Download 1. Presence of increased intrathecal pressure is

NEUROMUSCULAR SKELETAL
by BUGGIN
1. Presence of increased intrathecal pressure is indicative of
*I get a jolt of back pain when I sneeze
2. 10 yoa female with mild back pain after PE. Only finding is 15 degree scoliosis, apex
of curve is at T9, T10 what management
*manipulation
-scoliosis
less than 20 degree  monitor and adjust
20 to 40 degree  brace  Millwakee
greater than 40 degreee  surgery  Herrington rods
3. 13 yoa female with constant low grade pain in midback. Aggravated playing
volleyball, shoulders becoming rounded
*Scheuermann’s disease  active teenager, schmoral’s node (form of
compression fracture)
-AS  NEVER in female teenagers
-Reiter’s syndrome  in males
-DISH (diffuse idiopathic dkeletal hyperostosis)  middle age
4. Diagnostic for tendinitis
*chief complaint, pain reproduced during resistive muscle testing
-O’Donoghue’s
5. Dizziness with nausea, progressive hearing loss and ringing in the ears
*Meniere’s syndrome  aka endolymphatic hydrops
tinitis, vertigo, deafness
6. Recent onset of photophobia with severe generalized headache, fever and malaise
*meningitis  infection of the cerebral spinal fluid (due to presence of glucose
and NO leukocyte)
-spondylosis  DJD
7. Difficulty during ambulation in dimly lit rooms is most suggestive of dysfunction in
*dorsal columns
-ambulation difficult  dorsal column, cerebellum
eyes closed  cerebellum
eyes open (light off)  dorsal column – has proprioception (feel or see
how to walk)
cerebellar lesion  ataxia
8. Most crucial information in case history of patient with post traumatic wrist pain
*color or temperature changes  vascular change
1
9. 14 yoa infrapatellar pain
*Osgood Schlatter
10. Repetitive dropping of the unsupported side of the pelvis
*waddling
11. Predispose to increased thoracic kyphotic
*Pott’s disease  aka TB of spine
12. Symptoms atypical of an L5 herniated nucleus pulposus
*loss of perineal sensation
-L5 herniated disc  S1 nerve
13. Gradually developed elbow pain in 25 yoa after repetitive use of screwdriver
*lateral epicondylitis
14. Most likely in patient with anterior chest pain of one week duration following a
month of repetitive coughing episodes
*costochrondritis
-rib fracture  lateral chest pain
-hiatal hernia  epigastric pain
15. Postural presentations is normal in a one year old
*pes planus  aka flat foot
-genu varus, coxa valgus  all normal in children
16. Abnormal gaits most commonly accompanies dysdiadochokinesia, pendular reflex
response and dysmetria
*ataxic cerebellar
-dysmetria  past pointing
-dysdiadochokinesia  coordination
-ataxic sensory  posterior column
17. Anatomic right leg deficiency of 1 cm typically results in a --- lumbar scoliosis with
spinous deviation --- the convexity
*right, away from
-righting reflex  head tilt  occiput and axis
18. Compensate for weak hip flexors by
*leg circumduction  stroke
19. Most common level for discopathy in cervical spine
*C5, C6  most motion in cervical spine
apex of cervical lordosis
2
20. Most commonly present on the involved side accompanying a C6, C7 disc syndrome
*weak wrist flexors  C6/C7 (C6 is disc and C7 is the nerve)
-brachioradialis  C6
-weak wrist extensors  C6
21. Best diagnosis if cervical flexion causes bilateral radiating pain to all extremities
*myelopathy  myelo = spinal cord
-polyneuropathy  diabetics, peripheral neuropathy
22. Pain during cervical distraction indicate
*muscle spasm
-cervical distraction  relieve radicular pain
-subclavian steal syndrome  subclavian steals blood supply causing dizziness
23. Anterior scalene muscle is most apt to compromise the contents of the thoracic outlet
during which maneuver
*ipsilateral head rotation and extension  Adson’s test
-medial scalene muscle test  contralateral head rotation and extension
(modified Adson’s)
-SCM = same side lateral flexion, opposite side rotation
24. Active hip and knee flexion during passive flexion of a supine patient’s neck
indicates
*meningeal irritation - Brudzinski test
-Kernig test meningitis
25. Diminished triceps reflex is associated with
*C7
-no reflex for C8
26. Pain on contralateral side during the maximum cervical compression test indicates
*muscular
-ipsilateral side  neural
27. Most common finding with osteochondrosis of the secondary epiphysis of the
vertebra
*kyphosis
-secondary epiphysis of the vertebra  endplate
28. Increased pressure on a growth plate decreases the rate of growth within the
endochondral ossification zones
*Heuter Volkmann
-Risser Ferguson and Cobb’s  evaluation of scoliosis
