In-Class Exam 1

Trauma Study: Each year, roughly 1% of athletes in collegiate soccer games will suffer a concussion in Canada; this statement describes an epidemiological finding in terms of a) Risk b) Incidence proportion c) Incidence d) Both a and b

D. Both a and b

Trauma Study: The best term that can be used to accurately compare likelihood of injury among sports and different teams is a) Incidence proportion b) Incidence c) Incidence rate d) Prevalence

C. Incidence rate

Trauma Study: T/F? Fibrin is a major protein in blood clot

True

Trauma Study: T/F? Thrombin is an enzyme that is required to make fibrin in blood clot

True

Trauma Study: T/F? Tissue plasminogen activator is given to patients to stop bleeding

False

Trauma Study: Complement system has the following functions: a) Opsonization b) Increase membrane permeability and lysis of cells c) Chemotaxis d) All of the above

D. All of the above

Trauma Study: T/F? Both neutrophil and macrophage are phagocytes

True

Trauma Study: T/F? Lipoxygenase is involved in producing prostaglandin

False

Trauma Study: T/F? COX2 inhibitor is an aspirin like drug with less side effects on the stomach

True (historical GI comparison; cardiovascular risks remain)

Trauma Study: Prostaglandin has the following effects: a) Pro-inflammatory b) Increase tissue proliferation c) Increase risk on certain cancer and reverse some ageing effects on tissues d) All of the above

D. All of the above

Trauma Study: Activated complement system can form the membrane attack complex with antibodies

True

Trauma Study: The white blood cells first to arrive at the injured tissue are a) PMN (polymorphonuclear) cells b) Neutrophils c) Pus cells d) All of the above

D. All of the above (intended answer)

Trauma Study: Diapedisis is a) Programmed cell death b) A process of cell division for white blood cells c) A process by which white blood cells migrate out of blood vessels d) Also referred to as phagocytosis

C. A process by which white blood cells migrate out of blood vessels

Trauma Study: The following statements about NSAID drugs are correct EXCEPT a) They inhibit prostaglandin synthesis b) They may delay repair phase if used over a long time c) They inhibit cyclooxygenase d) They cause stomach bleeding which can be completely prevented if proper coating is used to neutralize acidity of these drugs

D) They cause stomach bleeding which can be completely prevented if proper coating is used to neutralize acidity of these drugs

Trauma Study: Which one of the following enzymes is only found in neutrophil? a) Myeloperoxidase b) Superoxide dismutase c) NADPH d) Cyclooxygenase

A. Myeloperoxidase (intended; also occurs in monocytes)

Trauma Study: Drugs that block inducible form of prostaglandin is referred to as a) COX2 inhibitor b) COX1 inhibitor c) Lipoxygenase d) None of the above

A. COX2 inhibitor

Trauma Study: Inhibition of the myeloperoxidase stops production of a) Hydrogen peroxide b) Superoxide c) Hypochlorous acid d) None of the above

C. Hypochlorous acid

Trauma Study: Prostaglandin is a pyretic agent that causes a) Bleeding b) Neocapillary formation c) Fever d) Activation of lymphocytes

C. Fever

Trauma Study: Which one of the following enzymes is responsible for neutralizing oxygen free radicals which cause tissue damage? a) Superoxide dismutase b) Cyclooxygenase c) Myeloperoxide d) NADPH oxidase

A. Superoxide dismutase

Trauma Study: Vioxx is a new drug that can be used to control arthritis pain while avoiding stomach upset. And it is therefore likely to inhibit a) Super oxide dismutase b) Cyclooxygenase 2 c) Streptokinase d) Myeloperoxidase

B. Cyclooxygenase 2

Trauma Study: __ is not one of the processes involved in the remodeling phase a) Increase in cross linked among collagen fibres b) Reorientation of collagen fibres c) Fibrosis d) Lysis of scar tissue

C. Fibrosis (primarily a repair/proliferation process; phases overlap)

Trauma Study: The following processes occur during tissue repair after muscle injury except a) Proliferation of vascular endothelial cells b) Complete regeneration of muscle cells c) Formation of scar tissue by fibroblast d) Removal of cell debris and other foreign substances

B. Complete regeneration of muscle cells

Trauma Study: Collagenous scar formation is more efficient and tolerant of tensile forces than the original mature tissue. True or False?

False

Trauma Study: Ligament regains its strength after injury faster than muscle because it has poor blood supply compared to muscle. True or False?

False

Trauma Study: M2 macrophage promotes tissue regeneration. True or False?

True

Trauma Study: When does a skin wound have maximum tensile strength after injury? a) 0-10 days b) 10-20 days c) 20-30 days d) 30-40 days e) 40-50 days

e) 40-50 days

Trauma Study: Which one of the following cells is stimulated to become osteoblast by bone morphogenic? a) Osteocyte b) Osteoclast c) Osteoprogenitor cell d) None of the above

C. Osteoprogenitor cell

Trauma Study: Regeneration of ___ is NOT possible during repair phase a) Capillary b) Skeletal muscle c) Cardiac muscle d) Skin cells

C. Cardiac muscle

Trauma Study: A typical bone fracture will repair and regain its original strength in 3 months. True or False?

