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Flashcards in OCS McGee Deck (113)
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1


1. What is the most common location associated with Gout?
a. 1st MCP joint
b. Patellofemoral joint
c. 5th TMT joint
d. 1st MTP joint

d.  Correct

2


A 22 year old sedentary male presents to your clinic with an insidious onset of low back pain for three weeks.  The patient reports his pain is increased with rest and decreased with activity.  The pain is localized to his lower lumbar and upper SIJ region.  Radiographs have not been taken and NSAID’s have helped reduce the pain.

1. Based on the above information, the patient’s signs and symptoms are most closely associated with
a. Ankylosing Spondylitis
b. Herniated Nucleus Pulposus
c. Mechanical low back pain
d. Spondylolisthesis

a. Correct
b. Incorrect. This is typically associated with a flexion + rotation mechanism with symptoms extending distal into the buttocks and lower extremities
c. Incorrect. This is typically associated with trauma or microtrauma (not insidious onset) and is typified by pain decreased with rest and increased with activity
d. Incorrect. This is typically associated with trauma or overuse from gymnastics or activities involving extremes of lumbar extension

3


A 22 year old sedentary male presents to your clinic with an insidious onset of low back pain for three weeks.  The patient reports his pain is increased with rest and decreased with activity.  The pain is localized to his lower lumbar and upper SIJ region.  Radiographs have not been taken and NSAID’s have helped reduce the pain.

2. This patient would most likely benefit from which of the following physical therapy interventions?
a. Bedrest for 48 hours and education about staying as active as possible and continuing to take his NSAID’s
b. Flexion exercises and education about sleeping with a pillow under his knees
c. Extension exercises and education about discontinuing usage of a pillow under his head while sleeping
d. Mechanical lumbar traction

a. Incorrect. This is standard medical management for mechanical low back pain
b. Incorrect. This is a typical intervention for spondylolisthesis as it decreases the extension moments at the lower lumbar spine
c. Correct: Extension exercises assist in maintaining mobility and the discontinuation of using a pillow under his head assists in decreasing a kyphotic spine
d. Incorrect. This is indicated for HNP.

4


What is the “classic triad” associated with Reiter’s Syndrome?
a. Arthritis, laryngitis, ptosis
b. Arthritis, conjunctivitis, laryngitis
c. Arthritis, ptosis, urethritis
d. Arthritis, conjunctivitis, urethritis

d.   Correct. Arthritis occurs most commonly in the weightbearing joints with an asymmetric presentation.  There is a mild redness, tearing and burning of the eyes which lasts for a few days.  There is an increased frequency and burning associated with urination (typically the first symptom).  Reiter’s syndrome is a self-limiting disease that typically resolves in 3-4 months

5


4. Reiter’s Syndrome has two forms, each associated with a different pathology.  These two pathologies are:
a. Flu & Meningitis
b. Malaria & Ringworm
c. Typhoid & Yellow Fever
d. Venereal Disease & Dysentery

d. Correct. The two forms of Reiter’s Syndrome are associated with dysentery and venereal infection

6


 A series of chronic relapses of Reiter’s Syndrome typically causes which of the following?
a. Pain at the PIP’s and DIP’s of the hands and a decrease in depth perception
b. Upper cervical spine hypermobility and kidney infection
c. Lumbar/SIJ deformity and chronic Plantar Fasciitis and Achilles tendonitis
d. Pannus formation at the wrist and PIP’s of the hand

a. Incorrect
b. Incorrect
c. Correct: Lumbar and SIJ deformity (assess by radiograph) is common.  Chronic Achilles tendonitis and Plantar Fasciitis occurs because the disease process makes inflammation at tendinous insertions common.
d. Incorrect. This is common in Rheumatoid Arthritis

7


Fibromyalgia is most appropriately defined as a
a. Muscle endurance disorder
b. Myofascial pain disorder
c. Sleep disorder
d. Psychosomatic disorder

a. Correct. Fibromyalgia is a muscle endurance disorder resulting in muscle fibers becoming taut, fibrous bands that place a stretch on tendinous insertions and fascia.  These painful sites are commonly known as “tender points”.
b. Incorrect. Myofascial pain syndrome is typified by one or two trigger points within a single muscle with a characteristic pain referral pattern.
c. Incorrect. 70-90% of all Fibromyalgia patients suffer from an inability to attain stage 4 sleep.  However, poor sleep is only a symptom and a contributing cause of Fibromyalgia.
d. Incorrect.  Although once thought to be a suspect diagnosis, Fibromyalgia has very specific diagnostic criteria.

