IMPACT Quizzes Flashcards by nikolai M

SI joint - Form vs Force closure

Form - passive restraints, shape, ligaments.

Force - stability provided by muscular system

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articular surface of innominate and sacrum (cartilage)

sacrum - hyaline cartilage

innominate - fibrocartilage

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Position: more cranial than it should be ,Kinetic Test: often all kinetic tests positive for that side ,Passive mobility: inferior “glide restricted with a jammed end feel

upslip sublux

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Position: more anteriorly rotated than it should be ,Kinetic: posterior rotation and lateral rotation tests (ipsilateral step (Gillette’s), contralateral side flexion, sacral flexion) are positive ,Passive mobility: ipsilateral sacral flexion (PA on ipsilateral superior sacral corner) and/or posterior rotation and/or superoanterior glide restriction

anterior innominate sublux

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Active supine and/or prone SLR difficulty with improvement when the SIJs are passively compressed assesses which type of closure

Form closure

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What are primary stress tests of SI?

Anterior and posterior gapping. (gap/compress)

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The following would indicate the cause of pain to be:

No evidence of systemic disease
Instability of the SIJ
Loss of hip extension on that side
Instability of the lumbosacral junction
Long leg on that side

a. Infectious Sacroillitis
b. Reiter’s dx
c. Segmental dysfunction
d. Minor Trauma
e. Anklosing spondylitis

D - minor trauma

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Stoddard test used as a secondary stress test will test for

a. Stability of the innominate on the sacrum in a cephalad direction
b. ‘’ ‘’ sacrum in a dorsal direction
c. ‘’ ‘’ sacrum in a ventral direction
d. ‘’ ‘’ sacrum in a caudal direction

Stability of the innominate on the sacrum in a dorsal direction

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Dx: Patient presents with:

Positive Fortin’s finger test
Positive pain provocation tests with pain in the groin or Fortin’s area
Reduction of pain in the provocation tests with SIJ support
Exacerbating factors more related to activity than posture

= sign of buttock?
=pain from lumbar spine?
= pain from SIJ?

Pain from SI joint.

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Which of the sacroilliac joint ligaments is the weakest

Select one:

a. illiolumbar
b. Long posterior
c. Short posterior
d. Ventral
e. Interosseus sacroilliac

Ventral

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Which of the following isn’t a Major lesion for the SIJ?

Select one:

a. Reiter’s Dz
b. segmental dysfunction
c. Anklosing spondylitis
d. Fracture

segmental dysfunction

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When checking SIJ mobility through the Anterior innominate, pt is lacking left posterior glide, this would indicate

Select one:

a. Left SIJ subluxed posteriorly
b. restricted anterior glide on the left
c. Left SIJ subluxed anteriorly
d. Sacroillitis

Left SIJ subluxed anteriorly

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List 3 ways of assessing mobility of the SIJ
Select one or more:

a. Position testing
b. active resisted testing
c. Passive mobility testing
d. Kinetic testing
e. gapping test

position testing
passive mobility testing
kinetic testing

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Which SIJ test has shown high validity and very high sensitivity value.

Select one:

a. Fortin’s test
b. forward flexion test
c. dorsal ligament stress test
d. dorsal innominate shear test

Fortin’s test

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If you are concerned that the left sacroilliac joint won’t extend you will test this by

Select one:
a. push down on the right ILA to test left sacral extension

b. push down on the right sacral base to test left sacral extension
c. push down on the left sacral base to test left sacral extension
d. push down on the left ILA to test left sacral extension

a. push down on the right ILA to test left sacral extension

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To test the end feel for the posterior glide of the innominate you will

Select one:

a. Stabilize the opposite side down and glide the innominate into extension
b. Stabilize the opposite side down and glide side to be tested up
c. Stabilize the opposite side up and glide the innominate to be tested up
d. Stabilize the opposite side up and glide the innominate into extension

b. Stabilize the opposite side down and glide side to be tested up

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Manipulation is often not the treatment of choice for minor SIJ lesions

Select one:
True
False

False

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33 y/o male presents with SIj pain +fortin’s point, antalgic gait, no pain bleow the knees, very mild swelling of the foot. The initial diagnosis, given the age, is that this is a minor lesion that will improve with manipulation.

Select one:
True
False

False

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When evaluating SIJ dysfunction resisting contralateral shoulder extension decreases pain during a prone SLR, this would indicate a form closure problem and a good prognosis.

Select one:
True
False

False

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When treating a L C5/C6 Extension subluxation you will
Select one:
a. Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the Transverse process
b. Flex the spine, come onto the superior segment on the left, take up the slack, and thust is inferior through the articuar pillar
c. Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articular pillar
d. Extend the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articuar pillar

c. Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articular pillar

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Which of the following is NOT associated with a cervical disc herniation?
Select one:
a. Signs of radiculopathy
b. Severe ROM limitation in all ranges
c. non-obligate functional loss
d. Severe unilateral arm and neck pain

c. non-obligate functional loss

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Short duration episodic pain, moderate pain and referral, with flexion OR extension loss is indicative of...?
Select one:
a. Viscerogenic pain
b. Stenosis
c. Disc herniation
d. Segmental dysfunction

d. Segmental dysfunction

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All of the following are spinal chord reflexes for central inhibition except:
Select one:
a. ULTT
b. DTR
c. Hoffman
d. Clonus
e. Babinski
f. Oppenheimer

a. ULTT

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You typically do NOT have posterior ligament tears with MVAs?

Select one:
True
False

True

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With a vertical stability test, the tectoral membrane is often suggested as the stabilizing ligament. C2 is stabilized with a pinch grip and the other hand applies traction to the occiput. The signs and symptoms we are looking for are VBI or pain reproduction.. Select one: True False

True

When testing the superior lateral glide of left C3 on C4, right TP of C3 can be stabilized and an inferior medial glide of left C4 on C3 can be performed to create a relative superior-lateral glide of left C3 on C4. Select one: True False

True

An inferior medial posterior(IMP) glide of the left C3 on C4 causes an extension moment at the left C3 inferior facet joint. Select one: True False

True

When checking for integrity of the vestibulocochlear nerve, the pt reports hearing less in the L ear. You have the pt hum while they place their hands over their ears. The pt notices that the humming appears to be louder on the R side. This is most likely to be a mechanical dysfunction relative to a neural dysfunction. Select one: True False

True

Neuropathy Myelopathy Radiculopathy

Neuropathy – Peripherral nerve lesion, defined anesthesia, Myelopathy – any functional disturbance and/or pathological change in the spinal cord. UMN lesion., Radiculopathy – Spinal nere or root involvement, LMN lesion

Neuropraxia Axonotmesis Neurotmesis

Neuropraxia : Pressure on a nerve root that leads to primarily motor loss with little sensory or autonomic involvement. Interruption in physiologic function without significant anatomic damage. No deterioration within the nerve. Grade 1 , Mild 2-3 min Axonotmesis - Grade II. Degeneration within an intact neurolemnal sheath. Persisting motor loss that last longer than 2 weeks. Normal EMG 18-21 days – persisting abnormality up to 1 year Neurotmesis - Grade III. A lesion in a peripheral nerve that leads to complete paralysis of the muscles supplied by that nerve. Disruption of the neurolemnal sheaths of all or part of the nerve, usually more than 60%. Recovery ranges from 0-30%, rarely more.

Dural pain does not have to occur with weakness or sensory loss. Select one: True False

True

Testing the strength in mid range allow you to evaluate the eccentric fatigibility of the muscle with maximum motor units recruited. Select one: True False

False

rue/False: ALL of the following are potential causes of transverse ligament instability. Rheumatoid arthritis, recurrent URTI in children, Down's syndrome, steroids age<9, and Reiter's Dz. Select one: True False

True

Fatiguing weakness is a neuromuscular response occurring at the synapse Select one: True False

True

``` Which of the followinng is not a sign of Horner's Syndrome Select one: a. Pupil dilation b. ptosis c. Fascial Flushing d. Eye recession e. Decreased or absent sweating ```

a. Pupil dilation

``` Which of the following is not likely to be a cause of torticollis. Select one: a. Grisel's Syndrome b. AA subluxation c. Anterior Subluxation of T1 on T2 d. OA block ```

c. Anterior Subluxation of T1 on T2

Viscerogenic pain is best described as Select one: a. systemic, multiple joints. b. Slow pain, hard to localize or intense unremitting pain, stabbing c. intense, neuropathic d. diffuse, aching, poorly localized, may be referred increased with exertion

b. Slow pain, hard to localize or intense unremitting pain, stabbing

Positive lower motor neuron test and negative Hoffman's would indicate a high cervical cord compression? Select one: True False

false

``` Match the EIS with the diagnosis: Severe unilateral arm and neck pain, obligate loss of function, neuropathic pain, severe ROM limitation all ranges affected. Select one: a. Lateral stenosis b. Major Fracture/Dislocation c. Posttraumatic arthritis d. Disc Herniation e. Biomechanical Dysfunction f. central stenosis ```

d. Disc Herniation

