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NBCE PART 4 BOARDS ORTHOPEDICS
PART IV NBCE EXAM 2024 ACTUAL 200
EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) |
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EDITION
Foraminal Compression Test ------CORRECT ANSWER-------------The patient is seated and actively rotates head from side to side. Then the doctor exerts downward pressure and the head is rotated to each side with pressure. Positive Radicular Pain - > Nerve Root Compression Positive Local Pain - > Foraminal Encroachment Jackson's Compression Test ------CORRECT ANSWER-------------The patient is seated and the doctor laterally flexes the patient head to the left and the right and applies downward pressure. Postive Radicular Pain - > Nerve Root Compression Distraction Test ------CORRECT ANSWER-------------The patient is seated and the doctor holds under the mastoid and pulls the patient's head superior, removing the weight of the head. "What did you experience?" Decreased Pain - > Nerve Root Compression
Increased Pain - > Sprain/Strain O'Donohue's Test is for.... ------CORRECT ANSWER-------------Determining whether it is a SPRAIN or STRAIN O'Donohue's Test Performed ------CORRECT ANSWER-------------1) Patient actively moves part against resistance.
- Then the doctor moves part passively through a full ROM. Pain Active: STRAIN (damage in mm tissue) Pain Passive: SPRAIN (damage I'm ligamentous tissue) Valsalva's Maneuver ------CORRECT ANSWER-------------The doctor asks the patient to take a deep breath and hold while bearing down. Postive Radicular Pain - > SOL Maximal Cervical Compression Test ------CORRECT ANSWER------------- Patient is seated and actively rotated and extended head. If no pain the patient is asked to maximally laterally flex head in the same direction. Repeat on the other side. No compression applied. Postive Radicular pain - > Nerve Root Compression Shoulder Depression Test ------CORRECT ANSWER-------------Patient is seated, the doctor depressed the patient's shoulder while laterally flexing the cervical spine away from the shoulder. Repeat on other side.
Eden's Test Performed ------CORRECT ANSWER-------------Patient is seated and doctor palpated for the radial pulse. Patient brings shoulder down and back and then flexes chin to their chest. Positive if alteration to amplitude of radial pulse - > compression between first rib and clavicle Adson's Test AKA ------CORRECT ANSWER-------------Scalenus Anticus Test Scalenus Anticus Test Performed (MUST KNOW) ------CORRECT ANSWER-------------Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head TOWARDS the tested side and extends head. Patient takes a deep breath and holds it. Postive if alteration to amplitude of radial pulse - > Scalenus Anticus Syndrome (Cervical "Halstead" rib) Modified Adson's Test AKA ------CORRECT ANSWER-------------Scalenus Medius Test Scalenus Medius Test Performed (MUST KNOW) ------CORRECT ANSWER-------------Patient is seated and doctor abducts, extends and externally rotates arm while taking the radial pulse. Patient rotates head AWAY from the tested side and extends head. Patient takes a deep breath and holds it. Positive if alteration to amplitude of radial pulse - > Scalenus medium syndrome (Subclavian Artery)
Wright's Test AKA ------CORRECT ANSWER-------------Hyperabduction Maneuver Hyperabduction Maneuver Performed (MUST KNOW) ------CORRECT ANSWER-------------Patient is seated and doctor palpated radial pulse. Both arms are abducted 180degrees. The doctor notes at what angle the radial pulse diminishes or disappears. Positive f pulses are lost greater than 10degrees difference - > Pectorals Minor Syndrome (Axillary Artery) Reverse Bakody Maneuver ------CORRECT ANSWER-------------Patient is seated and patient actively placed palm on top of their head. Positive is pain is increased - > TOS Halstead's Test ------CORRECT ANSWER-------------Patient is seated and extends their head backwards. The examiner exerts downward traction and slight abduction on arm while taking patient's pulse. Positive if alteration in the amplitude of the radial pulse - > cervical rib Rotator Cuff Injury...is muscle or tendon more commonly injured? ------ CORRECT ANSWER-------------TENDONS Which Rotator cuff tendon is most likely injured? ------CORRECT ANSWER-------------SUPRASPINATUS
