General, Ortho, Neuro

Question 1

What do you look for posture wise in the lateral projection?

Answer 1

EAM, anterior body of C7, acromion process, middle of GH joint, anterior 1/3 of sacrum, center of greater trochanter, just bhind center of knee, 1” anterior to lateral malleolus

Question 2

Describe kyphosis-lordosis

Answer 2

Hourglass appearance of spine, head forward, neck hyperextended, thoracic spine flexed more than usual and lumbar spine is hyerextended so pelvis is tilted anteriorly, knees slightly hyperextended

Question 3

Describe sway back

Answer 3

Head held forward, neck in slight extension, thoracic spine backward, lumbar spine flattened, pelvis tilted posterior, hip joints hyperextended along w/knees

Question 4

Describe military back

Answer 4

Had neutral, lumbar spine is hyperextended and pelvis is tilted anteriorly

Question 5

Parts of the stance phase?

Answer 5

Heel strike (0%), foot flat (15%), push off (30%), acceleration (45%)

Question 6

Parts of the swing phase?

Answer 6

toe-off (60%), swing through (75%), heel strike 100%

Question 7

RLA phases of gait for stance and swing?

Answer 7

Stance: initial contact, loading response, mid-stance, terminal stance
Swing: pre-swing, initial swing, mid-swing, terminal swing

Question 8

Hip flexors act during what part of the gait? Weakness results in?

Answer 8

Acceleration

Abnormal acceleration and swing w/thrusting of the trunk backwards to passively swing the leg

Question 9

Hip extensors act during what part of the gait? Weakness results in?

Answer 9

Heel strike

Forward lurch of trunk on heel strike and patient compensates w/excessive lordosis

Question 10

Hip abductors act during what part of the gait? Weakness results in?

Answer 10

Stance phase

Trendelenburg (lurching) gait-superior gluteal nerve

Question 11

Hip adductors act during what part of the gait? Weakness results in?

Answer 11

Heel strike, toe off

Abnormal rotation of the leg and pelvis

Question 12

Knee extensors act during what part of the gait? Weakness results in?

Answer 12

Heel strike, acceleration
Knee buckles (especially walking downstairs)

Question 13

Knee flexors act during what part of the gait? Weakness results in?

Answer 13

Deceleration, heel strike

Knee snaps out too hard at end of swing and knee buckles w/heel strike

Question 14

Foot dorsiflexors act during what part of the gait? Weakness results in?

Answer 14

Swing phase, heel strike

Foot drop, steppage gait, foot slap w/heel strike

Question 15

Foot plantar flexors act during what part of the gait? Weakness results in?

Answer 15

Toe push-off

Short step on affected side w/poor push off

Question 16

Describe antalgic gait

Answer 16

Pt favours one leg by putting as little weight as possible on it in order to reduce the pain on that side

Question 17

Describe choreic gait

Answer 17

Jerky twitching dancing gait in Huntington’ and rheumatic fever

Question 18

Describe deteriorating tandem gait

Answer 18

Worsening tandem walk while counting from 50 backwards is an early sign of Alzheimer’s disease

Question 19

Describe drunken gait

Answer 19

Classic wide-based staggering gait seen in cerebellar disease

Question 20

Describe festinating gait

Answer 20

Shuffling (propulsion gait) w/tendency to accelerate as the pt leans forward seen in Parkinson’s

Question 21

Describe hemplegic gait

Answer 21

Spastic leg extended and rotated internally, foot inverted and plantar flexed, limb swung out to keep foot off ground seen in CVA

Question 22

Describe scissor gait

Answer 22

Stiff shuffling movement w/legs crossing over due to increased adductor tone seen in cerebral palsy or paraplegia

Question 23

Describe sensory ataxic gait

Answer 23

Wide-based uneven gait w/high steps and slapping of feet on ground seen in pt w/dorsal column path as in tabes dorsalis, Vit B12 def, diabetes mellitus

Question 24

Describe steppage gait

Answer 24

Pt has to excessively flex hip and knee to allow drop foot to clear the ground when walking seen w/foot drop (peripheral neuropathy)

Question 25

Describe waddling (lurching) gait

Answer 25

Pt leans to same side as weight is placed, due to paralysis of gluteus medius and minimus muscles and may be seen in pts with hip replacements; aka Trendelenburg gait in Duchenne muscular dystrophy and pts w/hip replacements

Question 26

``` Neck ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 26

``` Flexion: 60 Extension 70 Abduction 45 Adduction 0 Rotation 80 ```

Question 27

``` Thoracic ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 27

``` Flexion: 50 Extension: 30 Abduction: 0 Adduction: 0 Rotation: 30 ```

Question 28

``` Lumbar ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 28

``` Flexion: 80 Extension: 35 Abduction: 25 Adduction: 0 Rotation: 0 ```

Question 29

``` Shoulder ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 29

``` Flexion: 180 Extension: 50 Abduction: 180 Adduction: 50 Rotation: 90 ```

Question 30

``` Elbow ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 30

``` Flexion: 140 Extension: 0 Abduction: 0 Adduction: 0 Rotation: 90 (pronation/supination) ```

Question 31

``` Wrist ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 31

``` Flexion: 90 Extension: 70 Abduction: 20 Adduction: 55 Rotation:0 ```

Question 32

``` MCP ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 32

``` Flexion: 90 Extension: 10 Abduction: 20 Adduction: 0 Rotation: 0 ```

Question 33

``` PIP ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 33

``` Flexion: 90 Extension: 0 Abduction: 0 Adduction: 0 Rotation: 0 ```

Question 34

``` DIP ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 34

``` Flexion: 60 Extension: 0 Abduction: 0 Adduction: 0 Rotation: 0 ```

Question 35

``` Hip ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 35

``` Flexion: 120 Extension: 30 Abduction: 45 Adduction: 30 Rotation: 40 internal, 45 external ```

Question 36

``` Knee ROM Flexion Extension Abduction Adduction Rotation ```

Answer 36

``` Flexion: 150 Extension: 0 Abduction: 0 Adduction: 0 Rotation: 0-5 ```

Question 37

``` Ankle ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 37

``` Flexion: plantar 40 Extension: dorsi 20 Abduction: 0 Adduction: 0 Rotation: 30 inversion, 20 eversion ```

Question 38

``` 1st MTP ROM: Flexion Extension Abduction Adduction Rotation ```

Answer 38

``` Flexion: 45 Extension: 70-90 Abduction: 0 Adduction: 0 Rotation: 0 ```

Question 39

Flexors at the shoulder? | Extensors?

Answer 39

Flex: pec major, deltoid Ext: lat, deltoid, teres major

Question 40

Medial and lateral rotators of the shoulder?

Answer 40

Medial: Pec major, lat dorsi, teres major Lateral: Infraspin

Question 41

Adductors and abductors of the shoulder?

Answer 41

Adductor: Pec major, lat dorsi, teres major Abductor: Deltoid, supraspin

Question 42

What does biceps do at the elbow? Triceps?

Answer 42

Biceps: Flexion and supination (medial rotation) Triceps: extension, adductors

Question 43

What does flexor carpi radialis at the elbow? ulnaris?

Answer 43

Radialis: Flexion, abductor Ulnaris: flexion, adduction

Question 44

What do flexor digitorum profudnus and superficialis do at the MCP? Extensor digitorum?

Answer 44

FDP/S: Flexion | ED: extension

Question 45

Psoas action at the hip? Piriformis?

Answer 45

Psoas: flexion, lateral rotation Piriformis: lateral rotation

Question 46

What are the action of gut max and med at the hip?

Answer 46

Max: extension, adduction Med: Abduction

Question 47

What extends the knee? flexes?

Answer 47

Extends: Quads Flex: gastrocs and biceps femoris

Question 48

Plantarflexors at the ankle? Dorsiflexors?

Answer 48

Plantar: Gastroc, post tib, peroneus/fibularis Dorsiflex: Ant tib

Question 49

Inverters of the ankle? Everters?

Answer 49

Ant and post tib invert | Peroneus/fibularis evert

Question 50

Is atrophy of the muscle an upper or lower motor neuron lesion?

Answer 50

Lower

Question 51

Bent 4th or 5th fingers and palmar ridge are indicative of what pathology?

Answer 51

Dupuytren's contracture

Question 52

Bouchard's nodes are found at what joint? Part of what pathologies?

Answer 52

Proximal interphalangeal joints | OA or RA

Question 53

A cold painful large joint with crepitus could be what pathology?

Answer 53

OA

Question 54

Crepitus over moving tendons could indicate?

Answer 54

Scleroderma

Question 55

Fasciculation is part of an upper or lower motor neuron lesion?

Answer 55

Lower

Question 56

Gottron's papules are? Indicative of what pathology?

Answer 56

Lumps on the knuckles | Dermatomyositis

Question 57

Haygarth's nodes are found where? Part of what pathology?

Answer 57

Metacarpophalangeal joints | RA

Question 58

Heberden's nodes are found where? Part of what pathology?

Answer 58

Distal interphalangeal joints | OA

Question 59

Heliotrope discolouration of eyelids is part of what pathology?

Answer 59

Dermatomyositis

Question 60

Interossei wasting could indicate damage to what nerve?

Answer 60

Ulnar nerve

Question 61

Pseudohypertrophic calves is an indicator of?

Answer 61

Duchenne's muscular dystrophy

Question 62

Spatulate (spade-like) hands are indicative of?

Answer 62

Acromegaly

Question 63

Tapered tight finger tips are part of?

Answer 63

Scleroderma

Question 64

Thenar eminence wasting is indicative of damage to what nerve?

Answer 64

Median

Question 65

Inability to clash paper between extended fingers is a sign of ?

Answer 65

Ulnar nerve palsy

Question 66

Inability to extend wrist against resistance is a sign of?

Answer 66

Radial N palsy

Question 67

Unable to oppose the thumb to the pinky is a palsy of what nerve?

Answer 67

Median N

Question 68

Wasted lateral leg compartment is a sign of what syndrome?

Answer 68

Charcot-Marie-Tooth syndrome

Question 69

Acromegaly: Cause? Presentation? Management?

Answer 69

Excessive GH after growth plates fused; due to pituitary adenoma Large spatulate hands, latern-shaped jaws, overhanging brows, increased hat size, headaches, visual problems (like bitemporal hemianopia), enlarged sella, arrow-head appearance of terminal phalanges, heel pad >23 mm on lateral x-ray of foot Refer to endocrinologist

Question 70

Ankylosing Spondylitis: Cause? Presentation? Management?

