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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