CPRs

Question 1

anterior shoulder instability

Answer 1

1. anterior drawer
2. relocation
3. Apprehension
   stage derivation 2006

Question 2

Ankylosing spondylitis

Answer 2

1. morning stiffness less than 30 minutes
2. improvement in back pain with exercise but not with rest
3. awakening because of night pain in the second half of the night
4. alternating buttock pain
   stage: validated
5. less than 40
6. insidious onset

Question 3

Canadian cervical spine rule

Answer 3

Determine need for x-ray after trauma
any 1 high risk
1. greater than 65
2. dangerous mechanism of injury (fall >1m or 5 stairs, axilal head load, high speed MVA, motorized rec veh, bike accident)
3. paresthesia in UE
any 2 low risk factors allowing for safe assessment of ROM
1. simple rear end MVA
2. normal sitting posture
3. ambulatory at any time since injury
4. delayed onset of pain or absence of tenderness
COUPLED with AROM less than 45 deg

Question 4

CTSs

Answer 4

1. shaking hands for symptom relief
2. wrist-ration index greater than 0.67 AP/width
3. symptom severity score greater than 1.9
4. reduced median sensory field of digit 1
5. age greater 45 years
   stage derivation 2005

Question 5

cervical myopathy

Answer 5

1. gait deviation
2. positive hoffman’s test (DIP flick produces reflexive finger flexion)
3. positive inverted supinator sign (brachioradialis reflex produces finger flexion and possible elbow ext)
4. positive babinski (toe flexion)
5. age greater than 45

Question 6

cervical radiculopathy

Answer 6

1. Positive ULTT -A
2. involved cervical rotation less than 60
3. Positive distraction
4. positive spurling’s
   derivation

Question 7

DVT

Answer 7

10 point test, score 3 or greater high probability, 1-2 moderate, 0 low
- active CA, paralysis or recent immobilization, recently bed ridden or major surgery in past 12 weeks, entire leg swollen, tender along DV system, calf swelling of at least 3cm relative, pitting edema relative, previous DVT, collateral superficial veins, (-) alterative explanation

Question 8

Hip OA

Answer 8

1. squatting aggravates pain
2. • scour for groin or lateral hip pain
3. active hip flexion causes primary pain
4. passive IR less than 25 degree
5. active hip extension causes primary pain

Derivation level of development 2008

Question 9

lumbar stenosis

Answer 9

1. bilateral symptoms
2. leg pain greater than back pain
3. pain during walking and standing
4. pain relief upon sitting
5. greater than 48 years old

derivation stage 2011

Question 10

MCL

Answer 10

1. trauma by ER force
2. rotational trauma
3. pain with vagus stress test at 30 degree
4. laxity with valgus stress at 30 degree

derivation 2008

Question 11

meniscus

Answer 11

1. history of catching or locking
2. joint line tenderness
3. pain with forced hyperextension (modified bounce)
4. pain with maximal passive knee flexion
5. positive McMurray

derivation 2006

Question 12

Ottawa ankle rule

Answer 12

determine if x-ray is required
1. inability to weight bear following injury
or
2. lateral and medial distal/posterior 5cm malleolus tenderness
3. bone tenderness at the navicular base or 5th met

2017

Question 13

ottawa knee rule

Answer 13

determine if knee x-ray are needed

1. age greater than 55
2. tenderness at the head of the fibula
3. isolated tenderness of the patella
4. inability to flex the knee to 90
5. inability to bear weight immediately and upon ER evaluation

validated

Question 14

Pulmonary embolism

Answer 14

Score based assessment

1. over 65 +1
2. previous DVT or PE +3
3. surgery or factor within 1 month +2
4. active malignant condition +2
5. unilateral lower limbs pain +3
6. hemoptysis +2
7. HR 75-94 bpm +3
8. HR greater than 95 ppm +5
9. pain with deep palpation of lower limb and unilateral edema +4

High risk greater than 10
medium risk 4-10
low less than 4

Validated

Question 15

full thickness RTC tear

Answer 15

1. painful arch sign
2. drop arm sign
3. infaspinatus weakness
4. ER weakness
5. night pain

combined two studies both in derivation from 2006

Question 16

SIJ

Answer 16

1. SI distraction
2. SI compression
3. thigh thrust
4. Gaenslen’s
5. Sacral thrust
6. FABER/Patrick

Validated 2003,2005,2006

Question 17

Subacrominal impingement

Answer 17

1. Positive HK
2. painful arc
3. infraspinatus MMT

derivation 2005

Question 18

vertebral compression fracture

Answer 18

1. age greater than 52 or age greater than 70
2. no presence of leg pain
3. BMI less than 22
4. does not regularly exercise
5. female gender
6. prolonged use of corticosteroids
7. significant trauma

Derivation 2009 and 2010

Question 19

cervical manipulation for neck

Answer 19

Puentedura 2012
1. symptoms less than 38 days
2. positive expectation of manipulation help
3. rotation difference of 10 or greater
4. mid cervical pain with PA gliding
tseng 2006
1. NDI less than 11.5
2. (B) symptoms
3. less the 5 hours day sedentary work
4. movement helps pain
5. no change in pain with ext
6. spondylosis with our radiculopathy

Question 20

CT manipulation for shoulder pain

Answer 20

2017 study did not support

1. pain free shoulder flexion less than 127
2. shoulder IR less than 53 @90
3. negative neer
4. not taking medication for shoulder pain
5. symptoms less than 90 days