Yergason's Test ------CORRECT ANSWER-------------The patient flexes their elbow to 90 degrees while seated. The doctor palpates the biceps tendon and actively resists the patient's attempt to actively supinate the hand and flex the elbow. Positive: Audible click or snap in bicipital groove - > Bicipital Tendon Instability Dawbarn's Sign ------CORRECT ANSWER-------------The doctor palpates the subacromial bursa and elicits pain. The doctor passively abducts patient's shoulder without moving his/her fingers off of the subacromial bursa. Positive: Reduction of pain in second maneuver - > Subacromial Bursitis Impingement Sign ------CORRECT ANSWER-------------The patient slightly abducts their arm and the doctor passively moves their arm through a full flexion. This causes a jam of the greater tuberosity against the lacrimal surface. Positive: Pain - > Tendonitis (overuse of tendons) Supraspinatus Press Test AKA ------CORRECT ANSWER-------------Empty Can Test Empty Can Test Performed ------CORRECT ANSWER-------------Patient abducts shoulders to 90degrees and the doctor apple resistance. The patient flexes shoulders to 30 degrees and points thumbs downward and resistance is applied again. (Hold & push the proximal elbow). Positive: Weakness - > Supraspinatus Tear
Speed's Test ------CORRECT ANSWER-------------Patient is seated with elbow slightly flexed and palm up. The doctor resists the patient's attempt to flex shoulder while extending and supinating the forearm. Positive: Pain - > Bicipital Tendonitis Subacromial Push Button Test ------CORRECT ANSWER-------------Doctor applies a deep pressure over the subacromial bursa. Postive: Pain - > Supraspinatus degeneration OR Subacromial bursitis Passive Shoulder Approximation ------CORRECT ANSWER------------- Patient is standing and the doctor asks patient to lift shoulders up and back (squeeze the shoulder blades together). Positive: Pain in scapular region - > T1 or T2 Nerve Root problem on side of pain Bryant's Test ------CORRECT ANSWER-------------Doctor observed patient standing and notes the heights of axillary folds. Positive: lower axillary fold on involved side - > Shoulder Dislocation Brachial Plexus Tension Test ------CORRECT ANSWER-------------Patient is seated. Patient places both hands behind his/her head and pulls elbows posteriorly. Positive: Pain - > C5 Nerve Root Lesion and/or TOS
Postive: Pain in the lateral elbow-> Lateral Epicondylitis Reverse Cozen ------CORRECT ANSWER-------------Same except arm is supinated and doctor pulled on flexed wrist. Positive: Pain in medial elbow->Medial Epicondylitis Mill's Test ------CORRECT ANSWER-------------Doctor passively flexes patient's fingers, wrist, elbow and the brings elbow around and into max pronation and extension. Positive: Pain in Lateral Elbow - > Lateral Epicondylitis Reverse Mill's ------CORRECT ANSWER-------------Patients hand is flat, patient flexes and doctor resists. Postive: Pain in Medial Elbow - > Medial Epicondylitis Tinel's Sign (wrist) ------CORRECT ANSWER-------------Percuss over the flexor retinaculum (anterior portion of the wrist where a watch would sit) and the Tunnel of Guyon (most medial portion of above) Postive: Tingling in the lateral 3 fingers (Carpal Tunnel Syndrome) of medial two fingers (Ulnar Impingement) Phalen's Sign ------CORRECT ANSWER-------------The patient flexes writs maximally and holds position for one minute, pushing hands together. Positive: tingling into lateral 3 fingers of hand - > Carpal Tunnel Syndrome
Pinch Grip Test ------CORRECT ANSWER-------------Ask the patient to put the tip of their thumb to the tip of their index finger. Positive: if they put the pads of their thumb and forefinger together - > Ant. Interosseous N. Syndrome - > Median N. Lesion Froment's Paper Sign ------CORRECT ANSWER-------------Doctor places a piece of paper between the patient's thumb and index finger (all other fingers too) and attempts to pull it out. Positive: Cannot hold paper-> Ulnar N. Palsy Finkelstein's Test ------CORRECT ANSWER-------------Patient makes a fist with thumb inside fist; then fist is passively ulnar deviated. Positive: Pain over the anatomical snuff box - > DeQuervain's Disease AKA Stenosing Tenosynovitis. Stenosing Tenosynovitis ------CORRECT ANSWER------------- Bracelet Test ------CORRECT ANSWER-------------Doctor applies compression around patient's wrist like a bracelet. Positive: Pain - > RA (if bilateral) or Strain/Sprain (if unilateral) Straight Leg Test ------CORRECT ANSWER-------------Patient is supine. Doctor places one hand under heel and the other over the knee and slowly, passively raises patient's leg.
Positive: pain in symptomatic side - >medial disc lesion Millgram's Test ------CORRECT ANSWER-------------Patient supine. Asked toe actively elevate legs off the table 6 inches. Hold for 30seconds. Positive: Pain - > SOL Leg Lowering Test ------CORRECT ANSWER-------------Patient supine. Doctor moves patient's legs passively to 90degrees and ask's patient to bring legs back down to the table. Positive: LBP - > SOL Bilateral SLR ------CORRECT ANSWER-------------SLR on L, SLR on R, SLR bilaterally Positive: Pain occurs earlier on bilateral than unilateral - > Lumbosacral Joint Lesion Goldthwait's Sign ------CORRECT ANSWER-------------SLR with hand under lumbar section of the spine. Positive: Pain 0 - 30degrees: SI joint 30 - 60degrees: Lumbosacral joint 60 - 90degrees: Lumbar spine or contralateral SI joint Linder's Sign ------CORRECT ANSWER-------------Passively flex patient's head to chest.