``` Match the EIS with the diagnosis: dermatomal parasthesia, aching in neck and arm, dermatomal sensory hypoesthesia Select one: a. Major Fracture/Dislocation b. Posttraumatic arthritis c. Biomechanical Dysfunction d. central stenosis e. Lateral stenosis f. Disc Herniation ```

e. Lateral stenosis

``` Match the EIS with the diagnosis: bilateral upper limb parasthesia, aching or pain in both arms, bilateral upper limb hypoesthesia, potential CNS signs Select one: a. Central stenosis b. Posttraumatic arthritis c. Biomechanical Dysfunction d. Major Fracture/Dislocation e. Disc Herniation f. Lateral stenosis ```

a. Central stenosis

``` Match the EIS with the diagnosis: short duration episodic pain, moderate pain, moderate referral, non-obligate or no loss of function, - Scan Select one: a. Lateral stenosis b. Biomechanical Dysfunction c. Central stenosis d. Major Fracture/Dislocation e. Disc Herniation f. Posttraumatic arthritis ```

b. Biomechanical Dysfunction

``` Match the EIS with the diagnosis: immediate onset of severe pain, immediate fixed torticollis, immediate loss of function, severe limitation in ROM. Select one: a. Biomechanical Dysfunction b. Posttraumatic arthritis c. Central stenosis d. Disc Herniation e. Lateral stenosis f. Major Fracture/Dislocation ```

f. Major Fracture/Dislocation

Testing the reflex of the extensor pollicus longus could be used to evaluate the C8 reflex loop Select one: True False

True

Triceps and wrist extensor reflex testing would be used to evaluation C7. Select one: True False

False | Wrist extensor = C6.

Which of the following best includes segmental dysfunction Select one: a. a feeling of giving way b. Pain unaffected by movement c. Pain referred down the leg and into the foot d. Severe and constant pain

a. A feeling of giving way

Which ribs are atypical ribs? Select one: a. 1,2,3,12 b. 1,2,6,12 c. 1,2,10,11 d. 1,2,11,12

d. 1,2,11,12

``` Which nerve supplies the posterior longitudinal ligament, superficial annulus fibrosus, epidural blood vessels, anterior dura mater, dural sleeve, and posterior vertebral periosteum Select one: a. Superior Dorsal Rami b. Sinuvertebral nerve c. Inferior Dorsal Rami d. Ventral Rami ```

b. Sinuvertebral nerve

``` Thoracic disc herniations occur more commonly which of the following regions Select one: a. T6-T9 b. T3-T6 c. T1-T3 d. T9-T12 e. C8-T1 ```

d. T9-T12

``` Decreased rib excursion <4mm and SIJ pain is indicative of Select one: a. Rheumatoid Arthritis b. Ankylosing spondylitis c. Reiter's disease d. Neoplasm e. Sacroillitis ```

b. Ankylosing spondylitis

``` Pancoast tumor is often associated with all the following except Select one or more: a. Horner's Syndrome b. TOS symptoms c. C8 or T1 nerve root radicular sx d. weak biceps and wrist extensors ```

d. weak biceps and wrist extensors

``` Which nerve innervates the costovertebral joint and intercostal muscles at that level? Select one: a. Dorsal rami b. Ventral Rami c. Sinuvertebral joint d. spinal root nerves ```

b. Ventral Rami

``` Which of the following is not considered part of the neurological exam during he scanning exam Select one: a. babinski b. reflexes c. range of motion d. dermatome e. key muscle(myotome) ```

c. range of motion

Which answer below is not a specific consideration for the thoracic spine. Select one: a. primary site of early bone loss b. thoracic watershed effect c. Thoracic spinal canal is smaller relative to the spinal canal

a. primary site of early bone loss

``` T10 dermatome is tested at the level of the Select one: a. groin b. Pubis Symphysis c. Umbilicus d. Xiphoid process ```

c. Umbilicus

Which of the following is not an indication of a thoracic spinal cord compression Select one: a. Bilateral hypotonic reflex b. hyper reflexive ankle jerk/knee jerk reflex c. positive clonus d. Positive extensor-plantar response

a. Bilateral hypotonic reflex

``` Which of the following is not a medical condition contraindicating spinal manipulation. Select one: a. Rheumatoid arthritis b. cancer c. generalized hypermobility d. systemic arthropathy e. Osteoporosis f. bleeding disorders ```

c. generalized hypermobility

Which of the following is not a contraindication for manipulation in the thoracic spine. Select one: a. Lower thoracic and shoulder pain b. Radicular pain c. Lower limb parasthesia d. Bleeding disorders or anticoagulant intake e. Somatic pain in the arm

Somatic pain in the arm

When making a diff dx from Costochondritis vs Tietze Syndrome, Costochondritis has palpable edema and Tietze syndrome is characterized by pain without swelling. Select one: a. False b. True

a. False Both involve inflammation. Tietze's is less common and often causes chest swelling, which may last after pain and swelling is gone.

A positive Beevor's test would be indicated by a drawing into the direction of the weak region. Select one: True False

False | movement of the nail towards the head on flexing the neck.

Lower ribs demonstrate pump handle motions and upper ribs demonstrate bucket handle motions. Select one: True False

False Lower ribs are bucket. Upper are pump

The thoracic discs are less predisposed to degeneration than are the cervical and lumbar discs because of the smaller ranges of movement in this region. Select one: True False

True

With anterior drawer test, you can differentiate the lateral and medial ligment stability, increased backward glide noted on the right medial tibia would indicate Select one: a. lateral instability b. Grade I tear of the deep tibiotalar ligament c. medial instability d. Grade III tear of the talofibular ligament

medial instability

For the ankle ligamentous testing, superficial and deep bands were tests with Select one: a. lateral collateral ligament testing at the ankle b. deltoid ligament testing at the ankle c. Posterior tib-Fib ligament testing at the ankle d. Anterior Tib-Fib ligament testing at the ankle

deltoid ligament testing at the ankle

L2 question: A distance runner presents to your clinic with medial foot and lateral lower leg pain. You r/o stress fx, muscle tear, and tibiofibular jt issues. You narrow your examination to the foot, determining that a tarsal joint is involved. You suspect... Select one: a. 2nd MET head stress fx resulting in compensatory over pronation b. Talocrural subluxation resulting in decrease triceps surae activation c. naviculotalar jt dorsal subluxation resulting in posterior tib tendinitis d. Dorsal cuboid subluxation resulting in fibularis tertius tendonitis

naviculotalar jt dorsal subluxation resulting in posterior tib tendinitis

``` With the standing squat test, the relative foot position expected during the squat is _____________. Select one: a. Inversion b. Eversion c. Supination d. Pronation ```

Pronation

``` Pt presents with burning pain at medial calcaneus. After assessment you determine their medial to lateral glide into eversion is limited. What joint is most likely involved? Select one: a. Medial anterior subtalar jt b. Lateral anterior subtalar jt c. Lateral posterior subtalar jt d. Medial posterior subtalar jt ```

Medial anterior subtalar jt

During the talar swing test, all the following can be evaluated except Select one: a. Ability of the talus to glide b. The conjunct rotation of medial and lateral rotation c. Talocalcaneal glide assessment d. Amount of dorsiflexion and plantar flexion

Talocalcaneal glide assessment

``` Pt presents with limited DF at the cuboidocalcaneal jt. As you assess the motion, what is the conjunct rotation that will be missing? Select one: a. ventrolateral b. dorsolateral c. ventromedial d. dorsomedial ```

dorsolateral

``` You are treating a 21 y.o female athlete who sustained a inversion with plantar flexion sprain 4 weeks ago. She had an MRI performed because she is a olympic level pole vaulter, which were negative. Currently, she is c/o feeling like there is a pebble in her shoe when she walks. There is no edema present. What do you suspect? Select one: a. stress fracture of the talus b. Subluxed plantar cuboid c. Deep bone bruise d. posterior tib. tendinitis ```

Subluxed plantar cuboid

You performed the talar swing test and noted the end feel of dorsiflexion to be slightly limited and the lateral glide restricted. Since no muscular unit can restrict this glide and the end feel is not consistent with pericapsular restriction you determine this to be a subluxation that should respond to manipulation.Your first choice for manipulation of this joint will be a J-stroke manipulation of the Talocrural joint. Select one: True False

False

You perform the ankle distraction manipulation in a full dorsiflexed position. Select one: True False

False

When performing a "flick" subtalar manipulation into eversion your thumbs will ALWAYS be on the medial border of either the anterior or posterior jt. Select one: True False

True

When performing a tarsal jt manipulation you should have the patient apply traction by holding the leg just superior to the malleoli and leaning back. Select one: True False

True

``` Talocrul joint is a modified sellar joint with Select one: a. 3 degrees of freedom b. One degree of freedom c. Two degrees of freedom ```

1 DoF pure sellar (saddle) vs modified seller (1DoF)

Anterior drawer test is performed with knee bent with foot flat on the mat. Stabilize the foot and push the crus backwards. A positive test is indicated Select one: a. If the lateral motion/rotation is noted the lateral ligaments are lax. b. if the anterior Tib fib syndesmosis is torn c. if the posterior Tib fib syndesmosis is torn d. pain is noted during the test

If the lateral motion/rotation is noted the lateral ligaments are lax.

