Lecture Final Review Questions Flashcards by Lindsay Kirkpatrick

Your patient has lateral elbow pain. What exam procedures are best to assess the soft tissue structures associated with plausible causes? (choose all that apply)
A) Varus (adduction) stress test
B) Valgus (abduction) stress test
C) Golfer’s test
D) Cozen’s test
E) Mill’s test

A) Varus (adduction) stress test
D) Cozen’s test
E) Mill’s test

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A 30 year old woman complains of tingling and numbness in the medial portion of her hand extending to her little finger. Select all plausible differential diagnosis for this patient.
A) C6 nerve root
B) C8 nerve root
C) nerve entrapment in the cubital tunnel
D) nerve entrapment in the cubital fossa
E) carpal tunnel syndrome

B) C8 nerve root
C) nerve entrapment in the cubital tunnel

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What muscles are used to evaluate L3?
A) iliopsoas
B) adductors
C) tibialis anterior
D) extensor hallicus longus & brevis
E) peroneus longus & brevis

B) adductors

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The dermatomal sensory distribution for L4 is in what area?
A) across the mid thigh
B) across the thigh just above the knee
C) along the lateral foot
D) along the medial lower leg, in front of the malleolus to the great toe
E) along the medial lower leg, behind the malleolus to the great toe

E) along the medial lower leg, behind the malleolus to the great toe

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What type of pain is usually described as cramping, spasm or aching?
A) neurologic
B) dermatogenous
C) sclerotogenous
D) myotogenous
E) vascular

myotogenous

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Glute max test evaluates which nerve(s)? (choose all that apply)
A) superior gluteal
B) inferior gluteal
C) L4 nerve root
D) L5 nerve root
E) S1 nerve root

B) inferior gluteal
E) S1 nerve root

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The achilles reflex evaluates which nerve(s)? (choose all that apply)
A) deep peroneal (fibular)
B) tibial
C) L4 nerve root
D) L5 nerve root
E) S1 nerve root

B) tibial
E) S1 nerve root

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Sensation along the lateral lower leg corresponds with which nerve(s)? (choose all that apply)
A) deep peroneal (fibular)
B) superficial peroneal (fibular)
C) L4 nerve root
D) L5 nerve root
E) S1 nerve root

B) superficial peroneal (fibular)
D) L5 nerve root

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What test(s) is(are) designed for piriformis syndrome? (choose all that apply)
A) piriformis stretch test
B) piriformis stress test
C) Bonnet’s test
D) Goldthwaite’s test
E) Braggard’s test

A) piriformis stretch test
C) Bonnet’s test

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What does a positive Kemp’s test indicate?
A) radiculopathy
B) SI sprain or subluxation
C) lumbosacral involvement
D) facet syndrome
E) piriformis syndrome

A) radiculopathy

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Which of the following tests or signs are used to confirm a lateral disc lesion causing a radiculopathy?
A) advancement test
B) bowstring sign
C) Goldthwaite’s test
D) Linder’s test
E) well leg raise

D) Linder’s test

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Which orthopedic test/sign is used to differential a lumbo-sacral issue vs. an SI problem?
A) Lewin’s standing
B) Neri’s bowing sign
C) Belt test
D) Advancement test
E) Adam’s test

C) Belt test

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Which of the following tests or signs could be positive with a radiculopathy caused by a disc lesion?
A) Turyn’s test
B) straight leg raise
C) Sicard’s test
D) Braggard’s test
E) advancement test

All of the above

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Which patient position is appropriate for Gaenslen’s test?
A) standing
B) seated
C) prone
D) supine
E) lateral decubitus (side-lying)

D) supine

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Sag sign indicates:
A) meniscus injury
B) LCL tear
C) MCL tear
D) PCL tear
E) ACL tear

D) PCL tear

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Distal lateral knee pain should be evaluated with: (choose all that apply)
A) valgus (abduction) stress
B) Dryer’s sign
C) Noble’s test
D) Ober’s test
E) common peroneal (fibular) pure patch

