Question 1

What is the most reliable screening test for cervical spondylotic myelopathy in a client with complaints of low back pain?

Accepted Answer

Cervical spondylotic myelopathy has been verified as a potential cause of low back pain. The Babinski sign may be the most reliable screening test. There is no single reliable or valid clinical screening test or combination test that can be used to confirm spinal cord compression myelopathy. An imaging study is usually needed to differentiate biomechanical from medical cause of radicular pain, if giving a patient conservative care fails to bring about improvement.

Question 2

Severe esophagitis will most often refer pain to what anatomic area?

Accepted Answer

Severe esophagitis may refer pain to the anterior cervical area or, more often, the midthoracic spine. The pain pattern will most likely present in a band of pain starting anteriorly and spreading around the chest wall to the back.

Question 3

Ovarian cysts present as part of the polycystic ovary syndrome put a woman at risk for what medical conditions?

Accepted Answer

Ovarian cysts present as part of the polycystic ovary syndrome put a woman at increased risk for insulin resistance and potentially increased risk for cardiovascular disease as well.

Question 4

Clients with neurogenic lumbar pain will obtain relief from which posture?

Accepted Answer

Because the vertebral canal is wider when the spine is flexed, relief from neurogenic pain may be obtained when the spine is flexed forward.

Question 5

What type of headache will cause most clients to seek physical therapy treatment?

Accepted Answer

Primary headaches include migraine, tension-type headache, and cluster headache. The therapist often provides treatment for secondary headache called cervicogenic headache.

Question 6

When seen early in the course of symptoms, neck or back pain of a systemic, medical, or viscerogenic origin is usually accompanied by

Accepted Answer

When seen early in the course of symptoms, neck or back pain of a systemic, medical, or viscerogenic origin is usually accompanied by full and painless range of motion without limitations. When the pain has been present long enough to cause muscle guarding and splinting, then subsequent biomechanical changes occur.

Question 7

The therapist begins an examination of a patient with a history of lumbar complaints. During the examination, the physical therapist is unable to reproduce the pain with any position or provocation test. What is the correct course of action by the physical therapist?

Accepted Answer

Back pain that is unrelieved by rest or change in position, or pain that does not fit the expected mechanical or neuromuscular skeletal pattern, should raise a red flag. When the symptoms cannot be reproduced, aggravated, or altered in any way during the examination, additional questions to screen for medical disease are indicated.

Question 8

What cranial nerve root is involved if a patient reports deep aching pain in the occipital, retroorbital, or temporal areas with referred pain to the face, ear, or subocciput?

Accepted Answer

Deep aching pain in the occipital, retroorbital, or temporal areas may be present with pain referred to the face, ear, or subocciput from irritation in the C2 nerve root. This is often present in clients with a diagnosis of rheumatoid arthritis within the last 2 years.

Question 9

What is the most common cause of back pain referred from the stomach?

Accepted Answer

Long-term use of NSAIDs is the most common cause of back pain referred from the stomach or duodenum.

Question 10

What type of cancer is the most common primary malignancy involving the spine?

Accepted Answer

Multiple myeloma is the most common primary malignancy involving the spine, often resulting in diffuse osteoporosis and pain with movement that is not relieved while the person is recumbent.

Question 11

A patient with complaints of lumbar/thoracic pain finds relief when lying on the involved side. What information does this convey to the therapist?

Accepted Answer

Autosplinting is considered a valuable red flag for possible pulmonary involvement. Autosplinting occurs when the client prefers to lie on the involved side. It is uncommon for a person with true musculoskeletal dysfunction to find relief in symptoms by lying on the involved side.

Question 12

Which of the following structures in the cranium does not have pain receptors?

Accepted Answer

The brain itself does not feel pain because it has no pain receptors. Most often a headache is caused by extracranial disorder. Headache pain is related to pressure on other structures such as blood vessels, cranial nerves, sinuses, and membranes surrounding the brain.

Question 13

Where are the complaints of pain in a client with intermittent claudication?

Accepted Answer

Ipsilateral pain or discomfort (intermittent claudication) occurs with obstruction of the popliteal artery and is a common first symptom of peripheral vascular disease.

Question 14

Which of the following individuals has the highest likelihood of vertebral fracture?

Accepted Answer

The highest likelihood of vertebral fractures occurs in women aged 75 years or older.

Question 15

What body system should be screened thoroughly if a patient complains of thoracic spine pain?

Accepted Answer

The proximity of the thoracic spine to the chest and respiratory organs requires careful screening of the cardiopulmonary system in anyone with back pain of unknown cause or medical history of cancer or pulmonary problems. Thoracic pain can also be referred from the kidney, biliary duct, esophagus, stomach, gallbladder, pancreas, and heart. Pain from the other systems mentioned is possible in the thoracic spine, but the most likely medical cause of thoracic spine pain would be the cardiopulmonary system.

Quiz 14: Screening the Head, Neck, and Back