Answer 70

Chronic inflammatory condition of SI joints and axial skeleton marked by bone formation at ligament and tendon attachments Low back pain >3 months, better w/exercise not rest, limitation of lumbar spine movement in sagittal and coronal planes, bilateral sacroiliac tenderness, decreased chest expansion w/inspiration, X-rays show shiny corners, marginal syndesmophytes, dagger sign, bamboo spine, ESR and alkaline phosphatase elevated in active phase, HLA B27 + Co-manage w/rheumatologist

Question 71

Charcot Marie Tooth Diease: Cause? Presentation? Management?

Answer 71

Hereditary motor and sensory neuropathy w/peroneal (fibularis) muscle atrophy Wasted fibularis, foot drop, high arch, claw toes Neurologist

Question 72

Dermatomyositis: Cause? Presentation? Management?

Answer 72

Autoimmune inflammatory disease affecting muscle and skin Fatigue, heliotrope discolouration of eyelids and muscle fatigue, CK-MM/LDH elevated, ANA+ Dermatologist --> muscle and skin biopsy

Question 73

Duchenne's muscular dystrophy: Cause? Presentation? Management?

Answer 73

X-linked chromosomal abnormality w/deficient dystrophin Proximal muscle weakness, pseudohypertrophic calf muscles, +Gower's sign, waddling gait Refer to pediatrictian -> Muscle biopsy

Question 74

Dupuytren's Contracture: Cause? Presentation? Management?

Answer 74

Contracture of palmar fascia; seen with diabetes mellitu, cirrhosis and chronic phenytoin use 4th/5th fingers bent toward palm w/longitudinal palmar ridge Co-manage w/hand surgeon

Question 75

Ehlers-Danlos syndrome: Cause? Presentation? Management?

Answer 75

Inherited CT w/defective collagen Hypermobile joints, skin that easily stretches and is damaged, kyphoscoliosis Refer to pediatrician

Question 76

Gout: Cause? Presentation? Management?

Answer 76

Metabolic condition characterized by deposition of uric acid crystals in joints Sudden onset of severe joint pain, big toe swelling, tophi, soft tissue swelling, bony erosions w/overhanging edges, - birefringent needs crystals in aspirated synovial fluid Co-manage w/rheumatologist, advice on avoidance of alcohol, purine rich foods and fluids

Question 77

Lyme disease: Cause? Presentation? Management?

Answer 77

Infection of skin, nerves, muscles, joints caused by Borrelia burgdorferi transmitted by deer tick Stage 1: presents w/flu-like illness w/erythema migrans Stage 2: Bell's palsy, peripheral neuropathy Stage 3: Chronic arthritis and muscle pains Refer to rheumatologist Lyme-ELISA confirmatory

Question 78

Marfan's: Cause? Presentation? Management?

Answer 78

Hereditary condition resulting in defective fibrillin production Presents w/tall, thin body habitus, hypermobile joints, lens dislocation, aortic incompetence, mitral valve prolapse, dissecting thoracic aorta Refer to internist

Question 79

Osteoarthritis: Cause? Presentation? Management?

Answer 79

Progressive degeneration of articular cartilage Pain in weight bearing joints (knee, hip, spine), morning stiffness lasting <1 hr, pain worse w/use and towards end of day, joint space narrowing, subchondral sclerosis, marginal osteophyets, subchondral cysts Co-manage w/orthopedist, advice on weight loss, exercise, nutritional supplements with glucosamine

Question 80

Osteomyelitis: Cause? Presentation? Management?

Answer 80

Bacterial infxn of bones; commonly associated w/IV drug use and Staph aureus Fever, nearby joint swollen, warm, red, leukocytosis, elevated neutrophils, soft tissue swelling w/Brodie's abscess, involucrum, sequestrated bone Refer to hospital for MRI

Question 81

Osteoporosis: Cause? Presentation? Management?

Answer 81

Progressive metabolic bone disease in which generalized decreased bone density, seen more commonly in postmenopausal women and men after 70's Decreased height, increased kyphosis, dowager hump, increase risk of fx, accentuated trabecular, Wade's triangle, serum calcium and phosphate normal, DEXA score >2.5 Co-manage w/orthopedist, prevention aimed at risk reduction-smoking cessation, regular weight-bearing exercises and increased Ca2+ and Vit D

Question 82

Rheumatic Fever: Cause? Presentation? Management?

Answer 82

Autoimmune disorder triggered by strep pyogenes (heart, skin, joints) Syndenham's chorea, polyarthritis, erythema marginatum, carditis, subcutaneous nodules, ASOT/ESR elevated and PR interval prolonged Refer to hospital

Question 83

Rheumatoid Arthritis: Cause? Presentation? Management?

Answer 83

MC autoimmune disorder; seen MC in middle aged females Bilateral PIP, MCP and wrist pain w/morning stiffness lasting >1 hr, RF raised, with ESR and anti-CCP, symmetrical bilateral intra-articular erosions, periarticular osteoporosis w/ulnar deviation of MCP joints Co-manage w/pulmonologist

Question 84

Scleroderma: Cause? Presentation? Management?

Answer 84

Chronic autonomic CT disorder characterized by fibrosis; MC in females Thickened shin skin over fingers, sensitivity to cold, joint pains w/tendon crepitus, SoB, fatigue, dysphagia; calcinosis cutis, raynaud's, esophageal hypomotility, sclerodactyly, telangiectasia (CREST), anti scl-70 + Co-manage w/pulmonologist

Question 85

Scoliosis is ok for Chiropractic w/in how many degrees? Bracing? Surgery?

Answer 85

10-20 20-40 >40

Question 86

Septic Arthritis: Cause? Presentation? Management?

Answer 86

Acute infection of one joint caused by bacterial infection seen in IV drug use; Staph aureus is the MC causative organism Fever, severe acute joint pain w/swelling and marked decrease in ROM, leukocytosis and high neutrophils, WBC in joint aspiration and bacteria Hospital

Question 87

Pott's disease/TB of spine: Cause? Presentation? Management?

Answer 87

Infection by mycobacterium tuberculosis Fatigue, gibbus, psoas abscess, destruction of anterior vertebral body, lesions in apex of lungs Refer to infectious disease specialist

Question 88

C5 dermatome, muscle test, reflex?

Answer 88

Lateral arm Deltoid (abduct shoulder) Biceps brachii

Question 89

C6 dermatome, muscle test, reflex?

Answer 89

Lateral forearm to thumb Biceps brachii (flex elbow) Brachioradialis

Question 90

C7 dermatome, muscle test, reflex?

Answer 90

Middle finger Triceps (extend elbow) Triceps

Question 91

C8 dermatome, muscle test, reflex?

Answer 91

5th finger to inner forearm FDP (flex fingers) None

Question 92

T1 dermatome, muscle test, reflex?

Answer 92

Medial elbow Abduct little finger None

Question 93

T2 dermatome, muscle test, reflex?

Answer 93

Axilla N/A N/A

Question 94

T4 dermatome, muscle test, reflex?

Answer 94

Nipple N/A N/A

Question 95

T7 dermatome, muscle test, reflex?

Answer 95

xiphoid region N/A N/A

Question 96

T10 dermatome, muscle test, reflex?

Answer 96

Umbilical region N/A N/A

Question 97

T12 dermatome, muscle test, reflex?

Answer 97

Suprapubic region N/A N/A

Question 98

L1 dermatome, muscle test, reflex?

Answer 98

Inguinal region N/A Cremasteric

Question 99

L2 dermatome, muscle test, reflex?

Answer 99

Anterior thigh Iliopsoas (flex hip) Cremasteric

Question 100

L3 dermatome, muscle test, reflex?

Answer 100

Lateral thigh Quadriceps femoris (Squat and rise) Patellar

Question 101

L4 dermatome, muscle test, reflex?

Answer 101

Medial leg to big toe Tibialis Anterior (dorsiflex and invert ankle) Patellar

Question 102

L5 dermatome, muscle test, reflex?

Answer 102

Dorsum of foot Extensor hallucis longus (extend big toe, heel walk) Hamstring

Question 103

S1 dermatome, muscle test, reflex?

