Nycc Ruddy Review Part Iv Sp01

Front 1

Question

Back 1

Answer

Front 2

When viewing a CERVICAL FRACTURE, look for

Back 2

PRE-VERTEBRAL soft tissue abnormalities

Front 3

Sclerosis of L5 pedicle: (3)

Back 3

Mets, Agenesis, or Osteoid osteoma

Front 4

What is the probable cause of a missing lamina?

Back 4

Laminectomy (hemilaminectomy)

Front 5

Oppenheimer

Back 5

Anterior scalloping due to pulsations caused by an abdominal aortic aneurysm

Front 6

Protrusio acetabuli likely causes: (2)

Back 6

RA Bone softening dz like Paget's

Front 7

Otto's

Back 7

Pelvis

Front 8

Juxtarticular osteoporosis

Back 8

RA

Front 9

Rf+

Back 9

RA, SLE, Scleroderma (CREST)

Front 10

Is blood work warranted for DJD?

Back 10

NO

Front 11

Ortho tests for hip DJD: (4)

Back 11

Patrick, Fabere, Ely, Hibbs

Front 12

Non-descended scapulae

Back 12

Sprengle's deformity

Front 13

Bilateral SI problem

Back 13

Enteropathic athritis (gut) or Ankylosing Spondylitis

Front 14

Klippel-Fiel (3)

Back 14

Sprengle's non-descended scapulae, non-union defect of lamina, web neck

Front 15

Ortho for Ankylosing Spondylitis (2)

Back 15

Lewin & Forrestier

Front 16

Cervical rib ortho tests positive for TOS (2)

Back 16

Halstead & Adson's

Front 17

Cloaca of bone

Back 17

Entrance of infection. Should be a clean hole. Sequestrum will be 'in the middle part.' Involucrum is a bone collar. Blood work = elevated ESR, fever, CBC w/ diff

Front 18

Structures that go through the POSTERIOR PONTICLE

Back 18

Vertebral Artery & 1st Cervical Nerve (goes to suboccipital triangle)

Front 19

For kids, rule out (2)

Back 19

Infection and Tumor (osteosarcoma and Ewing's)

Front 20

DISH

Back 20

Disc spaces ARE maintained, FLOWING hyperostosis (candle wax appearance). Associated w/ DIABETES. Do HLA B-8 test.

Front 21

Paget's bloodwork

Back 21

ALK PHOS. Late stage Pagets can become osteosarcoma.

Front 22

Bilateral HAND x-ray of 55 year old FEMALE

Back 22

d/dx: Bilateral RA or gout. SPOTTY CARPAL sign. Labs = ESR & Rf+

Front 23

49 year old male with cervicothoracic pain

Back 23

TOS, DISH (loves LUNG area). Film presented will show mid-body hyperostosis. Disc space MAINTAINED. Two clinical conditions = adult onset DM, osteoporosis

Front 24

50 year old MALE with lower back pain

Back 24

Prostate or lumbar aneurysm. Most significant finding = 8cm AAA. DOPPLER US and vascular study.

Front 25

APOM, lateral, and AP cervical views shown with NO trauma

Back 25

2 significant findings: AGENSIS of DENS (i.e., non-union). Is it STABLE or NOT? Is there radiating arm pain? Anytime there is upper cervical instability, consider cervical myelopathy.

Front 26

28 year old with neck pain and no history of trauma

Back 26

Severe carotid artery calcification, especially at bifurcation [C3 level]

Front 27

14 year old with knee pain. Views are bilateral AP and Lateral

Back 27

Cortical erosion at tibial tuberosity (not an O-S disease). FRAGMENTATION ---SEPTIC ARTHRITIS

Front 28

Older, long standing LBP, recent exacerbation, cannot walk without pain

Back 28

Grade I-II, SPONDYLOLYTIC SPONDYLOLISTHESIS. No pedicle = most significant finding then becomes OSTEOLYTIC METS. Refer out.

Front 29

Mid back, thoracic film of male with MARGINAL SYNDESMOPHYTES

Back 29

ANKYLOSING SPONDYLITIS: SHINY CORNER sign = increased sclerosis at corner. HLA-B27, (+) ESR

Front 30

YOUNG male with GROIN pain

Back 30

LEGG-CALVE-PERTHES dz. Avascular necrosis could result. Complicated by non-union, fragmentation.