C) Noble’s test
E) common peroneal (fibular) pure patch

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What nerve(s) supply sensory innervation to the dorsum of the foot between the 1st and 2nd toes?
A) L4 nerve root
B) L5 nerve root
C) deep peroneal (fibular) nerve
D) superficial peroneal (fibular) nerve
E) tibial nerve

B) L5 nerve root
C) deep peroneal (fibular) nerve

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P-A drawer of the ankle assesses which ligament?
A) anterior talo-fibular
B) posterior talo-fibular
C) talo-calcaneal
D) anterior tibio-talar
E) posterior tibio-fibular

A) anterior talo-fibular

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Which test is used to evaluate vascular insufficiency in the lower extremity?
A) Allen’s test
B) Buerger’s test
C) Homan’s test
D) Moses’ test
E) Clark’s sign

B) Buerger’s test

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The majority of information needed to make a clinical diagnosis comes from:
A) history
B) inspection
C) palpation
D) orthopedic tests
E) neurologic tests

history

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Which orthopedic test(s) are designed for ankylosing spondylitis? (choose all that apply)
A) Shepelmann’s test
B) Forestier’s bowstring test
C) Lewin’s standing test
D) Lewin’s supine test
E) Lewin-Gaenslen’s test

B) Forestier’s bowstring test
D) Lewin’s supine test

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What exam procedure is used to evaluate the vascular integrity of the anastomosis in the upper extremity?
A) ROOS’ test
B) Milroy’s test
C) Berger’s test
D) Allen’s test
E) Adson’s test

D) Allen’s test

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Which cranial nerve innervates the muscle that brings the eye down and in?
A) CN II
B) CN III
C) CN IV
D) CN V
E) CN VI

C) CN IV

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Posterior circulation compromise may cause which? (choose all that apply)
A) apallesthesia
B) intention (kinetic) tremors
C) loss of balance
D) loss of vision

A) apallesthesia
B) intention (kinetic) tremors
C) loss of balance
D) loss of vision

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Your patient complains of sharp pain shooting into the arms when looking down. What sign is this? A) Linder's sign B) Forrestier's sign C) Lewin's sign D) L'Hermitte's sign E) Lindner's sign

D) L'Hermitte's sign

Your patient complains of sharp pain shooting into the arms when looking down. Which of the following is MOST LIKELY to cause the positive sign presented? A) multiple sclerosis B) muscular dystrophy C) ankylosing spondylitis D) lateral disc lesion E) medial disc lesion

A) multiple sclerosis

What is the least invasive test for a space occupying lesion?

Triad of Dejerine

What test can be used to differentiate SI involvement from LSJ involvement in a patient that is not comfortable lying on a table?

Belt test

Pain, swelling and redness in the calf after a flight may indicate what?

deep vein thrombosis/thrombophlebitis

What test would be positive in a patient with pain, swelling and redness in the calf after a flight?

Moses' test Homan's test (never do these if you really suspect DVT)

Which of the following positive findings would help to confirm a nerve root etiology in a patient complaining of numbness and tingling into the left hand? A) Wright's test B) Bakodi test C) O'Donaghue's maneuver D) Apley's scratch test

B) Bakodi test

Which of the following tests would confirm a thoracic outlet syndrome etiology in a patient presenting with numbness and tingling in the left hand? A) Shoulder depression test B) Bakodi's test C) Reverse Bakodi's test D) Allen's test

C) Reverse Bakodi's test

Which thumb muscle would test 5/5 in a patient that has carpal tunnel syndrome? A) Opponens pollicus B) Flexor pollicus brevis C) Flexor carpi radialis D) Adductor pollicus

D) Adductor pollicus (innervated by ulnar n)

Wasting of the thenar eminence is associated with what? A) radial nerve impingement B) median nerve impingement C) apical lung tumor D) C5 nerve root impingment

B) median nerve impingement

What other test would most likely be positive in a patient with a positive Mittlemeyer marching test? A) Weber's test B) Romberg's test C) Babinski Weil D) Romberg's position

