Solutions for Review Questions

Primary injuries can be self-inflicted, caused by another individual or entity, or caused by the environment. Secondary injuries are essentially the inflammatory response that occurs with the primary injury.

Microtraumatic injuries occur as a result of a cumulative repetitive overload, incorrect mechanics, and/or frictional resistance. Macrotraumatic injuries occur with a sudden overloading of the musculoskeletal tissues.

(1) Coagulation and inflammation stage. (2) Migratory and proliferative stage. (3) Remodeling stage.

Neutrophils are white blood cells of the polymorphonuclear (PMN) leukocyte subgroup that appear during the inflammation stage. Neutrophils are filled with granules of toxic chemicals (phagocytes) that enable them to bind to microorganisms, internalize them, and kill them.

Monocytes are white blood cells of the mononuclear leukocyte subgroup. The monocytes migrate into tissues and develop into macrophages, and provide immunological defenses against many infectious organisms.

E

A

A

A

C

Empathy is the ability to see another person's viewpoint so that a deep and true understanding of what the person is experiencing can be made.

An examination refers to the gathering of data and information concerning a topic. An evaluation refers to the making of a value judgment based on the collected data and information.

The history, systems review, and tests and measures.

Neutral questions are structured in such a way so as to avoid leading the patient into giving a particular response.

To identify possible health problems that require consultation with, or referral to, another health-care provider.

Viscerogenic, vasculogenic, neurogenic, psychogenic, and spondylogenic.

The intentional production of false symptoms or the exaggeration of symptoms that truly exist.

False.

L4–L5.

Migraine.

The swing period begins as the foot is lifted from the ground and ends with initial contact with the ipsilateral foot.

The four intervals of the swing period include preswing, initial swing, midswing, and terminal swing.

Normal cadence is considered to be between 90 and 120 steps per minute.

False.

Stability of the weight-bearing foot throughout the stance period, foot clearance of the non-weight-bearing foot in swing, appropriate prepositioning of the foot for initial contact, and adequate step length.

The lower crossed syndrome has the following characteristics: the erector spinae and iliopsoas are adaptively shortened (tight), the abdominals and gluteus maximus are weak, there is an anterior pelvic tilt, an increased lumbar lordosis, and a slight flexion of the hip. The hamstrings are frequently shortened in this syndrome.

Any five of the following: age, strength and flexibility imbalances, psychological aspects, evolutionary and hereditary influences, structural deformities, disease, pregnancy, habit, or pain.

Postural muscles—Relatively strong muscles that are likely to be poorly recruited, lax in appearance, show an inability to perform inner range contractions over time, or provide a stable base for other muscles to work from.

Phasic muscles—These muscles tend to become relatively weak compared to the postural muscles and are more prone to atrophy and adaptive shortening and show preferential recruitment in synergistic activities. In addition, these muscles will tend to dominate movements and may alter posture by restricting movement.

Plain radiographs.

The following structures are listed in order of descending density: metal, bone, soft tissue, water or body fluid, fat, and air.

Plain-film, or conventional, radiographs.

Ligamentous injuries, joint instabilities.

Magnetic resonance imaging (MRI).

Arthrography.

Angiography.

Spatial resolution and contrast resolution.

Coordination, communication, and documentation; patient/client-related instruction; and direct interventions.

PRICEMEM (Protection, Rest, Ice, Compression, Elevation, Manual therapy, Early motion, and Medications).

Stimulation of the large fiber joint afferents of the joint capsule, soft tissue, and joint cartilage, which aids in pain reduction; stimulation of endorphins, which aids in pain reduction; a decrease of intra-articular pressure, which aids in pain reduction; the mechanical effect which increases joint mobility; the remodeling of local connective tissue; the increase of the gliding of tendons within their sheaths; and an increase in joint lubrication.

The inflammatory stage of healing.

The clinical aims during the inflammatory phase are to avoid painful positions, improve range of motion, reduce muscle atrophy through gentle isometric muscle setting, and to maintain aerobic fitness.

Pharmacokinetics is the study of the physicochemical factors involved as the body absorbs, distributes, metabolizes, and eliminates a drug. Pharmacodynamics refers to the effect the drug has on the body.

The part of the autonomic system (sympathetic or parasympathetic) that is in control at rest is said to exert predominant tone.

Water-soluble vitamins include the B complex, vitamin C, biotin, choline, and folacin (folic acid).

Liver and kidneys.

Exercise increases muscular blood flow and temperature and thus can enhance absorption through molecular diffusion across biological membranes. Exercise may also sequester some drugs and reduce the availability of the drug for elimination. Thermal agents that increase regional blood flow can potentially increase delivery of a drug to a specific tissue site. Theoretically, cold can restrict drug delivery by causing vasoconstriction at the cryotherapy site.

When there is mild pain; a nonirritable condition demonstrated by pain that is provoked by motion but which disappears very quickly; intermittent musculoskeletal pain; the pain reported by the patient is either relieved by rest or by particular motions or positions; and the pain is altered by postural changes or movement.

Any five from the following: bacterial infection, malignancy, systemic localized infection, sutures, recent fracture, cellulitis, febrile state, hematoma, an acute circulatory condition, an open wound, osteomyelitis, advanced diabetes, hypersensitivity of the skin, and constant severe pain.

Traumatic hyperemia, pain relief, and decreasing scar tissue.

Strain–counterstrain, or functional techniques.

Joint mobilizations.

Posture, direct trauma, extremes of motion, electrical injury, and compression.

Double-crush syndrome.