Front 31

Female, constant KNEE pain

Back 31

GIANT CELL TUMOR or OSTEOSARCOMA [both at distal femur]. LYTIC, SOAP bubbly appearance. This was a malignant case (film Ruddy uses)

Front 32

Puncture wound at LB

Back 32

INFECITON and/or DISCITIS. Present with low grade fever and fatigue.

Front 33

63 y.o. with chronic LBP

Back 33

Late stage ANKYLOSING SPONDYLITIS shows BAMBOO spine, TROLLEY TRACK sign, DAGGER sign. Exonerative? arthropathy. HLA-B27 +. MARGINAL syndesmophytes.

Front 34

What is a marginal syndesmophyte?

Back 34

Associated with ANKYLOSING SPONDYLITIS: Marginal syndesmophyte formation = thin vertical dense spicules bridging the vertebral bodies. Ossification of outer fibers of annulus fibrosus. Not anterior longitudinal ligament.

Front 35

Melhorosis means

Back 35

candle waxing, flowing hyperostosis

Front 36

bridging osteophytes

Back 36

Reiter's

Front 37

non-marginal syndesmophytes

Back 37

DJD

Front 38

MVA with a cervical series and oblique. Why oblique shot?

Back 38

Arm pain; encroachment of IVF; facet dislocation or perched (partially dislocated). Diagnosis: Encroachment

Front 39

Lymph node evaluation

Back 39

series of 3 each: locations?

Front 40

35 yo male: 3 week hx of chronic mid and LBP. Perform LUMBAR ROM, Kemp's, Yeoman's, Patrick-Fabere's

Back 40

Pain on both SI. SOF of back pain. Limited ROM and painful. Dx: ANKYLOSING SPONDYLITIS (ie, 35 yo male w/ limited ROM, especially in extension)

Front 41

34 yo female: neck and shoulder pain

Back 41

Perform ACTIVE ROM of cervical. Distraction. Bakody's. Cervical compression. Maximal foraminal compression. Muscle test for C5 and C6.

Front 42

34 yo female rugby player w/ band-like pain in LB

Back 42

Milgram's (pilgrim of lifting legs), SLR, Braggard's, Laguerre in the air, Nachlas (anterior thigh pain)

Front 43

Zone of CAPERNICUM

Back 43

Salter-Harris fx

Front 44

Posterior spinal line, aka?

Back 44

Posterior SPINOLAMINAR line (lines posterior length of canal)

Front 45

When George's line moves, the ____________ moves, too.

Back 45

spinolaminar line

Front 46

Anterior shoulder pain: any visceral conditions?

Back 46

Upper lobe tumors (Pancoast)

Front 47

Mass in distal FEMUR, young patient, not painful, extremely common:

Back 47

Osteochondroma. Pedunculated more common than sessile.

Front 48

Possible sequelae of osteochondroma?

Back 48

98% of time there is no complication but 2% risk of malignant. Pedunculated more common than sessile.

Front 49

25 year old female w/ LBP has a lateral lumbar film

Back 49

Trauma, kidney, urinary tract? Repetitive UTI (lower pelvic pain) can come PYELO/GLOMERULONEPHRITIS = flank pain. Will show WBC CASTS in urinalysis.

Front 50

Gross compression fx w/ step defect

Back 50

Means NEW fx. What else shows me it is a recent fracture? ZONE OF IMPACTION. Mechanism of trauma? HYPERFLEXION

Front 51

Lateral and oblique spinal views are missing a spinous process. Body is gone. Dx?

Back 51

LYTIC METS or MULTIPLE MYELOMA. Sx: Fatigue with weight loss and PAIN AT NIGHT. Follow up with this question: Does the pain keep you awake at nigh or is is pain you can bear to sleep through?

Front 52

Review the following techniques: Cross body pull, Beside (called reinforced tp?), Crossed pisiform, Pisiform mam push, Spinous pull move on L3,PI ilium side posture PULL move, Posterior sacrum on L, Flexion restriction of L5/S1...

Back 52

GH joint restriction A-P glide, fibular head anterior

Front 53

Physical exam: ascultate and describe the valves

Back 53

Aortic (R 2nd ICS), Pulmonic (L 2nd ICS), Erbs (L 3rd ICS along mid-clavicular line), Tricuspid (L 6th ICS parasternal), Mitral (L 6 ICS mid-clavicular line)

Front 54

Patient with radiating leg pain. Perform BEEVOR'S, Spinal percussion, Schepelmann's, Kernig, Brudzinski's

Back 54

Know spinal level for above and below umbilicus: (T10 @ umbilicus, T12 PS, T7 xyphoid, T4 nipple line)

Front 55

Shooting pain down both legs upon Brudzinski's

Back 55

myelopathy from meningeal irritation

Front 56

Always ask what kind of pain the pain-tient is experiencing, not just 'is that painful?' Why?