8

A 48 year old homemaker presents to your clinic with a four month history of bilateral neck and shoulder pain of insidious onset.  She complains of poor sleep, lack of endurance, and an onset of symptoms with using her upper extremities for greater than 15 minutes.  Her pain is severely impacting her quality of life.  Upon physical examination, you discover tenderness to palpation at the bilateral Suboccipital muscles, bilateral upper Trapezius, the medial portion of the supraspinatus muscles bilaterally, and the intertransverse spaces of C6-7 bilaterally.  You also discover tenderness along her right elbow at the lateral epicondyle and at her bilateral paraspinals of L4/5.  When palpating, you are careful to use only enough pressure to cause the nailbed of your finger to blanche.  You have performed special tests that have ruled out all other cervical and shoulder pathology.  Based solely on the above information, would you diagnosis this patient with Fibromyalgia?

a. Yes
b. No

a. Incorrect. This patient has several criteria that fit the diagnosis of Fibromyalgia to include pain for greater than 3 months and poor sleep.   She also has 11 tender points that are tender to palpation and the examiner used the appropriate amount of force (enough to turn the nailbed white, approximately 4kg of force).  However, the diagnostic criteria of Fibromyalgia require that 11 of 18 specific tenderpoints be tender.  The paraspinals of the lumbar spine are not among those tenderpoints.  Also, the patient must complain of “widespread” pain that is bilateral, above and below the waist, and include the axial and appendicular skeletal pain.
b. Correct

9


A 17 year old female soccer player presents to your clinic 24 hours after sustaining a Grade 2 contusion to her right quadriceps.   She is leaving for a soccer road trip that very afternoon and asks your advice as to whether put heat or ice on her leg while traveling on the team bus.  She states that she has been icing for the past 24 hours, however, she has heard conflicting advice regarding the use of ice or heat after the first 24 hours of the injury.  You instruct her to do which of the following?
a. Use ice
b. Use heat
c. Use ice for the next 24 hours, then switch to heat
d. Neither.  If she is OK to play soccer this weekend, she doesn’t need to worry about the bruise. 

a. Correct. Cold modalities are indicated for acute contusions
b. Incorrect.  Muscle contusions often have deep bruising associated with them.  By applying heat, an increase in temperature can result in an increased bleeding which has been shown to result in Myositis Ossificans.
c. Incorrect. 
d. Incorrect.

10


9. A 68 year old retired metal worker is 9 weeks status post right TKA.  The patient has been on a fishing vacation for the past two weeks.  When he returns for physical therapy, you notice he has a flexion contracture at his right knee that is preventing him from attaining the last 15 degrees of knee extension.  He was able to attain terminal knee extension prior to leaving for vacation.  He reports that he was not adherent to his home exercises while on vacation and that he is beginning to develop some low back pain.  Which of the following interventions would you choose to perform in the clinic in order to restore this patient’s range of motion as rapidly as possible?


a. Contract/Relax stretches to his hamstrings
b. Static stretch to his hamstrings
c. Ultrasound to his distal hamstrings followed by Contract/Relax stretches to his hamstrings
d. Ultrasound to his distal hamstrings followed by static stretch to his hamstrings

a. Correct.  Contract/Relax stretches will increase range of motion more rapidly than static stretches.  While static stretches are effective, the patient can perform static stretches at home.
b. Incorrect.  The patient can perform static stretches at home.  Doing these in the clinic is not the most effective use of time.
c. Incorrect.  Ultrasound is contraindicated over plastic implants and joint cement. 
d. Incorrect.  Ultrasound is contraindicated over plastic implants and joint cement.

