin over index finger (dermatome) is subserved by afferent fibers from which dorsal root?
a. C5
b. C6
c. C7
d. C8
C) Although there is considerable overlap between adjacent dermatomes, the C7 dermatome supplies sensation to the area of skin over the index finger. The C6 dermatome supplies sensation to the first digit, whereas the C8 dermatome supplies the fifth digit. The C5 dermatome supplies sensation to the lateral aspect of arm.
The parasympathetic (craniosacral)
division of the autonomic nervous system (ANS) involves presynaptic para sympathetic neuron cell bodies located within two sites of the central nervous system (CNS). Which one of the following is not part of the cranial parasympathetic outflow?
a. Ciliary ganglion
b. Celiac ganglion
c. Ptergopalatine ganglion
d. Otic ganglion
B) The celiac ganglion is part of the sympathetic (thoracolumbar) division of the
ANS. The cranial parasympathetic outflow is via cranial III, VII, and IX involving ciliary, pterygopalatine, otic, and submandibular ganglia. Cranial nerve X provides parasympathetic outflow to multiple visceral organs (heart, lungs, upper gastrointestinal system). Additionally, sacral parasympathetic outfl ow supplies the lower gastrointestinal and genitouri nary system via pelvic splanchnic nerves arising from S2, 3, 4 segments.
The sympathetic (thoracolumbar)
division of the ANS involves
postsynaptic sympathetic fibers arising from sympathetic trunks by different means, depending on their destination.
Which one of the following is not part of the thoracolumbar sympathetic outflow?
a.Ciliary ganglion
b. Celiac ganglion
c. Aorticorenal ganglion
d. Superior and inferior mesenteric ganglia
A) The ciliary ganglion is part of the parasympathetic (craniosacral) division of the ANS.
A newborn is holding his head with his chin rotated toward the left and the ear approximating the right shoulder.
Which muscle is primarily implicated?
a. Left cervical paraspinal
b. Right cervical paraspinal
c. Left sternocleidomastoid
d. Right sternocleidomastoid
D) Congenital torticollis occurs in 1 per 250 live births, with 75% involving the right side.
The most common cause is fi brosis of the sternocleidomastoid. The presence of a cervical hemivertebra is less common. On physical examination, a nontender enlargement in the sternocleidomastoid is noted.
Which one of the following ligaments is not directly attached to the spinous processes?
a. Posterior longitudinal ligament
b. Ligamentum nuchae
c. Interspinous ligament
d. Supraspinous ligament
A) The posterior longitudinal ligament attaches to the posterior rim of vertebral bodies and disc from C2 to the sacrum.
When palpating the cervical spine, which of the following statements regarding landmarks is incorrect?
a. Transverse process of C2 is palpated at the angle of the mandible
b. The first palpable midline spinous process is of C2
c. C7 has the largest cervical spinous process, also known as the vertebral prominens
d. Thyroid cartilage is located at the level of C6, C7 anteriorly
D) The thyroid cartilage is located at the level of C4, C5 anteriorly.
When palpating the thoracolumbar and sacral spine, which of the following statements regarding landmarks is incorrect?
a. Spinous process of T3 is at the level of the spine of the scapula
b. T8 is at the level of the inferior angle of the scapula
C. S2 is at the level of the posterior superior iliac spine
d. L2 is at the level of the iliac crests
D) L4 is at the level of the iliac crests.
Weakness of which muscle would correlate with compression of the C5 nerve root? S
a. Biceps brachii
b. Extensor carpi radialis (ECR)
c. Triceps brachi
d. Flexor digitorum profundus (FDP)
A) Compression of the C5 nerve root will result in weakness of the biceps brachii.
Compression of C6 and C7 nerve roots would result in weakness of the extensor carpi
L radialis and triceps, respectively. Compression of C8 and T1 nerve roots would result in weakness of flexor digitorum profundus and abductor digiti minimi (ADM/interossei, respectively.
Weakness of which muscle would - correlate with compression of the T1 nerve root?
a. Abductor digiti minimi (ADMinterossei
b. Extensor carpi radialis (ECR)
c. Triceps brachii
d. Flexor digitorum profundus (FDP)
A) Compression of the T1 nerve root would result in weakness of the ADM/interossei.
Compression of C6 and C7 nerve roots would result in weakness of the extensor carpi radialis and triceps, respectively. Compression of the C8 nerve roots would result in weakness of the flexor digitorum profundus.