-Wolff’s law  increased pressure causes increased density on bone
3
29. Ankylosis at the costotransverse and the costovertebral articulations is most
commonly indicated by a positive --- test
*chest expansion
30. Winging of the scapula in a standing patient is usually due to weak
*serratus anterior  SALT (serratus anterior – long thoracic) your wings
31. Localized pain along the lateral border of the rib cage during anterior to posterior
compression indicates
*rib fracture
32. Hip flexion during external rotation of the thigh tests
*psoas
-TFL  abduction
33. If right lateral bending of the torso is severely restricted and causes a left lumbar
paraspinal pain and myospasm with pain radiating to the left buttock --- syndrome
*quadratus lumborum
-pain radiating to left buttock  sciatic pain due to tightening of piriformis
-tightening of the QL will cause spasm of the piriformis
-L5 rotation with sacrum problem will cause rib subluxation due to QL
34. Weakness of the extensor hallicus longus
*L5 = L4 disc
35. Dull posterior thigh pain during straight leg raise test
*tight hamstrings
36. If the posterior drawer sign demonstrates hypermobility of the tibia, lesion is
*posterior cruciate
37. Injuries most likely to impair forearm rotation
*fracture of the radial head
-torn bursa  can not extend
-tennis elbow  may be able to rotate forearm
38. Anterior drawer test performed with 15 degrees of the external rotation of the lower
leg evaluates the anterior cruciate ligament and
*medial collateral ligament  drawer test ALWAYS testing ligament
-meniscus  does not limit motion
39. Findings of auditory testing indicate sensorineural deficit of CN VIII
*sound which lateralizes to the unoccluded ear
-sensorineural deficit  NO hearing
-sound which lateralizes to the occluded ear  normal
-air to bone conduction ratio of less than 2:1  obstruction
4
40. A slipped capital femoral epiphysis causes --- during passive hip flexion
*abduction
41. Shoulder pain produced at 150 degrees of passive abduction is indicative of --- joint
dysfunction
*sternoclavicular
-first 20 glenohumoral
-20 to 120 scapulothoracic and glenohumoral
-after 120 sternoclavicular
42. Holding the elbow in extension while performing passive wrist flexion and pronation
*lateral epicondylitis  aka tennis elbow
more common
Mill’s and Cozen
-medial eppicondylitis  aka golfer’s, Little Leaguer’s
43. Pain in the region of the sinus tarsi during passive plantar flexion and inversion of the
foot is indicative of
*anterior talofibular  most common position of ankle sprain
-sinus tarsi  lateral depression of foot
44. Lesion of the sensory cortex --- the distance between two recognizable points in 2
point discrimination testing is
*increase
45. Inability to identify an object by palpating its size and shape is
*astereognosis
46. Symmetrical defect in the lower quadrant of the visual field indicate
*radiations  ¼ of upper or lower quadrant of the visual field lost
-chiasm
-tract
-nerve
47. Patient presents with an inability to wrinkle the left forehead or close the left eye
tightly. The left side of the mouth does not rise during smiling. The cause is probably
a --- motor neuron lesion of the --- facial nerve.
*lower, left  hyporeflexia
-facial nerve does not cross
-cause could also be Bell’s palsy, stroke, mysthenia gravis
48. Cervical neurologic stimulation produces headaches due to upper cervical afferent
convergence with fibers from the nucleus of
*CN V – has both sensory and motor
-CN IV and VI is both motor only
5
49. Patient who is unable to look laterally in a cardinal gaze exam probably has lesion of
*abducens
50. Patient with 20 year history of diabetes mellitus. An exam indicate hair loss over
dorsal aspect of the foot and mid calf of each lower extremity the etiology of the hair
loss is
*chronic arterial insufficiency  see shiny tight skin
-peripheral neuropathy  see muscle changes
51. Unable to protrude tongue
*hypoglossal  tongue deviates to the weak side
52. Primarily supplied by the fifth cervical nerve
*deltoid  C5 only
-biceps  C5, C6 shared innervation
53. Ulnar nerve lesion in the arm is likely cause a loss of
*adduction and flexion
-extension  radial nerve
-supination  brachioradialis
54. Occurs in both upper and lower motor neuron disease
*muscle weakness
-fasciculation  only lower motor neuron
-clonus and hyperreflexia  upper motor neuron only
55. Sensory innervation to the dorsum of the foot
*L5
56. Procedures is employed during the physical exam to rule out coarctation of the aorta
