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OCS: Practice Tests > Deck 7 > Flashcards

Deck 7 Flashcards

1
Q

Which of the following is the best treatment for a patient with lumbar stenosis?

A. Sciatic nerve tensioners, laser treatment, stretching
B. Lumbar flexion exercises, TM walking, and sub-therapeutic ultrasound
C. Manual therapy, BW supported TM walking, exercise
D. Repeated lumbar extension

A

C. Manual therapy, BW supported TM walking, exercise

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2
Q

30F accountant referred with c/o sharp pain originating in the L groin and radiating to the medial aspect of the upper thigh, lower leg, and foot.

What nerve is most likely affected?

A. Sciatic nerve
B. Femoral nerve
C. Saphenous nerve
D. Tibial nerve

A

C. Saphenous nerve

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3
Q

30F accountant referred with c/o sharp pain originating in the L groin and radiating to the medial aspect of the upper thigh, lower leg, and foot.

How would you assess the neurodynamics of the nerve affected in this case?

A. PROM hip flexion, knee extension, DF
B. PROM hip extension, knee flexion, PF
C. PROM hip flexion, knee extension, DF, eversion
D. PROM hip flexion, knee extension, DF, inv

A

C. PROM hip flexion, knee extension, DF, eversion

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4
Q

30F accountant referred with c/o sharp pain originating in the L groin and radiating to the medial aspect of the upper thigh, lower leg, and foot.

You are able to reproduce sx with your neurodynamics testing. Further questioning reveals she only experiences sharp pain and radicular symptoms with sitting. Repeated motions testing has no effect. Hip exam reveals (+) FADIR, PROM hip 105˚flex, 5˚ ext, 12˚ IR. R hip was WNL for all testing. What is the likely dx?

A. Acetabular labral cyst
B. L3-L4 disc herniation
C. Adhesion of the gracilis
D. Hip OA

A

A. Acetabular labral cyst

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5
Q

What is the best view on radiographs to ID a scotty dog sign in the lumbar spine?

A

Oblique

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6
Q

On the oblique XR, the scotty dog will appear to have what?

A

a collar

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7
Q

What type of lumbar spine fx of the pars interarticularis is characterized by fatigue failure resulting in stress fx according to the Wiltse-Neman classification?

A. Dysplastic
B. Pathologic
C. Isthmic IIA
D. Isthmic IIB

A

C. Isthmic IIA

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8
Q

Wiltse-Neman classification of pars fx: Isthmic IIB is indicative of

A

elongated pars interarticularis

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9
Q

Wiltse-Neman classification of pars fx: dysplastic spondylolisthesis is due to

A

congenital defect

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10
Q

Wiltse-Neman classification of pars fx: pathologic spondylolisthesis is usually caused by

A

structure weakness or pathology like a tumor

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11
Q

Wiltse-Neman classification of pars fx: Isthmic IIA is indicative of

A

pars fx due to fatigue

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12
Q

For what grade of spondylolisthesis is surgical intervention most indicated?

A. Grade I
B. Grade II
C. Grade III
D. Grades III and IV

A

D. Grades III and IV

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13
Q

What is a Grade III spondylolisthesis?

(%) slippage

A

51-75%

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14
Q

What is a Grade IV spondylolisthesis?

(%) slippage

A

76-100%

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15
Q

Pt presents with 10 year hx of back pain. Reports global pain along entire upper and lower back. She states any quick movements increase pain to 10/10. She said that all of her pain stems from a car accident 10 years ago at a traffic stop light. What condition does the pt most likely present with?

A. RA
B. Central sensitization
C. WAD
D. Back pain with Lhermitte’s sign

A

B. Central sensitization

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16
Q

WAD may cause symptoms that last as long as __ years after MVA

A

2 years

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17
Q

Lhermitte’s sign is suggestive of

A

SC pathology

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18
Q

Central sensitization will likely require a multidisciplinary approach of

A
  • specific rehabilitation
  • psychotherapy
  • pharmacological management
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19
Q

25F presents via direct access with intermittent LBP that began 4 weeks ago. She is in a WC in the waiting room d/t LE weakness. She reports her symptoms have worsened within the last few days. She complains of incontinence and decreasing sensation in the perianal region. What imaging modality is most recommended?