Positive: Pain the lumbar spine - > Root Sciatica Bowstring Sign ------CORRECT ANSWER-------------SLR to point of pain + flex knee to Doctor's shoulder + pressure in popliteal fossa Positive: Pain in lumbar region or radiculopathy - > Sciatica (BEST TEST) Bonnet's Sign ------CORRECT ANSWER-------------Patient supine. Doctor internally rotates, abducts leg and the performs SLR. Positive: Radicular pain - > Piriformis Syndrome Becterew's Test ------CORRECT ANSWER-------------Patient seated. Doctor stabilizes thighs and patient attempts to extend both legs. Positive: pain or leaning back - > Disc (posteromedial disc IF pain when good leg is raised) Minor's Sign ------CORRECT ANSWER-------------Ask patient to rise from a seated position. Positive: support body with good side - > sciatica Kemp's Test ------CORRECT ANSWER-------------Patient seated. Doctor rotates patient's trunk and laterally bends towards and then away from affected side. Positive: Sciatica pain in involved side - > Disc Local pain - > Facet
Stork Test ------CORRECT ANSWER-------------Patient stands making a yoga tree pose. Extends. Positive: Pain - > Spondy or SI lesion Gaenslen's Test ------CORRECT ANSWER-------------Patient supine with involved side near exam table edge. The opposite knee and thigh are fully flexed against abdomen of patient. Involved leg is slowly lowered off table by Doctor. The Doctor then applies downward pressure against clasped knee and extended hip. Positive: SI pain - > SI lesion Lewin-Gaenslen's Test ------CORRECT ANSWER-------------Patient lie on unaffected side and pulls (table contacting) lower knee to chest. Doctor stabilizes pelvis and hyper extends top thigh. Positive: SI pain - > SI lesion Iliac Compression ------CORRECT ANSWER-------------Patient lies on unaffected side. Doctor contacts upper iliac crest and exerts downward pressure. Positive: SI pain - > SI lesion Hip Abduction Stress Test (KNOW) ------CORRECT ANSWER------------- Patient lies on unaffected side. Patient actively abducts top leg and the doctor exert downward pressure on proximal to knee. Positive: Pain at PSIS - > SI lesion Weakness - >Glut Med weakness
Femoral Nerve Traction Test (KNOW) ------CORRECT ANSWER------------- Patient lies on unaffected side. Patient extends knee and Doctor brings hip to 15degrees of extension...if no pain, increase extension and flex knee. Positive: Pain in anterior thigh - > L2, L3, L4 N. root lesion Hibbs Test ------CORRECT ANSWER-------------Patient is prone. Doctor stabilizes hip on side she is standing. Doctor take opposite ankle and flexes knee to 90degrees. Doctor slowly pushes leg laterally away producing internal rotation of the hip. Positive: SI pain - > SI joint lesion Nachlas Test ------CORRECT ANSWER-------------Pain prone. Heel is approximated to same buttock. Doctor stabilizes hip. Positive: SI Pain-> SI lesion Yeoman's Test ------CORRECT ANSWER-------------Doctor stabilizes SI joint. Flexes affected knee and hyperextends the thigh by lifting leg off the table. Positive SI pain - > SI lesion Prone Hyperextension Test (KNOW) ------CORRECT ANSWER------------- Patient is prone. Doctor stabilizes the lumbosacral area. Doctor lifts legs while the knee remains extended.
Ely's Sign ------CORRECT ANSWER-------------Patient prone. Heel to buttock. Postitive: hip elevated - > Hip flexor contracture Ely's Test ------CORRECT ANSWER-------------Patient prone. Heel to opposite buttock. Positive: Pain - > Hip Lesion Trendelenburg's Test ------CORRECT ANSWER-------------Patient is standing and lifts on leg. Positive: Hip falls on side that is lifted - > glut med weakness on standing side Neri's Sign ------CORRECT ANSWER-------------Standing patient bends forward at waist. Positive: Knee buckles - > Tight hamstrings Lewin-Gaenslen's Test ------CORRECT ANSWER-------------Patient lies on unaffected side and pulls lower knee to chest. Dr. stands behind patient, stabilizes pelvis and hyperextends the top thigh Positive: SI pain - > SI lesion Dekleyn's ------CORRECT ANSWER-------------Patient supine w/ head extended off table. Dr. instructs pt to hyperextend and rotate the head. hole for 15-45 seconds.
(+) if produces vertigo, blurred vision, nausea, syncope, nystagmus (ind) vertebrobasilar artery circulation compromise Vertebrobasilar Artery Functional Maneuvar ------CORRECT ANSWER------ -------patient seated, auscultate (bell) and palpate subclavian and carotid arteries. If no bruit, patient rotates and hyperextends the head to each side (+) if produces vertigo, blurred vision, nausea, syncope, nystagmus (ind) vertebrobasilar artery circulation compromise Ptosis ------CORRECT ANSWER-------------Bilateral (ind) Myasthenia Gravis Unilateral (ind) Horner's Syndrome or CN III lesion Iritis/ Uveitis ------CORRECT ANSWER-------------Seen in early stages of AS Papilledema ------CORRECT ANSWER-------------an indication of increased intracranial pressure Arteriosclerosis on eye exam ------CORRECT ANSWER-------------AV nicking, silver wire arterioles, widened light reflex Hypertension on eye exam ------CORRECT ANSWER-------------flame hemmorhages, cotton wool spots, narrow light reflex