*pulse difference between the upper and lower extremity
-if coarctation of abdominal aorta  timing of the femoral vs radial pulse
-aortic arch  upper pulse asymmetrical (right has blood supply, left doesn’t)
cephalic
carotid
subclavian
-MI  no pulse or pulse, symmetrical
-abdominal aorta  lower pulse asymmetrical
57. To evaluate for low pain threshold, the doctor applies digital pressure to the patient’s
*mastoid process  Libman’s test  pain threshold and malingerer test
6
58. A patient with a lesion of the axillary nerve is likely to have decreased sensation over
the
*deltoid muscle
-thenar eminence  median nerve
-axilla  T2
-elbow  T1  medial and lateral antebrachial
59. The ability to preceive the presence of vibration w when a tuning fork is played over
a boney prominence is called
*pallesthesia  vibration sense
-kinesthesia  your perception of movement
-stereoanesthesia  inability to recognize object in your hand
-graphesthesia  recognize writing
60. Stimulation of the patellar reflex is initiated by stretch of
*muscle spindle
-pacinian corpuscle  touch
61. A lesion of which of the following locations is likely to present a recent history of an
outburst of severe poorly localized pain
*thalamus  brain
-localized pain  nerve root
62. The presence of pathologic reflex in a lower extremity is indicative of a lesion in the
--- tract
*corticospinal
-pathologic reflex  upper motor neuron lesion  absent
-spinothalamic and corticobulbar  ascending  sensory
63. Indicated by plantar flexion of the foot and toes during plantar stimulation
*normal response
-UMNL  flaring of toes
64. Cranial nerves serves as the afferent limb of the corneal reflex
*trigeminal
-testing afferent in (CN5) and efferent out (CN 7)
65. A herniated nucleus pulposus which compresses the nerve root between the 3rd and 4th
lumbar segment diminishes which of the following reflexes
*knee jerk
66. Ulceration is a common finding in which of the following causes of peripheral edema
*chronic venous insufficiency
-orthostatic edema  posturally related circulation problem
-loss of hair  due to loss of blood flow
7
67. The most common location of a peripheral artery aneurysm is the --- artery
*popliteal
68. Progressive worsening headaches, papilledema, vomiting, convulsions and focal
neurological deficits without fever
*intracranial masses
-papilledema  fundoscopic exam  bulging fundus
-MS is NOT inflammatory
69. Arterial disease manifest which of the following clinical findings
*shiny, thin skin  loss of hair
-marked edema  venous insufficiency
70. The posterior tibial pulse is palpable at which site
*posterior to the medial malleolus
71. More common among males, manifests muscle weakness, atrophy and irregular
twitching of involved muscles, but is not accompanies by sensory or mental deficits
*amyotrophic lateral sclerosis  Lou Gerhig’s disease
LMNL  upper extremity
UMNL  lower extremity
NO sensory deficit
-myasthenia gravis  fatigue of cranial nerve small muscles  fine in the
morning and gets worse at night
-Parkinson’s disease  has mental deficits  resting tremor (tremor when at rest
 “rest in the Park”
-MS  triad of sin (scanning speech, intention tremor, nystagmus)  Charcot’s
triad  generally female (young adult)  intentional tremor (tremor with
motion)
72. A patient presents with an altered gait and difficulty performing the finger to the nose
test or rapid alternating movement. Which system is implicated
*cerebellar  ataxia, dysmetria, dysdiadochokinesia
73. --- is not a characteristic of Parkinson’s disease
*intention tremor
-characteristic of akinesia (no movement), rigidity, festinating gait
-progressive  put on aerobic exercise (will use up the neurotransmitter) else
cause spasming and contraction of muscle
74. A constant tinnitus which begins faintly and becomes progressively louder is most
characteristic of
*otosclerosis
-tinnitus  seen with vertigo  Mennier’s disease
-NOT positional if constant
8
75. Patient presents with diplopia, ptosis, dysphagia, dysarthria, limb weakness and an
expressionless face all of which become worse in the evening
*myasthenia gravis
76. Characterized by muscle dysfunction following injury or disease of upper motor
neuron at the level of the cortex or throughout the course of their fibers within the
brain
*cerebral palsy  caused by birth injury
-Arnold Chiari syndrome  protrusion of the brain out through the foramen
magnum
-Brown Sequard syndrome  contralateral spinal problem  sensory problem on
one side and motor on the other side
77. Damage to the radial nerve often lead to
*wrist drop
DCM
(Dr Cuma)
