1.Which of the following is TRUE regarding mechanical low back pain (LBP)?
a. Most LBP recovery exceeds 6 months
b. 90% of LBP patients do not return to normal function even after 2 months
c. 10% of patients with acute LBP have resolution within 4 months without intervention
d. Approximately 80% of adults will have LBP at some time in their lives
d. Approximately 80% of adults will have LBP at some time in their lives
- Evidence based medicine refers to:
a. Following specific protocols for treatment as outline by the latest scientific research
b. Applying the findings from the best available scientific research to every patient
c. Integrating individual clinical expertise with the best available clinical evidence from systemic research
d. Never using a treatment approach that has been validated by a Randomized Controlled Clinical Trail
c.Integrating individual clinical expertise with the best available clinical evidence from systemic research
- Which of the following statements about lumbar disc herniation is TRUE?
a. A classic finding associated with a symptomatic herniated disc is relief of pain with lumbar flexion
b. A disc herniation that is visible on MRI will always be symptomatic
c. Herniation most often occurs in the anteromedial aspect of the disc
d. It is possible to have a disc protrusion yet still have a normal neurological examination
d. It is possible to have a disc protrusion yet still have a normal neurological examination
- Which statement is TRUE regarding the degeneration of lumbar discs?
a. Failure of the nutrient supply to the disc is a factor thought to contribute to degeneration
b. Disc degeneration is an inevitable consequence of aging
c. Disc degeneration is caused by hard labor such a repetitive heavy lifting
d. 98% of symptomatic degeneration lumbar discs occur at the level of L2-L3
a. Failure of the nutrient supply to the disc is a factor thought to contribute to degeneration
- which of the following is characteristic of normal disc aging?
a. Circumferential tears
b. Disc space narrowing
c. Internal disc disruption
d. Dehydration of the disc
d. Dehydration of the disc
- Differential Diagnosis refers to:
a. The top two conditions that are possible given a particular set of signs, symptoms and clinical findings
b. The top three conditions that are possible given a particular set of signs, symptoms and clinical findings
c. The list of conditions that are possible given a particular set of signs, symptoms and clinical findings.
d. The list of conditions that you have been able to rule in given a particular set of signs, symptoms and clinical findings
c. The list of conditions that are possible given a particular set of signs, symptoms and clinical findings.
- Most low back pain is uncomplicated and even without an intervention, will self-resolve within:
a. 1-2 months
b. 1-2 weeks
c. 3-4 months
d. 4-6 months
a. 1-2 months
- From the choices provided, which of the following is the MOST COMMON etiology of LBP?
a. Disc disruption resulting in extrusion of the nucleus pulpous
b. Osteoporotic compression fracture
c. Visceral disease
d. Facet dysfunction
d. Facet dysfunction
- Unilateral motor weakness of the extensor hallicus, unilateral pain projection into the posterolateral thigh and calf, sensory defect in the dermatome supplied by the affected nerve, and intact reflexes are all findings commonly with:
a. Posterolateral disc herniation at the L4-L5 disc
b. Posterolateral disc herniation at the L3-L4 disc
c. Posterolateral disc herniation at the L5-S1 disc
d. Midline, central lumbar disc herniation
a. Posterolateral disc herniation at the L4-L5 disc
- A passive Straight Leg Raise (SLR) test is performed with the knee extended which will stretch the sicatic nerve. Dural movement (tension) starts at _____ of elevation.
a. 0
b. 70
c. 30
d. 50
c. 30
- Onset of localized back pain at ______ of leg elevation during the Straight Leg Raise test suggests that the pain may be mechanical secondary to lumbar muscle or joint pain
a. 30
b. 0
c. 40
d. 70
d. 70
- The doctor performs an orthopedic test on a patient by raising the unaffected leg with the knee extended, to see if it reproduces the radicular pain the patient is complaining of in the contralateral leg. The patient’s chief complaint of radicular pain in the affected leg does not increase. In fact, it decreases. This finding indicates the patient likely has a:
a. Lateral disc protrusion on the affected side
b. medial disc protrusion on the affected side
c. Central disc protrusion
d. Central infectious meningitis
a. Lateral disc protrusion on the affected side
- Your patient is not complaint with your treatment recommendations and you observe inconsistences during your examination. Furthermore, the patient seems to be displaying an exaggerated level of pain and disability. Which test would be helpful to evaluate whether this patient is exaggerating their symptoms?
a. Magnuson’s Test
b. Brudzinski’s Test
c. Kernigs test
d. Sicards test
a. Magnuson’s Test
- A patient presents with a complaint of radiating pain in the left leg and demonstrates antalgic positioning towards the…. Examination reveals difficulty with toe walking and absent Achilles. Which of the following is Most likely responsible for the signs and symptoms?
a. L5/S1 left medial disc protrusion
b. L4/L5 left medial disc protrusion
c. L5/S1 left lateral disc protrusion
d. L4/L5 left lateral disc protrusion
c. L5/S1 left lateral disc protrusion
- The doctor stabilizes the patient’s PSIS w/one hand. The doctor’s other hand reaches and grasps the patient’s shoulder. The doctor passively bends the patient’s spine forward, laterally and obliquely backwards. The doctor then repeats this to the other direction contacting the opposite side of the spine. Positive finding is radicular pain into the lower extremity or localized lower back pain. A positive finding may indicate irritation of spinal nerve roots, facet problems, capsulitis, and/or muscle spasms or ligamentous strain. Which test was just performed?
a. Slump test
b. Kemp’s test
c. Sicard’s test
d. Milgram’s test
b. Kemp’s test
- The doctor performs an orthopedic test on a patient by raising the unaffected leg with the knee extended, to the point that it elicits pain in the contralateral leg. The patient’s chief complaint of radicular pain in the affected leg increases. This is considered a positive finding for this test. This finding indicates:
a. Probable facet syndrome on the affected side
b. Probable medial disc protrusion on the affected side
c. Probable lateral disc protrusion on the affected side
d. Probable central disc protrusion
b. Probable medial disc protrusion on the affected side
- With the patient supine you perform an SLR test. This provokes radicular pain along the back of the patient’s leg. You then bend the patient’s knee. This relieves their pain. Applying firm pressure within the popliteal fossa reproduce the radicular pain. This finding indicates the patient likely has:
a. Hamstring strain
b. An extruded lumbar disc
c. A bulging lumbar disc
d. SI joint dysfunction
b. An extruded lumbar disc
- Radiculopathy describes:
a. Any disease that affects the spinal nerve roots
b. Any pain caused by an extradural lesion
c. Any pain felt in the back of the leg that extends from the buttocks to the knee
d. Any disease that results in paresthesia and loss of reflexes
a. Any disease that affects the spinal nerve roots
- An antalgic patient with severe back pain has a positive SLR, Laseque’s and Valsalva’s Test whereby each test reproduces a radicular pain that travels down the back of the patient’s leg into their foot. Dermatome and myotome testing reveal abnormalities corresponding to an S1 nerve root lesion. This patient MOST LIKELY has a lumbar disc ________
a. Protrusion
b. Extrusion
c. Sequestration
d. Bulge
b. Extrusion
- A patient complains of unilateral, achy low back pain. Kemp’s Test is positive but without radiculopathy. Valsalva’s Test is negative but reproduces the achy low back pain. Goldwaith’s Test reproduces the patient’s chief complaint but only after the lumbar SP’s have fanned out completely. This clinical picture indicates this patient is most likely suffering from:
a. Space occupying lesion causing sciatic radiculopathy
b. Sacroiliac joint dysfunction
c. Lumbar facet syndrome
d. Lumbar disc herniation
c. Lumbar facet syndrome