A. MRI
B. Radiograph
C. Dx US
D. Myelography and CT scan

A

A. MRI

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20
Q

When cauda equina is suspected, the most recommended imaging is

A

MRI

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21
Q

28M presents with back pain after a fall while skateboarding x 1 week. Notice a large palpable effusion that migrates caudally with AROM flexion and in this position, the effusion can be moved by the therapist. MRI showed collection of fluid within the soft tissue of the lumbar spine. What is the most likely dx?

A. Epidural abscess
B. L4-5 disc extrusion
C. Transverse myelitis
D. Morel-Lavalée lesion

A

D. Morel-Lavalée lesion

22
Q

An epidural abscess usually presents with signs of

A

infection

23
Q

Transverse myelitis is this type of pathology

A

demyelinating

24
Q

Transverse myelitis (is/is not) associated with acute injury

A

is not

25
Q

Morel-Lavallée lesion: what is it?

A

post-traumatic hemolymphatic collection of fluid that compromises the interfacial planes of soft tissue and muscle

26
Q

What muscles cause R trunk rotation?

A. R EO and R IO
B. R EO and L IO
C. L EO and R IO
D. L EO and L IO

A

C. L EO and R IO

27
Q

If a pt experiences L3-4 disc herniation, which nerve root is most likely to be affected based on anatomical orientation of the nerves?

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

A

B. L4

28
Q

Which of the following has the best utility to dx lumbar spinal stenosis?

A. Sx decrease with sitting
B. Sx abolished with sitting
C. Sx improved walking with shopping cart
D. Pain below buttocks

A

B. Sx abolished with sitting

29
Q

A. Sx decrease with sitting
B. Sx abolished with sitting
C. Sx improved walking with shopping cart
D. Pain below buttocks

Why does B have the best utility to dx lumbar spinal stenosis?

A

B has the highest SPECIFICITY

30
Q

70F referred for LBP reports primary complaint is B cramping sensation after walking 200 ft and when riding a bike x 15 minutes. What is causing her cramping?

A. Vascular claudication
B. Chronic exertional compartment syndrome
C. Lumbar stenosis
D. Neurogenic claudication

A

A. Vascular claudication

31
Q

What best describes a Schmorl’s node?

A. Nucleus pulposus extrudes through the annulus fibrosus
B. Nucleus pulposus and annulus fibrosus fragment into the epidural space
C. Protrusion of the nucleus pulposus through a vertebral body end plate
D. Osteophyte causing stenosis in the lateral foramen

A

C. Protrusion of the nucleus pulposus through a vertebral body end plate

32
Q

25M referred with acute LBP. Insists that you review XR from ED. On lumbar spine, you notice a scotty dog sign. What is this sign indicative of?

A

fx of pars interarticularis resulting in spondylolysis

33
Q

Scotty dog: the nose is what structure?

A

transverse process

34
Q

Scotty dog: the eye is the

A

pedicle

35
Q

Scotty dog: the front leg is the

A

inferior articular facet

36
Q

Scotty dog: the ear is the

A

superior articular facet

37
Q

Pt referred for recent onset LBP that started 5 days ago. C/o radicular symptoms to mid-left thigh. PMH: prior episode of LBP 1 year ago, HTN, OP, DM, knee arthroscopy 3 years ago. What is the best tx option for this pt?

A. Manipulation
B. Stabilization exercises
C. Directional preference
D. Traction

A

C. Directional preference

38
Q

A pt is referred postpartum for localized LBP. Which factor would make her least likely to have successful bout of PT focusing on stabilization?

A. Age < 30
B. Age < 35
C. Age < 40
D. Age < 45

A

D. Age < 45

39
Q

Individuals < (age) are more likely to succeed from a stabilization program than those between 40-45 yo

A

< 40

40
Q

Which pt will most likely benefit from repeated lumbar flexion exercises?

A. Recent onset of sx with radiculopathy to the L hip
B. 30 yo post-partum female
C. 60 yo pt with cramping in the legs with walking which is abolished with sitting
D. 45 yo pt with radiculopathy into the L heel

A

C. 60 yo pt with cramping in the legs with walking which is abolished with sitting

41
Q

Based on the classification approach for LBP, which classification has the least research to support it?