RUA
drop  radial
claw  ulna
age  median
78. A patient who exhibits dysdiadochokinesia most likely has
*ataxia
-unconscious proprioception  cerebellar
79. Leriche’s syndrome is characterized by occlusion of
*aortic bifurcation
-problem with abdominal aorta  where it bifurcates  decrease arterial supply
to the legs
-not enough blood in the femoral artery BUT the occlusion is in the abdominal
aorta
80. Characterized by chronic progressive small vessel disease
*polycythemia  long ago people thought vessels decreased instead of too many
blood vessels
81. Nerves most likely entrapped in the lower extremity in a patient with nocturnal
burning foot muscle weakness which is confirmed by electromyography
*posterior tibial  tarsal tunnel syndrome
-carpal tunnel syndrome  nocturnal pain
82. Patient presents with severe right sided throat pain which radiates into the right ear.
Talking, swallowing and eating elicit the pain. Exam of the pharynx is normal
*glossopharyngeal neuralgia
-trigeminal neuralgia  Tic Delereau
-Bell’s palsy  CN 7
9
83. Describes the pattern of neurological sign and symptoms secondary to an
intervertebral foramina lesion
*dermatomal  nerve root  IVF
-soma  muscle, tendon, ligament, myofascia
84. The presence of right sides ataxia, dysmetria dysarthria, intention tremor and general
hypertonia is suggestive of an intracranial mass located in the
*right cerebellar hemisphere  NO crossing over of cerebellum
-crossing occurs in the cortex
85. Patient presents with bilateral leg pain during walking. Continued walking produces
paresthesia, numbness and foot drop
*central spinal stenosis  nerve root
-muscle weakness  nerve compression
-paresthesia  nerve
-numbness  nerve OR arterial
-myoneural junction disorder  myasthenis gravis  muscle to nerve
-cerebrovascular disorder  stroke
86. Bilateral soft pitting edema following prolonged sitting or standing with no associated
cutaneous changes
*orthostatic edema  change in symptoms with change in posture
87. A hyperabduction syndrome results from compression of the neurovascular bundle
between the rib cage and the --- muscle
*pectoralis minor
-hyperabduction syndrome  pectoralis minor syndrome  Wright’s syndrome
88. Is a peripheral and cerebellar neuropathy caused by alcohol abuse
*Wernicke Korsakoff syndrome
-Charcot Marie Tooth Disease  toothpick legs in children (little girls)
-Guillian Barre syndrome  paralysis progressing upward from feet  due to flu
vaccination
89. A patient with Duchenne’s muscular dystrophy exhibits which finding
*absence of dystrophin  chemical agent responsible for calcium uptake in
muscle causing enlargement
-decrease muscle pain and deep tendon reflexes
-abnormally high CPK
-waddling gait
-Becker’s muscular dystrophy  affects the 18 yoa (Duchenne’s affect the 8 yoa)
10
90. Result of severed lateral bands or the avulsion of the distal insertion of the extensor
digitorum tendon
*mallet finger  in extension fingers dip down at the tips
-swan neck deformity (hyperextension of the proximal and flexion of the distal) or
Boutonniere’s (flexion of the proximal and extension of the distal)  RA
-Heberden’s nodes  DIP  OA
-Boutonniere’s  IP
-Haygarth  PIP  RA
“He Boo Hay”
91. Stenosing tenosynovitis of the abduction pollicus longus and extensor pollicus brevis
is called
*Dequervain’s disease  Finkelstein’s test
-Keinbock’s  avascular necrosis of lunate
-Dupuytren’s contracture  thickening of the palmar tendon causing flexion of
the 4th and 5th digits
-Sever’s disease  avulsion fracture of the calcaneous  in children
92. Types of headache characterized by general head pain and tenderness over the occiput
and cervical trapezial musculature
*tension
93. Chorea is characterized by which of the following
*fine, rapid, rhythmic involuntary movements
94. A 30 yoa obese male presents with a history of gradually progressive difficulty
climbing stairs. Exam reveals hyperlordosis, quadriceps atrophy, large calves,
sluggish deep tendon reflexes and elevated serum creatinine kinase levels
*Becker’s dystrophy  MS in men
95. Most apt to atrophy during prolonged, post operative immobilization of the knee
*vastus medialis
96. Kohler’s disease is an osteochondrosis of the
*tarsal navicular
97. Bending deformity and long thin tubular bones which appear osteoporotic and poorly
trabeculated are characteristic of
*rickets  bone softening
-osteogenesis imperfecta  genetic disorder passed from father to son  blue
sclera
-hypoparathyroidism  more calcium in bone  aka pseudogout
11
98. A 72 yoa female presents with shoulder pain which occurs when she combs her hair
or dresses herself. She has a restricted shoulder range of motion in all directions and
marked hyperkyphosis. x-rays are normal
*adhesive capsulitis  aka frozen shoulder  lateral scapula giving appearance
of hyperkyphosis
-AC separation  aka etaulatic sign  step deformity
-separation  ONLY AC
99. A 50 yoa male presents with a six month history of gradually progressive fatigue, low
back pain and decreased appetite. He relates a 15 pound weight loss in the last 3
months. One month ago he had a normal prostate exam. Lumbar x-rays reveal
generalized osteopenia.
*early multiple myeloma
100.
Joint is most often affected by hemophilia
*knee  affected by most anything
101.
Subcutaneous calcification may occur as a sequelae of
*dermatomyositis
102. Commonly manifests as flexion deformities at the proximal phalangeal and
metacarpal phalangeal joints and causes ulnar deviation at the wrist
*RA
103. The most common initial complaint of the patient with progressive systemic
sclerosis
*Raynaud’s phenomenon
104. Conditions in an adult is most likely to cause avascular necrosis of the femoral
head
*sickle cell anemia  with Thalassemia major ONLY ones to affect joints
-Paget’s disease  thickening  more bone
105.
Conditions may result in multiple levels of thoracic boney fusion
*ankylosing spondylitis
106.
The most likely cause of painful scoliosis in an adolescent
*osteoid osteoma  pain at night relieved by aspirin
107. A Levi Lorain dwarf is characterized by normal body proportions --- range of
motions and --- mental development
*normal; normal
-Achondroplastic dwarf  abnormal body proportions  abnormal range of
motion  normal mental development
12
108.
Degenerative spondylolisthesis occurs at
*L4
-traumatic spondylolisthesis  L5
109. Blood analysis of a 65 yoa male reveals normochromic, normocytic anemia,
normal serum alkaline phosphatase, increased serum calcium, elevated ESR,
hyperglobulinemia and rouleaux formation
*multiple myeloma  reversal of albuminglobulin ratio
-rouleaux formation  stacking of the RBC
-sarcoidosis  found in women, usually African  see potatoe nodes
110.