L2 nerve root compression would cause which of the following reflex abnormalities?
a. Patellar tendon
b. Cremasteric
c. Cross adductor
d. Achilles tendon
B) L2 nerve root compression would result in cremasteric reflex abnormalities. The cremaster muscle receives innervation via the genitofemoral nerve (L1 and L2). Patellar tendon and Achilles tendon reflexes would be present in L3/L4 and S1 nerve root compressions, respectively. Cross adductor reflex is a withdrawal reflex on one side, with an inhibitory response on the contralateral side to maintain balance-for example, stepping on a nail would result in flexion of the affected limb and extension of the contralateral limb.
All of these are accessory muscles of inspiration except:
a. Sternocleidomastoid
b. Trapezius
c. Pectoralis major
d. Internal intercostals
D) The internal intercostals are accessory muscles used during expiration. In addition to the other choices above, the external intercostals and scalene muscles serve as accessory muscles during inspiration.
Diaphragmatic muscle contraction (innervated by the phrenic nerve) serves as the primary muscle of respiration during inspiration.
Scoliosis can be classified as structural or functional. Which one of the following is not characteristic of structural scoliosis?
a. Most cases are idiopathic
b. It is reversible
c. Subtype of structural scoliosis includes idiopathic
d. Subtypes of structural scoliosis include congenital or acquired
B) Structural scoliosis is not reversible.
Subtypes include idiopathic, congenital, or acquired. Idiopathic scoliosis accounts for 80% of structural scoliosis.
Scoliosis can be classified as structural or functional. Which one of the following is not characteristic of functional scoliosis?
a. Can be due to muscle spasm
b. Can be secondary to a herniated disc
c. Can be due to senile changes in person’s spine
d. Can be postural
C) Senile changes in a person’s spine result in the acquired type of structural scoliosis and is not reversible. All other answer choices are characteristic of functional scoliosis and are reversible.
Evaluation of scoliosis involves the
Adams test (forward bending test) and measuring the Cobb angle using a posterior-anterior (PA) radiograph, which measures:
a. The angle formed at the intersection between the horizontal line drawn along the iliac crest and a line drawn along the superior end plate of the vertebra tilted the most at the top of the curve
b. The angle formed at the intersection between a line drawn along the superior endplate of the vertebra tilted the most at the top of the curve, and a similar line drawn along the inferior endplate of the vertebra tilted the most at the bottom of the curve
c. The angle formed at the intersection between a line drawn along the superior endplate of the vertebra tilted the most at the top of the curve, and a similar line drawn bisecting the center of the curve
d. The angle formed at the intersection between a line drawn along the inferior endplate of the vertebra tilted the most at the bottom of the curve, and a similar line drawn bisecting the center of the curve
B) If the Cobb angle exceeds 50° to 60°, abnormalities in pulmonary function tests may appear. Treatments are based on the degree of curvature: 1°to 20° observation; 20 to 40° bracing; greater than 40 ° evaluation for surgery.
The basic functional element of the neuromuscular system is a motor unit, which consists of all of the following except:
a. An anterior horn cell (motor nerve cell body)
b. The dorsal root ganglion
c. Peripheral nerve
d. Neuromuscular junction
B) The dorsal root ganglion contains cell bodies of the afferent spinal nerves responsible for relaying sensory information.
A motor unit contains the following components from proximal to distal: anterior horn cell, motor nerve axons, peripheral nerve, the neuromuscular junction, muscle fibers.
Components of the neuromuscular unction include all of the following except:
a. Motor nerve cell body
b. Presynaptic region
c. Synaptic cleft
d. Postsynaptic region
A) All of the answer choices except the motor nerve cell body are components of the neuromuscular junction. The motor nerve cell body gives rise to motor nerve axons.
Nerve connective tissue includes all of the following except:
a. Myelin sheath
b. Endoneurium
c. Perineurium
d. Epineurium
A) Endoneurium is the connective tissue that surrounds each individual axon and its myelin sheath. The myelin sheath itself improves conductance of the electrical signal down an axon.
Medial winging of the scapula is caused by which of the following nerve injuries?
a. Weakness of serratus anterior due to spinal accessory nerve iniury
b. Trapezius weakness due to long?
thoracic nerve injury
c. Serratus anterior weakness due to long thoracic nerve injury
d. Trapezius weakness due to spinal accessory nerve injury
C) Choices A and B are paired with the incorrect nerves. Choice D is responsible for lateral winging of the scapula.
All of the following are correct regarding the intervertebral disc except:
a. The pressure obtained in the sitting position is double the pressure when the patient stands
b. The interior of the disc have no nociceptive innervation
C. The fibrous outer ring (annulus fibrosis) is held taut by the pressure in the central nucleus pulposus
d. The dorsal portion of the annulus fibrosis has no nociceptive innervation
D) The dorsal portion of the annulus fibrosis is innervated by the medial branch of the segmental spinal nerves.