A. Manipulation
B. Stabilization exercises
C. Directional preference
D. Traction

A

D. Traction

42
Q

Studies that failed to demo the effectiveness of traction could be due to

A

heterogeneity of groups included

43
Q

Pt referred by PCM for LBP. Exam shows B sciatic with motor loss, sacral sensory loss, and sphincter disturbance, Pt has a hx of opioid use. What is the most likely dx and what referral is most indicated?

A. CES: urgent referral required in < 48 hrs
B. CES: urgent referral required in < 96 hrs
C. Disc herniation complicated by opioid use; assess for centralization of symptoms with repeated movements
D. Mod to severe stenosis, refer back to PCM in 30 days if conservative tx fails

A

A. CES: urgent referral required in < 48 hrs

44
Q

Why might opioid use make dx of CES difficult?

A

common side effect of constipation

45
Q

This would be more suggestive of CES than constipation

A

urinary retention

46
Q

Which is the best surgery for a pt with degenerative spondylolisthesis resulting in stenosis?

A. Decompression and fusion
B. Microdiscectomy
C. Decompression surgery alone
D. Disc replacement

A

C. Decompression surgery alone

47
Q

No difference in decompression alone and decompression and fusion at what follow ups?

A

2 and 5 year

48
Q

In a direct access setting, you are evaluating a 9 yo pt for LBP and radicular symptoms along the anterior and anteromedial aspect of the leg. You perform the femoral nerve tension test and it is positive. What should your next course of action be?

A. Perform repeated motion testing to assess if symptoms centralize
B. Since symptoms do not go below the knee, perform lumbar manipulation
C. More info is needed to direct care
D. Refer pt to physician or specialist for imaging

A

D. Refer pt to physician or specialist for imaging

49
Q

In a direct access setting, you are evaluating a 9 yo pt for LBP and radicular symptoms along the anterior and anteromedial aspect of the leg. You perform the femoral nerve tension test and it is positive. Why is referral to physician or specialist for imaging warranted?

A
  • symptoms suggestive of radiculopathy in upper lumbar spine
  • in a young person, these symptoms are rare
  • need to r/o sinister pathology
50
Q

Caucasian 70M referred for LBP. PMH significant for smoking, but pt quit 5 years ago. 15 yr hx of LBP, unchanged by active lumbar movements and no reproducible hip or SI pain on assessment. He reports decreased activity level and inc LBP within the past 4 weeks. UA to describe a position that eliminates his sx. Has been to PT in the past and has had success managing back pain. No PMH CA, changes in b/b function, or paresthesia into the LEs. Neural tension testing negative. No gait disturbance. Pain worsening and wakes him up at night. He reports pain is different than previous episode of back pain. What should the PT do next during the physical exam?

A. Ask more about b/b behavior due to concern for constipation
B. Palpate the abdomen and back and auscultate the stomach
C. Screen for morning stiffness and presence of psoriasis or oncholysis
D. Recommend 6MWT

A

B. Palpate the abdomen and back and auscultate the stomach

51
Q

60M presents after MVA 5 weeks prior. Primary complaint of inc’d intermittent LBP since accident. Pt declined XR at ED. No apparent red flags upon assessment. However, over the next 3 sessions, pain continued to worsen. Since IE, pt has been to the ED with complaints of urinary dysfunction and a dx workup was performed confirming multiple myeloma.

Which of the following is the least concerning aspect of this pt’s case for a dx of cancer?

A. Age > 49
B. Prior hx of CA
C. Worsening pain with conservative tx
D. Duration of episode of pain > 1 mo

A

B. Prior hx of CA

52
Q

60M presents after MVA 5 weeks prior. Primary complaint of inc’d intermittent LBP since accident. Pt declined XR at ED. No apparent red flags upon assessment. However, over the next 3 sessions, pain continued to worsen. Since IE, pt has been to the ED with complaints of urinary dysfunction and a dx workup was performed confirming multiple myeloma.

Which of the following answer of “any” pt case would most increase your suspicion of CA causing LBP?

A. Age > 49
B. Prior hx of CA
C. Worsening pain with conservative tx
D. Duration of episode of pain > 1 mo

A

B. Prior hx of CA

OCS: Practice Tests (25 decks)

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