A 62-year-old white male presents with a chief complaint of right knee pain and swelling. Past medical history is significant for obesity with a body mass index (BMI) of 34 kg/m2, diet-controlled type 2 diabetes mellitus, and hypertension. His medications include hydrochlorothiazide and acetaminophen as needed for pain. Physical examination is remarkable for a moderate-size effusion of the right knee, with range of motion limited to 90° of flexion and 160° of extension. There is minimal warmth and no redness. He has crepitus with range of motion. With weight bearing, he has outward bowing of the legs bilaterally. A radiogram of the right knee shows osteophytes and joint space narrowing. Which of the following is the most likely finding on joint fluid examination?
A. A Gram stain showing gram-positive cocci in clusters
B. A white blood cell count of 1110/mm3
C. A white blood cell count of 22,000/mm3
D. Positively birefringent crystals on polarizing light microscopy
E. Negatively birefringent crystals on polarizing light microscopy
Answer
A woman presenting with symmetrical joint swelling with associated pain and stiffness is likely to be suffering from
arthritis related to gout
rheumatoid arthritis
osteoarthritis
ankylosing spondylitis
Answer
Osteoarthritis is likely to involve
inflammation of the synovial membrane and pannus formation
degeneration of articular cartilage and changes to the underlying bone
pannus formation and degeneration of the articular cartilage
degeneration of articular cartilage with no changes to the underlying bone
Answer
Which of the following statements best describes osteoporosis?
reduction in bone mineralisation
increased porosity of bone due to loss of bone mass
bone loss through increased activity of osteoblasts
increased porosity of bone due to reduced activity of osteoclasts
Answer
Bone tumours are most commonly:
- primary benign neoplasms
- primary malignant neoplasms
- seen in infancy
- metastatic tumours from breast or lung
Answer
A 42yo homecare nurse arrives for her initial evaluation at outpatient rehab. The doctor has diagnosed her with a right L4/L5 facet lock, supported by MRI results. Lumbar movement into ___________________ causes or increases neurological symptoms due to foraminal stenosis.
- Contralateral Sidebending
- Extension
- Flexion
- Ipsilateral Rotation
Answer
As the therapist, you are now conducting special tests to reconfirm the physician’s diagnosis of ‘facet lock’. You will expect which of the following tests to exacerbate your patient’s symptoms:
- Babinski’s
- Lachman
- Ober’s
- Quadrant
Answer
You are designing a plan of care (POC) for your 47yo patient who has a pathological facet segment. You will incorporate the following to ensure they receive the best quality of care:
- Extension/Rotation biased exercises to decompress the pathological segment
- Flexion biased therapeutic exercise combined with grade I/II joint mobilizations to reduce pain by inhibiting muscle guarding and increasing the synovial quality of the joint
- Flexion biased therapeutic exercise combined with grade IV/V joint mobilizations to reduce pain by inhibiting muscle guarding and increasing the synovial quality of the joint
- Start by applying a hot pack for 10 minutes to sooth the pain being sure to check for errythema every few minutes, follow that with a couple minutes of U/S, then the big-3 should be performed
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A 37yo construction worker arrives at your outpatient facility for his initial evaluation for low back pain. While taking his history, he mentions to you that he forgot to tell his PCP that there’s a slight pain in his abdomen
which radiates to his back. He says it’s probably nothing serious which is why he had forgotten to mention it. Your best course of action would be to:
- Ask patient to stay tough while you get through the evaluation
- Call the PCP, leave a message of your findings, and then continue your evaluation and treatment
- Continue evaluation, but just be aware that there may be secondary complications that may develop, so you must be able to act in case of emergency
- Stop evaluation immediately and refer him out to see his PCP
Answer
Mrs. Q, a 57yo patient is here to see you for her initial evaluation. She attempts to make a great first impression by bringing a box of pastelitos y café con leche. As you begin the ‘subjective’ portion of your
evaluation, she begins telling you about her husband who is a graphic designer, her sister who works in a bank but recently received a promotion, her children who are all married and living out-of-state, as well as nieces and nephews who are still in school. As you begin filtering the irrelevant information, she informs you that her low back has been ‘continuously throbbing’. She then begins to sob, and states that all she wants out of therapy is just to be pain free for once in her life. Your most appropriate course of action would be to:
- Call 911, because Mrs. Q may be suffering a myocardial infarction.