Testing the conjunct rotation of the navicular, the glide is Select one: a. plantar with adduction b. dorsally for everted navicular, palmar glide for inverted navicula c. dorsally with adduction d. dorsally for inverted navicular, palmar glide for everted navicular

dorsally for inverted navicular, palmar (plantar) glide for everted navicular

``` Pain posterior ankle, passive dorsiflexion painful, isometric plantar flexion painful, tender over tendon Select one: a. subtalar subluxation b. Achilles tendonopathy c. Tibialis anterior tendonopathy d. anterior subluxed talus e. peroneus longus tendonopathy ```

Achilles tendonopathy

``` Pain anterior ankle, pain on stepping over foot, decreased dorsiflexion and posterior glide, pathomechanical end feel. Select one: a. Achilles tendonopathy b. peroneus longus tendonopathy c. Tibialis anterior tendonopathy d. anterior subluxed talus e. subtalar subluxation ```

anterior subluxed talus

``` Pain lateral ankle, passive inversion painful, isometric eversion painful, tender over tendon Select one: a. Tibialis anterior tendonopathy b. peroneus longus tendonopathy c. sever's dz d. Achilles tendonopathy e. plantar fascitis ```

peroneus longus tendonopathy

``` Pain anterior ankle, passive plantarflexion painful, isometric DF/IV painful, tender over tendon Select one: a. Achilles tendonopathy b. plantar fascitis c. Tibialis anterior tendonopathy d. peroneus longus tendonopathy e. sever's dz ```

Tibialis anterior tendonopathy

``` Pain medial or lateral ankle, pain mainly on heel strike, inversion and eversion painful and decreased, anterior medial or posterior medial glides restricted. Select one: a. anterior subluxed talus b. peroneus longus tendonopathy c. Tibialis anterior tendonopathy d. Achilles tendonopathy e. subtalar subluxation ```

subtalar subluxation

with dorsiflexion and plantar flexion the conjunct rotation that needs to occur is medial glide with plantar flexion and lateral glide with dorsiflexion. Select one: True False

True

When testing the distal tib/fib joint in the sidelying position, a positive test will give a capsular end feel and a negative test will give a springy end feel. Select one: True False

False

Matching - Bowel, bladder, genital dysfunction (pick one) - S4 palsy - neoplasm, kidney, AS, aortic aneurysm - compression fraction - spondylolithesis

- S4 palsy

Forbidden area pain (pick one) - S4 palsy - neoplasm, kidney, AS, aortic aneurysm - compression fraction - spondylolithesis

- neoplasm, kidney, AS, aortic aneurysm

Wedging (pick one) - S4 palsy - neoplasm, kidney, AS, aortic aneurysm - compression fraction - spondylolithesis

compression fracture

Step deformity (pick one) - S4 palsy - neoplasm, kidney, AS, aortic aneurysm - compression fraction - spondylolithesis

spondylolithesis

bilateral multisegment sign (pick one) - cauda equina compression - sign of the buttocks - neoplasm - viscral

-cauda equina compression

severe gluteal pain with empty end feel of hip motions (pick one) - cauda equina compression - sign of the buttocks - neoplasm - viscral

sign of the buttock

non adjacent root involvement (pick one) - cauda equina compression - sign of the buttocks - neoplasm - viscral

neoplasm

pain unrelated to trunk movement (pick one) - cauda equina compression - sign of the buttocks - neoplasm - viscral

visceral

38y/o female with pain under her right heel. Pain on walking, no pain sitting or lying, more pain with running. Better with shoes. whole calcaneous is tender. Select one: a. plantar fascitis b. Stress Fracture c. L5 nerve root lesion d. Fat pad pathology e. S1 root f. arthritis

Fat pad pathology

``` 22 y/o female in an MVA presents with sudden, severe lower thoracic pain bilaterally, given fracture in this age group is not common, which question might give you the most information. Select one: a. Is your pain worse at night b. Are you still having your period c. do you have pain with flexion ```

Are you still having your period

``` 48 year old male with LBP, pain in both legs to mid calf, moderate pain that comes on with walking patient, not standing. Select one: a. Central stenosis b. Cervical disc herniation c. Vascular claudication d. Lateral disc herniation ```

Vascular claudication

``` 53y/o male with back and anterior thigh pain that is somatic. Pain worse with walking and better with sitting. worse walking up the hill. no pain wiht standing. Select one: a. lateral stenosis b. metastatic disease c. aortic aneurysm d. herniated disc ```

Aortic aneurysm - | can cause the pain due to erosion of the vertebral body or pain from dissection. Artery has nociceptors.

``` With thoracic extension, both inferior facets on the superior segment glide inferior. If the left facet does not extend, R transverse process is now posterior to the left. The next step is to perform the PAIVM. The PAIVM will help determine between all the following possibilities except.. Select one: a. Right extension Hypermobility b. Left extension hypomobility c. Left extension hypermobilty ```

Left extension hypermobilty

``` Which of the following is usually not a hallmark of radiculopathy Select one: a. Segmental distribution of weakness b. Non-fatigable weakness c. Hypotonicity d. hyporeflexia ```

Non-fatigable weakness

``` 34y/o male, moderate LBP on the left, 3rd time in 18mo, he hasn't missed any work as accountant Select one: a. Lateral stenosis b. postural syndrome c. end plate fracture d. Disc herniation e. Segmental dysfunction ```

Segmental dysfunction

``` 72 y/o male, central bilateral pain, pain with walking, extension increases sx rather than flexion. Select one: a. Lateral stenosis b. Claudication c. Central stenosis d. Disc herniation ```

Central stenosis

Following a positive PPIVM on the right in flexion, testing the PAIVM you will apply the glide to the left transverse process to assess for the end feel. Select one: a. False b. True

False | no, you want to push R to assess the flexion

``` Male 30, presents with SIJ pain, worse in the morning, decreased rib excursion Select one: a. Ankylosing Spondylitis b. Segmental dysfunction c. Crohn's dz d. Sacroillitis e. Reiter's dz ```

``` Male 30, presents with SIJ pain, mild peripheral swelling and recent history of Illness Select one: a. Rheumatoid Arthritis b. Segmental dysfunction c. Ankylosing Spondylitis d. Crohn's dz e. Reiter's dz ```

Reiter's dz

Neuropathic pain is due to damage of the spinal nerve or root, not mild compression. Select one: True False

True

You can not have neuropathic pain without radiculopathy Select one: True False

True

Reflex inhibition of the causes multifidi causes instability in the spinal segment in the phase transition model, Nociceptive input is used to increase facilitation of the multifidi in this model. Select one: True False

False

Asking a female about her period cycle would have no impact on your decision to manipulation Select one: True False

False

Somatic pain occurs with radiculopathy Select one: True False

False

A positive scanning exam leads to a medical diagnosis. Select one: True False

True

Straight leg raise: Neural and dural structures start to move at around 60degrees of flexion. The lower degree of positive indicates a higher probability of a disc herniation. Select one: True False

True

``` You decide to manipulate a patient with pins and needles down the leg with a one segment distribution. Which technique would be the best choice. Select one: a. Sidelying flexion manipulation b. Sidelying extenion manipulation c. Manipulate into flexion d. Banana manipulation into flexion ```

Manipulate into flexion

A local kyphosis would be considered a more serious observation than a sway back or a rotoscoliosis Select one: a. False b. True

True

Which muscle group would most likely also test weak if the cause is an L3 root palsy Select one: a. ankle plantaflexors b. ankle evertors c. hip flexors d. hip adductors

Hip ADDuctors

``` A positive Hoffman's sign plus a Babinski response indicates which of the following Select one: a. spinal cord compromise at T7/8 b. spinal cord compromise at C4/5 c. spinal cord compromise at T3/4 d. spinal cord compromise at T11/12 ```

spinal cord compromise at C4/5

``` The manual treatment of choice for the patient whose pain precedes the onset of tissue resistance is Select one: a. Grade 3 or 4 mobilization b. Grade 1 or 2 mobilization c. no manual treatments are appropriate d. Grade 5 mobilization ```

Grade 1/2

An extension mobilization is most likely to be indicated in which of the following situations Select one: a. moderate pain on sitting after more than 20 minutes b. severe pain on walking less than a few feet c. severe pain on sitting for less than 2 minutes d. moderate non-progressive pain on walking more than 100 meters

moderate non-progressive pain on walking more than 100 meters

Which of the following contraindicates manual treatment Select one: a. low back and unilateral leg pain b. severe low back pain c. pain which can not be improved or worsened by the therapist during the examination d. pain at rest that is relieved by motion

pain which can not be improved or worsened by the therapist during the examination

``` Overpressure is applied at the end of range to assess which of the following Select one: a. the condition of contractile tissues b. end feel c. willingness to move d. quality of movement ```

End feel

Evidence of spinal cord compromise above T12 is typically suggested by which of the following Select one: a. urinary incontinence plus Babinski responses bilaterally b. urinary retention plus Babinski responses bilaterally c. urinary incontinence plus non-Babinski responses bilaterally d. urinary retention plus non-Babinski responses bilaterally

urinary retention plus | Babinski responses bilaterally

Acute cauda equina syndrome is most suggested by which of the following Select one: a. low back pain, bilateral leg pain and parasthesia plus negative Babinski responses b. bilateral leg parasthesia and urinary retention c. low back pain, bilateral leg pain and parasthesia plus bilateral Babinski responses d. low back pain with no leg pain plus urinary incontinence