Answer 103

Lateral foot Gastrocnemius or fibularis longus (toe walk) Achilles

Question 104

Reflex grading on the Wexler scale

Answer 104

``` 0 - no response 1 - diminished response 2 - normal 3 - Brisk response 4 - Very brisk response w/clonus ```

Question 105

Muscle grading on the Van Allen scale

Answer 105

0 - no muscular contraction 1 - Barely detectable flicker of contraction 2 - Full ROM but not against gravity 3 - Full ROM against gravity not resistance 4 - Full ROM against gravity and some resistance 5 - Full ROM against gravity and resistance

Question 106

Nerve roots for the anal wink reflex?

Answer 106

S3, 4

Question 107

Criteria for an upper motor neuron lesion?

Answer 107

Spastic paralysis, increased tone, increased reflexes w/clonus, no atrophy or fasciculation, present Babinski and hoffmann reflexes

Question 108

Criteria for a lower motor neuron lesion?

Answer 108

Flaccid paralysis, decreased tone and reflexes, atrophy and fasciculations present, absent babinski/hoffmann reflexes

Question 109

Spinal cord reflexes are carried by what tract?

Answer 109

Lateral corticospinal tract

Question 110

Removal of inhibition of what neuron causes spastic paralysis seen in an upper motor neuron lesion?

Answer 110

Renshaw cell

Question 111

Abulia is? Could indicate what pathology?

Answer 111

Inability to make decisions | Stroke, damage to basal ganglia

Question 112

An absent corneal reflex could indicate damage to what cranial nerves?

Answer 112

CN V (afferent) CN VII (efferent)

Question 113

Agnosia is? Could indicate what pathology?

Answer 113

Inability to recognize sight, sounds, words | Stroke, dementia or severe head injury

Question 114

Akinesthesia is? Could indicate damage to what tract?

Answer 114

Loss of proprioception | Dorsal column

Question 115

Anascoria is? Could indicate damage to?

Answer 115

Unequal pupil size | CN III's sympathetics or parasympathetics

Question 116

Aphasia is? Could indicate damage to

Answer 116

Unable to express oneself w/words | Broca's speech area (Brodmann areas 44 and 45)

Question 117

Apraxia is? Could indicate damage to?

Answer 117

Inability to perform learned movement | Cerebellum

Question 118

Asthenocoria is? Is present in what pathology?

Answer 118

Sluggish pupil light reflex (Arroyo's sign) | Addison's

Question 119

Ataxia is? Could indicate damage to?

Answer 119

Loss of balance | Cerebellar, vestibular/dorsal column damage

Question 120

Athetosis is? Could indicate damage to?

Answer 120

Slow snake like movements | Damage to putamen in basal ganglia

Question 121

Bielschowsky's sign is? Could indicate damage to?

Answer 121

Head tilt to opposite side | CN IV palsy (S.O. muscle)

Question 122

Bitemporal hemianopia is? Could indicate damage to?

Answer 122

Both temporal halves blind | CN II damage at optic chiasm or pituitary tumor

Question 123

Cape like loss of pain and temperature is indicative of a?

Answer 123

Syringomyelia

Question 124

What is Cushing's triad? Caused by what?

Answer 124

High BP, low pulse, irregular respiration | Raised intracranial pressure

Question 125

Dysarthria test? Damage to what?

Answer 125

Say KuLaMi | K = CN X, L = CN XII and M = CN V

Question 126

What is Homan's sign? Present with?

Answer 126

Flexion of thumb after flicking middle finger | UMN lesion in upper limb

Question 127

Homonymous hemianopia is? Damage is where?

Answer 127

Same halves on both sides missing | Damage to contralateral optic radiation

Question 128

Loss of gag reflex is indicative of damage to?

Answer 128

CN IX (afferent) and X (efferent)

Question 129

Loss of stereognosis is? Damage to?

Answer 129

Recognize objects by feeling | Dorsal column

Question 130

Mittelmeyer test is? If positive could indicate damage to

Answer 130

March on spot w/eyes closed | Vestibular N damage (side turned to)

Question 131

Pill rolling/resting tremor is seen in what pathology?

Answer 131

Parkinson's

Question 132

Decerebrate rigidity is? Seen with brainstem lesions below what?

Answer 132

Upper limbs in extension | Red nucleus

Question 133

Decorticate rigidity is? Seen with brainstem lesions above what?

Answer 133

Upper limbs in flexion | Red nucleus

Question 134

Clasp knife rigidity is seen with?

Answer 134

Upper motor neuron lesion

Question 135

Scanning speech, intention tremor, nystagmus =

Answer 135

MS

Question 136

Sign of benediction is indicative of?

Answer 136

Median nerve damage

Question 137

Synesthesia is? Caused by?

Answer 137

Perceiving sounds as different colours | Unknown; hereditary (?)

Question 138

Titubation not in time with the pulse is a sign of?

Answer 138

Cerebellar disease

Question 139

Tongue deviates to one side is indicative of damage to?

Answer 139

Ipsilateral CN XII palsy/damage

Question 140

Postural tremors are seen with?

Answer 140

Hyperthyroidism

Question 141

UMN/LMN lesions in >=3 limbs diagnosis?

Answer 141

ALS

Question 142

Uvula deviation is indicative of?

Answer 142

Damage to CN X on opposite side

Question 143

Inability to adduct thumb is what nerve damaged? Extend? Oppose?

Answer 143

Ulnar Radial Median

Question 144

Cricothyroid is innervated by?

Answer 144

Superior laryngeal N

Question 145

Palatoglossus is innervated by?

Answer 145

Pharyngeal plexus of CN X

Question 146

Stylopharyngeus is innervated by?

Answer 146

Glossopharyngeal N

Question 147

Arm flexors are supplied by what N (roots)?

Answer 147

Musculocutaneous N (C5, 6, 7)

Question 148

Arm extensors are innervated by what N (roots)?

Answer 148

Radial (C5-T1)

Question 149

Flexor muscles of the thigh are supplied by what N (roots)?

Answer 149

Femoral N (L2-4)

Question 150

Adductors of the thigh are supplied by what N (roots)?

Answer 150

Obturator N (L2, 3, 4)

Question 151

Extensor compartment of the thigh are supplied by?

Answer 151

Sciatic N

Question 152

Lateral compartment of the leg muscles are supplied by what Nerve?

Answer 152

Superficial peroneal/fibular N

Question 153

Posterior compartment of the leg muscles are supplied by what nere?

Answer 153

Tibial N

Question 154

Muscles of the anterior compartment of the leg and dorsum of foot are supplied b what N?

Answer 154

Deep peroneal/fibular N

Question 155

Mucles of the sole of the foot are supplied by what nere?

Answer 155

Lateral and medial plantar branches of the tibial nerve

Question 156

Gluteus maximus is supplied by what N (roots)?

Answer 156

Inferior gluteal N (L5-S2)

Question 157

Acoustic Neuroma: Caused by? Presents as? Management?

Answer 157

Benign tumor of Schwann cells affecting the vestibular part of CN VIII - part of Type II neurofibromatosis Facial palsy, ipsilateral deafness Refer to neurosurgeon --> CT scan

Question 158

Amyotrophic Lateral Sclerosis: Caused by? Presents as? Management?

Answer 158

Rapidly progressive degenerative NM condition resulting in LMN lesions in upper limbs and UMNL's in lower limbs Muscle weakness, clumsy movements along w/dysphagia and dysarthria of 3/4 limbs, , patchy sclerosis of SC and periventricular plaques in brain with Dawson's fingers on MRI Co-manage w/neurologist

Question 159

Bell's Palsy: Caused by? Presents as? Management?

Answer 159

Unilateral LMN of CN VII caused by HHV Type I or associated w/Lyme disease Inability to smile and wrinkle forehead on one side w/ipsilateral loss of taste and hyperacusis on same side Co-manage w/neurologist; chiropractic adjustments and nutritional supplements

Question 160

Charcot Marie Tooth Disease: Caused by? Presents as? Management?

Answer 160

Hereditary motor and sensory neuropathy w/peroneal muscle atrophy Wasted peroneal muscles, foot drop, high arch and claw toes along w/loss of touch in feet and legs (hands and arm) Co-manage w/neurologist

Question 161

Erb's Palsy: Caused by? Presents as? Management?

Answer 161

Traction trauma during vertex delivery to upper roots (C5/6) of brachial plexus Extension, forearm pronated, wrist flexed Co-manage w/neurologist

Question 162

Huntington's: Caused by? Presents as? Management?

Answer 162

Hereditary neurological condition affecting basal ganglion, onset in 3rd decade Jerky involuntary movements, chorea, mental deterioration Co-manage w/neurologist

Question 163

Klumpke's paralysis: Caused by? Presents as? Management?

Answer 163

Traction injury during breech delivery to lower roots (C8/T1) of brachial plexus/distraction injury in catching themselves Claw hand Co-manage w/neurologist

Question 164

Multiple Sclerosis: Caused by? Presents as? Management?

Answer 164

Chronic demyelinating neurological disease of unknown origin MC in western European lineage Transient weakness, tingling in limb, scanning speech, intention tremor, nystagmus, visual problems, white foci in SC and periventricular tissue of brain on MRI Co-manage w/neurologist

Question 165

Subarachnoid Hemorrhage: Caused by? Presents as? Management?

Answer 165

Rupture of one of vessels in Circle of Willis; often seen in berry aneurysms Sudden onset of worst headache ever w/orw/o change in LoC, neck stiffness, no fever, + Kernig's and Brudzinski's Hospital --> Lumbar puncture, CT scan

Question 166

Describe how to do the abdominal reflex?

Answer 166

Light stroking of the four quadrants of the abdomen causes anterior abdominal wall to contract (T7-10 above umbilicus; T11-L1 below umbilicus)

Question 167

Describe how to do the carotid sinus reflex?

Answer 167

Massaging carotid sinus decreases HR (afferent portion, CN IX and efferent portion: CN X)

Question 168

Describe how to do the ciliospinal reflex?

Answer 168

Painfully pinching back of neck may cause pupil on same side to dilate (Afferent portion: C1-5, efferent: cervical spinal N)

Question 169

Describe how to do the Corneal reflex?

Answer 169

Blowing puff of air on cornea of the open eye will result in blinking of eye (afferent CN V; efferent CN VII)

Question 170

Describe how to do the cremasteric reflex?

Answer 170

Stroking inner aspect of upper thigh causes ipsilateral testis to be elevated (L1 and 2)

Question 171

Describe how to do the gag reflex?

Answer 171

Touching soft palate of throat cause pt to gag (CN IX/X)

Question 172

Describe how to do the oculocardiac reflex?

Answer 172

Massaging eyeballs will decrease HR (afferent: CN V1, efferent: para via CN X)

Question 173

Describe how to do the plantar reflex?

Answer 173

Stroking outer aspect of plantar surface of foot from posterior to anterior and medial causes big toe and other toes to plantarflex

Question 174

Describe how to do the uvular reflex?

Answer 174

Touching uvula causes it to be elevated (afferent: CN IX, efferent: CN X)

Question 175

Describe how to do the babinski reflex?

Answer 175

Stroking outer part of plantar aspect of foot from posterior to anterior and medial results in up-going big toe and flaring of the toes

Question 176

Describe how to do the chaddock reflex?

Answer 176

Stroke skin over lateral malleolus will cause an up-going big toe and flaring of other toes

Question 177

Describe how to do the Ganda reflex?

Answer 177

Downward pressure on 4th toe and suddenly releasing it with a snap causes dorsiflexion of the big toes

Question 178

Describe how to do the Glabella reflex?

Answer 178

Tapping the glabella repeatedly will cause continuous blinking of the eyes as long as the glabella is being tapped

Question 179

Describe how to do the Gordon's calf reflex?

Answer 179

Squeezing mid calf causes up-going big toe and flaring of other toe

Question 180

Describe how to do the Gordon's finger reflex?

Answer 180

Compression of pisiform may result in flexion of all fingers or just flexion of thumb and index finger

Question 181

Describe how to do the Hoffman reflex?

Answer 181

Flicking middle finger of pt will cause adduction of thumb and slight flexion of index finger

Question 182

Describe how to do the Oppenheim reflex?

Answer 182

Rung thumb along anteromedial aspect of tibia will cause upgoing big toe and flaring of others

Question 183

Describe how to do the Rossolimo reflex?

Answer 183

Tapping tips of toes causes excessive flexion of toes

Question 184

Describe how to do the Schaffer reflex?

Answer 184

Squeezing Achilles cause up-going big toe and flaring of other toes

Question 185

Describe how to do the Snout reflex?

Answer 185

Tapping closed lips above midline repeatedly will cause lips to pout

Question 186

Describe how to do the Tromner reflex?

Answer 186

Tapping palmar aspect of tips of middle and index fingers cause flexion of all four fingers and thumb

Question 187

Halfway between angle of jaw and mastoid process you find the?

Answer 187

TVP of C1

Question 188

Hyoid bone is at the level of?

Answer 188

C3

Question 189

Upper border of the thyroid cartilage is at the level of?

Answer 189

C4

Question 190

Lower border of the thyroid cartilage is at the level of?

Answer 190

C5/6

Question 191

Last moveable SP on flexion 70% of the time? 30%?

Answer 191