11

10. A 43 year old male recreational basketball player presents to your clinic with acute patella tendonitis.  You decide to utilize iontophoresis using dexamethasone to treat the inflammation and ask a technician to set-up the treatment.  Once the patient is ready, you stop by to ensure the parameters are correct before beginning the iontophoresis treatment. The technician comments that there was only 1.25cc of dexamethasone left in the medicine dispenser and that he used a 1.5cc pad.  You check to ensure that no dexamethasone has leaked from under the pad.  It hasn’t.  You notice that the technician has placed the dispersive pad on the patient’s distal quadriceps.  The active pad is placed over the patella tendon with pre-wrap covering the pad along the edges to keep it in place.  The negative electrode is attached to the active pad.  The generator is set to 40mA-min.  Based on this information, what is most likely to cause a burn during this treatment?

a. Intensity: 40mA-min is too high of a setting for dexamethasone
b. Pre-wrap covering the active pad
c. Too little medication on the active pad
d. Wrong polarity: dexamethasone should be pushed from the positive electrode

a. Incorrect.  40mA-min is an ideal intensity for iontophoresis
b. Incorrect.  The pre-wrap is only covering the edges of the pad.  Risk of burns increase when something is placed directly over the electrode, thus compressing it against the skin.
c. Correct.  One of the most common causes of burns associated with iontophoresis is an under-filled pad.
d. Incorrect.  Dexamethasone is negatively charged.

12

11. A 27 year old female presents to physical therapy to reduce scar-tissue adhesions to her right forearm 3 months after a radial shaft fracture was surgically repaired with open reduction/internal fixation.  You elect to combine iontophoresis and transverse friction massage in order to break up the scar tissue.  What agent will you “push” with the iontophoresis?
a. Acetic acid
b. Dexamethasone
c. Dexamethasone combined with Lidocaine
d. Iodine

a. Incorrect.  Acetic acid is used to treat calcific tendonitis
b. Incorrect.  Dexamethasone is used to treat inflammation
c. Incorrect.  Dexamethasone combined with Lidocaine is used to treat inflammation and pain.
d. Correct.  Iodine is used as an anti-sclerotic agent.

13


Your clinic performed a research study to determine the efficacy of lumbar manipulation in patients with acute low back pain.  Ten subjects were included in the study and were equally divided into two groups.  The experimental group received lumbar manipulation twice a week for two weeks.  The control group received moist heat and TENS for twenty minutes, twice a week for two weeks.  The outcome measure was the Oswestry Disability Index which patients were asked to complete before their initial treatment and after their last treatment.  A two-tailed t-test was performed with a significance set at p<0.05. 


12. Based on the above information, what was the independent variable of this study?
a. Manipulation
b. Moist heat and TENS
c. Oswestry Disability Index
d. T-test
 

a. Correct.  Manipulation was the variable or intervention being studied
b. Incorrect.  This was the control treatment
c. Incorrect.  This was the dependent variable
d. Incorrect.  This was the statistical test

14


Your clinic performed a research study to determine the efficacy of lumbar manipulation in patients with acute low back pain.  Ten subjects were included in the study and were equally divided into two groups.  The experimental group received lumbar manipulation twice a week for two weeks.  The control group received moist heat and TENS for twenty minutes, twice a week for two weeks.  The outcome measure was the Oswestry Disability Index which patients were asked to complete before their initial treatment and after their last treatment.  A two-tailed t-test was performed with a significance set at p<0.05. 

13. In order for the Oswestry Disability Index to be an appropriate outcome measure for this study, it must have:
a. Construct validity
b. Content validity
c. Concurrent validity
d. Predictive validity

a. Correct.  Construct validity pertains to the extent to which a tool measures what it claims to measure.  In this example, the Oswestry Disability Index should have high construct validity for assessing disability in patients with low back pain.
b. Incorrect.  Content validity pertains to whether the test samples the behavior that is being studied.  For example, if you were writing an anatomy final examination, you would want to ensure the test had good content validity.  This means that the final examination measured all parts of human anatomy equally.  For example, equal parts of gross anatomy and microanatomy.
c. Incorrect.  Concurrent validity pertains to the relationship between test scores of what is being measured (test #1) and what it is being compared to (test #2).  For example, if a researcher wants to validate a new back assessment questionnaire (Acme Back Index), she will want to compare it to a questionnaire that represents the “gold standard” (the Oswestry for example).  She would have the subjects take both questionnaires at the same time and compare the Acme (test #1) to the Oswestry (test #2). 
d. Incorrect.  Predictive validity measures the extent to which a future prediction can be made based on a measure made today.