Transient clonus elicited during a muscle stretch reflex is graded
*4+
-1+  hyporeflexia
-2+  normal
13
1. 49 yoa female presents with an acute complaint of paresthesia over the palmar aspect
of her right thumb and first two fingers
*median nerve  pronator teres syndrome or carpal tunnel
2. The inability to recognize familiar aspects of the environment such as shapes,
symbols, sounds geometric forms is
*agnosia
-apraxia  death to a nerve
-anoxia  decreased oxygen
-aphasia  difficulty articulation
-aphagia  difficulty swallowing
3. A cause of transient structural scoliosis
*nerve root irritation  antalgic lean
-postural  functional scoliosis
-transient  refers to disc herniation or nerve compression
4. Conditions presents with intermittent pain along a dermatome of a rib with vesicles
*herpes zoster
5. 60 yoa females presents with stiff posture and absence of facial expression. Which
gait
*propulsion (aka festinating, rigid)  Parkinson’s  resting tremors  “rest in
the Park”
-MS  intentional tremor
6. Weak ankle dorsiflexion results in which
*steppage  lift up high
-slappage gait  decreased sensory so hit floor to hear
7. Procedures increases intrathecal pressure
*Valsalva
-Jandrassik  distract someone when doing a reflex
8. Thoracic kyphosis is primarily maintained by which
*vertebral bodies
9. Indicated by palpation of the left iliac crest posteriorly compared to the right
*anterior superior rotation of the right ilium
10. Scoliosis in which of the following areas is most apt to be problematic at the lowest
degree of the curvature
*thoracic  due to pressure on heart
14
11. Neck extension with right rotation during deep inspiration causes neurovascular
compression with the right
*scalene muscles
-cervical rib  Eden’s  costoclavicular
12. Weakness of wrist flexion is due to a lesion at the --- nerve
*C7
13. Calcification of the tibial collateral ligament along the medial condyle of the femur is
called
*Pellegrini Steida’s disease  wisp of smoke on x-ray
14. Reflexes most efficiently tests the C6 nerve root
*brachioradialis
-biceps  C5 AND C6
15. A patient experiences episodic pain in the lower extremities which increases with
walking, relieved by a few minutes of rest and not influenced by a stooped posture
*vascular insufficiency
neurogenic claudication  due to nerve  pain occurs at different
distances  comes from the spinal cord (both legs affected) so
pressure off the cord cause relief
vascular claudication  due to vessels  always get to the same spot
when pain occur  posture does NOT help
16. Patient presents with severe headache, morning stiffness, depression, weight loss and
fever should be investigated for
*polymyalgia rheumatica  severe stiffness and shoulder pain
-giant cell arteritis  same as temporal arteritis
17. Condition characterized by hair loss, shiny atrophic skin and cyanosis, a cool pale
foot with deficient pulses
*arterial insufficiency
18. Action tremors and past pointing are signs of a lesion in
*cerebellum
-vestibular nuclei  CN 8  equilibrium, vertigo
-cerebral motor cortex  crude motion
19. An L5 disc herniation is likely to produce weakness of hip --- and numbness of --*extension; posterolateral aspect of leg  S1 nerve
20. 50 yoa patient presents with transient episodes of slurred speech which lasts no longer
than 120 minutes. Which is most likely to localize the cause
*carotid artery auscultation
15
21. Local tenderness with referral from sclerotomal pain is elicited by digital pressure on
the upper border of the posterior shoulder.