Back 56

Because tingling is different from shocking dysthesia, radiation, pressure, etc.

Front 57

Dizziness and apparent nausea upon turning head. Tests to perform?

Back 57

Weber's, Swivel chair, deKleyn's, Barre-leiou (COW) test. Check for UE proprioreception.

Front 58

deKleyn's test?

Back 58

Pt. Supine with head extended off the end of the table, active rotation & hyperextension, to each side for 15 seconds

Front 59

Barré-Leiou's sign test, George's cerebrovascular craniocervical functional test, Maigne's test, Hautant's test, Underberg's test, Hallpike maneuver, and deKleyn's or Wallenberg's tests.

Back 59

All are variations of the same theme: extreme rotation and extension of the head designed to provoke cerebral ischemia during positional change of the cervical spine.

Front 60

A test is positive if it provokes signs or symptoms of vertebrobasilar insufficiency (eg, nystagmus or symptoms of vertigo, dizziness, tinnitus, visual blurring, nausea, or faintness).

Back 60

A positive test is considered a contraindication to cervical manipulation. One of the most commonly used tests is deKleyn's test.

Front 61

Positive deKelyn's results for VBA insufficiency

Back 61

(+)vertigo, nystagmus, dizziness or nausea indicates basilar artery insufficiency

Front 62

George's Screening Procedure

Back 62

Pt. Seated, history, bilateral blood pressure, subclavian & carotid artery bruit tests, vertebrobasilar artery functional maneuver

Front 63

Positive George's procedure for VBA insufficiency

Back 63

(+)high risk history (+)10mm Hg difference from side to side or feeble radial pulse is indicative of subclavian stenosis (+)subclavian or carotid bruit indicative of arterial stenosis (+)vertigo, nystagmus, dizziness or nausea during functional maneuve

Front 64

Vertebrobasilar artery functional maneuver

Back 64

Pt. Seated, active rotation & hyperextension of head to each side for 3-5 seconds

Front 65

Positive results for vertebrobasilar artery functional maneuver

Back 65

(+)vertigo, nystagmus, dizziness, nausea, faintness indicates vertebrobasilor artery insufficiency indicative of vertebral, basilar artery insufficiency

Front 66

Barre-Leiou test

Back 66

Pt. Seated, active rotation of head from side to side, slowly then accelerate

Front 67

Positive results for Barre-Leiou test

Back 67

(+)vertigo, nystagmus, dizziness indicates vertebral artery insufficiency

Front 68

Hallpike maneuver test

Back 68

Pt. supine with head extended off the end of the table, passive extension, rotation & lateral flexion to each side for 15 seconds

Front 69

Positive results for Hallpike maneuver test

Back 69

(+)vertigo, nystagmus, dizziness or nausea indicates vertebrobasilar artery insufficiency

Front 70

Hautant test

Back 70

Pt. Seated with arms forward & hands supinated, active rotation & hyperextention of head to each side

Front 71

Positive results for Hautant test

Back 71

(+)drifting of arms indicates vertebrobasilar insufficiency

Front 72

Underburg's test

Back 72

Pt. standing with arms forward & hands supinated, with eyes closed, active rotation & hyperextention of head, Pt. Then marches in place for 15 sec., repeat for opposite side

Front 73

Positive results for Underburg's test

Back 73

(+)drifting of arms or loss of balance indicates vertebrobasilar or carotid artery insufficiency

Front 74

WEBER test result: Lateralization of tuning fork to Right?

Back 74

Sensory neuro loss on Left, OR air conduction block on the Right. Neuro, opposite. Block, same. Tell examiner you would do the follow up test [Rinne] given this finding.

Front 75

What MUST you do first as part of the SWIVEL CHAIR test?

Back 75

the Barre-Leiou test.

Front 76

Swivel test is simply an increase in speed of the _______________ test. What is the positive of a swivel chair test?

Back 76

Barre-Leiou. A positive SWIVEL CHAIR test: patient becomes nauseous and dizzy.

Front 77

D/Dx positive swivel chair test?