15

The researchers involved in this study were particularly worried about a Type 2 Error occurring when they performed their statistical tests.  A Type 2 Error is:


a. Stating there is a difference between two treatments when there is not one
b. Stating there is no difference between two treatments when there is one
c. The generalization from the sample being studied to the population
d. The probability of reaching a correct decision

a. Incorrect.  This is the definition of a Type 1 Error.  It means the researchers are afraid of “backing a loser”.
b. Correct.  This typically occurs with a small sample size.  It means “missing a winner”.
c. Incorrect.  This is the definition of External Validity
d. Incorrect.  This is the definition of the Power of a Statistical Test

16


15. A 33 year old male recreational tennis player reports that he heard a “pop” and felt immediate pain when performing a serve three days ago.  His shoulder hurts when he attempts to elevate his arm greater than 90°.  You suspect a labral injury.  You immediately perform the anterior apprehension test (for SLAP lesions) as described by Mimori.  The test is negative.  You feel confident that the patient does not have a SLAP lesion because the test has a reported high degree of:
a. Power
b. Precision
c. Sensitivity
d. Specificity

a. Incorrect.  Power relates to the probability of reaching a correct decision with a statistical test
b. Incorrect.
c. Correct. Sensitivity pertains to the True Negatives of a test.  A simple trick in remembering this is SnNOut: Sn sensitivity N when negative Out rules out the pathology
d. Incorrect.  Specificity pertains to the True Positives of a test.  A simple trick in remembering this is SpPIn: Sp specificity P when positive In rules in the pathology

17


A 30 year old left-hand dominant female sustained a compression injury to her left arm approximately 2cm proximal to the medial epicondyle.  The injury occurred three weeks prior and is beginning to show signs of improvement.  Physical examination revealed decreased pinch and grip strength, compromised thumb stability with manual resistance, and flexion contractures or “clawing” of the 4th and 5th fingers. 

If this patient had a negative Tinel’s sign at the elbow, what is the most likely classification of her nerve injury?
a. Axonotmesis
b. Neurapraxia
c. Neurotmesis
d. Wallerian Degeneration

a. Incorrect.  This is a second-degree injury and would produce a (+) Tinel’s sign.
b. Correct. This is a first-degree injury (least severe).  Due to the local demyelination, Tinel’s sign would be negative.
c. Incorrect.  This is a fifth-degree injury caused by a complete transaction of the nerve.  Tinel’s sign would be positive.
d. Incorrect.  This is a component of an axonotmesis.

18


A 30 year old left-hand dominant female sustained a compression injury to her left arm approximately 2cm proximal to the medial epicondyle.  The injury occurred three weeks prior and is beginning to show signs of improvement.  Physical examination revealed decreased pinch and grip strength, compromised thumb stability with manual resistance, and flexion contractures or “clawing” of the 4th and 5th fingers.

If this patient had a positive Tinel’s sign at the elbow, what is the most likely classification of her nerve injury?
a. Axonotmesis
b. Neurapraxia
c. Neurotmesis
d. Wallerian Degeneration

a. Correct.  Axonotmesis would produce a (+) Tinel’s sign.  Since the mechanism of injury was compression, we are not concerned with a total transaction of the nerve (Neurotmesis) which would also elicit a (+) Tinel’s sign but would not be showing signs of improvement.
b. Incorrect.  This would cause Tinel’s sign to be negative
c. Incorrect.  While we would expect a positive Tinel’s sign with this injury, the nerve would have been totally transected – unlikely with a compression injury – and thus would not be showing signs of improvement. 
d. Incorrect.  While Wallerian degeneration is a component of an Axonotmesis injury, it is not a classification of a nerve injury in and of itself.

19


Assuming that this patient had an Axonotmesis, what would be her predicted rate of nerve recovery?
a. ½ inch per week
b. 1 inch per week
c. 1 inch per month
d. No recovery

c.   Correct.  The proper prognosis for nerve recovery following an Axonotmesis is approximately 1 inch per month. 