Question 21

benefit from exercise for Ank Spon

Answer 21

2009blanco FDLP cleland

1. SF-36 physical less than 37
2. SF 36 bodily less than 27
3. Bath AS disease activity less than 31

Question 22

hip mobilization for knee OA

Answer 22

2007 currier derivation
1, hip or grain pain 
2. anterior thigh pain
3. passive knee flexion less than 122 
4. passive hip IR less than 17
5. pain with hip distraction

Question 23

manipulation for LBP

Answer 23

validated 2006 invalidated 2008 did not generalize well
1. duration of symptoms less than 16 days
2. at least on e hip with less than 35 degree of IR
3. lumbar hypomobility
4. no symptoms distal to the knee
FABQ less than 19

Question 24

Manual therapy and exercise for ankle sprain

Answer 24

derivation 2009 whiten, cleland mintken

1. symptoms worse when standing
2. symptoms worse in the evening
3. navicular drop greater than 5 mm
4. distal tibiofibular joint hypomobility

Question 25

mechanical traction for LBP

Answer 25

``` 2007 and 2009 derivation 1. FABQ less than 21 2. no neuro impairments 3. older than 30 4. non manual work status 2007 - leg symptoms, peripheralization, cross SLR, nerve root compression findings ```

Question 26

mechanical traction for neck pain

Answer 26

2009 derivation 1. peripheralization of symptoms with lower cervical spine mobility 2. positive shoulder abduction test 3. less than 55 4. positive ULTT-A 5. postive neck distraction test

Question 27

Mobilization with movement for lateral elbow pain

Answer 27

1. age less than 49 2. affect side grip less than 25# 3. unaffected grip greater than 75# 4. chang in pain greater than 25% post treatment

Question 28

orthotics for patellofemoral pain

Answer 28

1. age over 25 2. short height 3. worse pain less than 5/10, usual less than 2/10 4. mid foot width difference of less than 10mm 5. DF knee flexed less than 40 6. decreased knee pain with single leg squat while using orthosis

Question 29

Lumbar stabilization exercise

Answer 29

hicks 2005 derivation, 2014 Rabin suggested 2 variable 1. age less than 40 2. straight leg raise greater than 90 3. **aberrant movement pattern** 4. **postive prone instability**

Question 30

Thoracic manipulation for neck pain

Answer 30

cleland 2007 derivation, cleland 2010 invalidated but found it does help symptoms 1. symptoms less than 30 days 2. no symptoms distal to shoulder 3. no change in pain with ext 4. FABQ less than 12 5. flat thoracic kyphosis 6. cervical extension less than 30 deg

Question 31

closed cervical fracture

Answer 31

1. age <55 2. single 3. condition involved trauma 4. acute condition 5. condition involved ER visit

Question 32

Pittsburgh knee rule

Answer 32

blunt trauma or fa fall as mechanism of injury plus 1. age older than 50 or younger then 12 2. inability to walk 4 weight bearing steps in ER

Question 33

Lumbar manip for PFP

Answer 33

1. difference in hip IR greater than 14 2. ankle DF with knee flexed greater than 16 3. navicular drop greater than 3 mm 4. no stiffness with sitting 20 minutes 5. squatting most painful activity

Question 34

PFP taping

Answer 34

1. tibial varum angulation greater than 5 degrees 2. positive patellar tilt Lesher, Jonathan D., et al. "Development of a clinical prediction rule for classifying patients with patellofemoral pain syndrome who respond to patellar taping." Journal of Orthopaedic & Sports Physical Therapy 36.11 (2006): 854-866.

Question 35

stress fracture (lower leg)

Answer 35

``` BSI score greater than 3 and exam score 1 or greater risk 1. poor aerobic fitness at start of training program 2. female 3. h/o stress fracture 4. eating disorder or caloric insuff 5. pes cavus symptoms 1. gradual onset 2. increase with activity 3. dull aching pain 4. night pain 5. recent increase in activity exam 1. focal bone tenderness 2. pain with hip IR 3. painful hop test 4. painful fulcrum test 5. painful tuning fork 6. antalgic gait Nye, Nathaniel S., et al. "Improving diagnostic accuracy and efficiency of suspected bone stress injuries: algorithm and clinical prediction rule." Sports health 8.3 (2016): 278-283. ```

Question 36

hip arthoscopy benefit

Answer 36

1. female 2. pincer impingement 3. labral tear 4. HOS-adl 2 score 4. WHOQOL good physical health 5. WHOQOL pyso good Stephan, Patrick, et al. "Developing a risk prediction model for the functional outcome after hip arthroscopy." BMC musculoskeletal disorders 19.1 (2018): 122.

Question 37

Radiculopathy treatment success

Answer 37

- less than 54 - dominant arm NOT affected - looking down does not increase symptoms - providing multi modal treatment Predictors of Short-Term Outcome in People With a Clinical Diagnosis of Cervical Radiculopathy 2007

Question 38

Benefit from nerve mobilization

Answer 38

1. neuropathic pain qualities (S-LANSS) of 12 or greater, 2. older age (study 18-60 year olds) 3. deficit in elbow extension range of motion during ULNT1MEDIAN Baseline Characteristics of Patients With Nerve-Related Neck and Arm Pain Predict the Likely Response to Neural Tissue Management. Nee 2013

Question 39

cervical headache

Answer 39

1. Cervical flexion rotation test (decreased upper cervical rotation) 2. PAIVMs C0-C3 3. decreased cervical ROM