C7 | T1

Question 192

Root of spine of scapula is at what vertebral level?

Answer 192

T3

Question 193

Burn's space is at what vertebral level??

Answer 193

T2

Question 194

Manubriosternal level is at what vertebral level?

Answer 194

T4/5

Question 195

Inferior scapular angle lying down is at what vertebral level?

Answer 195

T6

Question 196

Inferior scapular angle sitting up is at what vertebral level?

Answer 196

T7

Question 197

Xiphisternal angle is at what vertebral level?

Answer 197

T9

Question 198

Xiphoid process is at what vertebral level?

Answer 198

T10

Question 199

Iliac crest or umbilicus is at what vertebral level?

Answer 199

L4

Question 200

PSIS is at what vertebral level?

Answer 200

S2

Question 201

1/3 along a line btw ASIS and umbilicus is where you find?

Answer 201

Base of the appendix

Question 202

Meeting point of right linea semilunaris and 9th rib is where you find?

Answer 202

Fundus of gallbladder

Question 203

Btw 9-11th ribs in the left midaxillary line is where you find?

Answer 203

Spleen

Question 204

1/2 btw ASIS and pubic symphysis in the groin is where you find?

Answer 204

Femoral A

Question 205

1/2 btw ischial tuberosity and greater trochanter is where you find?

Answer 205

Sciatic N

Question 206

1/2 btw the mastoid process and sternoclavicular joint is where you find?

Answer 206

Carotid A bifurcation

Question 207

1 finger's breath medial to bicipital tendon in elbow is where you find?

Answer 207

Brachial A

Question 208

1 finger's breath posterior and below medial malleolus is where you find?

Answer 208

Posterior tibial pulse

Question 209

Just lateral to flexor carpi radialis tendon is where you find?

Answer 209

Radial pulse

Question 210

Just lateral to the extensor hallicus longus tendon is where you find?

Answer 210

Dorsalis pedis

Question 211

A C5/6 disc herniation will affect which nerve root?

Answer 211

C6

Question 212

An L4/5 disc herniation will affect which nerve root?

Answer 212

L5

Question 213

Describe Budzinski test and interpretation:

Answer 213

Passively flex neck of supine patient towards the chest. If the patient's hips and knees flex in response to action = meningitis

Question 214

Describe Cervical compression test and interpretation:

Answer 214

Ask pt to sit up and bend head backwards while you press down on vertex. If pain = subluxation, arthritis, facet degeneration

Question 215

Describe Dejerine's triad and interpretation:

Answer 215

Ask seated pt to cough, strain, sneeze if pain increases = space occuyping lesion

Question 216

Describe Kernig's test and interpretation:

Answer 216

With pt lying supine w/hips and knees partly flexed attempt to extend knee. If pain or other knee flexes involuntarily = meningeal irritation (meningitis or subarachnoid hemorrhage)

Question 217

Describe Rinne test and interpretation:

Answer 217

Place vibrating 512 tuning fork over mastoid and ask pt to say when sound is no longer heard (bone conduction). Then place vibrating tuning fork 1" from ear and repeat (air conduction) Normal AC>BC if BC>AC conduction loss (otitis media) if AC and BC are decreased on one side it is nerve conduction deficit

Question 218

Describe Weber test and interpretation:

Answer 218

Place 512 vibrating tuning fork on vertex of patient's head and ask patient to state where sound loudest. If patient chooses one ear = problem w/one ear (not necessarily the ear they chose)

Question 219

If a headache is worse in the morning + Dejerine's triad one should suspect?

Answer 219

Brain tumor

Question 220

Occipital headache radiating to eyes + tender occipital N one should suspect?

Answer 220

Occipital neuralgia

Question 221

Overweight female + bilateral papilledema after tetracycline use =

Answer 221

Pseudotumor cerebri

Question 222

Brain Tumor: Caused by? Presents as? Management?

Answer 222

SOL in cranium H/A worse w/coughing/straining/sneezing, diplopia (CN VI), deafness (CN VIII), dysphagia (CN X), irrational thoughts (frontal lobe), blurred vision, papilledema Neurologist --> CT scan/MRI

Question 223

Cervicogenic Headache: Caused by? Presents as? Management?

Answer 223

Discomfort in head originating from cervical spine Head pain radiating to eyes, related to specific neck movements, decreased passive neck movements w/taut and tender muscles Chiropractic management is very effective

Question 224

Cluster Headache: Caused by? Presents as? Management?

Answer 224

Syndrome of recurrent paroxysmal episodes of sudden severe unilateral headaches occur over a period of weeks at the same time every day, triggered by alcohol or afternoon naps Red eye, nasal congestion, runny nose on same side as headache Co-manage w/neurologist and headache specialist

Question 225

Classic migraine: Caused by? Presents as? Management?

Answer 225

Syndrome of recurrent unilateral throbbing headaches preceded by aura of flashing lights; may be triggered by tyramine in aged cheese and red wines Nausea and vomiting, photophobia, phonophobia, aggravated by activity Co-manage w/headache specialist

Question 226

Common Migraine: Caused by? Presents as? Management?

Answer 226

Syndrome of recurrent unilateral throbbing headaches that aren't preceded by aura of flashing lights Nausea, vomiting, photophobia, phonophobia, worse w/activity Co-manage w/headache specialist

Question 227

Influenza: Caused by? Presents as? Management?

Answer 227

Respiratory tract infection from influenza virus spread by droplets or aerosol dispersal Abrupt onset of fever, headache, myalgia, stuffy nose, may worsen into a pneumonia in very young and elderly Serology, chiropractic, rehydration, nutritional supplements, children and elderly to hospital if SOB, high fever, change in LOC

Question 228

Arnold's/Occipital Neuralgia: Caused by? Presents as? Management?

Answer 228

Occipital headache due to compression of greater occipital N (dorsal ramus C2) Pain btw occiput and atlas radiating to behind eye on affected side Chiropractic care helpful

Question 229

Tension type headache: Caused by? Presents as? Management?

Answer 229

Chronic recurrent daily bitemporal headaches bilateral and squeezing in nature Headaches are not aggravated by activity; not associated w/nausea, vomiting, photophobia Adjust, advice on stress reduction

Question 230

Trigeminal Neuralgia: Caused by? Presents as? Management?

Answer 230

Disorder of trigeminal N producing pain with cold/touch/wind Severe excruciating, lancinating pain for few seconds to 2 minutes along distribution of trigeminal N, usually mandibular division, MRA reveal aberrant A near one division of N Co-manage w/neurologist

Question 231

CPPD: Caused by? Presents as? Management?

Answer 231

Joint disease of calcium pyrophosphate deposition in articular cartilage, common in DM, hemachromatosis, hyperparathyroidism Asymptomatic - painful joints (knee, wrist, hip, shoulder), linear calcification in articular cartilage on film and + birefringent rhomboid crystals on aspiration Co-manage w/rheumatologist

Question 232

Enteropathic arthritis: Caused by? Presents as? Management?

Answer 232

Joint disease with specific inflammator bowel disease (Crohn's, UC) Painful knees, ankles, SI joints, recurrent diarrhea, elevated ESR, HLA-B27+ Co-manage w/rheumatologist

Question 233

Gonococcal arthritis: Caused by? Presents as? Management?

Answer 233

Infective monoarthritis caused by N. Gonorrhea, spread by blood Hot swollen painful joint following thick purulent urethral discharge, leukocytosis, elevated neutrophils, aspiration shows WBCs and gram - diplococci Hospital

Question 234

Describe Bonnet test and interpretation:

Answer 234

Pt supine, raise extended leg, internally rotate foot, adduct extended limb. If pain radiates into leg = piriformis syndrome

Question 235

Describe Buerger test and interpretation:

Answer 235

Elevate leg until it becomes pale. Return leg from raised position and let it have over side of bed. Pink colour return slowly. May become red due to dilation of artrioles in attempt to get rid of metabolic waste that has built up = Buerger's disease, peripheral vascular diseae, arterial insufficiency

Question 236

Describe Freiberg test and interpretation:

Answer 236

Pt supine, passively abduct and internally rotate hip on side w/pain to passively stretch pririformis muscle if pain = piriformis syndrome

Question 237

Describe Homan test and interpretation:

Answer 237

Pt supine, raise straight leg 10o, dorsiflex ankle and queeze calf. If pain DVT, ruptured plantaris tendon, ruptured Baker's cyst

Question 238

Describe Pace test and interpretation:

Answer 238

Pt ext rtn and abduct hip while you resist these movements if pain = piriformis syndrome

Question 239

Buerger's disease/Thromboangitis obliterans: Caused by? Presents as? Management?

Answer 239

Young male smokers; inflammation of medium size arteries and veins Intermittent claudication, weak peripheral pules, anti-inflammatories useless, + Buerger's test Co-manage w/vascular specialist --> angiography confirms

Question 240

Cellulitis: Caused by? Presents as? Management?

Answer 240

Superficial skin infxn caused by Staph aureus/Strep pyogenes Painful, red, hot swollen leg well defined edges, leukocytosis and raised neutrophils on CBC Hospital or medical practitioner for antibiotics

Question 241

Compartment Syndrome: Caused by? Presents as? Management?

Answer 241

Trauma to muscles in ant/lat compartment of leg causing ischemia Pain and swelling, numbness, later loss of affected peripheral pulse (dorsalis pedis) Refer to hospital --> Intracompartmental pressure confirms

Question 242

Difference between lateral and medial disc bulge?

Answer 242

Lateral: lean away from affected side Medial: lean towards affected side

Question 243

Peripheral vascular disease: Caused by? Presents as? Management?

Answer 243

Atherosclerotic narrowing of BV of lower limb intermittent claudication worse on exertion and better resting along w/hair loss in legs and feet (May present w/Leriche syndrome: intermittent claudication, decreased peripheral pulses bilaterally and impotence) Co-manage w/vascular surgeon --> angiography

Question 244

Piriformis syndrome: Caused by? Presents as? Management?

Answer 244

Radiating leg pain due to compression of sciatic N as it passes through piriformis muscle Radiating leg pain, + SL, Bonnet's, Freiberg's, Pace's might be positive Adjust and stretch

Question 245

Describe Bowstring test and interpretation:

Answer 245

Left affected leg of supine pt w/knee flexed until above shoulder and apply firm pressure on hamstring and popliteal fossa. If either causes leg/back pain = NR compression

Question 246

Describe Braggard test and interpretation:

Answer 246

SLR then lower limb 5o below where pain felt and dorsiflex foot if pain increases = irritation of sciatic N roots

Question 247

Describe double leg raise test and interpretation:

Answer 247

Raise each leg of supine pt separately noting angle pain is produced then both together, if angle less than lumbosacral joint involvement

Question 248

Describe Lasegue test and interpretation:

Answer 248

Grasp heel of affected extended limb of supine pt in one hand and place other hand on knee, flex hip while knee flexed, extend knee while leg elevated if limited ROM b/c pain = sciatic N or NR irritation

Question 249

Describe Lewin's supine test and interpretation:

Answer 249

Stabilize thighs on table and ask pt to sit p w/o hands, pain/inability = sciatica or lumbosacralpathology

Question 250

Describe Lindner test and interpretation:

Answer 250

Passively flex pt head then neck to chest of pt, if pain along lumbar spine/back of thigh and leg = sciatica due to disc herniation (esp lateral)

Question 251

Describe Milgram test and interpretation:

Answer 251

Ask supine pt to raise both extended legs so heels 6" off table and hold for 30s if pain/inability = disc lesion OR raised intrathecal P

Question 252

Describe Sicard test and interpretation:

Answer 252

If SLR + lower leg below pain extend big toe of affected foot if duplicates pain = sciatic NR compression

Question 253

Describe SLR test and interpretation:

Answer 253

Place one hand below heel of supine pt's extended limb and other hand on knee, lift leg note angle pain happens if between 0-35o extradural NR irritation (piriformis syndrome), 35-70o disc herniation, >70o lumbosacral jt disease

Question 254

Describe Well Leg Raise/Fajersztajn test and interpretation:

Answer 254

Raise asymptomatic leg of pt and dorsiflex foot if pain inaffected leg = disc comp of roots of sciatic N (medial disc protrusion on contralateral side) or dural sleeve adhesions

Question 255

Describe Ely test and interpretation:

Answer 255

Flex knee of prone pt to bring heel to touch opposite buttock, if inability to flex iliopsoas pathology or inflammed roots of femoral N if after full knee flexion can't hyperextend hip = hip lesion

Question 256

Describe Femoral N stretch test and interpretation:

Answer 256

Stabilize hip place one hand on ilium of prone pt, passively flex knee and extend hip, if ext of hip causes pain along anterior thigh = femoral N irritation

Question 257

Describe Nachlas test and interpretation:

Answer 257

Passively flex knee f prone pt to same buttock while exerting downward pressure on pelvis to prevent buckling at hips if pain = lumbosacral pathology

Question 258

Describe Adam supported/Belt test and interpretation:

Answer 258

Ask standing pt to bend forward once and then while bracing your hip on pt's sacrum and holding onto their ASIS's If pain after second maneuver lumbar issue if pain disappears after second maneuver pelvic problem

Question 259

How does the pt stand w/a posterior disc herniation?

Answer 259

Slightly flexed (extension causes pain)

Question 260

Describe Kemp's test and interpretation:

Answer 260

Grab opposite shoulder of affected pelvis and lean pt backward into lumbar extension, aim shoulder to affected side where weight-bearing pressure on facet is greatest, if localized pain facet problem if radiation into thigh and leg NR compression due to disc

Question 261

Describe Schober test and interpretation:

Answer 261

Mark 2 spots 5 cm below PSIS and 10 cm above ask pt to bend forward and touch toes w/o bending knee and measure distance subtract 15 if <5cm = AS

Question 262

Describe one-legged standing lumbar extension test and interpretation:

Answer 262

Have pt stand on one leg w/extension of spin, stand behind to support pt if necessary. If aggravates LBP part fracture or facet (unilateral) or lumbar (bilateral) instability

Question 263

Describe Bechterew test and interpretation:

Answer 263

Ask pt to extend affected leg and exert downward pressure on thigh if pain radiates = disc lesion/sciatica

Question 264

Describe Minor test and interpretation:

Answer 264

Ask seated pt to stand up if pt has to support himself by placing one hand on healthy thigh/knee keeping affected side bent over = lumbosacral pathology

Question 265

Describe Erichsen test and interpretation:

Answer 265

Place hands over dorsum of iliac bone of prone pt and thrust bilaterally to midline if pain over SI = SI joint problem

Question 266

Describe Fortin Finger test and interpretation:

Answer 266

Pt point to where pain is, if medial and inferior to PSIS = SI pathology

Question 267

Describe Gaenslen test and interpretation:

Answer 267

Pt lie facing upward w/affected side close to edge of table flex hip and knee of unaffected side to abdomen of pt w/one hand, allow affected leg to hang off end of table, place other hand on knee of affected side and apply downward pressure on both knees, if increase in pain in SI region = SI pathology

Question 268

Describe Goldthwait test and interpretation:

Answer 268

Slowly raise affected leg of supine pt w/one hand while other under lumbar region if btw 0-30o SI pathology, 30-60o LS joint pathology, 60-90 lumbar pathology

Question 269

Describe Hibbs test and interpretation:

Answer 269

One hand firmly on dorsum of iliac bone, flex opposite knee 90o and push pt leg laterally causes internal rotation of head of femur if pain in SI SI pathology and hip could be hip pathology

Question 270

Describe Iliac compression test and interpretation:

Answer 270

Have pt lie on unaffected side and apply downward pressure on ilium to check for SI pathology

Question 271

Describe Patrick - Fabere test and interpretation:

Answer 271

Place external malleolus of one limb over patella of opposite limb w/pt supine and apply downward pressure, if pain in SI then SI pathology

Question 272

Describe Yeoman test and interpretation:

Answer 272

W/pt prone place one hand over affected SI jt flex knee of affected side place other hand under affected thigh and lift knee off table, if increases pain in SI could be injury of anterior SI ligament

Question 273

Describe Gillet (stork) test and interpretation:

Answer 273

Palpate both PSIS(s) while standing on both feet then w/one leg raised if PSIS on tested side fails to move PI there is sacroiliac fixation

Question 274

Facet Syndrome: Caused by? Presents as? Management?

Answer 274

Irritation of zygapophyseal joint due to injury or degeneration Back pain worse on lateral bending and extension, + Kemp's

Question 275

Multiple Myeloma: Caused by? Presents as? Management?

Answer 275

Neoplastic plasma cell disease, MC in older men LBP @night, fatigue w/recurrent infxn, x-ray shows generalized osteopenia, multiple lytic lesions, rain-drop skull, serum electrophoresis shows M spike and increased IgG levels, Benc Jones protein in urine hypercalcemia, reversed albumin/globulin ratio Co-manage w/internist

Question 276

Describe Hautant test and interpretation:

Answer 276

W/pt seated extend arms in front w/palms facing up, pt close eyes and extend and rotate head to opposite side if arms drift or pt complains of dizziness or blurred vision or nystagmus = VBAI

Question 277

Describe Romberg test and interpretation:

Answer 277

Pt stand w/feet together and eye open, stand to side and behind to catch pt and ask to close eyes if sway after eye closed = dorsal column pathology if before cerebellum problem

Question 278

Cerebellar disorder: Caused by? Presents as? Management?

Answer 278

Damage to cerebellum due to degenerative disease or alcohol abuse Ataxia, tendency of drifting to side where damage is worse, dysdiadochokinesia, past-pointing, intention tremor Co-manage w/neurologist

Question 279

Friedreich's ataxia: Caused by? Presents as? Management?

Answer 279

Inherited disease causes progressive damage to cerebellum, dorsal columns of spinal cord and heart Early twenties ataxia, areflexia, loss of vibration sense and heart failure Co-manage w/neurologist

Question 280

Parkinson's: Caused by? Presents as? Management?

Answer 280

Chronic neurologic disease of substantia nigra and basal ganglia Shuffling gait, mask-like fascies, pill-rolling tremor, bradykinesia, microphagia Co-manage w/neurologist

Question 281

Wilson's disease: Caused by? Presents as? Management?

Answer 281

Genetic disease associated w/defective copper transport resulting in accumulation of excess copper accumulating in brain, prancreas, testis, liver, heart, eyes Decreased libido, Kayser-Fleischer rings in periphery of cornea, low levels of ceruloplasmin Co-manage w/internist

Question 282

Dengue Fever: Caused by? Presents as? Management?

Answer 282

Flavi virus infection spread by Aedes aegypti mosquitoes Fever, headache, severe muscle and joint pain (break bone fever), saddle back, feel bad 3-4 days relapse 2-3 days Refer to M.D.

Question 283

Dermatomyositis: Caused by? Presents as? Management?

Answer 283

Inflammatory autoimmune disease affecting muscle and skin Heliotrope discolouration of eyelids, Gottron's pupules on knuckles and fatigue, raised CK-MM and LDH Co-manage w/dermatologist

Question 284

Polymyalgia Rheumatica: Caused by? Presents as? Management?

Answer 284

Chronic inflammatory autoimmune disease affecting proximal muscles, MC women >60, underlying giant cell arteritis pathology Pronounced stiffnes of neck, shoulder, upper back muscles which improves with activity, temporal headache (temporal arteritis), elevated ESR Co-manage w/rheumatologist

Question 285

Trichinosis: Caused by? Presents as? Management?

Answer 285

Parasitic disease caused by eating raw/undercooked pork or game meat infected w/Trichinella spiralis Muscle pain, fever, periorbital edema, splinter hemorrhages, elevated eosinophils and CK-MM, ELISA for larva antigen is diagnostic Co-manage w/internist

Question 286

Describe Chvostek test and interpretation:

Answer 286

Pt seated tap facial N as it passes through parotid in front of ear and below zygomatic if same side of face twitches hypocalcemia in hypoparathyroidism

Question 287

Describe Lhermitte test and interpretation:

Answer 287

Passively flex pt neck to chest if sharp electrical pains shoot into arms/legs could be cervical myelopathy, MS, dural irritation

Question 288

Describe pinch grip test and interpretation:

Answer 288

Seated pt hold tips of thumb and index finger as if pinching attempt to pull tips apart if you can damage to anterior interosseous br of median N

Question 289

Anterior Interosseous N syndrome: Caused by? Presents as? Management?

Answer 289

Damage of ant interosseous br of median N as it passes through the forearm Weakness in flexor pollicis longus muscle and flexor digitorum profundus, + pinch grip test Co-manage w/neurologist

Question 290

Crutch/Saturday Night Palsy: Caused by? Presents as? Management?

Answer 290

Compressive injury of radial N in axilla by improper crutch use or sleeping w/arm draped over bench Wrist drop/inability to extend elbow, patch of anesthesia btw thumb and index finger dorsally Co-manage w/neurologist - decreased nerve conduction velocity

Question 291

Guillain-Barre syndrome: Caused by? Presents as? Management?

Answer 291

Acute immune mediated demyelinating polyradiculopathy predominantly affecting motor system preceded by viral infection/vaccination Gradual symmetric motor weakness initially of distal muscles in legs and ascends to affect muscles of arms and diaphragm, increased protein and less WBC in CSF Refer to hospital - ventilation may be needed

Question 292

Poliomyelitis: Caused by? Presents as? Management?

Answer 292

Acute viral inflammation of anterior horn of gray matter in spinal cord Mild flu like illness which may be followed by flaccid paralysis of a group of muscles in upper or lower limb Refer to hospital

Question 293

Posterolateral sclerosis/subacute combined degeneration of the spinal cord: Caused by? Presents as? Management?

Answer 293

Damage to posterior columns and dorsolateral tracts by Vit B12 deficiency Fatigue, muscle weakness, hyperactive deep tendon reflexes w/sensory ataxia along w/burning feet and paresthesis, Babinski, Romberg may be positive, B12 low and there will be macrocytic normchromic anemia w/hypersegmented neutrophils Co-manage w/neurologist

Question 294

Describe Bakody test and interpretation:

Answer 294

Ask seated pt to place palm of affected extremity flat on top of head if reduces pain NR compression or irritation due to IVF encroachment if pain exacerbated + reverse bakody for anterior scalene TOS

Question 295

Describe Brachial plexus tension test and interpretation:

Answer 295

Passive abduction of arms, elbows extend, shoulders externally rotate pt flexes elbow if pain irritation of roots of brachial plexus

Question 296

Describe Jackson test and interpretation:

Answer 296

Seated pt extend and rotate head to affected side, place downward pressure if exacerbates pain NR compression by space occupying lesion/subluxation

Question 297

Describe Cervical distraction test and interpretation:

Answer 297

Seated pts head and neck neutral, doc distracts neck by exerting upward pressure on occiput and chin. Distraction reduces pain = NR compression/facet joint if increases pain = strain/sprain

Question 298

Describe maximum cervical compression test and interpretation:

Answer 298

Seated pt rotate neck to shoulder and extend head to affected side if no pain flex while in rotation if pain radiates into affected arm NR compression/facet involvement if pain opposite = muscular strain

Question 299

Describe O'Donohgue test and interpretation:

Answer 299

Seated pt to flex, extend, laterally bend and rotate neck against resistance and then passively if pain in resisted muscle strain if passive ligamentous sprain

Question 300

Describe Rust sign and interpretation:

Answer 300

If pt holds up head in both hands cervical fracture or severe sprain

Question 301

Describe shoulder depressor test and interpretation:

Answer 301

Push down on shoulder and pt lat flexes neck to opposite shoulder if pain on depressed side adhesions to dural sleeve or spinal NR or joint capsule structrues

Question 302

Describe Soto-Hall test and interpretation:

Answer 302

One hand on sternum of supine pt to prevent thoracic or lumbar flexion, doc places other hand under occiput and flexes neck to chest if localized pain in posterior neck vertebral fracture, sprain, meningeal irritation, subluxation

Question 303

Describe Spurling test and interpretation:

Answer 303

St pt's head and neck neutral, doc pushes down, rotate and flex head to affected side and warn of taping, if exacerbates NR irritation (cervical spondylosis or disc herniation)

Question 304

Burner/stinger: Caused by? Presents as? Management?

Answer 304

Distraction traction injury to brachial plexus involving C5/6 Nr from neuropraxia Burning/stinging pain, numbness in neck, radiation into shoulder/arm, weakness in adduction, external rotation, flexion of shoulder Refer to neurologist if conservative chiropractic care w/ice, anti-inflammatory nutritional supplements doesn't help

Question 305

Whiplash: Caused by? Presents as? Management?

Answer 305