*infraspinatus tendinitis  insertion at upper border of the posterior shoulder
-tzeitze syndrome  costochondritis
22. Compression of which of the following tissues is responsible for neck pain which
occurs when the patient turns to one side
*nervous
-muscular  contraction
23. Intensified when there is a problem with the pancreas, intestine and colon as a cause
of low back pain
*increased intra abdominal pressure
24. A patient who has the mouth closed tightly has a lesion of which cranial nerve
*trigeminal  muscles of mastication
25. Often accompanies an upper motor neuron lesion
*increased muscle spindle activity
-increased muscle fasciculation and muscle flaccidity  LMNL
26. Superficial reflex is the test of choice for cauda equina syndrome
*anal wink reflex  S2, S3
-cauda equina syndrome  loss of bowel and bladder
27. The sternal compression test is useful in determining the presence of which of the
*rib fracture  pain at the lateral border
28. In a patient with scoliosis which is not changed with early bending. This is most apt
to be
*structural
29. The patient presents with a recent history of decreased abdominal muscle tone.
Examination reveals that the umbilicus migrates to the left and down, when the
patient performs a sit-up. Which level is denervated
*T6 to T10 on the right  Beevor’s sign  umbilicus migrates to the strong side
-if pulled down  T10 to T12
30. Reflexes is modulated by the autonomic nervous system
*ciliospinal  pinch neck and eyes dilate
31. Pain at the costosternal articulation during lateral chest compression indicates
*costochondritis
16
32. Weakness of which of the following muscles is noted if the patient lifts the right foot
and the ipsilateral buttock drops
*left gluteus medius  Trendelenburg test
33. With the patient prone the knee is flexed and the hip passively extended. If pain is
intensified by this movement, where is the lesion
*SI  Yeoman’s test
34. In a patient with bilateral sciatic, exacerbation of pain occurs with the patient prone
and the heels approximated to the buttocks
*spinal stenosis
35. Pain elicited during strength testing in flexion with external leg rotation indicates
which
*iliopsoas strain
36. In patients with central lumbar stenosis pain is relieved in which positions
*flexion
37. A posterolateral disc herniation at which of the following levels affects the L5 nerve
root
*L4, L5
38. Structures must be evaluated to verify a shoulder separation
*AC
-dislocation  glenohumeral
39. The direct pupillary light reflex tests the integrity of the afferent fibers of the --cranial nerve and the efferent fibers of the --- cranial nerve
*II and ipsilateral III
-indirect  II and contralateral III
40. A patient presents with a recent history of episodes of severe vertigo, nausea,
vomiting, hearing loss and tinnitus provoked by fatigue, The attacks last two hours
*Meniere’s disease  vertigo, tinnitus, hearing loss (deafness)  aka
endolymphatic hydrops
41. Muscles is most commonly torn in a rotator cuff injury
*supraspinatus
42. Varus stress at the knee joint tests the integrity of the --- ligament
*lateral collateral
17
43. Pain which is produce by palpating the base of the shoulder at the medial tuberosity
and resisting movement of the arm while the patient attempts medial rotation of the
shoulder with the elbow flexed to 90 degree most likely indicates --- tendinitis
*bicipital  Yergason’s test
44. A 54 yoa patients presents with a 4 month history of persistent cough. He has right
anterior chest discomfort with localized pain 1-2” lateral to the sternum. There is no
history of trauma
*costochonditis
45. A painful arc which occurs from 10 to 20 degrees and again from 90 to 110 degrees
in a coronal plane of shoulder abduction is most likely due to impingement of which
*supraspinatus tendon
46. In a patient with chronic adhesive capsulitis of the shoulder, palpation of the scapula
during passive abduction detects --- movement of the scapula
*early
47. The tentative diagnosis in a patient who presents with recent onset of slowly
increasing weakness and fatigue of facial and chewing muscles accompanied by
increasing difficulty swallowing
*myasthenia gravis
48. The dorsal pedis pulse can be palpated --- to the --*lateral; extensor hallicus longus tendon
49. Historical questions will assess a 40 yoa patient with thoracic pain that may have had
Scheuermann’s disease
*Do you remember having fatigue accompanied by mid back pain as a young
teenager  also have Schmoral’s nodes
50. The most common presentation for a pituitary adenoma
*bitemporal homonymonus hemianopsia  pituitary at optic chiasm
51. Best defined as a failure of muscle coordination to focus on an object of the fovea
centralis at the same time in each eye
*stabismus
52. Pain increased by recumbency is most indicative of
*neoplastic  tumors increase at night or with rest
-hematologic  pain increase when standing
53. The most likely diagnosis for a young patient with a history of urethral discharge, red
and sore eyes and joint pain
*Reiter’s disease  caused by Clamydia
18
54. Inability to perform a skilled motor activity is
*apraxia  don’t use it
-agnosia  can’t recognize it
-dysarthria  difficulty speaking
55. Nerve roots is most likely affect if the patient presents with a history of alternating
pain and numbness in the lateral aspect of he foot
*S1
56. A patient has pain through resisted flexion and supination of the elbow most likely
has a lesion of which muscle
*biceps  Yergason’s
57. The most likely initial clinical impression of a young patient who can not straighten
her knee
*torn meniscus  decrease range of motion
-ligament problem  describe drawer sign
58. Tracts carries vibration sense
*posterior columns
-lateral spinothalamic  pain, temperature, light touch
-ventral spinothalamic  crude touch
