New York Physical Therapy Ebook Continuing Education

31. The correct answer is C. Rationale: Both the olfactory and vestibulocochlear nerves are involved in smell and hearing. The olfactory nerve is involved in smell and can be tested via the introduction of a familiar smell. The vestibulocochlear nerve is involved with smell and can be tested by rubbing your fingers near both of the client’s ears and looking for side-to-side differences. 32. The correct answer is B. Rationale: The eleventh cranial nerve, the accessory nerve, supplies the trapezius muscle. One of the functions of the trapezius muscle is shrugging the shoulder, so manually testing the strength of the trapezius muscle by providing resistance to this motion is one way to test the function of this cranial nerve. 33. The correct answer is B. Rationale: The atlas (C1) articulates with the occipital condyles of the skull, an articulation that is sometimes call C0–C1. This joint provides mechanical stability between the head and cervical spine while allowing for 50% of cervical spine flexion–extension. 34. The correct answer is A. Rationale: The transverse ligament provides stability to the articulation between the C1 and C2 vertebrae. It runs posterior to the dens with attachments to the atlas. The anterior surface of this ligament is covered with articular cartilage to allow articulation with the odontoid process. 35. The correct answer is C. Rationale: Levels C2–C3 and C5–C6 are the cervical levels most often involved when facet joint dysfunction is a source of neck pain. 36. The correct answer is D. Rationale: Pain from the C5–C6 facet joints is often felt along the base of the neck and top of the shoulder. Less commonly, pain from the C5–C6 facet joints can extend into the suboccipital area. Infrequently it may cause pain in the scapular region. It Rationale: Radiculopathy at C2–C4 is considered uncommon, and detection of motor deficits at these levels is hard to detect. The structure associated with C2-4 weakness is the diaphragm. 38. The correct answer is A. Rationale: The levels most often involved in cervical does not cause pain in the head. 37. The correct answer is A. Rationale: Spurling’s test is both highly sensitive and highly specific for diagnosing cervical radiculopathy as confirmed by magnetic resonance imaging and electrodiagnostic findings. For this test, the patient is seated and the assessor side bends the neck toward the affected side then applies compression force downward from the top of the head. The test is positive if it reproduces the client’s symptoms. 40. The correct answer is C. Rationale: The onset of cervical myelopathy is related to degenerative changes, with diagnosis most commonly occurring in the 50s. Diagnosis of this condition is rare before the age of 40. 41. The correct answer is A. Rationale: Reflex testing is a typical part of the clinical examination for physical therapy clients with neuromuscular conditions. Radicular conditions, which put pressure on an individual nerve root, cause reflexes to be hypoactive, which is also caused hyporeflexia. Degenerative cervical myelopathy, which puts pressure on the spinal cord, causes reflexes to be hyperactive, which is also called hyperreflexia. radiculopathy are C6 and C7. 39. The correct answer is D.

20. The correct answer is C. Rationale: About half of cervical rotation comes from the C1/ C2 level, and the flexion–rotation test is used to isolate this level and assess rotation motion. A positive test is present when there is a range of motion restriction with firm resistance or a 10-degree difference in motion between the painful and nonpainful sides. Dysfunction in the upper cervical spine is associated with cervicogenic headaches. 21. The correct answer is C. Rationale: The deep cervical flexor muscles, longus colli and capitis, provide cervical segmental support and stability. The craniocervical flexion test is used to test for dysfunction in these muscles. 22. The correct answer is C. Rationale: According to the International Classification of Headache Disorders, one of the diagnostic criteria for cluster headaches is a sense of agitation or restlessness. Patients with cluster headaches have a difficult time lying down and Rationale: According to Raney et al. (2019), more than one-third of patients with neck pain will develop chronic symptoms lasting greater than six months. Physical therapists can help minimize this trend through accurate diagnosis of neck pain and effective treatment. 24. The correct answer is B. Rationale: Unexpected weight loss is a sign that often accompanies the presence of malignancy. When this symptom accompanies neck pain, further investigation into the possibility characteristically pace the floor. 23. The correct answer is D. Rationale: A three- to five-minute lag between an increase in activity and the onset of neck pain is characteristic of angina. 26. The correct answer is C. Rationale: Pulmonary conditions can cause neck pain, and differential diagnosis for these types of conditions is important. Autosplinting, where the client prefers to lie on the involved side for pain relief, is a valuable red flag of possible pulmonary involvement. 27. The correct answer is B. Rationale: Many cognitive factors have been associated with neck pain. These include catastrophizing, low self- efficacy, passive coping, self-perceived poor health, and fear-avoidance beliefs. Active coping is not associated with the onset of neck pain. 28. The correct answer is D. Rationale: At levels above the C8 vertebrae, the nerve roots exit via the superior notch of the vertebrae. At C8, this pattern changes and the nerve roots exit at the inferior notch of C8. This pattern continues throughout the thoracic and lumbar spine, where the nerve roots corresponding to each vertebral level exit below. 29. The correct answer is A. Rationale: The dens, or odontoid process, is a vertical projection of C2 and a common site of cervical fracture. 30. The correct answer is D. Rationale: When disc herniation causes compression of the involved nerve root at the C6–C7 level, dermatome involvement with possible numbness in the anterior arm and the radial side of the hand to the thumb and index finger, myotome involvement includes the elbow flexors and wrist extensors, while the reflexes involved are the biceps and brachioradialis. of cancer/tumor is warranted. 25. The correct answer is A.

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