20


19. Assuming that this patient had an Axonotmesis, what would be her expected prognosis?
a. 100% recovery
b. 50-75% recovery
c. <50% recovery
d. No recovery

a. Correct.  The prognosis for axonotmesis (and neuropraxia) is complete recovery
b. Incorrect.
c. Incorrect.
d. Incorrect.  Fourth degree (neuroma incontinuity) and fifth-degree (Neurotmesis) injuries will not recover.

21


20. Which of the following tissues has the ability to regenerate itself instead of repairing with scar tissue?
a. Bone
b. Ligament
c. Muscle
d. Tendon

a. Correct.  Bone can regenerate via osteoblastic activity.
b. Incorrect.
c. Incorrect.
d. Incorrect. 

22


Which of the following is an example of the pathology attributed to Rheumatoid Arthritis?
a. Chronic thickening and edema of the synovial lining
b. Thinning and breakdown of hyaline cartilage
c. Inability to weightbear on the MTP’s of the feet
d. Inability to flex the DIP’s of the hand

a. Correct
b.  Incorrect.  This is a pathology associated with Osteoarthritis
c.  Incorrect.  This is an impairment typically associated with OA
d.  Incorrect.  This is an impairment typically associated with OA

23


What are the most common locations associated with Rheumatoid Arthritis?

A.) DIP’s, hips, knees, feet
B.) DIP’s, wrists, hips, feet 
C.) PIP’s, wrists, knees, feet
D.)  Shoulders, PIP’s, hips, knees

C

24

What is the “telltale” radiographic sign of Ankylosing Spondylitis?
A) Bamboo Spine
B) Degenerative Disc Disease
C) Schmoral’s nodes 
D) Scotty Dog

A) Correct
B) This is a normal sign of aging
C) This is a sign of compression fractures
D) This is a sign of spondylolisthesis

25


A 24 year old male presents to your clinic following a traumatic injury that occurred to his right shoulder 2 days prior while playing basketball.  The patient stated that an opposing player struck his right forearm while he was attempting to catch a pass.  He immediately felt pain and a “pop” at the time of injury.  After further questioning, you determine his arm was in a position of approximately 100° abduction, 90° of external rotation, and slight extension at the time of injury and that the opposing player’s force was directed from anterior to posterior.  The patient is very hesitant to move his arm and presents with his arm in glenohumeral neutral and slight adduction.

Based upon the information above, you suspect the patient most likely has what type of injury?
a. Anterior glenohumeral instability
b. Acromioclavicular sprain
c. Posterior glenohumeral instability
d. SLAP lesion

a. Correct.  The most common mechanism for anterior glenohumeral subluxation/dislocation is an indirect trauma with the arm abducted, externally rotated, and extended.
b. Incorrect.  This is typically seen with a direct trauma to the superior shoulder
c. Incorrect.  The most common mechanism for posterior glenohumeral subluxation/dislocation is an axial load with the shoulder in adduction, flexion, and internal rotation
d. Incorrect.  The most common mechanism is a traction injury to the long head of the biceps or FOOSH.

26


A 24 year old male presents to your clinic following a traumatic injury that occurred to his right shoulder 2 days prior while playing basketball.  The patient stated that an opposing player struck his right forearm while he was attempting to catch a pass.  He immediately felt pain and a “pop” at the time of injury.  After further questioning, you determine his arm was in a position of approximately 100° abduction, 90° of external rotation, and slight extension at the time of injury and that the opposing player’s force was directed from anterior to posterior.  The patient is very hesitant to move his arm and presents with his arm in glenohumeral neutral and slight adduction

Based on the mechanism of injury, what structures are most likely to be compromised?
a. Inferior Glenohumeral Ligament Complex & Biceps Brachii
b. Coracoclavicular ligament
c. Posterior Glenohumeral capsule
d. Anterior labrum and long head of the Biceps tendon

a. Correct.  With the glenohumeral joint in 90°/90° Abd and ER, the primary restraints to anterior humeral translation are the Inferior Glenohumeral Ligament Complex & Biceps Brachii
b. Incorrect.  This would be injured with a AC sprain
c. Incorrect.  This would be injured with posterior instability
d. Incorrect.  This would be injured with an anterior SLAP injury