59. Nerve is involved in pronator teres syndrome
*median
60. Distinctive characteristic of carpal tunnel from the history
*nocturnal pain
61. Tapping on which structure would elicit tingling sensation in a patient with ulnar
neuritis
*medial to the olecranon
62. Patient who has an irregular rate and rhythm when asked to tap his feet repeated on
the floor has a lesion of which
*cerebellum  rhythmic and repeated
63. Repetitive muscle tests are best used to detect --- lesions
*myoneural junction  found in people with myasthenia gravis
64. Injury to which of the following nerves produces atrophy of the thenar eminence
*median  Ape hand
65. Weakness of wrist flexion, forearm pronation and thumb opposition suggest --- nerve
*median
19
66. If the tongue deviates to the right when it is protruded which structure is involved
*right hypoglossal
-uvula  deviates to the strong side
67. Intrathecal pressure causes compression of which of the following tissues
*nerve
68. Will NOT produce pathological reflex
*muscular dystrophy
-MS, ALS  UMNL
69. Pathological reflexes classically found in the lower extremities most likely indicates a
lesion
*above C6
-pathological reflex  UMNL  occur above C6
70. Ulceration is a common finding in which cause of peripheral edema
*chronic venous insufficiency  old ulcerations
71. Athetoid movement is best described as
*slow writhing, involuntary
-slow repetitive (rhythmic) and involuntary  Chorea
72. Fine rapid tremor are found in
*thryotoxicosis  Grave’s disease  hyperthyroidism
-MS and Parkinson’s  slow tremor
73. Not seen in an UMNL
*increased superficial reflexes
-increased deep tendon reflexes  UMNL
74. A 37 yoa female has pain and swelling in her right foot after an inversion sprain nine
months ago. The pain and swelling are aggravated by prolonged standing and
walking. Exam shows swelling and tenderness over the dorsum of her right foot and
all orthopedic and neurological tests are normal. X-ray shows moderate osteopenia
throughout the tarsals
*reflex sympathetic dystrophy  post-traumatic, inflammation, osteopenia
75. Pain which occurs at the extreme range of motion is least likely caused by
*active contraction of muscle
76. The patient has a two year history of coldness, weakness, occasional aching and
gradual muscle atrophy in the entire upper limb. There are normal deep tendon
reflexes
*subclavian artery stenosis  subclavian steal syndrome
-brachial plexus compression  change in reflexes
20
77. Dysarthria, diplopia, dysphagia, binocular visual disturbances, vertigo, ataxia and
drop attacks are
*vertebrobasilary artery transient ischemic attack  both eyes affected
-carotid transient ishemic attack  NO drop attacks (sudden fainting)  ONLY
one eye affected
78. Maneuver best differentiates functional from structural scoliosis
*Adam’s sign
79. Acromioclavicular pain is differentiated from glenohumeral pain by
*actively elevating the shoulder without abducting the arm
-pushing against a wall  posterior rib and winged scapula
80. Loss of deep tendon reflexes is not the result of which lesion
*pyramidal tract  conscious motor function
-alpha motor neuron  GTO
81. A disc lesion which causes foraminal encroachment between C7 and T1 is likely to
result in weakness of
*finger flexors
-finger extensors  C7
-forearm extension  C6
82. Foot drop may result from damage to which
*peroneal  tibialis anterior
83. Sustained rhythmic alternating contraction and relaxation after sudden dorsiflexion of
the foot is
*clonus
84. A scissor gait is seen in
*cerebral palsy
85. An 82 yoa male has pitting edema of the left leg below the knee. There is tenderness
to palpation over the midline of the calf. The swollen area is warm and erythematous.
*deep vein thrombosis
86. At which site are you most apt to find stress fractures in the foot
*second and/or third metatarsal head  aka March’s fracture
-fifth metatarsal  aka Dancer’s fracture
87. Distinguishes Raynaud’s disease from Raynaud’s phenomenon
*presence of underlying condition
21
88. The flexed hip is abducted and this elicits a palpable click in a patient with a
congenital hip dislocation
*Barlow’s  also Ortalani’s test
89. A lesion of which nerve causes inability to extend the thumb
*radial
90. Orthopedic test performed in the cervical spine is used to check for maximum
decrease in the IVF
*Spurling’s test
-Rust’s sign  indicative of C1 fracture  patient holding back of head
91. If the hip and knees flex during passive neck flexion with the patient supine
*spinal meningitis
92. A 65 yoa male presents with deep bone pain in the spine and ribs precipitated by
movement. Lab indicates a mild normocytic, normochromic anemia, increased ESR,
increased IgG, decreased IgA and IgM and free lambda light chains detected by a 24
hour urine electrophoresis
*multiple myeloma
93. Which artery do peripheral aneurysms most commonly occur
*popliteal
94. Event is not part of the stance phase of gait
*leg advancement
-advancement  stance  push off
1. Difficulty during ambulation in dimly lit rooms is most suggestive of dysfunction in
which part of the central nervous system
*posterior columns
-ambulation  walking
22
2. A patient presents with a slow deliberate gait. The feet are wide apart and
occasionally slap the floor. The patient watches foot placement very carefully when
walking
*steppage  slappage is better  decreased proprioception
-waddling  Duchenne’s muscular dystrophy
3. Lumbar range of motion is most restricted in the late stages of AS
*extension
4. The patient presents with an inability to wrinkle the left side of the forehead or to
close the left eye tightly. The left side of the mouth does not rise during smiling. The
cause is --- motor neuron lesion in the --- facial nerve
*lower, left  NO crossing over of facial nerve
5. Test of choice for a patient with cauda equina syndrome
*anal