Hyperextension injury to neck seen in rear-end collisions Neck pain, decreased ROM in neck, neck stiffness, occipital headache, dysphagia, soft tissue swelling in retrophrayngeal space >6mm @C2 and >22mm @C6 Ice, rest, anti-inflammatory nutritional supplements initially, cautious adjustments, pain free ROM exercises

Question 306

Describe anterior drawer of foot test and interpretation:

Answer 306

Grasp tibia of supine pt and calcaneus with other hand, push tibia down and pull calcaneus up if talus slides anteriorly tear in anterior talofibular ligament

Question 307

Describe duchenne's sign and interpretation:

Answer 307

Pt supine, push head of 1st metatarsal w/thumb and have pt push down, normal = medial and lateral borders plantarflex, when only lateral border plantar flexes and medial dorsiflexes Duchenne's sign is present indicative of superficial fibular N lesion

Question 308

Describe Helbing's sign and interpretation:

Answer 308

Ask pt to stand, look at Achilles tendon if medial curvature excessive foot pronation in pes planus

Question 309

Describe Morton's test and interpretation:

Answer 309

Squeeze heads of metatarsals together if pain Morton's neuroma or metatarsalgia

Question 310

Describe Thompson test and interpretation:

Answer 310

Pt prone, passive flex knee and squeeze calf if no plantar flexion complete rupture of Achilles tendon

Question 311

Describe Tinel at ankle test and interpretation:

Answer 311

Percuss area behind malleolus of affected side if pain tarsal tunnel syndrome

Question 312

Describe Varus stress at ankle test and interpretation:

Answer 312

Grab calcaneus while other hand stabilizes pt's leg evert ankle if pain deltoid ligament damage (eversion sprain)

Question 313

Describe Valgus stress at ankle test and interpretation:

Answer 313

Grab calcaneus while other hand stabilize pt's leg invert ankle if pain anterior talofibular of calcaneofibular ligament damage (inversion sprain)

Question 314

Achilles tendon rupture: Caused by? Presents as? Management?

Answer 314

Traumatic injury causing a complete or partial tear in the Achilles tendon Pop and severe pain behind ankle, unable to plantarflex ankle, +Thompson test Refer to orthopedist --> MRI confirmation

Question 315

Bedroom Fracture: Caused by? Presents as? Management?

Answer 315

Traumatic injury to one of toes Swollen toe, break in phalanx on x-ray Orthopedist if distal fragment is displaced

Question 316

Bunion: Caused by? Presents as? Management?

Answer 316

Osseous cartilaginous enlargement of medial eminence of head of 1st metatarsal, MC in females w/fam hx Hallus valgus deformity, X-ray shows deformity + soft tissue swelling Refer to podiatrist

Question 317

Complex regional pain syndrome/reflex sympathetic dystrophy/Sudeck's atrophy: Caused by? Presents as? Management?

Answer 317

Exaggerated neruovascular response to trauma, MC in females and feet, 5% all traumatic injuries Severe chronic burning pain, ab swelling, atrophy of skin over affected area, x-ray shows osteopenia Co-manage w/neurologist

Question 318

Erythomelalgia/Burning feet syndrome: Caused by? Presents as? Management?

Answer 318

Uncommon peripheral neurovascular pain disorder may be familial or triggers w/autoimmune disease or side effect of med Pain and redness of hands and feet Co-manage w/neurologist

Question 319

Jones'/Dancer's Fracture: Caused by? Presents as? Management?

Answer 319

Trauma injury to 5th met, seen in dancers Pain and swelling over lateral side of foot, X-ray shows transverse break of base of 5th met Refer to the hospital

Question 320

March fracture: Caused by? Presents as? Management?

Answer 320

Stress fx of shaft of 2-4th metatarsal due to repetitive marching trauma Pain in foot worse on walking w/tenderness on compression of affected bone Co-manage w/podiatrist

Question 321

Morton's neuroma has pain worse with what part of walking?

Answer 321

Push off

Question 322

When is pes planus normal?

Answer 322

Considered normal in a 1 year old child

Question 323

Plantar fasciitis: Caused by? Presents as? Management?

Answer 323

Condition of foot related to plantar fascia, more in women in sedentary occupations and high-heel shoes; over-pronation of foot Pain at plantar fascia attachment on calcaneus worse w/pronation of foot, x-ray may show calcaneal spur (origin of adductor digiti minimi) Stretch calf muscles, royce night splints, anti-inflammatory nutritional supplements, podiatrist

Question 324

Pott's ankle fractures: Caused by? Presents as? Management?

Answer 324

Trauma to ankle affecting lateral malleolus Pain, swelling, discolouration of ankle, x-ray shows fracture lateral and/or medial malleolus, posterior tubercle of distal tibia Refer to hospital

Question 325

What nerve is affected in tarsal tunnel syndrome?

Answer 325

Posterior tibial N

Question 326

Describe Cozen test and interpretation:

Answer 326

Seated pt clench fist, pronate and extend wrist, grasp pt elbow and attempt to flex pt wrist. Lateral epicondylitis

Question 327

Describe Mill test and interpretation:

Answer 327

Passively flex pt forearm, fingers, wrist and extend wrist and hold in this position. If action causes pain in region of lateral epicondyle lateral epicondylitis.

Question 328

What is the motion restricted by an occult elbow fracture?

Answer 328

Full extension

Question 329

Describe reverse Cozen test and interpretation:

Answer 329

Ask pt to flex wrist and forearm and hold forearm in supination. Attempt to force pt's wrist into extension while the patient resists doctor's efforts. If originating in medial epicondyle = golfer's elbow, medial epicondylitis

Question 330

Describe valgus stress test at elbow and interpretation:

Answer 330

Stabilize arm of pt with one hand grasp wrist of pt and extend elbow attempt to abduct if pain Medial collateral ligament damage

Question 331

Describe varus stress test at elbow and interpretation:

Answer 331

Stabilize arm of pt w/one hand. Grasp wrist of pt and extend elbow, adduct elbow if pain lateral collateral ligament damage

Question 332

What motion is limited in a lateral collateral ligament sprain of the elbow?

Answer 332

Adduction of the extended elbow

Question 333

Management of lateral epicondylitis?

Answer 333

Rest, ice, compression, ultrasound, advice n change of tennis racket, wrist strengthening exercises

Question 334

Little league elbow: Caused by? Presents as? Management?

Answer 334

Trauma to injury to elbow in children caused by repetitive baseball throwing, damage to epiphyseal plate of medial humeral epicondyle Pain in medial elbow Rest and ice and US

Question 335

Motion impaired by medial collateral ligament sprain of the elbow?

Answer 335

Abduction of the extended elbow

Question 336

Management of medial epicondylitis?

Answer 336

Rest, ice, ultrasound

Question 337

X-ray finding of occult elbow fracture?

Answer 337

Fat pad sign

Question 338

Posterior impingement syndrome: Caused by? Presents as? Management?

Answer 338

Overuse and repetitive forced extensions of elbow w/tip of olecranon of ulna jamming into olecranon fossa Pain in back of elbow especially when throwing or straightening elbow, x-ray spur formation on olecranon Rehab exercises

Question 339

Describe Anvil test and interpretation:

Answer 339

Percuss heel of supine pt if jarring in hip fracture of neck of femur if localized pain in leg fracture in fibula or tibia if pain in thigh fracture of femur if heel pain calcaneal fracture

Question 340

Describe Laguerre test and interpretation:

Answer 340

Ask supine pt to flex thigh and knee at right angles, support foot of pt w/forearm and abduct and externally rotate pt's thigh if pain in hip = hip lesion, iliopsoas spasm, sacroiliac lesion

Question 341

Describe Noble test and interpretation:

Answer 341

Pt seated knee flexed at 90 pressure on lateral femoral epicondyle and passively extend knee pain around 30o flexion is + for ITBS

Question 342

Describe Ober test and interpretation:

Answer 342

Pt lie on unaffected side, grasp pt's ankle and stabilize pelvis flex knee at 90o passively abduct and allow knee to fall if leg abducts ITBS or trochanteric bursitis

Question 343

Describe Thomas test and interpretation:

Answer 343

Supine pt to bend hip and knee of unaffected side to abdomen and bring knee to chest and hold if opposite limb comes off table flexion deformity of hip or tight hip flexors

Question 344

What causes AVN of the hip?

Answer 344

Legg-Calve Perthe disease, elderly pt, long use of corticosteroids, diabetes, alcoholism

Question 345

What is Putti's triad:

Answer 345

Small femoral epiphysis, lateral displacement of femur and increased inclination acetabular roof

Question 346

Who is most likely to get Legg-Calve-Perthes diease?

Answer 346

4-8 year old boys

Question 347

Meralgia Paresthetica: Caused by? Presents as? Management?

Answer 347

Compression neuropathy involving lateral femoral cutaneous nerve seen in overweight persons Pain and tingling over anterolateral thigh Co-manage with neurologist, weight loss plan

Question 348

SCFE: Caused by? Presents as? Management?

Answer 348

Possible Salter-Harris Type 1 fracture in overweight children btw 8-17 years Painful true short leg with external rotation and limited flexion, abduction, medial rotation, frog leg x-ray shows downward slippage of epiphysis of head of femur and disruption of Kline's line Co-manage with orthopedist

Question 349

Subcapital femoral fracture: Caused by? Presents as? Management?

Answer 349

Trauma caused by fall on hip in elderly Pain, decreased ROM, limb in external rotation 911

Question 350

Transient hip synovitis: Caused by? Presents as? Management?

Answer 350

Self limiting inflammation of synovial lining of hip joint, traumatic or viral Painful limb, affected limb in flexion, abduction, external rotation with decreased medial rotation of hip Refer to orthopedist

Question 351

Describe abduction/valgus of the knee test and interpretation:

Answer 351

Pt supine and legs fully extended place hand against lateral knee in line with joint while ankle grasped with other hand and attempt to abduct leg if pain over medial knee medial collateral ligament injury if no pain repeat at 30o

Question 352

Describe adduction/varus of the knee test and interpretation:

Answer 352

Supine and extended knees one hand over medial joint and ankle with other and attempt to adduct leg if pain over lateral knee lateral collateral ligament injury if not repeat at 30o flexion

Question 353

Describe Apley compression test and interpretation:

Answer 353

Pt lie prone w/legs extended and ankle over edge of table, anchor pt thigh w/knee grasp bottom of foot and hold leg above ankle and apply downward pressure and externally rotate knee at 90o then internally if pain/click meniscus tear

Question 354

Describe Apley distraction test and interpretation:

Answer 354

Pt prone, flex leg at 90o, stabilize thigh w/knee and pull up pt's ankle while internally and externally rotate leg if pain M/LCL damage if reduction in pain meniscus tear

Question 355

Describe drawer at knee test and interpretation:

Answer 355

Pt supine and flex knees at 90o sit on feet of pt and grasp leg pull tibia anterior and push it posterior if >6mm movement torn cruciate ligament

Question 356

Describe Lachman test and interpretation:

Answer 356

Pt supine, knee flex 30o stabilize thigh wtih one hand grasp proximal tibia and pull forward if excessive anterior movement or mushy end feel ACL tear

Question 357

Describe McMurray test and interpretation:

Answer 357

Pt supine grasp ankle fully flex knee so heel close to buttock, place other hand over knee, rotate tibia internally and extend knee keeping hip partially flexed if click or pain lateral meniscus damage if external rotation causes pain medial meniscus damage

Question 358

Describe patellar apprehension test and interpretation:

Answer 358

Pt supine and knee fully extended push patella laterally if pt tightens quadriceps, test + for chondromalacia patella

Question 359

Describe Waldron test and interpretation:

Answer 359

Place hand over pt's patella and ask pt to squat if pain/crepitus throughout maneuver,+ for chondromalacia patella

Question 360

ACL Damage: Caused by? Presents as? Management?

Answer 360

Trauma to knee in young active males; part of O'Donoghue's unhappy triad Popping sound at time of injury, pain and swelling, + Lachman's and anterior drawer signs Refer to orthopedist --> MRI confirms

Question 361

Chondromalacia patella: Caused by? Presents as? Management?

Answer 361

Soft tissue disorder due to poor patellar tracking, weak vastus medialis Anterior knee pain worse on going down stairs; +patellar apprehension Co-manage w/orthopedist; strengthen vastus medialis

Question 362

Genu recurvatum: Caused by? Presents as? Management?

Answer 362

Knee condition due to knee joint laxity or weak quadriceps femoris Hyperextended knee Refer to orthopedist

Question 363

Genu valgum: Caused by? Presents as? Management?

Answer 363