- low back pain, - bilateral leg pain and parasthesia - negative Babinski responses

``` The least likely cause of viscerogenic low back pain in a woman is Select one: a. intrauterine tumors b. extrauterine tumors c. rectal cancer d. pneumonia ```

pneumonia

Which of the following symptoms in the low back pain patient should be considered the least serious Select one: a. multisegmental bilateral aching on walking b. the pain cannot be made better or worse c. sudden onset of severe pain after trauma d. the pain prevents the patient from sleeping

multisegmental bilateral aching on walking

When moving through moving active lumbar range of motion testing the following finding is of least importance during the scanning examination Select one: a. momentary deviation during the test b. pain and spasm on extension c. limitation of movement associated with pain d. a painful arc

limitation of movement associated with pain

Normal left side flexion of L3/4 comprises which of the following Select one: a. left translation of the vertebra plus extension of the left facet b. left translation of the vertebra plus extension of the right facet c. right translation of the vertebra plus flexion of the right facet d. left translation of the vertebra plus flexion of the left facet joint

left translation of the vertebra plus extension of the left facet

The lumbar spine is limited into extension and right side flexion, the most likely joint dysfunction is Select one: a. extension hypomobility of the left joint b. flexion hypomobility of the left joint c. extension hypomobility of the right joint d. flexion hypomobility of the right joint

extension hypomobility of the right joint

The most likely presentation of lumbar central stenosis is Select one: a. no low back with bilateral leg pain on walking b. moderate low back and bilateral leg pain on walking c. severe low back and bilateral leg pain on walking d. no low back and bilateral leg pain on walking

moderate low back and bilateral leg pain on walking

An extra-articular hypomobility will be determined by a positive PPIVM and positive PAIVM Select one: a. False b. True

False

``` All are potential end feels for the lumbar PAIVM except Select one: a. hard/jammed b. Spasm c. elastic d. firm/capsular e. soft ```

elastic

Stressing of a damaged spinal nerve root can cause somatic pain. Select one: True False

True

During the lumbar scan isometric contractile tests of the muscles of the leg are performed in order to assess the state of the nerve roots motor conduction Select one: True False

True

A damaged spinal nerve root is capable of generating only neuropathic pain and not somatic pain Select one: True False

True

Weakness caused by radiculopathy is identified by non-fatiguing weakness in a segmental distribution Select one: True False

False

The uncontained lumbar disc herniation typically presents with severe low back and leg pain worsened by sitting and walking Select one: True False

True

The sacroiliac pain provocation stress tests are designed to detect upslips and other forms of joint dysfunction that are amenable to manual therapy Select one: True False

False

A flexion mobilization would be indicated for a patient who complained of low back with referred pain in the leg that is worsened by coughing. Select one: True False

False

Painful hypermobility may present as pain with full range of motion. Select one: True False

True

``` Identify the condition: pain, predominately with sitting, Limited flexion inner quadrant(flexion, adduction, IR) and FABER's painful, limited medial rotation. Select one: a. Psoas tendonitis b. Fracture of the femoral neck c. Sign of the Buttocks d. Anterior hip subluxation ```

Anterior hip subluxation

When performing the arthrokinematic test on the hip, all are relevant EXCEPT Select one: a. Therapist observes for stiffness and end feel b. Distraction is performed recognizing the plane of joint is antero-lateral c. Therapist should appreciate a fair amount of laxity with distraction d. Test position is 70 degrees Hip Flexion, a bit of lateral rotation and a bit of ABD

Therapist should appreciate a fair amount of laxity with distraction

``` Pain at anterior hip, Age 35+, non episodic, increased pain with weight bearing capsular pattern Select one: a. Subluxation b. Labral tear c. Hip arthrosis d. Perths's disease e. loose body f. Stress fracture ```

Hip arthrosis

``` 42 Female PT presents with: Pain in the groin region, Increased pain with running not limiting running. Limited pain the following day and with ADL's Select one: a. Stress fracture b. Subluxation c. Perths's disease d. Hip arthrosis e. loose body f. Labral tear ```

Stress fracture

``` 42 Female patient with: Pain in the groin region, restricted ER/IR, + FABER, PAM is negative, pain on quadrant testing Flexion,add, IR. Select one: a. Labral tear b. Hip arthrosis c. Subluxation d. Perths's disease e. Stress fracture f. loose body ```

subluxation

``` 42 Female patient with: Severe buttocks pain, limited ROM non capsular in all planes with empty end feel Select one: a. Labral tear b. loose body c. Sign of the Buttocks d. Gluteal bursitis e. Hip arthrosis f. Stress fracture g. Rheumatoid arthritis ```

Sign of the buttocks

Loose bodies present with a springy end feel on one or more movement tests and the subjective report is often a twinge followed by a period of pain. Select one: a. True b. False

True

``` In early arthritis which motion quadrant will most likely be restricted Select one: a. Flexion, adduction, Internal rotation b. Flexion, abduction, external rotation c. Extension lateral rotation d. Extension medial rotation ```

Extension medial rotation

``` The hip quadrant that examines flexion, abduction and lateral rotation most closely resembles Select one: a. Squish test b. FABER c. ober test d. Log roll test ```

FABER

``` Loss of which motions is common and will have a large impact on normal gait Select one: a. Extension-lateral rotation b. Flexion-Medial rotation c. Flexion-lateral rotation rotation d. Extension-Medial rotation ```

Extension-Medial rotation

Arthrokinematic motion tests for the hip are flexion/extension and medial/lateral rotation Select one: True False

False

Hypermobility or instability of the SIJ should trigger a hip mobility assessment Select one: True False

True

The hip is an modified ovoid joint with 3 degrees of freedom Select one: True False

False Pure ovoid (3DoF) vs modified ovoid (2DoF). pure = equal curvature in all direction. Modified has unequal curvatures

The closed packed position of the hip is ER/LR/ABD Select one: True False

False

Tibofemoral arthrokinematic motion is tested by drawing the tibia forward and backward in Select one: a. 45 degrees flexion b. 90 degrees flexion c. 15 degrees flexion d. 30degrees flexion

30degrees flexion

The capsular pattern of the knee is flexion limitation is greater than extension. Select one: a. False b. True

True

``` Which of the following do not typically present with a capsular pattern. Select one or more: a. meniscal tear b. loose body c. after immobilization d. Osteoarthritis ```

meniscal tear and | loose body

The closed packed position of the knee is flexion and internal rotation of the tibia. Select one: a. False b. True

False

``` In non weight bearing, knee extension is coupled with Select one: a. External rotation b. Internal Rotation c. medial glide d. lateral glide ```

With knee end of range techniques, there are no glides or conjunct rotations involved with the mobilization or contract relax techniques. Select one: a. True b. False

False

Extreme end of range treatment for knee flexion involve medial rotation and gliding the tibia backward. Select one: True False

False | Hinging?

To test the anterior fibers of the MCL, the knee and hip are held in 90degrees and stress is applied by rotation of the leg around your body(video) Select one: True False

True

The Thessaly test has better sensitivity and specificity for identifying meniscal tears compared to apley's. Select one: True False

True

During mobilization with a neutral glide of the tibiofemoral joint for increased extension, this technique is performed by Select one: a. Gliding the femur anterior on the tibia b. Gliding the femur posteriorly on the tibia c. Gliding the tibia posteriorly on the femur

Gliding the femur posteriorly on the tibia

To stress the inferior facet of the patella, the knee is placed in about 20degrees of flexion and the patella is glided side to side. Select one: True False

True

``` Relative body weight with ascending stairs creates how much force through the patellofemoral joint. Select one: a. 1x body weight b. 3-4x body weight c. 5-6x body weight d. 7-8x body weight ```

3-4x body weight

With quadrant testing, end range motion is assessed with the ovoid of motion provides no additional information Select one: True False

False

Glides for the superior tibiofibular joint are anterior-medial and posterior-lateral. Select one: True False

False antero-lateral and posteromedial.

During left rotation of the body in standing, the motion at the rigth superior Tibio-fibular joint will be Select one: a. The tibia will rotate medially on the fibula b. The fibula glides anteriorly c. The fibula will rotate medially on the tibia d. The tibia will rotate laterally on the fibula

The tibia will rotate medially on the fibula

``` When the foot moves into pronation, the superior fibula glides.. Select one: a. supero posterolateral b. supero anteriomedial c. supero anteriolateral d. supero posteromedial ```

supero postero medial

``` Mobilization/manipulation of the superior tib fib joint to increase the anterior glide is performed in which position Select one: a. Quadruped b. supine c. prone d. sidelying ```

Quadruped

The superior tibio-fibular joint is a modified ovoid with one degree of freedom. Select one: True False

True | Simple, synovial, modified ovoid (bicondylar)

``` In weightbearing, the mensici move which direction with extension Select one: a. posterior b. medial to midline c. Anterior d. lateral to midline ```

With Slocum's test, Select one: a. Knee bent 90d, glide the tibia anteriorly, the knee is then place the knee in medial rotation and repeat, the knee should have more anterior posterior displacement. b. Knee bent 15d, glide the tibia anteriorly, the knee is then place the knee in medial rotation and repeat, the knee should have more anterior posterior displacement c. Knee bent 90d, glide the tibia anteriorly, the knee is then place the knee in medial rotation and repeat, the knee should tightenup considerably. d. Knee bent 90d, glide the tibia anteriorly, the knee is then place the knee in lateral rotation and repeat, the knee should tightenup considerably.