Back 77

Cervicogenic vertigo, VBAI

Front 78

Chest pain. Perform posterior fremitus and ascultate the lung field. State all the findings and do sternal compression posteriorly.

Back 78

Pt cross arms. Review changes in case of pneumonia and emphysema upon fremitus, breathing, percussion, etc. Pt. supine, press down on sternum. Pain (+) could be rib, thoracic, etc.

Front 79

In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that occur in sequence with each heartbeat.

Back 79

These are the first heart sound (S1) and second heart sound (S2), produced by the closing of the AV valves and semilunar valves

Front 80

Heart murmurs are generated by turbulent flow of blood, which may occur inside or outside the heart. Murmurs may be physiological (benign) or pathological (abnormal).

Back 80

Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, really turbulence as blood flows through it. Abnormal murmurs occur with valvular insufficiency (or regurgitation), allowing backflow bc incompetent valve closes halfway.

Front 81

The first heart tone, or S1, forms the "lub" of "lub-dub" and is composed of components M1 and T1. What causes the "Lub" sound?

Back 81

It is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves, i.e. tricuspid and mitral (bicuspid), at the beginning of ventricular contraction, or systole.

Front 82

The S1 sound results from reverberation within the blood associated with the sudden block of flow reversal by the valves.[1] If M1 occurs slightly after T1, then

Back 82

the patient likely has a dysfunction of conduction of the left side of the heart such as a left bundle branch block.

Front 83

The second heart tone, or S2, forms the "dub" of "lub-dub" and is composed of components A2 and P2. What causes the "dub" sound?

Back 83

It is caused by the sudden block of reversing blood flow due to closure of the semilunar valves (the aortic valve and pulmonary valve) at the end of ventricular systole, i.e. beginning of ventricular diastole.

Front 84

he S2 sound results from reverberation within the blood associated with the sudden block of flow reversal into the ventricles by the aortic and pulmonic cusps. When does an S2 split occur?

Back 84

Splitting of S2, also known as physiological split, normally occurs during inspiration.

Front 85

A widely split S2 can be associated with?

Back 85

right bundle branch block, pulmonary stenosis and atrial septal defect.

Front 86

You perform fremitus. The patient has an increase in "99" sound. Meaning?

Back 86

any consolidation

Front 87

You perform fremitus. The patient has a decrease in "99" sound. Meaning?

Back 87

Pneumothorax, or any air in pleural space

Front 88

You perform lung percussion. The patient has a hyper-resonance. Meaning?

Back 88

Emphysema, because lungs are 'bags of air' all over. There is no expansion area left because the lungs are fully expanded, fully inflated.

Front 89

How will hyper-resonant lung breath sound?

Back 89

Distant, far away.

Front 90

You perform percussion over a patient's lungs and it sounds dull. Meaning?

Back 90

Consolidation. Dull thud over pneumonia. Normal diaphragm excursion.

Front 91

You ascultate a patient's lungs and hear no vesicular sounds over the middle lobe, just wheezes and crackles. Meaning?

Back 91

Middle lobe consolidation (pneumonia)

Front 92

Any entity (trauma) that makes the lung go away makes ________ go away.

Back 92

fremitus

Front 93

You ascultate and percuss a patient's lung fields; you hear resonance and vesicular breath sounds. Meaning?

Back 93

Normal lungs: resonance and vesicular breath sounds

Front 94

You ascultate the lungs but hear no breath sounds on the left lower lobe. The percussion resonates like a drum. Only the right side is inflating when the patient breathes. Meaning?

Back 94

Pleural effusion (can be spontaneous) and if fluid is bloody, it could be a hemothorax. This is a DRUM resonance because it is full of blood. If it were a pneumothorax, it would be full of air and have a typmpanic sound.

Front 95

Zero diaphragmatic excursion on one side, +5 excursion on the other. Meaning?

Back 95

Hemidiaphragm. could be Pneumothorax or hemothorax. Depends on the resonance sound: is it typmpanic (air = pneumothorax) or drum like (fluid = pleural effusion of fluid, perhaps blood/hemothorax).

Front 96

Why doesn't pneumonia resonate either tympany or drum like?

Back 96

Because it is SOLID, ie, conSOLIDation. It sounds DULL. Think of an idiot with a consolidated, thick mind, dullard.