C) Babinski Weil

Visual acuity is tested using what? A) Visual fields of gaze B) Direct and indirect light reflex C) Cardinal fields of gaze D) Snellen eye chart

D) Snellen eye chart

What other test would you expect to be positive in a patient with a positive English test? A) Tinel tap at the carpal tunnel B) Tinel tap at the tunnel of Guyon C) Finkelstein's test D) Froment's paper test

A) Tinel tap at the carpal tunnel

A positive test for Phalen's test is what? A) wrist pain B) pain at the radial styloid C) pain and paresthesia in the thenar eminence D) reduced radial pulse patency

C) pain and paresthesia in the thenar eminence

What is the diagnosis of a 4+J biceps reflex? A) corticospinal tract lesion B) corticobulbar tract lesion C) normal reflex D) hyperreflexic

A) corticospinal tract lesion

Your patient presents with a right antalgic lean with right lower extremity pain. What is the likely position of the disc herniation relative to the nerve root?

medial

Your patient presents with a right antalgic lean with right lower extremity pain. What position would likely aggravate this condition?

lean away

Your patient presents with swelling of the lower leg and foot, and has warmth in the calf area. They admit they just returned from a vacation in England. What is an appropriate diagnostic procedure?

doppler ultrasound

Your patient presents with apallesthesia, intention tremors, and loss of vision. What could cause this?

posterior blood circulation compromise

What test for meningitis should you do if you thought there was even a small chance of VBAI?

Kernig's test

Your patient has lateral knee pain. What test(s) could you perform to test the lateral collateral ligament?

varus (adduction) stress test

Your patient has lateral knee pain. What test(s) could you perform to test the iliotibial band?

- Ober test - Noble test

Your patient has lateral knee pain. What test(s) could you perform to test the lateral meniscus?

- Apley compression/grinding test - McMurray test

Your patient has lateral knee pain. What test(s) could you perform to test the common fibular nerve?

- no muscle test, no reflex - sensory pure patch over fibular head

Your patient has deep pain and swelling in the right leg after vacationing in Great Britain. The leg feels warm to the touch and is red in colour. What do you suspect and how should this be assessed?

DVT - Homan's & Moses' tests (DO NOT PERFORM) - doppler ultrasound - D-dimer testing

Your patient complains of lateral hip pain. She has snapping hip syndrome from ITB contracture, and has had surgery on the opposite side. She also has a keloid scar. What test would be positive?

Ober test

Ginny's mom notices that she is walking funny. When she steps with her right foot, she lifts her foot higher and her toes hit the floor first. What disease(s) could cause this?

- Myasthenia Gravis - Charcot Marie Tooth disease - Guillian-Barre - Diabetes - Polio - Lyme disease - Porphyria

Ginny's mom notices that she is walking funny. When she steps with her right foot, she lifts her foot higher and her toes hit the floor first. What structures do you suspect are involved?

- tibialis anterior - deep peroneal n

Your patient Hal has posterior thigh pain when you left his leg up to 50 degrees of flexion. What tests will be positive for hamstring AND for sciatic neuritis?

- Lewin’s standing test - Neri’s Bowing sign - advancement test

What tests can differentiate between hamstring AND for sciatic neuritis?

Bowstring sign

Your patient Inga has weakness with plantarflexion and eversion on the left side. What muscles are most likely involved?

Fibularis (peroneus) brevis & longus

Your patient Inga has weakness with plantarflexion and eversion on the left side. What peripheral nerve is most likely involved?

superficial fibular n

Your patient Inga has weakness with plantarflexion and eversion on the left side. What orthopedic test would most likely be positive?

Duchenne sign

Your patient Inga has weakness with plantarflexion and eversion on the left side. What disc would most likely be herniated?

Your patient has a glute max lurch when walking. Assuming it is due to nerve root injury, what other muscles would be weak?

- peroneus (fibularis) L&B - Gastrocnemius - soleus

Lena has sharp shooting pain down her right leg that is worse when seated trying to abduct the legs. What do you suspect?

Piriformis syndrome (r/o disc lesion)

name 2 tests that would be positive for piriformis syndrome.