Knee bent 90d, glide the tibia anteriorly, the knee is then place the knee in medial rotation and repeat, the knee should tightenup considerably.

When performing the body rotation test, the head is fixed and the body is rotated at the trunk to the left.. Select one: a. CN II, IV and VI will be indicated with a positive test b. Looking for VBI or spondylogneic pain with cervical right rotation during this test c. Positive sx indicate laberinthine dysfunction d. positive sx would indicate VBI or spondylogneic pain with left cervical rotation during this test

Looking for VBI or spondylogneic pain with cervical right rotation during this test

A positive standing Huatards test would be Select one: a. loss of balance b. Dropping of the arms and pt unable to hold position c. 6 CN tests positive in quick scan d. nysagmus

Dropping of the arms and pt unable to hold position

When the VA enters from C2-7 instead of C6 it is at risk for all the following except. Select one: a. Increased calcification due to loss of support. b. Rotation manipulation c. trauma. d. Compression by fiberous tissue

Increased calcification due to loss of support.

Ossification of restraining ligament of atlanteal groove can cause and increased risk for Select one: a. Embolism b. Stenosis c. Psuedoaneurysm d. Calcification of the artery

Stenosis

Which of the following is an ABSOLUTE contraindication to manipulation Select one: a. a post-menapausal patient b. a history of trauma c. a history of severe delayed posttraumatic pain d. an immediate onset of acute torticollis after trauma

an immediate onset of acute torticollis after trauma

Which THREE statements about drop attacks are true. Select one or more: a. they almost always cause the patient to fall forwards b. they are often associated with facial injuries c. they are any fall to the ground where the patient retains consciousness d. they are a contraindication to manual therapy

a. they almost always cause the patient to fall forwards b. they are often associated with facial injuries d. they are a contraindication to manual therapy

Which of the following is, of itself, is a contraindication to cervical manipulation Select one: a. dizziness b. An instability above the level to be manipulated c. moderate pain d. Limited cervical flexion

Dizziness

``` Which THREE of the following are part of Wallenberg's (lateral medullary) syndrome Select one or more: a. vertigo b. Horner's syndrome c. ataxia d. drop attacks ```

a. vertigo b. Horner's syndrome c. ataxia

``` Which of the THREE following conditions may commonly cause non-fracture anterior instability at the antlantoaxial segment Select one or more: a. Reiter's disease b. trauma c. rheumatoid arthritis d. gout ```

Reiter's disease Rheumatoid arthritis Gout

Which two of the following are most true about craniovertebral instability Select one or more: a. there are usually spinal cord signs and symptoms involved b. it is most commonly caused by severe trauma c. it is most usually associated with system arthritic disease d. it is rarely seen in general practice

c. it is most usually associated with system arthritic disease d. it is rarely seen in general practice

Down's syndrome causes instability in adults more commonly than in children Select one: a. False b. True

True

Which of the following signs/symptoms would most alarm you in a patient whose neck you had manipulated the previoius day Select one: a. dizziness b. a significant increase in pain c. tingling in the lips d. a signficant decrease in range of motion

Tingling in the lips

Which TWO of the following are components of Horner's syndrome Select one or more: a. exophthalamus b. enophthalamus c. constricted pupil d. dilated pupil

enophthalamus constricted pupil **interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis)

Which of the following characterises a pseudoaneurysm Select one: a. a ballooning out of the adventitia and media b. a ballooning out of the adventitia c. an inward ballooning of the intima d. a ballooning out of all three layers of the artery

a ballooning out of the adventitia

Patient presentation includes: minimal loss of range severe right low back pain referral to the right buttock right trunk deviation on extension All else being negative, this patient is a candidate for manipulation Select one: True False

False Severe - key word.

Patient presentation includes: minimal loss of range moderate right low back pain referral to the right buttock right trunk deviation on extension Providing the biomechanical exam is appropriately positive and there are no contraindications this patient is a candidate for manipulation Select one: True False

True Moderate - key word

On testing hearing, increased sensation of humming in the deaf ear is indicative of sensorineural deafness Select one: True False

False -louder in the good ear = sensorineural (viral - needs immediate treatment or hearing loss) If the patient hears the tuning fork in the Weber test louder in the deafer ear then it implies that the loss is conductive; if they hear it louder in the less-deaf ear then it implies that the loss is sensorineural.

When testing the cerivcal spine, which joint should be evaluated if flexion, extension and side bending is restricted at C4-C5 on the right. Select one: a. Left facet glide for extension at C4-C5 b. Inferior glide of left C5 uncovertebral joint on C6 c. superior glide of the left uncovertebral joint d. Right facet glide for flexion at C4-C5 e. Right facet glide for extension at C4-C5

superior glide of the left uncovertebral joint | c

True VBI or pain reproduction

True L side less. Hear it louder on the R. = sensorineural

Matching bilateral upper limb parasthesia - brain stem - peripheral nerve - lateral spinal stenosis - spinal cord - nerve root

spinal cord

Marching radicular pain - brain stem - peripheral nerve - lateral spinal stenosis - spinal cord - nerve root

Nerve root

Marching hemilateral parasthesia - brain stem - peripheral nerve - lateral spinal stenosis - spinal cord - nerve root

Brain stem

Matching non-segmental causalgia (CRPS) - brain stem - peripheral nerve - lateral spinal stenosis - spinal cord - nerve root

peripheral nerve

Matching unilateral upper limb parasthesia - brain stem - peripheral nerve - lateral spinal stenosis - spinal cord - nerve root

lateral spinal stenosis

Chances of having VBI without headache is low. Chance of having VBI without dizziness is very low. Select one: True False

True

Which type of dizziness more common is caused by VBI?? Type 1 Type 2

Type 2. Type 1 = vertigo (illusion of movement) Type 2 = presyncope (light headedness, nausea, fainting) Type 3 = dysequilibrium (being off balance and commonly confined to older pt) Peripheral and central dizziness are the two types??? Central is a problem with the brain itself.

The most common point of entry for the vertebral artery into the transverse foramen is at C5 Select one: True False

False C6??

Which ONE of the following is usually the cause of the most severe vertigo Select one: a. labyrinthine pathology b. vertebrobasilar ischemia c. head injury d. cerebellopontine tumor

labyrinthine pathology

37 y/o male patient presentation includes: minimal loss of range into flexion moderate right low back pain referral to the right buttock, trilevel numbness right trunk deviation on extension All else being negative, this patient is a candidate for manipulation Select one: True False

False *tri-level numbness

An intramural tear is one where the adventitia is intact Select one: True False

True

Vertebral artery hypoplasia is defined as one artery being smaller than the other Select one: True False

False - is underdevelopment or incomplete development of a tissue or organ. -Hypoplastic right vertebral artery implies that this artery is very small and its function is taken over by the left vertebral artery

Pt presents to clinic s/p MVA. Pt reports severe pain, presents with extremely guarded movements, and is unable to dissociate cervical from whole body rotations. What is the most appropriate next step? Select one: a. Perform VBI exam b. Isometric muscle test cervical region to test for fracture c. Measure AROM to determine limitation pattern d. Refer to ED for possible odontoid fracture

Refer to ED for possible odontoid fracture

When mobilizing the cervical spine for an extension hypomobility on the right at C4-C5, you will lift and translate with the right hand and the left hand will.. Select one: a. induce right translation of the segment. b. maintain right side bending c. Stabilize the head into opposite side flexion to maintain the head in neutral against translation d. Stabilize the head into right side flexion to maintain the head in neutral against translation

Stabilize the head into opposite side flexion to maintain the head in neutral against translation

Patient has a loss of right translation and a jammed end feel, which technique is a non specific manipulation for either flexion or extension hypomobility causing this limitation. Select one: a. Left z joint flexion subluxation manipulation b. right z joint extension subluxation manipulation c. UV joint manipulation d. Translation manipulation

Translation manip

When treating a L C5/C6 Extension subluxation you will Select one: a. Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articuar pillar b. Flex the spine, come onto the superior segment on the left, take up the slack, and thust is inferior through the articuar pillar c. Extend the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articuar pillar d. Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the Transverse process

Flex the spine, come onto the inferior segment on the left, take up the slack, and thust is inferior through the articuar pillar

``` To test the motions of elevation and protraction in the clavical, you will test Select one: a. The anterior roll b. distraction of the SC joint c. posterior roll ```

The anterior roll