Front 97

You ascultate a patient's left upper lung field: there is no vesicular (breath) sound, no fremitus when you palpate. There is no diaphragmatic excursion on the left, either. There IS hyper-resonance and tympany in the upper left field.

Back 97

Pneumothorax! It's all air, no lung.

Front 98

Normal diaphragm excursion

Back 98

3-5 cm

Front 99

Correct technique for ascultation of lung field

Back 99

Double tap diaphragm - they may give you a dead scope. Hold diaphragm tightly against chest. Listen for one full breath. If adventitious sound heard, ask patient to cough and listen again. Compare bilaterally. Keep in mind underlying anatomy.

Front 100

Upon ascultation of lung, you hear adventitous sound. Why ask patient to cough?

Back 100

Because bronchitis can be cleared by coughing.

Front 101

What is proper placement above clavice when ascultating and testing with hand for fremitus?

Back 101

Fully clear the clavicle.

Front 102

4 lung field distinctions (ie, vesicular)

Back 102

Tracheal (loud, high, harsh, over extrathoracic trachea), Bronchial (loud, high, tubular over manubrium), Bronchovesicular (moderate, rustling, tubular, over main bronchi), Vesicular (soft, low, gentle rustling, over peripheral lung)

Front 103

In what patients might it be normal to hear a gallop rhythm? (S3)

Back 103

Children and athletic adults (LUB-duppa). Otherwise, suggests congestive heart failure due to anemia, hyperthyroid, pregnancy

Front 104

What does an S3 gallop rhythm sound like?

Back 104

Milk hitting the side of an empty pail, getting more muffled as it fills up. Noise during fill stage as liquid hits empty vessel.

Front 105

S2 split

Back 105

late closure of semilunar valves (aorta and pulmonic)

Front 106

Crackles and rales/change in breath sound

Back 106

congestion, fluid, asthma, etc.

Front 107

On the chest x-ray of patient for which you just ascultated, percussed, or palpated for fremitus, what should you look for?

Back 107

CARDIOMEGALY (the normal heart size is half the chest cavity)

Front 108

19 yo male with midback pain. Perform AROM thoracolumbar, chest expansion, Kemp's, rib motion, and explain normal findings.

Back 108

Pulling sensation upon bending down seated = Right thoracolumbar paraspinal. Male chest expansion 2", female 1.5". D/dx Schuermann's, Ankylosing Spondylitis, muscular hypertonicity.

Front 109

What radiograph to order for Scheurmann's?

Back 109

AP, lateral thoracic. Look for multiple Schmorl's nodes, irregular endplates, angular wedging, hyperkyphosis

Front 110

Female comes in holding her arm. FOOSH fall. Perform Codman's, drop, Apley's scratch, Yergason, AROM for shoulder.

Back 110

Drop on Codman, watch eccentric return, too. Apley's = ER & ABd over head, INR & ADd behind back. Yergason's - biciptial instability (transverse humeral ligament over b. tendon) - patient tries to flex and supinate against resistance (Speed test).

Front 111

D/dx shoulder problem

Back 111

GHJ (apprehension test), supraspinatus (Neer's, Hawkins Kennedy, Gerber's lift off, Codman's, Supraspinatus press test), bicipital tendinitis (Yergason's, Abbot Saunders, Speed), ACJ sprain (Scarf, O'Briens)

Front 112

evaluation of shoulder

Back 112

Protraction (GH flexed to 90 degrees), Retraction (GH flexed to 90 degrees), Elevation (arm at side, lift pt's elbow), Depression. Flexion, Extension, Adduction across body, Abduction, Internal and external rotation arm at side, then at 90 degrees

Front 113

Normal acromiohumeral space measurement?

Back 113

7-11 cm

Front 114

Hoover's, Mankopf's, Magnuson's, Burn's bench tests

Back 114

MALINGERING tests

Front 115

Left wrist and hand pain. What tests?

Back 115

Froment's, Finkelstein's, Tinnel tap at elbow, at wrist, English's, Bunnell-Littler. Where is the sustained paresthesia going?

Front 116

Right knee pain. What tests?

Back 116

Slocum, Lachmann, AP drawer, PA drawer, Apley's compression, Patellar ballottement? (Clark's). McMurray's is NOT a pain test - it's a test for meniscus. Can do varus, valgus for pain, too.

Front 117

Please study the orthopedic tests from PAI

Back 117

and the diagnosis exam tests from PAII. Dr. Loia has a technique review on the class website for our tri. Watch it every day!