- Bonnet's test - Piriformis stretch test

Your patient demonstrates a bilateral steppage gait. What is most likely to be the reason? A) a disc lesion B) peripheral nerve entrapment C) systemic disease process D) cervical spinal cord compression E) VBAI F) cerebellar dysfunction

systemic disease process

Your patient says she has clumsiness while playing the piano with her left hand. What is this phenomenon called?

dysdiadochokinesia

Your patient says she has clumsiness while playing the piano with her left hand. What system is involved AND which side of that system?

cerebellum on the left

Your patient has pain at the medial knee. What structures are **most likely** involved?

- medial collateral ligament - medial meniscus

Name 2 neurologic reasons for tingling and numbness above the medial knee?

- L3 nerve root - obturator peripheral nerve

Paul is experiencing sharp pain along his right medial forefoot. It is aggravated by jogging and walking. **state** a condition you suspect.

- tarsal tunnel syndrome (most likely) - march Fx - morton's neuroma - metatarsalgia - jogger's foot (entrapment of medial branch of posterior tibial nerve)

Your patient has pain down their left lateral forearm when looking down. Could this be L'Hermitte's sign?

Yes (shock-like pain)

Your patient has pain down their left lateral forearm when looking down. Could this be Lindner's sign?

No, Lindner's is associated with lateral lumbar disc lesion

Your patient has pain down their left lateral forearm when looking down. Could this be a possible disc lesion?

Yes (lateral forearm = C6)

Your patient has pain down their left lateral forearm when looking down. Could this be a possible TOS?

Yes (middle scalene or possible costoclavicular)

Your patient has anteromedial knee pain. Name 3 conditions that are most likely.

- MCL - L3 - medial meniscus

Name 2 tests for chondromalacia patella

- patellar grind (Clarke's sign) - Fouchet's sign

Which direction is the patella likely to dislocate?

laterally

Name one test to confirm a suspected fractured patella

Dreyer’s sign

Name 2 tests for an ACL tear

Anterior drawer Lachman’s test

What symptoms are common with meniscal injuries?

Audible pop/click/snap in knee joint or pain in medial/lateral compartment

Name 2 tests for a meniscal injury

- Apley’s compression/grinding test - McMurray’s test

Your patient claims he cannot flex his right hip after a fall at work. He wants to know if you handle workers' comp. cases. What is the **best** exam procedure to perform?

Hoover’s

You notice scapular asymmetry that persists when the patient is flexed forward. What exam procedure is this called? What does this indicate?

Adam’s (forward bend) test Structural scoliosis

Name a test for a tear of the posterior talo-fibular ligament

Posterior drawer

Name a test to evaluate the Achilles' tendon

Thompson Test

Your patient has facial drooping on the right. When asked to raise their eyebrows, they cannot raise the right one. What condition do you suspect?

Bell's Palsy

Significant quadriceps weakness on one side will result in what type of gait?

hip hike or circumduction

Gene complains of dull pain at the anterior knee and an inability to extend his knee on the right. What condition could this be and what orthopedic test would you do?

Patellar Fx Dryer sign

Patient complains of sharp shooting pain down the right leg and is leaning to the right. She says it is like a lightning bolt when she sneezes. What do you suspect?

Medial disc lesion

Patient complains of dully achy pain in the posterior thigh. What do you suspect and what tests could you perform?

Hamstring strain Bowstring sign/Neres bowing sign/Lewing standing/SLR

Alice has pain and tingling in the lateral leg. What are the possible differentials?

- superficial peroneal n (most likely) - common peroneal n

Barney has a loss of ability to feel vibration, shaking when reaching for objects, and loss of vision. What is the likely cause of this?

- apallethesia: dorsal columns - intention tremor: cerebellum - loss of vision: CN II **posterior circulation compromise**

All ligaments of the hip restrict what motion?

extension

What motions are lost first with hip OA?

IR & flexion

Weakness of the biceps muscle with normal strength of the wrist extensors indicates a lesion of the: A) axillary n B) radial n C) median n D) C5 nerve root E) C6 nerve root

C5 nerve root