``` GH flexion(in sagittal plane) and abduction results in a conjunct rotation of Select one: a. lateral conjunct rotation b. Inferior conjunct rotation c. medial conjunct rotation d. superior conjunct rotation ```

lateral (ER) conjunct rotation

``` With forward elevation and abduction of the shoulder, what is the associated conjunct rotation? Select one: a. medial conjunct rotation b. lateral conjunct rotation c. superior conjunct rotation d. Inferior conjunct rotation ```

lateral conjunct rotation

To test the conoid portion of the coraco-acromial ligament Select one: a. humeral extension, lateral rotation, and distraction in 45 degrees abduction b. Pulling the vertical border of the scapula away from the chest wall c. stabilizing the scapulae and pull the inferior border up d. humeral extension, lateral rotation, and distraction in neutral

stabilizing the scapulae and pull the inferior border up

Match (explain) the test position with the ligament band for the coracohumeral and Inferior glenohumeral ligament A = Anterior band of coracohumeral lig B = posterior band of the coracohumeral lig C = post band of the inf GHL D = ant band of inf GHL

A = ext, ER, distraction and shear through line of arm B= Flex, ER, combined distraction with a dorsolateral shear C = 110d abd, post-inf shear, seated or supine D = 110d abd, ant-inf shear, can be supine or seated

Pure flexion of the shoulder is in the 30degree plane of the scapula. This is a pure spin with no conjunct rotation. Select one: True False

False

Match (explain) the position for the glenohumeral ligament tests A= superior band of GHL B= inf band of GHL C= middle band of GHL

A = ER, Ext, Add, +ant shear B= ER, Ext, 90-110d abd +ant shear C= ER, Ext, 45d abd +ant shear

Prolonged segmental facilitation of the levator scapulae can lead to adaptive shortening which causes protraction at the GH joint, this can lead to destabilization due to changing the superior tilt of glenoid increasing the rotator cuff muscular tone required to maintain proper GH positioning. Select one: True False

True

When evaluating muscle hypertonicity and adaptive shortening with scapulothroacic motion, understanding of the segmental innervation is important in understanding and evaluating segmental facilitation as the potential cause of dysfunction. Select one: True False

True

To test the glenohumeral Passive Arthrokinematic Glides(PAM's), the shoulder is positioned in neutral at the side with the scapula stabilized. Select one: True False

False

When testing PPM of shoulder Abduction is found restricted and painful what could you do to rule out segmental facilitation. Select one: a. Test motor strength b. Evaluate the PAM for restriction c. Test the reflexes of the Upper extremity d. Perform manual traction or wobble and retest

Perform manual traction or wobble and retest

``` In evaluating scapulothoracic mobility, protraction/elevation is found to be limited. the segmental innervation would be Select one: a. C7.C8 b. C5,C6 c. C4, C5 d. C6, C7 ```

C6, C7

For normal shoulder biomechanics with elevation and abduction, the thoracic spine must Select one: a. ipsilaterally sidebend with neutral flexion/extension b. Extend bilaterally for full motion c. contralaterally extend to decrease stress on the thoracic spine. d. Ipsilaterally side bend and extend

Ipsilaterally side bend and extend

To test the lateral transverse humeral ligament, the shoulder is flexed about 45degrees and laterally rotated with the pt resisting shoulder and elbow extension bowstringing the tendon. Select one: True False

False *IR

When assessing mobility of scapula you notice that the pt is restricted with scapular retraction and depression quadrant. What muscle is most likely responsible for restricting this motion? Select one: a. Serratus Anterior b. Pectoralis minor c. Latissimus Dorsi d. Levator scapula

