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NBCE EXAM PART 3 EXAM AND
STUDY GUIDE 300 QUESTIONS WITH
DETAILED VERIFIED ANSWERS
AND RATIONALES (100%
CORRECT) /A+ GRADE ASSURED
which of these involuntary movements is most characteristic of a patient with cerebral palsy? A. hemiballismus B. sydenham chorea C. athetosis D. fasciculation - ...ANSWER...C which of these is characteristic of acute midthoracic rib dysfunction? A. increased pain on inspiration B. pain referred to upper shoulder C. intercostal anesthesia D. epigastric pain - ...ANSWER...A What is the most likely dx for a 62 yom with right hip pain whose blood tests reveal elevated serum alkaline phosphatase and his radiographs demonstrate a mottled increase in bone density of the proximal femur? - ...ANSWER...Paget disease Which of these is not associated with an UMNL? A. muscle weakness
B. spasticity C. hyporeflexia D. Hoffmann sign - ...ANSWER...C The most appropriate recommendation for a high school baseball pitcher with cubital tunnel syndrome is - ...ANSWER...sleep with the elbow splinted in 45 degrees of flexion Decreased hematocrit is most characteristic of A. severe dehydration B. polycythemia vera C. chronic hypoxia D. cirrhosis - ...ANSWER...D retrosternal pain and dysphagia are the most common initial presenting symptoms of A. esophagitis B. pancreatitis C. duodenal ulcer D. angina pectoris - ...ANSWER...A mild, aching LBP that encompasses the entire lumbar region and posterior pelvis and worsens with active movement is characteristic of lumbar A. fracture B. strain C. disc syndrome D. facet syndrome - ...ANSWER...B The Hibbs test is used to assess of the hip A. ext rot B. int rot
what is the most appropriate case management for a patient with an acute quadriceps contusion? - ...ANSWER...rest and ice which of these is most likely present in the case hx of a 9 y/o with osteomyelitis? - ...ANSWER...previous upper respiratory infection which type of HA is most likely in a 30 yom who complains of unilateral periorbital pain, rhinorrhea, and indicates that the symptoms coincide with alcohol consumption? - ...ANSWER...cluster what additional finding is most likely for a 45 yof with bilateral carpal tunnel like symptoms, cold intolerance, and dry skin? - ...ANSWER...increased TSH which blood test is the most appropriate initial follow up if an elevated serum calcium level is found? - ...ANSWER...parathyroid hormone what lumbar position most often aggravates facet syndrome? - ...ANSWER...extension which landmark is used as the zero point for measuring venous pressure? - ...ANSWER...sternal angle small irregular pupils that accommodate but do not react to light are characteristic of - ...ANSWER...argyll robertson pupil
what is the most likely diagnosis for an elderly person with hip pain as the result of a fall whose inspection reveals a shortened ipsilateral leg and the hip fixed in 90 deg of ext rotation? - ...ANSWER...extracapsular femoral fracture an abnormal pinch test indicates injury to what nerve? - ...ANSWER...ulnar which fingers are most often affected by dupuytren contractures? - ...ANSWER...ring and middle (really its ring and pinky but this was the only good option) the primary muscle for opening the mouth is the - ...ANSWER...external pterygoid The part of the eye most likely to become the site of a melanoma is the A. conjunctiva B. lens C. sclera D. cornea - ...ANSWER …conjunctiva most appropriate for initial treatment of pseudotorticollis? - ...ANSWER...cervical adjustments what is the most likely diagnosis for a 20 y/o with a hx of smoking who is experiencing acute stabbing chest pain? - ...ANSWER...pleurisy which of these conditions predisposes and individual to dupuytren's contractures? - ...ANSWER...diabetes mellitus
C. pec minor muscle stretching D. soft cervical collar - ...ANSWER...C what is the most appropriate subsequent course of action for a 12 yom who is overweight with acute localized right hip pain whose radiographs reveal a slipped epiphysis? - ...ANSWER...refer for further ortho eval what is the most likely dx for a female patient with intermittent joint arthralgia and reversible ulnar deviation of the IP joints? - ...ANSWER...SLE Most likely dx if radiographs of a 12 yom with acute localized hip pain reveals a disruption of shenton line? - ...ANSWER...slipped femoral capital epiphysis B/L hilar adenopathy in a 30 yof with painless cervical lymphadenopathy is most characteristic of
...ANSWER...Hodgkin lymphoma carpal tunnel view is most appropriate for determining fractures of the - ...ANSWER...hook of hamate elevation of the alkaline phosphatase level to 3x the normal adult level in a 19 yom is
- ...ANSWER...suggestive of bone pathology such as osteosarcoma what is the most likely diagnosis for a 70 yom with calf pain that occurs when walking and is relieved by bending forward?
