Clinical Examination and Diagnoses

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Questions and Answers

What is the most likely diagnosis for a 65-year-old male with mid-back tightness and a history of gallbladder removal, characterized by pain in the T4-9 region?

Spinal metastasis

Cholecystitis

Non-speciﬁc back pain (correct)

Pancreatitis

Which structure is implicated in a positive Wright’s test for a patient with thoracic outlet syndrome?

Anterior scalene tightness

Cervical rib

Tight pec minor (correct)

Costoclavicular entrapment

Which test was performed on an 18-year-old female runner when her lateral knee pain was reproduced by dropping her leg posteriorly off the backside of the table?

Lateral pivot shift

Faber’s test

Fair’s test

Ober’s test (correct)

What is the likely diagnosis for a young male powerlifter with lateral thigh pain and tenderness originating from the posterolateral portion?

IT band syndrome Signup and view all the answers

What muscular tightness could be contributing to a patient diagnosed with thoracic outlet syndrome when experiencing symptoms during overhead activities?

Tight pec minor Signup and view all the answers

Which symptom is most consistent with a diagnosis of cholecystitis, particularly in a patient with a recent gallbladder removal?

Epigastric pain Signup and view all the answers

In the context of lateral knee pain, what condition is suggested by a positive Noble's compression test in a young male powerlifter?

IT band syndrome Signup and view all the answers

What is a common symptom of thoracic outlet syndrome that can be evaluated with a positive Roo's test?

Numbness in the fingers Signup and view all the answers

What is the most likely diagnosis for a patient exhibiting café au lait spots on their body?

Acoustic neuroma Signup and view all the answers

What is the likely diagnosis for a patient with chronic neck pain and radiculopathy, primarily affecting the right side, linked to IVF narrowing?

C4 radiculopathy due to C3-4 IVF narrowing Signup and view all the answers

Which test is likely performed when a patient feels wrist pain upon grasping their thumb and a passive ulnar deviation reproduces the symptoms?

Finkelstein’s test Signup and view all the answers

How should a patient with neck pain that has spread to the elbow be managed when recovery is slow?

Nerve velocity conduction study Signup and view all the answers

What is the next best step after an X-ray shows no fracture in a suspected scaphoid fracture following a FOOSH injury?

Re-x-ray in a week as fracture may be occult Signup and view all the answers

After a FOOSH injury with an initial normal X-ray, what should be done next if a follow-up X-ray still appears normal but suspicion of fracture remains high?

Bone scan Signup and view all the answers

What condition does a patient's symptom of pain when grasping their thumb indicate, especially if neurological tests are negative?

De Quervain’s tenosynovitis Signup and view all the answers

In the case of C4 radiculopathy related to C3-4 IVF narrowing, which symptoms would be expected?

Pain radiating down the lateral arm to the thumb Signup and view all the answers

What is the most likely diagnosis for a patient with low back pain from heavy lifting, pain with flexion, and relief with extension?

Intervertebral disc derangement Signup and view all the answers

What should be done if a patient experiencing mechanical neck pain wants to explore alternative treatment options due to discomfort with the popping sound during SMT?

Attempt using a different way to adjust her neck Signup and view all the answers

What is the most appropriate action when a new patient is aggressive towards the clinic staff?

Have the staff escort the patient out of the clinic Signup and view all the answers

By law, which forms are required to have the patient’s name on them during intake?

All of the above Signup and view all the answers

What is the most appropriate course of action if a SOAP note is mistakenly dated?

Sign beside your mistake and make a note on the proper date Signup and view all the answers

When is it necessary for a patient to sign a new ROF and informed consent?

If any aspect of the treatment has changed, which may carry separate and unique risks Signup and view all the answers

Which of the following describes a common symptom if a patient presents with radicular-like symptoms down their leg?

Numbness and tingling in the leg Signup and view all the answers

What is the most relevant reason to use alternative treatment options when a patient expresses discomfort with the current approach?

Patient comfort can significantly impact treatment adherence Signup and view all the answers

What is the most appropriate plan of management for a 70-year-old male with severe low back pain and a pulsatile mass in his abdomen?

Refer to ER Signup and view all the answers

What condition is being assessed with a test where one knee is flexed and the other leg hangs off the edge of the table?

Iliopsoas strain Signup and view all the answers

What is the best exercise to help treat winging scapula?

Push-up plus Signup and view all the answers

What is the best way to rehabilitate a supraspinatus strain?

Eccentric lateral raises Signup and view all the answers

What is the best treatment for adhesive capsulitis as diagnosed by a chiropractor?

Treat with firm joint mobilizations and soft tissue therapy Signup and view all the answers

Which structure is compressed in a patient with Morton’s neuroma?

Interdigital nerve Signup and view all the answers

During an examination of an acute ankle injury, which symptom would be the most concerning?

Severe pain along the lateral malleolus Signup and view all the answers

Following an acute lower extremity injury, what is the best plan of management for a patient with severe leg pain and diminished pulses?

Refer to ER Signup and view all the answers

What advice would be appropriate to give a patient seeking treatment for conditions other than conservative chiropractic options?

Exercise Signup and view all the answers

Which nerve is likely entrapped in a patient with sensory losses in the first three fingers and weakness in abductor pollicis brevis?