- Eat the food and drink the coffee she brought you as you finish your evaluation, then refer the patient back to her PCP, and inform the physician that you suspect a possible aortic aneurysm secondary to the patient’s statement.
- Educate Mrs. Q on her diagnosis, plan of care at therapy and eventual prognosis. Then ensure her that she will be receiving the highest quality of service possible in order to reduce the pain she’s been continuously experiencing.
- Refer the patient back to the PCP immediately, as it may be a possible aortic aneurysm.
Answer
An athlete was referred to your outpatient facility with diagnosis of displaced disk. The patient states that he works in a warehouse lifting boxes. What factor must you address first during your intervention _______.
- Ignore the situation
- Involve the patient in plyometric activities ASAP
- Patient’s motivational level may be affected by psychological distress
- Patient education on proper body mechanics
Answer
Patient comes in to your outpatient physical therapy facility with complains of low back pain for 3 days. Pt states that with activities such as: sitting for long periods, bending forward, coughing and sneezing causes him to have increased pain. During the observation part of the evaluation you noticed the patient is slightly shifted to the right.
The physical therapist should rule out __________.
- Disc displacement
- Facet Condition
- Hip bursitis
- Osteoporosis
Answer
Ms. Jones came in with a diagnosis of L4 disc displacement
. During your evaluation special test (s) that would help you confirm diagnosis include:
a. H and I Stability Test
b. Slump test
c. SLR
d. SLR and Slump test
Answer
Ms. Jackson comes in to your clinic with complains of pain that radiates down the right leg. The patient states she’s been feeling the symptom for a couple of months. A possible diagnosis that may be creating this symptom includes:
- muscle strain
- disc displacement with nerve root involvement
- bursitis of the hip
- ACL sprain
A 48-year-old white female secretary presents with progressive difficulty typing over the past month. She also notes that her hands begin to feel numb and weak after typing for long periods of time. Upon testing, which of the following deficits would be predicted?
A. Difficulty in abducting the fifth finger
B. Difficulty in adducting the thumb
C. Difficulty in flexing digits two and three at the metacarpophalangeal joints
D. Loss of sensation over the lateral half of the dorsum of the hand
E. Loss of sensation over the lateral half of the palm
F. Loss of sensation over the medial half of the dorsum of the hand
G. Loss of sensation over the medial half of the palm
Answer
Which one of the following is a manifestation of pauci-articular juvenile rheumatoid arthritis?
A) Uveitis
B) Splenomegaly
C) Thrombocytopenia
D) Glomerulonephritis
E) Erythema nodosum
ANSWERTags:
MCQ, Orthopedics, Rheumatic Disease, Arthritis
The most serious complication of a slipped capital femoral epiphysis is:
A) osteomyelitis.
B) pathologic fracture.
C) avascular necrosis.
D) chondrolysis.
E) gastrocnemius hypertrophy.
ANSWERTags:
MCQ, Orthopedics, femoral epiphysis
An 18-year-old white female presents to the emergency department with a history consistent with a lateral ankle sprain that occurred 2 hours ago while she was playing softball. She complains of pain over the distal anterior talofibular ligament, but is able to bear weight. There is mild swelling, mild black and blue discoloration, and moderate tenderness to palpation over the insertion of the anterior talofibular ligament, but the malleoli are nontender to palpation.
Which one of the following statements is true regarding the management of this case?
A) Anteroposterior, lateral, and 30° internal oblique (mortise view) radiographs should be done to rule out fracture.
B) Stress radiographs will be needed to rule out a major partial or complete ligamentous tear.
C) Early range-of-motion exercises should be initiated to maintain flexibility.
D) For best results, functional rehabilitation should begin within the first 24 hours after Injury.
E) The patient should use crutches and avoid weight bearing for 10-14 days.
AnswerTags:
MCQ, Orthopedics, Sprains, Fracture
A 10-year-old male is brought to your office after sustaining a fall on an outstretched hand. Radiographs show a nondisplaced fracture of the middle third of the clavicle.
Appropriate management would include which one of the following?
A) Intermittent heat to the area to help control pain
B) A figure-of-8 splint or sling support
C) Orthopedic consultation for surgical intervention
D) Early shoulder abduction exercises to prevent adhesive capsulitis
E) Weekly radiographs to assess callus formation
ANSWERTags:
MCQ, Orthopedics, Clavicular Fracture, Clavicle