- ...ANSWER...neurogenic claudication
most likely dx for a 60 yof who reports the recent appearance of a painless, raised, irregular lesion on her left leg, approximately 1 cm which has several blue and blue- black spots within it? - ...ANSWER...malignant melanoma most appropriate referral for a 56 y/o obese female with a one year hx of pain in the midchest that occurs most frequently after meals? - ...ANSWER...gastroenterologist absolute contraindication to use of mobilization technique? A. osteoporosis B. pregnancy C. arthrodesis D. Infectious arthritis - ...ANSWER...D most appropriate for initial management of a patient with weak abdominal muscles and a hyperlordotic lumbar curvature? A. Supine leg raises B. abdominal hollowing C. lumbar extensions D. gluteal stretching - ...ANSWER...C 24 year old female presents with hand pain and shiny skin on her arms and hands. Provocative cold environment and cryotherapy. X-ray shows erosions of distal tufts and calcinosis in hands. - ...ANSWER...Scleroderma Scleroderma
- Most likely differential diagnoses: - ...ANSWER...1) Acro- Osteolysis
- Calcinosis Cutis
- Systemic Sclerosis
- CT of spine
- Radionucleotide scan (Radiosyntogrophy, Bone scan) 39 year old female falls on an out stretched hand 8 weeks ago. The pain is getting worse and radiating to the shoulder. There is inflammation and color changes in the hand. Brachioradialis DTR could not be performed due to pain. She has a history of hypothyroid and is taking synthyroid for it. Provocative is emotional stress and an increase of activity. X- ray shows osteoporosis on hand. - ...ANSWER...Reflex Sympathetic Dystrophy Reflex Sypathetic Dystrophy Most likely Diagnosis: - ...ANSWER...1) Regional complex pain syndrome
- Sudek's Atrophy
- Reflex Sympathetic Dystrophy Reflex Sympathetic Dystrophy Best indicated tests: - ...ANSWER...1) Sympathetic nerve block
- Nerve conduction velocity
- Thermography Most likely Sequelae: - ...ANSWER...1) Hyperhydrosis (sweating from firing sympathetics)
- Osteoporosis
- Atrophic skin changes 23 year old football player who was hit from behind and injured his neck and is experiencing nausea and dizziness when stretching his neck. - ...ANSWER...Os-Odontoideum
Differential Diagnosis: - ...ANSWER...1) Os-odontoideum
- Odontoid fracture
- Whiplash Other findings most commonly associated: - ...ANSWER...1) Congenital block
- Occipitalization
- Atlas hyperplasia Tests that will most likely be performed: - ...ANSWER...1) Flexion and Extension x-rays
- Neurological Evaluation
- CT Scan (tells you fracture versus non-union) 32 year old female presents with bilateral leg weakness, vertigo, diplopia, and recent bladder issues. She has been smoking for 10 years. Babinski's is positive, Straight Leg Raise is negative, L-hermitte's is positive. - ...ANSWER...Multiple Sclerosis and Upper Motor Neuron Lesion via Cord Compression Follow up Procedures - ...ANSWER...1) MRI of brain
- Refer to neurologist
- Electrodiagnosis Associated Signs: - ...ANSWER...1) Visual disturbances
- Diplopia
- +3 DTR (hyperreflexia) Most likely sequelae: - ...ANSWER...1) Speech impairment (SIN)
- Spastic paralysis (UMNL) 3) Clonus (UMNL)
50 year old male presents with hip pain that is 6-7/10. Positive Hibb's and positive Anvil test. X-ray showed lytic lesions in femur. - ...ANSWER...Multiple Myeloma Radiographic Signs: - ...ANSWER...1) Osteolytic lesions
- Osteopenia
- Metaphyseal lesion Most likely Diagnosis: - ...ANSWER...1) Primary neoplasm
- Hematopoietic disease (affects bone marrow)
- Multiple Myeloma
- Most likely future sequelae: - ...ANSWER...1) Anemia (Aplastic)
- Increase in occurrences of infection
- Unexplained weight loss 28 year old male presents with asthma and a history of corticosteroid use. He has a decrease in right lateral flexion and an increased kyphosis. X-ray showed hemivertebra, hyperkyphosis, and scoliosis. - ...ANSWER...Structural scoliosis due to hemivertebra