Median nerve Signup and view all the answers

What muscle should be stretched to relieve headaches that start at the back of the head and move to the frontal region?

Suboccipitals Signup and view all the answers

If a patient has an elongated pedicle and a known spondylolisthesis, how would this spondylolisthesis be classified?

Isthmic Signup and view all the answers

What is the most likely diagnosis for an 80-year-old female patient with x-rays showing multiple vertebrae that appear less radiodense?

Osteoporosis Signup and view all the answers

Which muscle is likely to be palpated if a patient has arm pain that reproduces discomfort when palpated at the proximal third of the anterior humerus?

Brachialis tendon Signup and view all the answers

What symptom would you expect in a patient diagnosed with rosacea?

Redness over her face Signup and view all the answers

A factory worker presents with low back pain after lifting a heavy box. What is the most likely diagnosis if lumbar flexion relieves pain and lumbar extension exacerbates it?

Lumbar facet irritation Signup and view all the answers

Study Notes

Patient Presentation and Diagnosis

A 65-year-old male patient presents with mid-back tightness and pain in the area of T4-9. History reveals daily alcohol consumption and recent gallbladder removal. The most likely diagnosis is non-specific back pain.
A 27-year-old male office worker presents with neck and hand pain. Physical exam reveals thoracic outlet syndrome, confirmed by positive Roo's and Wright's tests. A positive Wright's test implicates costoclavicular entrapment.
An 18-year-old female runner presents with lateral knee pain, worsening with running. Physical exam includes a test where the patient lies on their side and drops their leg posteriorly, reproducing the pain. This test is Fair's test.
A young male powerlifter presents with lateral thigh to knee pain, exacerbated by increased training load. Physical exam reveals posterolateral thigh tenderness and positive Noble's compression test. The diagnosis is IT band syndrome.
A female cyclist presents with medial leg pain. A 36-year-old male factory worker presents with low back pain after lifting a heavy box. Physical exam reveals pain with flexion, relieved by extension. The most likely diagnosis is intervertebral disc derangement.

Chiropractor Treatment and Management

A patient receiving SMT treatment for mechanical neck pain experiences relief but expresses dislike for the "pop". The most appropriate action is to try using mobilization and soft tissue techniques.
A new patient in the waiting room is aggressive towards staff and demands to see the doctor. The most appropriate step is to have the staff escort the patient out of the clinic.
Intake paperwork for a new patient includes intake forms, SOAP notes, and an ROF. By law, all of the above forms are required to have the patient's name on them.
When completing a SOAP note, a mistake is made with the date. The most appropriate course of action is to signature beside your mistake a make a note on the proper date.
A new ROF and informed consent is required if any aspect of the treatment has changed, which may carry separate and unique risks.
A patient presents with radicular-like symptoms down their leg and café au lait spots. The most likely diagnosis is neurofibromatosis.

Specific Diagnosis and Treatment

A 45-year-old female with chronic neck pain and radiculopathy experiences symptoms on the right side of her neck and into her lateral forearm and thumb. X-ray shows IVF narrowing. The diagnosis is C6 radiculopathy due to C5-6 IVF narrowing.
A young female patient presents with wrist pain when grasping objects with her thumb. Neurological exam and cervical radiculopathy tests are negative. A test where the patient grasps their thumb and moves their hand into passive ulnar deviation reproduces the symptoms. This test is Finkelstein's test.
A patient receiving treatment for neck and posterior shoulder pain experiences progression of pain to their elbow. The appropriate management is nerve velocity conduction study.
A basketball player sustains a FOOSH injury and suspected scaphoid fracture. X-ray is negative. The next best step is re-x-ray in a week as fracture may be occult.
A patient with a FOOSH injury has normal initial and follow-up x-rays, but the doctor suspects a fracture. The next step is bone scan.
A patient presents with severe low back pain worsened with coughing, history of smoking, and a pulsatile abdominal mass. The most appropriate plan is refer to ER.

Anatomy and Physiology

A test where the patient lies supine, one knee flexed to the chest and the other hanging off the table, assesses for iliopsoas strain.
Winging scapula is best treated with eccentric lateral raises.
Supraspinatus strain is best rehabbed with eccentric lateral raises.
Adhesive capsulitis is treated with gentle joint mobilizations.

Nerve Entrapment

A patient presents with sensory losses in the 1st 3 fingers and weakness in abductor pollicis brevis. The entrapped nerve is median nerve.
A patient with headaches originating in the back of the head and moving to the temporal and frontal regions may benefit from stretching upper trapezius.
A patient diagnosed with spondylolisthesis and an elongated pedicle on x-rays has isthmic spondylolisthesis.
An 80-year-old female patient with multiple less radiodense vertebrae on x-rays and occasional low back pain likely has osteoporosis.

Miscellaneous

During a physical exam, palpating a muscle at the proximal 1/3 of the anterior humerus that reproduces arm pain indicates the biceps tendon.
A patient with rosacea will have redness over their face.
A factory worker with low back pain after lifting, relieved by flexion and pain with extension, and a positive Kemp's test likely has lumbar facet irritation.

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Description

This quiz evaluates your understanding of various patient presentations and their corresponding diagnoses. Each case includes key clinical details essential for identifying common conditions like thoracic outlet syndrome and IT band syndrome. Test your clinical reasoning skills and knowledge of physical exams.