Pec minor

``` 54 y/o male with left shoulder pain with all movement directions, obligate loss of function, diffuse deltoid pain, unable to sleep on the left side, capsular pattern of restriction Select one: a. Arthritis b. Adhesive capsulitis c. RC tear d. labral tear ```

Arthritis

29 year old cyclist presents with anterior shoulder pain, pain at extreme ranges, cross body adduction pain, Select one: a. Grade III cartilage hear of the humeral head b. posterior capsular restriction c. Hill Sach's lesion d. Restricted AC jt glides would indicate biomechanical dysfunction

Restricted AC jt glides would indicate biomechanical dysfunction

females>males, 1. moderate to severe headache 2. occipito-frontal-retroorbital distribution 3. superficial 4. clearly delineated 5. non-progressive 6. related to head-neck movements and positions 7. painful and restricted neck movements (segmental dysfunction) Select one: a. Spondylogenic (cervicogenic) Headaches b. Intracranial Headache c. Migraine with Aura (classic) d. Spondylogenic Dizziness

Spondylogenic (cervicogenic) Headaches

Females >>> males Age 30-40 and childhood (females = males) severe hemicranial headache (30-40% are bilateral),prodromal aura, which may include neurological symptoms (visual most common) or systemic symptoms such as nausea, lightheadedness, phonophobia, photophobia or vomiting, duration 4-72 hours, episodic careful ROM testing is negative or only very mildly affected Select one: a. Migraine with Aura (classic) b. Spondylogenic Dizziness c. Intracranial Headache d. Spondylogenic (cervicogenic) Headaches

Migraine with Aura (classic)

1. Severe sx at onset, 2. Non-persistent (usually < 40 seconds), 3. Directionally consistent for the trigger, 4. Almost always around a vertical axis, 5. Nystagmus is horizontal with a curve to it, 6. nystagmus is gaze suppressed** Select one: a. Peripheral Vertigo b. Vertebrobasilar Ischemia c. Central Vertigo d. Spondylogenic Dizziness e. BPPV

Peripheral vertigo

Age older (>50) unless the traumatic 1. severe, non-persistent, directionally consistent with the triggering movement and no accompanying neurological symptoms or signs 2. specific movement or position triggers the vertigo 3. turning in bed is often a problem 4. Hallpike-Dix produces vertigo and horizontal nystagmus to the downward ear Select one: a. Central Vertigo b. Vertebrobasilar Ischemia c. Peripheral Vertigo d. BPPV

BPPV

1. mild or moderate 2. persistent 3. alternates either between episodes or within an episode 4. can be around a sagital axis 5. nystagmus may be vertical but often purely linear 6. nystagmus is **gaze evoked **and may be spontaneous Select one: a. Vertebrobasilar Ischemia b. Peripheral Vertigo c. BPPV d. Central Vertigo

Central vertigo

Sex female = male Age average 38 years 1. dizziness (type 1 or 2) directly associated with the headache if vertigo it will be central type vertigo 2. posterior headache directly associated with the dizziness 3. neither associated with cervical pain except coincidentally 4. +/- neurological symptoms (most likely components of Wallenberg’s syndrome) 5. symptoms related to head not body movements 6. cranial nerve signs when patient symptomatic Select one: a. Central Vertigo b. Peripheral Vertigo c. BPPV d. Vertebrobasilar Ischemia

VBI

Rim tears tend to heal within 3-6 weeks Select one: True False

False

Look for Horners syndrome with longus coli tears. Select one: True False

False

When palpating the rectus capitus posterior minor, you have the pt look laterally side to side. Select one: True False

False

There are more spindle receptors in the suboccipitals than any other muscle in the body. Select one: True False

True

Which is not a cardinal sign of sx for central nervous system involvement with VBI? Select one: a. drop attacks b. Bilateral paraesthesia c. unilateral segmental anaesthesia d. ataxia e. nystagmus

c. unilateral segmental anaesthesia

Following cranio-vertebral flexion, and its subsequent tightening of the nuchal ligament, further forward bending of the head will predominantly occur at the cervico-thoracic junction and upper thoracic joints. Select one: True False

True

Patient presents post rear collision MVA with cervical ROM limited to 55 degrees. bilaterally and cervical neck pain. This is consistent with a high cervical fracture. Select one: True False

False

In mid cervical spine you find restriction in extension of right sidebending left translation which of the following biomechanical restrictions could cause this to occur. Select one: a. Right facet flexion subluxation only b. Restricted left facet joint glide into Flexion, Restricted left superior U-Jt inferior medial glide or right u-jt suprolateral glide c. Right U-Jt loss of superior medial glide d. Left facet extension subluxation only e. Restricted right facet joint glide into extension, Restricted right superior U-Jt inferior medial glide or left u-jt suprolateral glide

e. Restricted R facet joint glide into extension, Restricted right superior U-Jt inferio-medial glide or left u-jt superolateral glide

To assess the right uncovertebral joint(C3-C4) after finding a restriction in side bending right you will come onto the right transverse process of C3, stabilize the transverse process of C4 and glide C3 inferior medially Select one: a. True b. False

True

When testing flexion mobility of the cervical spine, a right side bending restriction is noted. This would be noted with a restriction of flexion, right side flexion, left translation. Select one: True False

False

describe normal cervical flexion from neutral

1- Craniovertebral joint flexes first 2 - then the lower cervical 3 - upper thoracic region flexes

A 50 y/o male carpenter complains of lateral elbow pain of his dominant side. match the most likely Dx with the description Isometric wrist extension and palpation over the common extensor tendon is painful and there is full ROM at the wrist and elbow. Select one: - tendonosis - tendonitis - articular dysfunction of elbow - C6 articular dysfunction

Tendonosis | full ROM

A 50 y/o male carpenter complains of lateral elbow pain of his dominant side. match the most likely Dx with the description Isometric wrist extension and palpation over the common extensor tendon is painful and there is painful decreased ROM at the wrist and elbow Select one: - tendonosis - tendonitis - articular dysfunction of elbow - C6 articular dysfunction

Tendonitis | decreased ROM

A 50 y/o male carpenter complains of lateral elbow pain of his dominant side. match the most likely Dx with the description Isometric wrist extension is painful and palpation over the common extensor tendon is not Select one: - tendonosis - tendonitis - articular dysfunction of elbow - C6 articular dysfunction

Articular dysfunction of elbow | tendon non painful

A 50 y/o male carpenter complains of lateral elbow pain of his dominant side. match the most likely Dx with the description over the common extensor tendon is painful and there is full ROM at the wrist and elbow but the pain varies with neck position Select one: - tendonosis - tendonitis - articular dysfunction of elbow - C6 articular dysfunction

C6 articular dysfunction

Matching - Tendonitis/osis/labral tear/AC dys Select one A - Point pain with full ROM B - Point pain with dec ROM

point pain, full ROM

Ligament tear, muscle belly tear, avulsion Select one: A - point pain with full ROM B - point pain with dec ROM

Dec ROM, point pain.

Referral pain from the viscera select one: A - dull aching diffuse pain at shoulder with full ROM B - generalized lateral shoulder pain with dec ROM

A - dull aching

Arthritis Select one: A - dull aching diffuse pain at shoulder with full ROM B - generalized lateral shoulder pain with dec ROM

B - dec ROM, generalized pain.

40 Year old woman complains of parasthesia in both arms. Which of the following test do you think are most important in diagnosing her condition. Select one: a. Clonus in the arms and legs b. deep tendon reflexes of the arms and legs c. Hoffmann's test d. ROM testing of the arms and neck

Hoffmann's test

Which of the following would be more specific for tendonopathy? Select one: a. full passive stretching of the tendon b. minimal contraction in the rest position c. palpation of the tendon for tenderness d. maximal isometric contraction testing in stretched position.

minimal contraction in the rest position

Which of the following questions when positive is most indicative of a labral tear? Select one: a. pain sleeping on that side b. pain on extreme ROM c. painful joint clicking d. sudden onset of severe pain with physical activity

painful joint clicking

A 38 year old female complains of pain in the anterior aspect of the right shoulder just below the acromion after reaching behind her to undo her bra one month ago. The pain was sudden and sharp followed by a moderate ache for a few hours. Over the next four weeks she has had two other episodes of similar pain once after lifting a heavy grocery bag and once on waking. Assume this patient has full ROM with moderate pain at the end of elevation, a positive load-shift test and positive O'Briens test. If the biceps long head tendon was tender on palpation and painful on contraction which hypothesis would you think most useful. Select one: a. the diagnosis is a primary biceps tendonopathy b. there is a labral tear and the tendonopathy is a part of it c. there is an axoplasmic flow problem causing tendonopathy d. there is a labral tear and a coincidental tendonopathy

there is a labral tear and the tendonopathy is a part of it

Assuming a primary biceps tendonopathy is caused by structural weakness from axoplasmic flow compromise, which of the following would describe the flow that is compromised. Select one: a. slow grade b. slow retrograde c. fast grade d. fast retrograde

slow grade

You discover the presence of reflex inhibition causing weakness of the lateral rotators and abductors of the shoulder but wobbling the shoulder does not increase the strength. Which of the following is most likely true? Select one: a. it is probably coming from the elbow b. it is probably coming from the C5 segment c. it is probably coming from the shoulder d. it is probably coming from the thoracic spine

it is probably coming from the thoracic spine

Reflex inhibition of the lateral rotators and abductors of the shoulder can co-exist with segmental facilitation of the C5/C6 segment but is not part of the facilitation Select one: a. false b. true

True

You find a flexion subluxation of the right facet joint of the T3/T4 segment which of the following describes it's MECHANICAL relationship to the patient having a labral tear Select one: a. it in an affect b. it is both cause and effect c. it is the cause d. it is unrelated

it is the cause

On examination, you find the long head of the biceps tendon tender to palpation and that a strong contraction of the muscle only in it's stretched position is painful, Which of the following is most likely true and most precise Select one: a. it is a biceps tendonopathy b. it is a biceps tendonitis c. it is to early to say because the transverse ligament hasn't been tested d. it is a biceps tendonosis

it is a biceps tendonosis

A 65 year old women complains of parasthesia and aching in both hands in the thumb and fingers and radial aspects of the forearm. There is also moderate aching in the back of the lower neck. What is the most likely diagnosis? Select one: a. bilateral cervical disc herniation b. bilateral lateral stenosis c. Spinal cord compression form the disc herniation d. spinal cord compression for central stenosis

bilateral lateral stenosis

A 50 y/o male carpenter complains of lateral elbow pain of his dominant side.he complains of pain on gripping but not on moving the elbow or the shoulder. Isometric wrist extension is painful but wrist and elbow movement are of full passive range and painfree. There is not tenderness over the common extensor tendon. Which of the following is most likely. Select one: a. extensor tendonosis b. extensor peritenitis c. radiohumeral articular dysfunction d. extensor tendonitis

radiohumeral articular dysfunction

You find the following: 1. right common extensor tendonosis 2. right c5/c6 flexion subluxation 3. No evidence of segmental facilitation 4. a right radioscaphoid palmar subluxation 5. a right abducted ulna Select one: a. treat everything but the tendonosis b. manipulation of the neck, elbow and wrist. treat the tendonosis c. manipulate the elbow and wrist and treat the tendonosis but don't treat the neck d. manipulate the neck and elbow and treat the tendonosis

manipulate the elbow and wrist and treat the tendonosis but don't treat the neck

You believe that there may be some structural weakness caused by AXT compromise, how do you best confirm this.. Select one: a. look for indirect evidence of slow flow compromise by looking for direct evidence of fast flow compromise b. look for direct evidence of slow flow compromise by asking after other enthesitis' in the same segment c. look for direct evidence of fast flow compromise by looking for rapidly fatiguing weakness in the same segment d. look for indirect evidence of fast flow compromise by looking for direct evidence of slow flow compromise

look for indirect evidence of slow flow compromise by looking for direct evidence of fast flow compromise

You believe that the diagnosis of tennis elbow you made is being caused by an extension subluxation of C5/C6 causing a combination of AXT compromise and facilitation. You are considering treating a thoracic subluxation as a contributing factor. Which of the following is the most likely to contribute and so be a viable target for treatment. Select one: a. an extension at T1/2 b. an extension subluxation at T3/4 c. A flexion subluxation at T1/2 d. a flexion subluxation at T3/4

A flexion subluxation at T1/2

A 33 year old man after an MVA complains of right upper neck pain with headache running from the right sub-occipital area over the top of the head to the right forehead. There is also a feeling of light headedness. What is the most likely cause. Select one: a. Upper cervical fracture b. Intracranial bleed c. Cervical biomechanical dysfunction d. Vertebrobasilar ischemia

Cervical biomechanical dysfunction

Which of the following is the most likely explanation for the presence of low central neck pain radiating into both upper trapezius in a weight lifter attempting and failing a dead lift overhead with very heavy weights. The onset of pain was sudden and severe. Select one: a. traumatic spondylolisthesis b. Clay shoveller's fracture(avuslion of C7 spinous process) c. segmental dysfunction d. posterior disc herniation

Clay shoveller's fracture(avuslion of C7 spinous process)

A 60 year old male involved in a head on collision MVA gradually develops right sided neck and shoulder pain over the next two days. A day later he develops right sided superior and temporal headache which over the next three days gradually increases in intensity but does not spread. here are no neurological symptoms. Which of the following is the most useful explanation. Select one: a. concussion headache b. post-traumatic migraine c. spondylogenic headache d. Intracranial bleed

Intracranial bleed

Which one of the following tests would you choose to do in a patient complaining of post traumatic neck pain, cervical ROM of about 80% of the expected and mild type I dizziness on turning the head to the right. Select one: a. minimized de Kleyns b. Body tilting c. Hall Pike -Dix d. Body rotation to the left

Body tilting (Body tilt is a safe test and can determine if the dizziness is coming from the vestibular system and if so testing the neck becomes less risky)

Immediately after a car accident a 68 year old male patient has a sudden onset of severe posterior and central upper cervical pain spreading out bilaterally and associated with a painful torticollis. Which of the following tests do you think is the most appropriate. Select one: a. Isometric testing b. cervical ROM testing c. very light compression d. PA testing

very light compression

A 38 year old female complains of pain in the anterior aspect of the right shoulder just below the acromion after reaching behind her to undo her bra one month ago. The pain was sudden and sharp followed by a moderate ache for a few hours. Over the next four weeks she has had two other episodes of similar pain once after lifting a heavy grocery bag and once on waking. Which of the following group of diagnoses do you believe the final diagnosis will come? Select one: a. tendonitis, tendonosis, labral tear, AC joint dysfunction b. ligamentous tear, muscle belly tear, avulsion fracture c. Traumatic arthritis, adhesive capsulitis, systemic arthritis d. referred from the neck, referred from the thoracic spine, referred from the viscera

tendonitis, tendonosis, labral tear, AC joint dysfunction

Adhesive capsulitis is a typical example of an arthritis Select one: True False

False

Painful weakness of lateral rotation of the shoulder and spasm on passive medial rotation is indicative of a grade 1 tear of the infraspinatus muscle Select one: True False

False

In the even that palpation of the tendon was tender you have diagnosed a tennis elbow but the patient has not changed his activities, work environment or been away from work prior to the onset. It is likely that his occupation has caused the tennis elbow. Select one: True False

False

Mod 8 - LE

Patient presents with right lower back and leg pain reaching the heel. He is deviated and is off work. Which of the following pairs of tests would be the most useful in diagnosing this condition? Select one: a. Neurological testing and SLR b. ROM and SLR c. Neurological testing and ROM d. ROM and compression distraction tests

ROM and SLR

A 40 year old women complains of severe central and bilateral low back pain with somatic pain into the backs of both thighs. Which pair of conditions are the most likely(they are not occurring at the same time but each give a similar presentation). Select one: a. central stenosis or median(posterior) disc herniation b. median(posterior) disc herniation or spondylolisthesis c. spondylolisthesis or central stenosis d. bilateral disc herniation or central stenosis

median(posterior) disc herniation or spondylolisthesis

A 29 year old man complains of severe central/bilateral low back pain with severe somatic pain into the backs of both thighs the pain worse on the right than the left in the legs and the back. There is no deviation and the pain is progressive. There is no history of a severe low back injury in adolescence. Which of the following pairs of tests would you carry out to prove the diagnosis. Select one: a. SLR and neurological tests b. ROM and PA's c. PA's and SLR d. ROM and SLR

ROM and PA's

Disc herniation pain improves with walking and worsens with sitting Select one: True False

False

Match - Unilateral segmental hyporeflexia - Radiculopathy - peripheral neuropathy - spinal cord compression - cauda equina syndrome

Radiculopathy

Match unilateral non-segmental hyporeflexia - Radiculopathy - peripheral neuropathy - spinal cord compression - cauda equina syndrome

peripheral neuropathy

Match - bil non-segmental hyper-reflexia - Radiculopathy - peripheral neuropathy - spinal cord compression - cauda equina syndrome

spinal cord compression

Match - bil, multisegmental hyporeflexia - Radiculopathy - peripheral neuropathy - spinal cord compression - cauda equina syndrome

cauda equina syndrome

Match - bil, multisegmental hyporeflexia - Radiculopathy - peripheral neuropathy - spinal cord compression - cauda equina syndrome

cauda equina syndrome

Select ALL the answers with conditions that may cause redness around a joint? Select one or more: a. gout b. Infective arthritis c. Uncomplicated traumatic arthritis d. Osteoarthritis e. rheumatoid arthritis

gout infective arthritis RA

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. Based on the history and prevalences the final diagnosis is likely to be which? Select one: a. referred pain from the lumbar spine b. a component of a larger systemic condition such as Reiter's disease or ankylosing spondylitis c. Plantarfascitis d. calcaneal stress fracture

Plantarfascitis

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. Since he uses appropriate equipment including boots that are in good condition. This condition is likely to be secondary to some predisposition on yet ascertained. Select one: a. False b. True

True

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. Assuming for the sake of this question only that the pain is referred from the lumbar spine, which test would be most sensitive(in the research sense of the word) in disproving it if negative. Select one: a. PA over L5 b. PA over L4 c. ROM testing d. SLR

PA over L5

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. An ipsilateral long leg may contribute to plantarfascitis, Select ALL of the mechanism below that cause this. Select one or more: a. Causes and inversion subluxation of the talocalcaneal joint b. Causes an anterior(medial rotation) subluxation of the talus c. Reduces AXT at the L5/S1 segment ipsilaterally d. Causes the anterior head of the talus to overstretch the plantar fascia

c. Reduces AXT at the L5/S1 segment ipsilaterally | d. Causes the anterior head of the talus to overstretch the plantar fascia

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. An ipsilateral long leg may contribute to plantarfascitis, Select ALL of the mechanism below that cause this. Select one or more: a. Causes and inversion subluxation of the talocalcaneal joint b. Causes an anterior(medial rotation) subluxation of the talus c. Reduces AXT at the L5/S1 segment ipsilaterally d. Causes the anterior head of the talus to overstretch the plantar fascia

c. Reduces AXT at the L5/S1 segment ipsilaterally | d. Causes the anterior head of the talus to overstretch the plantar fascia

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. Assuming for the sake of this question this is not a calcaneal stress fracture what in the patient's history tends to rule this out? Select one: a. He is 28 ear old b. There is no evidence of a pathology that could cause a stress fracture c. The stress being applied is not severe enough d. He is not a female

The stress being applied is not severe enough

Match - pain with each step and non-palpable calcaneal undersurface - heel spur - plantar fascia - STJ articular dysfunction - fat pad atrophy

heel spur

match - pain on WBing after rest with pain decreasing on walking - heel spur - plantar fascia - STJ articular dysfunction - fat pad atrophy

plantar fasciitis

Match - episodic pain - heel spur - plantar fascia - STJ articular dysfunction - fat pad atrophy

STJ articular dysfunction

Match - Pain on each step, hard surfaces worse - heel spur - plantar fascia - STJ articular dysfunction - fat pad atrophy

Fat pad atrophy

The lumbar spine may cause plantar fascitis by weakening its structural integrity. The mechanism for doing so would be which? Select one: a. S1 segmental facilitation b. Slow flow axoplasmic compromise from S1 c. L5 segmental facilitation d. Slow flow axoplasmic compromise from L5

Slow flow axoplasmic compromise from S1

A 28 year old man complains of pain under the medial side of the heel with a duration of four weeks. The onset followed a 2-day hiking trip with a heavy back pack on mountain trails. He is an experienced but moderate hiker. He has no similar history or other foot pain. Which of the following are you ore likely to find causing plantarfascitis in this patient? Select one: a. diabetic medial plantar neuropathy b. unstable mortise c. eversion subluxation of the calcaneous d. S1 radiculopathy

eversion subluxation of the calcaneous

Gradual stretching the plantarfascia with night splints or tape is a reasonable treatment. Select one: True False

False

You found an eversion subluxation at the posterior talocalcaneal joint and you believe it to be relevant to the patient's heel pain. You would manipulate it medially using an arthrokinematic technique. Select one: True False

False

A 45 year old woman complains of severe right low back and buttock pain of 2 weeks duration. The pain worsened over the following week but has leveled off since but not improved. She has no past history of similar pain. Her doctor diagnosed a disc herniation and gave her analgesics and rest. Answer the following. Based on the history the most likely diagnosis will be segmental dysfunction of the lumbar spine or SI joint but there was no previous history. Select one: True False

False

Which of the following test results will help you EXCLUDE the SI joint as the pain generator. Select one: a. (+) SLR b. (-) fortin's finger test c. (+) fortin's finger test d. (-) SLR

(-) fortin's finger test