- Most likely found with condition: - ...ANSWER...1) Hemivertebra
- Structural scoliosis (congenital)
- Primary defect of a growth center Next Appropriate Steps: - ...ANSWER...1) Extension rehabilitation
- Adjust
- Spinal stretching exercises
Progressions of condition: - ...ANSWER...1) Cardiac involvement
- DJD
- Neurological defects 62 year old female presents with an insidious onset of back pain and occasional headaches. Range of motion is decreased in all planes of motion. Ice is palliative and nothing is provocative. Both Jackson's and Foraminal Compression are positive with localized pain and she has an increased pulse rate. X-ray showed a Swiss cheese appearance in the skull and a missing pedicle in lumbar. - ...ANSWER...Lytic Mets
- Radiographic signs: - ...ANSWER...1) Swiss cheese appearance
- Owl winking sign
- Pathological collapse Most likely diagnosis: - ...ANSWER...1) Lytic mets
- Secondary malignancy
- Immune system dysfunction Best case management steps: - ...ANSWER...1) Refer to oncologist
- Radionucleotide scan
- PET/CT scan 82 year old female presents with sudden onset of low back pain while gardening. The pain is sharp when she moves and an 8/10. Ice makes it better. No orthopedic tests could be performed due to the pain. X-ray shows atherosclerosis of the abdominal aorta. The aortic artery is smaller than the vertebral
- CBC (check RBC for clotting) Best Recommendations: - ...ANSWER...1) Refer to cardiovascular specialist
- Elevate the leg
- Anti-coagulant therapy *A 23-year-old female woke up this morning with neck pain and stiffness. She rates her pain as being 7/10. On examination her head is tilted to one side, Cervical compression and distraction produce local pain. Kernig's and Brudzinski tests are negative. Muscle and sensory tests are all normal. Right lateral flexion and left rotation are significantly restricted. Which three diagnoses might be present in this patient? Paraspinal muscle contraction Sprained neck Torticollis Cervical disc Rheumatoid arthritis Sternocleidomastoid spasm Trapezius spasm Meningitis
Spinous fracture - ...ANSWER...Torticollis Sternocleidomastoid spasm Trapezius spasm *A 23-year-old female woke up this morning with neck pain and stiffness. She rates her pain as being 7/10. On examination her head is tilted to one side, Cervical compression and distraction produce local pain. Kernig's and Brudzinski tests are negative. Muscle and sensory tests are all normal. Right lateral flexion and left rotation are significantly restricted. Which should NOT be included in the management plan for this patient? Heat for Pain Ice for Pain Spray and Stretch Adjust AROM exercises Trigger Point Cervical Fusion Hard Cervical Collar
Thermotherapy - ...ANSWER...Massage the sore muscles Cold packs for the pain ROM exercises to patient's tolerance *A 31-year-old female presents with severe neck pain and weakness in the upper extremities following a MVA. She is unable to perceive pain in the region of her shoulders when tested with the pinwheel. Jackson's and Shoulder depression tests are positive. Which are the most likely diagnoses? Osteoporotic fracture Clay shoveler's fracture Anterior spinal artery syndrome Facet dislocation Hangman's fracture Posterior spinal artery syndrome Unstable fracture Whiplash associated disorder Stable fracture - ...ANSWER...Anterior spinal artery syndrome
Unstable fracture Whiplash associated disorder A 31-year-old female presents with severe neck pain and weakness in the upper extremities following a MVA. She is unable to perceive pain in the region of her shoulders when tested with the pinwheel. Jackson's and Shoulder depression tests are positive. What additional findings are most likely to be present in this patient? Numbness in both hands Shoulder weakness Decreased C7 tendon reflex Headache Pain with head movement Weak ankle flexors Lower extremity flaccid paralysis Weak wrist extensors Inability to recognize temperature in the hands - ...ANSWER...Shoulder weakness