Knee condition in overweight children or teens Knock knees Refer to orthopedist

Question 364

Genu Varum: Caused by? Presents as? Management?

Answer 364

Knee condition in rickets Bow legs Refer to orthopedist

Question 365

Lateral collateral ligament injury of the knee: Caused by? Presents as? Management?

Answer 365

Adduction injury in football players; least commonly injured knee ligament Pain, tenderness over lateral knee, pain worse on varus stress test and Apley distracion 3rd degree tears to orthopedist; rest, ice, compression

Question 366

Lateral meniscus tear: Caused by? Presents as? Management?

Answer 366

Injury to knee due to external rotation of body while foot anchored to ground Popping during injury; lateral/anterior knee pain which is worse on extension and internal rotation of flexed knee, McMurray's test + MRI confirm tear; refer to orthopedist

Question 367

Medial collateral ligament tear: Caused by? Presents as? Management?

Answer 367

Abduction injury of knee in football players, MC injured ligament of the knee Pain and tenderness over medial knee, pain worse w/valgus stress test, Apley distraction test Rest, ice, compression, refer 3rd degree tears to orthopedist

Question 368

Osgood Schlatter's disease: Caused by? Presents as? Management?

Answer 368

Repetitive injury to knee seen teenage basketball players Anterior knee pain w/tender swollen tibial tuberosity, X-ray show very prominent tibial tuberosity Rest, ice, taping across tib tub and avoid provocative movements

Question 369

Osteochondritis dessicans: Caused by? Presents as? Management?

Answer 369

Subarticular bone necrosis caused by blood deprivation,usually lateral medial epicondyle of femur Pain, swelling, crepitus, locking, x-ray shows necrosis, joint mice Co-manage with orthopedist --> MRI determines grade

Question 370

PCL damage: Caused by? Presents as? Management?

Answer 370

Trauma to knee in young active males Popping at time of injury, pain, swelling Refer to orthopedist, MRI confirm injury

Question 371

Sindig-Larsen Johansson syndrome: Caused by? Presents as? Management?

Answer 371

Repetitive injury to knee seen in young basketball and volleyball players btw 10-14 yrs Pain, tenderness over inferior pole of patella, x-ray show calcification in patellar tendon near attachment to inferior pole of patella Rest, ice, taping under patella helpful; avoid provocative movements help with recurrence

Question 372

Describe Bicycle test and interpretation:

Answer 372

Pt ride stationary bike, bend forward when leg pain experienced + for nerogenic claudication in central canal stenosis of lumber

Question 373

Describe Claudication test and interpretation:

Answer 373

Instruct pt to march in place 120 steps/min for 60 s note time pt complains of leg cramps if in one or both legs before minute is up peripheral vascular disease or Buergers disease

Question 374

Describe Fair test and interpretation:

Answer 374

Passive flexion, adduction and internal rotation of hip causes pain = piriformis syndrome

Question 375

Arterial embolism: Caused by? Presents as? Management?

Answer 375

Sudden occlusion of peripheral A in leg due to embolus from nearby thrombus Sudden onset of painful, pale, pulseless leg that is cold Refer to hospital to arrange for confirmatory angiogram

Question 376

DVT: Caused by? Presents as? Management?

Answer 376

Clot formation in deep leg vein due to venous stasis as with prolonged immobilization, leg vein trauma, hypercoagulability Painful swollen leg, Homans sign + Hospital --> US or venography confirmation

Question 377

Gonalgia Paresthetica: Caused by? Presents as? Management?

Answer 377

Compression neuropathy inferior patellar br of saphenous N Pain over medial aspect of knee and lower thigh Co-manage with neurologist

Question 378

Ruptured plantaris tendon: Caused by? Presents as? Management?

Answer 378

Trauma to tendon of plantaris during running Pop during injury and pain in calf, + Homan's Refer to hospital --> MRI confirmation

Question 379

Shin splints/Medial tibial stress syndrome: Caused by? Presents as? Management?

Answer 379

Overuse of muscles in anterior compartment Pain along medial aspect of tibia, bone scan confirm stress fractures Rest, ice, gentle taping helpful with chiropractic adjustments, advice on changing footwear

Question 380

Sickle cell disease: Caused by? Presents as? Management?

Answer 380

Genetic blood disorder which causes RBCs to sickle under hypoxic conditions Limb, joint pain, anemia, splenomegaly, priapism, jaundice, peripheral blood smear shows sickled cells Refer to hospital, hemoglobin electrophoresis will confirm diagnosis

Question 381

Describe AC traction test and interpretation:

Answer 381

Pt seated, arms hanging neutral, pull down on arm if separation of AC joint you have a separation

Question 382

Describe Codman/Drop arm test and interpretation:

Answer 382

Passively abduct seated pt's extended arm to just above shoulder, let arm down slowly when you let go if pain and arm drops suddenly RTC injury (supraspinatus)

Question 383

Describe Dawburn test and interpretation:

Answer 383

Palpate shoulder for localized tenderness, then passively abduct pt's arm if pain disappears subacromial bursitis

Question 384

Describe Dugas test and interpretation:

Answer 384

Seated pt place hand of affected side on opposite shoulder and attempt to touch chest with elbow if inability to do so anterior shoulder dislocation

Question 385

Describe Empty can/Jobe/Supraspinatus press test and interpretation:

Answer 385

Abduct pt shoulder to 90o w/elbow in extension ask pt to hold while you adduct arm ask pt to turn shoulder so thumb faces floor if pain suprapsinatus injury

Question 386

Describe Hawkins-Kennedy test and interpretation:

Answer 386

Raise seated pt arm to 90o shoulder flexion w/one hand while other stabilizes scapula then flex elbow at 90o and internally rotate arm if shoulder pain impingement or RTC tendonitis

Question 387

Describe Impingement/painful arc test and interpretation:

Answer 387

Slow abduction arm if pain btw 60-90o injury to supraspinatus tendon

Question 388

Describe Mazion shoulder maneuver and interpretation:

Answer 388

Ask pt to place palm of affected limb over opposite shoulder if pain adhesive capsulitis

Question 389

Describe Neer's test and interpretation:

Answer 389

Passively elevate arm into forward flexion w/arm internally rotated if pain impingement syndrome

Question 390

Describe O'Briend test and interpretation:

Answer 390

Ask pt to flex and adduct shoulder w/thumb down and hold position while you push down on arm repeat w/thumb facing up if pain SLAP lesion

Question 391

Describe Speed test and interpretation:

Answer 391

Standing pt to extend elbow, supinate forearm, flex and hold push down if pain in bicipital groove = bicipital tendonitis

Question 392

Describe Yergason test and interpretation:

Answer 392

Seated pt flex elbow 90o and hold forearm in pronation supinate forearm while hold pt's hand fixed if pain/click in intertubercular groove tenosynovitis of long head of biceps

Question 393

Management for bicipital tendonitis?

Answer 393

Rest, ice, US, transverse friction massage

Question 394

Describe Allen test and interpretation:

Answer 394

Tight fist occlude radial and ulnar A's release ulnar then radial if skin blanched >5s arterial embolism

Question 395

T4 syndrome: Caused by? Presents as? Management?

Answer 395

T4 hypomobility in females, poor posture, previous trauma Unilateral, bilateral upper chest/arm pain with paresthesia in hand, forearm, springing off offending thoracic vertebra reproduce symptoms Chiropractic adjustments helpful

Question 396

Describe Bracelet test and interpretation:

Answer 396

Mild to moderate pressure to medial and lateral aspects of distal ends of radius and ulna by encircling wrist with thumb and index finger if pain RA, fracture, sprain

Question 397

Describe Bunnel-Littler test and interpretation:

Answer 397

Passively flex distal interphalangeal joint after extending metacarpo-phalangeal joint, note degree of flexion of DIP, flex metacarpo-phalangeal joint and passively flex DIP joint if no change in degree of flexion, indicative of restriction of fibrous capsule of DIP joint if increase in flexion contraction of lumbrical related to that finger

Question 398

Describe Finkelstein test and interpretation:

Answer 398

Ask pt to make fist with thumb inside and bend in ulnar direction if pain over abductor pollicis longus and extensor pollicis brevis de Quervain's tenosynovitis and intersection syndrome

Question 399

Describe Phalen test and interpretation:

Answer 399

Ask pt to flex both wrists and press dorsal aspects together and hold for one minute if tingling and paresthesia radiates into thumb index or middle fingers = CTS

Question 400

Describe Reverse Phalen/Prayer sign test and interpretation:

Answer 400

Ask pt to extend both wrists maximally and press palmar aspects of wrists together as if in prayer hold 1 min if tingling and paresthesia into thumb, index, middle finger CTS

Question 401

Describe Press test and interpretation:

Answer 401

Seated pt place both hands on arms of stable chair and push off to support body with only hands if pain in trist TFCC tear

Question 402

Describe Tinel at wrist test and interpretation:

Answer 402

Percuss middle wrist for median N if tingling and paresthesia distally CTS and tap pisiform for ulnar N enrapment in Guyon's canal

Question 403

Describe wrist compression test and interpretation:

Answer 403

Compresion palm distal to crease w/both thumbs A-P, sustained pressure 15s-2 minutes if tingling and parestheia CTS

Question 404

Describe Adson test and interpretation:

Answer 404

Palpate radial pulse note amplitude rotate head to affected side and extend neck tak e a deep breath if disappearing pulse cervical rib or anterior scalene TOS

Question 405

Describe Eden/costoclavicular test and interpretation:

Answer 405

Palpate radial pulse note amplitude draw shoulders back and down and flex neck if pulse disappears costoclavicular TOS

Question 406

Describe Halstead test and interpretation:

Answer 406

Palpate radial pulse apply downward traction and ask pt to look up if disappears anterior scalene TOS

Question 407

Describe O'Riain/Wrinkle test and interpretation:

Answer 407

Immerse pt's fingers in water for three minutes, skin should wrinkle if not + test loss of sympathetic innervation as in CRPS

Question 408

Describe Roos test and interpretation:

Answer 408

Abduct arms to 90o bend elbows to 90o and open and close fists up to 3 minutes if symptoms reproduced TOS

Question 409

Describe Wright/hyperabduction test and interpretation:

Answer 409

Palpate pt radial pulse on side tested passively abduct arm to 180o while pule palpated note angle it disappears if 30o difference pec minor TOS

Question 410

Bennett's fracture: Caused by? Presents as? Management?

Answer 410

Trauma to 1st metacarpal bone, pain, swelling, decreased ROM of thumb, x-ray show fx of base of first met with subluxation of first carpo-metacarpal joint Refer to hospital --> wrist in cockup wrist splint

Question 411

Bowler's finger: Caused by? Presents as? Management?

Answer 411

Due to chronic compression or irritation of N on inside of thumb seen in bowlers Pain and paresthesia of thumb Advise to splint, stop bowling temporarily, orthopedist if conservative care fails

Question 412

Boxer fracture: Caused by? Presents as? Management?

Answer 412

Trauma to closed fist Pain, swelling, decreased movement of hand, x-ray show fx below head of 2nd/3rd metacarpals if break is in metacarpal if in 4/5th ballroom

Question 413

Who do you see CTS in?

Answer 413

Overweight females, pregnancy, hypothyroidism

Question 414

Chauffeur/Hutchinson fracture: Caused by? Presents as? Management?

Answer 414

Trauma to wrist Pain, swelling, decreased ROM, x-ray shows break through articular surface of distal radius near styloid Hospital --> cockup splint to immobilize wrist in partial extension

Question 415

Intersection syndrome: Caused by? Presents as? Management?

Answer 415

Overuse in weight lifters and skiers Pain, tenderness over area 4cm proximal to dorsal radial tubercle of Lister, crepitus where extensor carpi radialis longus/brevis intersect with abductor pollicis longus and extensor pollicis brevis

Question 416

Smith/reversed colles fracture: Caused by? Presents as? Management?

Answer 416

Trauma to distal radius Pain with movement and swelling in wrist, x-ray hows break through distal 1/3 of radius with anterior displacement of distal fragment Refer to hospital, use splint to immobilize

Question 417

TFCC Tear: Caused by? Presents as? Management?

Answer 417

Trauma injury to TFCC btw head of ulna and triquetral bones in wrist Wrist pain worse w/supination/pronation or weight-bearing on wrist, calcification on film Refer to orthopedist --> MRI/arthroscopy

Question 418

Ulnar N entrapment: Caused by? Presents as? Management?

Answer 418