6. Kayser Fleisher rings are pathognomonic of
*Wilson’s disease
7. A 78 yoa patient presents with difficulty walking, stooped posture and an unsteady
gait which improves when the patient holds onto the examiner’s arm and is
encouraged to walk in cadence with the examiner. All neurological tests are normal
*normal aging
8. A patient presents with neck pain. Cervical compression and distraction do not
produced radiating pain Passive cervical range of motion tests are painless during
normal range of motion. Strength testing during right click rotation in the neutral and
fully flexed positions displays grade 3 muscle strength and elicits pain
*muscle strain
9. Test does not assist in determining if a lateral ankle sprain includes injury to the
anterior talofibular ligament
*eversion with plantar flexion
10. Jaw jerk sign indicates which lesion
*V cranial nerve
11. An infection of he posterior ganglion of a nerve root
*herpes zoster  ONLY one that is dormant in the posterior ganglion
12. Sign present if tapping the area anterior to the ear with a neurologic hammer causes
ipsilateral twitching of muscles above the mouth
*Chvostek’s
23
13. A 26 yoa female presents with episodic pain, numbness and tingling at the parietal
occipital scalp which usually occurs on the same side of the head. Pain radiates from
the suboccipital area to the vertex and periorbital area
*greater occipital neuralgia
-neuralgia  patterned pain  episodic pain that is the same
14. Progressive muscle atrophy of the anterior tibial muscles occurs in
*Charcot marie tooth disease
-syringomyelia  shawl like distribution of the shoulder
15. Point tenderness on the rotator cuff over the greater tubercle of the humerus most
likely indicates injury to which muscle
*supraspinatus
-lesser tubercle, rotator cuff  subscapularis
16. A 32 yoa female presents with urinary incontinence, a staggering gait and a complaint
of intermittent fog in her right visual field. She had three episodes of neurologic
deficits in the last several months. She experiences shock like sensations down her
back when she flexes her head
*multiple sclerosis  Lehermitte’s
17. Aching or burning pain with a great disparity between the severity of the inciting
injury and the degree of symptoms is most characteristic of
*reflex sympathetic dystrophy  old injury
18. A 25 yoa female presents with severe unilateral headaches with accompanied by
nausea and photophobia. She states she has been under a great deal of pressure lately
*migraine headache
19. A patient experiences attacks which are characterized by abrupt cessation of activities
incoherent mumbling, picking of the clothing and subsequent confusion
*complex partial seizure  “out of it but still with it”
-locked in syndrome  can ONLY move eyes
20. The supported forward bending test attempts to differentiate between --- lesions
*lumbar and sacroiliac  belt test  aka supported Adam’s
21. The presence of pain and swelling over the area of the olecranon process is indicative
of
*bursitis
-tenosynovitis  occur at wrist and ankle
22. Damage to the radial nerve often leads to
*wrist drop
24
EXTRA NOTES
sclerosis of ear  chronic otitis media
14 yoa with pain and tenderness in posterior leg exacerbated by exercise  excessive
exercise
“close your eyes” bump into posterior column
standing, arms at 90 degree and eyes are closed  posterior column
light touch  lateral spinothalamic tract
cluster headache  last for one hour
toxic headache  hang over last long time
lamina  DOES NOT part of IVF (disc, pedicle, articular facets)
pituitary gland tumor  bitemporal hemianopsia
umbilicus deviates right lower quadrant  lesion at upper left quandrant
occiput/ atlas  flexion or nodding
young boy with large calves  MS (Duchenne’s)  waddling gait
18-30 yoa  Becker’s MS
Eisenstein’s line  measures spinal canal  12 mm is normal
SALT your wings  serratus anterior, long thoracic
spastic muscles and easy fatigue and worse at end of the day  MG
Parkinson’s  festinating gait and resting tremor
genu recurvatum  due to quadriceps
greatest loss in proprioception  akinesthesia (no movement feeling)
apraxia  decrease ability to do simple acts
agnosia  loss of ability to know familiar objects
sinus tarsi  anterior and lateral to calcaneus
if eye can NOT go inferior and medial  lesion of CN 4
25
increase serum alkaline phosphatase, increase hat size  osteitis deformans (Paget’s)
innervation of TMJ  CN 5  muscles of mastication
most common avulsion is head of rectus femoris
Weber lateralizes to left ear (left obstruction or right neurosensory loss) and Rinne’s test
shows air is better than bone on the left  patient would have right neurosensory
loss)
plaquing of spinal cord  demyelination  MS
ALS  UMNL of lower extremity and LMNL of upper extremity
cerebral palsy  birth disorder
Hutchinson’s triad  congenital syphillis  notch teeth
deep vein thrombosis  calf and edema
diabetes  arterial problem  expressed bilaterally
stocking and glove paresthesia  B12  megaloblastic anemia  pernicious anemia 
GI problem  leads to PLS (posterior latera sclerosis)  breakdown of spinal
cord
test L5  “5 toes in the air”  heel walk
atrohy of hand and hyperreflexia of patella  ALS
compromise of posterior spinal artery  spinocerebellar tract
posterior column  proproception
corticospinal and corticobulbar  motor
spinothalamic  pain, temperature, light touch
aggravates tripper points (or myofascial pain)  cold draft
Charcot’s joint  no pain or symptoms in a joint
most common sprain of ankle  plantar flexion and inversion  anterior talofibular
patient’s eye drifts lateral  lesion of CN 3
26
Duchenne’s MS  recessive sex linked carried by mother  occurs between 3-7 yoa
to differentiate between tendinitis and bursitis  restricted muscle test
fixed dilated pupils  lesion of CN 3
diplopia is type of  ophthalmoplegia headache
27