27

A fifteen year old female soccer player presents to your clinic 1 week after traumatic anterior dislocation of her right shoulder.  She states her athletic trainer had to reduce her injury on the sideline.  Since the time of injury, she has been treated in her training room with ice and TENS and has been wearing a sling.  Upon physical examination, you find the following:  Positive Anterior Apprehension/Relocation test, negative Feagin’s sign, and negative sulcus sign.  Radiographs reveal no fractures of the Humerus or Glenoid.

Based on the above information, this patient would most likely fit into which surgical diagnostic category?
a. AMBRI
b. Inferior Instability
c. SLAP Type 1
d. TUBS
 

a. Incorrect.  AMBRI stands for ATRAUMATIC MULTIDIRECTIONAL BILATERAL REHABILITATION (as appropriate) and rarely INFERIOR capsular shift surgery.  This patient’s injury was traumatic and there was no multidirectional instability as demonstrated by the negative Feagin's and Sulcus signs.  These injuries typically respond well to physical therapy and surgery is typically not recommended.
b. Incorrect.  This patient had negative Feagin’s and Sulcus signs – both assess for inferior instability of the shoulder.
c. Incorrect.  A Type 1 SLAP is associated with degenerative fraying of the superior labrum.
d. Correct.  TUBS stands for TRAUMATIC UNILATERAL anterior with a BANKART lesion responding to SURGERY.

28


A fifteen year old female soccer player presents to your clinic 1 week after traumatic anterior dislocation of her right shoulder.  She states her athletic trainer had to reduce her injury on the sideline.  Since the time of injury, she has been treated in her training room with ice and TENS and has been wearing a sling.  Upon physical examination, you find the following:  Positive Anterior Apprehension/Relocation test, negative Feagin’s sign, and negative sulcus sign.  Radiographs reveal no fractures of the Humerus or Glenoid.

When assessing this patient on the field, her athletic trainer would want to assess for possible injury to what nerve.
a. Axillary
b. Dorsal Scapular
c. Radial
d. Suprascapular

a. Correct.  Traumatic dislocations are often associated with Axially nerve injuries
b. Incorrect.  The Dorsal Scapular nerve comes off of the superior trunk of the brachial plexus and is not near the site of injury.
c. Incorrect.  Proximal Radial nerve injuries are typically associated with Humeral shaft fractures.  Radiographs showed no fractures with this patient.
d. Incorrect.  The Suprascapular nerve comes off of the superior trunk of the brachial plexus.  It is often associated with injuries involving excessive protraction of the shoulder.

29


A 27 year old female postal worker tore her right rotator cuff.  The patient elected to have surgery for her right shoulder.  What type of repair would allow for the fastest post-operative rehabilitation?
a. Arthroscopic
b. Open
c. Mini-Open

a. Incorrect.  While arthroscopic repairs were originally thought to be able to be progressed faster, research has shown that they must be progressed slowly due to the weaker fixation of the repair.  Recurrence rates for arthroscopic repairs are high, between 8-17%
b. Incorrect.  Open repairs require the deltoid muscle to be released/detached from the clavicle or acromion.  The patient cannot initiate AROM of the deltoid for 6-8 weeks.  Recurrence rates for open procedures is 5%.
c. Correct.  Mini-open repairs require a small, vertical incision be made between the anterior and middle deltoid fibers.  This allows for early initiation of deltoid AROM and a faster course of rehabilitation. 

30


6. What type of SLAP repair is typically associated with a bucket-handle tear of the superior labrum with an intact biceps tendon and biceps anchor?
a. Type 1 SLAP
b. Type 2 SLAP
c. Type 3 SLAP
d. Type 4 SLAP

a. Incorrect.  This is associated with a degenerative fraying of the superior labrum
b. Incorrect.  This is associated with the biceps anchor being pulled away from the glenoid
c. Correct.
d. Incorrect.  This is associated with a bucket-handle tear with a torn biceps tendon and the labrum being displaced into the joint