``` Elbow tunnel (behind elbow), Guyon's canal syndrome or handlebar syndrome affects cyclists or people using stationary bikes Pain along ulnar aspect of hand and little finger and clumsiness in hand, + Tinel's Refer to hand surgeon if chiropractic care is not helpful ```

Question 419

Cheiralgia paresthetica/Wartenberg's syndrome: Caused by? Presents as? Management?

Answer 419

Compression of superficial radial N at wrist, may be caused by tight handcuffs Numbness, paresthesia along lateral distal wrist, tapping over lateral aspect will reproduce symptoms Refer to neurologist if chiropractic care not helpful

Question 420

Leprosy: Caused by? Presents as? Management?

Answer 420

Nerve damage by mycobacterium leprae infection Claw hand, loss of sensation, swollen ulnar nerve Dermatologist

Question 421

B12 Deficiency: Caused by? Presents as? Management?

Answer 421

Nerve damage in true vegans, patients following gastric bypass, patients with autoimmune destruction of parietal cells in stomach or inpatients w/Crohn's disease of infestation w/tapeworm Diphyllobothrium Latum Glove and stocking loss of sensation, tongue is red and smooth, + Romberg if subacute degeneration of spinal cord, raised homocyteine and methylmalonic acid levels Refer to neurologist or hematologist

Question 422

Malingering tests:

Answer 422

Burn's bench, Hoover, Lasegue, Libman, Magnuson, Mannkopf