``` Which of the following test results would most help INCLUDING the SIJ at the main pain generator. Select one: a. (+) SLR and (+) hip flexion b. (-)SLR adn (-) hip flexion c. (+) SLR and (-) hip flexion d. (-) SLR and (+) hip flexion ```

(+) SLR and (+) hip flexion

45 y/o female w severe rt LBP and buttocks pain 2 weeks. After further questioning you find that the patient has a + fortin's test, problems turning in bed to the point where it will wake her and walking is by far her most difficult and painful thing to do and that unguarded movements cause severe momentary pain. She has no history of other joint involvement or gut problems. Which of the following is most likely true considering all of your current information. Select one: a. She has a lumbar segmental dysfunction. b. she has traumatic sacroilitis c. She has systemic sacroillitis d. she has a sacroilliac articular dysfunction

she has a sacroilliac articular dysfunction

It is impossible for women over the age of 50 to have a SIJ mechanical dysfunction Select one: True False

False

Moderately painful SI dysfunction = limited hip flexion and better SLR Lumbar disc herniation = limited SLR and near full range of hip flexion gluteal hematoma = limited hip flexion and spasm end feel Septic sacroilitis = limited hip flexion and empty end feel

info

On examination you find an innominate that is subluxed into extension(unable to posteriorly rotate). Which of the following is a reasonable cause for this. Select one: a. Ipsilateral short leg b. contralateral long leg c. hip flexion hypomobility d. hip extension hypomobility

hip extension hypomobility

The patient demonstrates a long leg with walking but normal leg length in standing. What is the probable explanation. Select one: a. undercompensation on the short leg b. hip extension hypomobility c. good compensation mechanism d. over compensation on the long leg

hip extension hypomobility

A 45 year old woman complains of severe right low back and buttock pain of 2 weeks duration. The pain worsened over the following week but has leveled off since but not improved. She has no past history of similar pain. Her doctor diagnosed a disc herniation and gave her analgesics and rest. Answer the following. Given all the information from the prior questions select ALL of the treatments that may reasonably be expected to improve things in the long and short term. Select one or more: a. a shoe raise in the short leg b. McKenzie passive extension exercises c. manipulation of the SIJ d. manipulation of the hip e. anti-inflammatory treaments to the SIJ f. Kegel's exercises

c. manipulation of the SIJ d. manipulation of the hip f. Kegel's exercises

IMPACT Quizzes Flashcards

(306 cards)