Visible atrophy, pain with palpation, diminished active and passive range of motion in the same direction, and weakness in the muscle distribution of a peripheral nerve.

L4–S2.

30–70 degrees.

Extensibility, elasticity, irritability, and the ability to develop tension.

The erector spinae, the biceps brachii, the long head of the triceps brachii, the hamstrings, and the rectus femoris.

Isometric, concentric, and eccentric.

An isotonic contraction is a contraction in which the tension within the muscle remains constant as the muscle shortens or lengthens.

True.

External rotation > abduction > internal rotation in a 3:2:1 ratio.

D

Subscapularis, teres major, pectoralis major, and latissimus dorsi.

Infraspinatus, teres minor, and posterior deltoid.

Supraspinatus, infraspinatus, teres minor, and pectoralis major.

False. It is the anterior band of the ulnar collateral ligament.

Full elbow extension and maximum forearm supination.

Pronator quadratus, pronator teres, flexor carpi radialis.

Posteriorly (especially posterior–lateral).

A

The scaphoid and the lunate.

Hamate, capitate, trapezoid, trapezium.

Ulnar nerve and artery.

D

B

Extension, internal rotation, and abduction–adduction.

Laterally, inferiorly, and anteriorly.

Ligamentum teres.

External rotation, abduction, and extension.

Gluteus medius.

Lateral collateral ligament.

Improve the weight-bearing capacity of the knee, decrease friction, and act to restrict anterior tibial translation.

Femoral.

Genu valgum.

Inferior facet.

Anterior tibiofibular, posterior tibiofibular, and interosseous.

Tibial.

A combination of ligaments, tendons, and muscle.

Calcaneal inversion, talar abduction, and talar dorsiflexion external rotation of the tibia.

The interdigital nerve.

Occipito–atlantal (O-A) joint: Occipital condyles are biconvex and articulate with the superior facets of the atlas which are biconcave. The atlanto–axial (A-A) joint has two lateral and two median articulations. The lateral articulations are biconvex, with lax capsular ligaments allowing for good mobility. The median articulations are formed between the posterior surface of the dens and the anterior aspect of the transverse ligament.

Dens, alar ligament, transverse ligament, and tectorial membrane.

Rectus capitis lateralis.

Tectorial membrane.

Obliquus capitis superior.

The usual site of origin is from the proximal part of the subclavian artery.

Four percent of the left arteries arise from the aorta. In this variation, the artery runs vertically and slightly medial and posterior to reach the transverse foramen of the lower cervical spine, although its exact direction is dependent on its exact point of origin (any anomalies result in tortuosity). The typical point of entry is at the C6 transverse foramen, but 10% of the population has entry points from C5 to C7. Also, the postsubclavian artery could have a kink in it.

Divided into four parts: (1) Within the transverse foramen of C2. The C2 vertebral foramen has two curves: the inferior curve is almost vertical, whereas the superior curve is more horizontal and orientated laterally. (2) Between C2 and C1. The second part runs vertically upward in the transverse foramen of C2 and is covered by the levator scapulae and the inferior capitis muscles. (3) In the transverse foramen of C1. In the third part, the suboccipital portion of the vertebral artery bends backward and medially in the transverse foramen of C1. (4) Between the posterior arch of the atlas and its entry into the foramen magnum. On exiting the transverse foramen of C1, the artery travels behind the mass of the superior articular process of the atlas to cross the posterior arch of the atlas in a groove in which it is held by a restraining ligament. From the medial end of this groove, the artery runs forward, inward, and upward to pierce the posterior atlanto-occipital membrane with the nerve of C1 which separates it from the posterior arch of the atlas. It penetrates the dural matter on the lateral aspect of the foramen magnum, about 1.5 cm lateral to the midline of the neck. The artery is vulnerable to direct blunt trauma in this portion.

(1) Pontine branches—pons. (2) Anterior inferior cerebellar artery—pons and cerebellum. (3) Superior cerebellar artery—pons midbrain and cerebellum. (4) Internal auditory (labyrinthine)—membranous labyrinth and eighth cranial nerve (vestibulocochlear). (5) Superior cerebral—thalamus (central), temporal lobe (temporal branch of the cortical), and the occipital lobe (calcarine branch of the cortical).

Olfactory (CN1).

D

C

D

Uncinate process.

Lowest (C8–T1).

The temporomandibular joint (TMJ), the masticatory systems, and the related organs and tissues such as the salivary glands. It also includes the muscles of facial expression.

The lateral pterygoid muscle.

Masseter, temporalis, and medial pterygoid.

E

The position when the tongue is against the palate of the mouth and the teeth are not in contact.

Coronally (to facilitate rotation).

Ribs 1, 10, 11, and 12 are atypical because they only articulate with their own vertebra and do not possess inferior demifacets.

Costovertebral.

Ribs.

T1–T6 = pump handle; T7–T12 = bucket handle.

Posterior longitudinal ligament.

Iliolumbar ligament.

E

Lumbar extension, ipsilateral side bending, and contralateral rotation of the lumbar spine.

Approximately 60 degrees of flexion and 25 degrees of extension.

The interosseous ligament.

Counternutation (posterior motion).

The piriformis primarily functions to produce external rotation and abduction of the femur, but is also thought to function as an internal rotator and abductor of the hip if the hip joint is flexed beyond 90 degrees.

The levator ani, a muscle group composed of the pubococcygeus, puborectalis, and iliococcygeus.

The right innominate rotates anteriorly, and the sacrum right side flexes and left rotates.