True in the PDF; actual fracture healing time varies

Trauma Study: Which of the following injured tissues is least likely to heal? a) Articular cartilage b) Bone c) Ligament d) Tendon

A. Articular cartilage

Trauma Study: The following are examples of neuralgia except a) Pain of a phantom limb b) A hypnotically induced pain c) Trigeminal pain d) Pain due to diabetic neuropathy

B. A hypnotically induced pain

Trauma Study: The process of scar tissue formation in repair phase is called a) Angiogenesis b) Fibrosis c) Phagocytosis d) Margination

B. Fibrosis

Trauma Study: Which of the following is incorrect regarding stages? a) The first phase is inflammatory or reactive phase b) The most important cell in the proliferative phase is the neutrophil c) The remodeling phase can take from 6 weeks to a year d) Regenerated connective tissue may be contracted or tight

B. The most important cell in the proliferative phase is the neutrophil

Trauma Study: Matching: 1) Colony stimulating factor 2) Lipoxygenase 3) Interleukin 4) Cyclooxygenase 5) Thrombin. Match with a) Promoting formation of fibrin b) Increasing number of neutrophils and macrophage c) Activating T lymphocyte d) Producing prostaglandin e) Producing leukotrienes

1-B; 2-E; 3-C; 4-D; 5-A

Trauma Study: Correct statements about affective aspect of pain are the following EXCEPT a) It is influenced by the slow pain b) It involves the limbic system c) It triggers associated autonomic response d) It reaches the sensory cortex which gives rise to sensation of pain

D. It reaches the sensory cortex which gives rise to sensation of pain

Trauma Study: Which one of the following structures is part of limbic system a) A delta fiber b) C fiber c) Anterior cingulate cortex d) Thalamus

C. Anterior cingulate cortex

Trauma Study: In the gate theory of pain control, pain is reduced a) By allowing less sensory inputs of all kinds reaching sensory cortex b) By allowing less pain provoking impulses reaching the spinal cord c) By reducing ascending pain provoking impulses and such reduction is achieved by increasing sensory input from other sensations d) By release of endogenous opiates

C. By reducing ascending pain provoking impulses through increased sensory input from other sensations

Trauma Study: The following structures form an inhibitory descending pathway that reduces pain input into the central nervous system EXCEPT a) Dorsal horn of the spinal cord b) Raphe nucleus c) Pituitary gland d) Periaqueductal gray matter

C. Pituitary gland

Trauma Study: Which one of the following is not a response to slow pain pathway activation? a) Withdrawal reflex b) Nausea c) Cold sweat d) Reduced muscle tone

A. Withdrawal reflex

Trauma Study: Which one of the following is an example of radiculopathy pain? a) Pain of a sprained ankle b) Tendonitis c) Paper cut d) Pain due to a herniated disk

D. Pain due to a herniated disk

Trauma Study: The following statements correctly describe the fast component of pain EXCEPT a) The impulses are transmitted by A delta fibers b) It causes withdrawal reflex c) It is a well localized pin prick sensation d) It travels to the brain within spinoreticular thalamic tract

D. It travels to the brain within spinoreticular thalamic tract

Trauma Study: The INCORRECT statement about deep somatic pain is that a) It is poorly localized b) It tends to trigger autonomic reactions c) It causes referred pain and increases blood pressure d) It influences the limbic system

C. It causes referred pain and increases blood pressure

Trauma Study: Which one of the following bone cells is responsible for bone absorption? a) Osteoblast b) Osteoclast c) Osteocyte d) Osteoprogenitor cell

B. Osteoclast

Trauma Study: The following factors may prolong the repair process after an injury EXCEPT a) Prolonged use of anti inflammatory drugs b) Diabetic condition c) Moderate exercise d) Existence of opportunistic infection

C. Moderate exercise

Trauma Study: Tissues least sensitive to pain are a) Muscle and its fascia b) Bone and cartilage c) Periosteum d) Ligament and joint capsule

B. Bone and cartilage

Trauma Study: Increase in blood ___ level may indicate muscle damage a) Creatine kinase b) Lysozome c) Prostaglandin d) Hemoglobin

A. Creatine kinase

Trauma Study: A strong muscle is less likely to be injured because a) It can be stretched longer before having structural failure b) It can absorb more energy before damage occurs c) It can bear greater strain d) It is stiffer

B. It can absorb more energy before damage occurs

Trauma Study: A strong muscle is unlikely to be injured because a) It can be stretched longer before it fails b) It is stiffer compared with a weaker muscle c) It is likely unnoticed if a minor injury occurs d) It can absorb more energy and is therefore less likely to be overstretched

D. It can absorb more energy and is therefore less likely to be overstretched

Trauma Study: Damage to the muscle in muscle strain is most likely to occur in a) In the tendon b) In the belly of the muscle c) In connective tissue surrounding muscle d) At the muscle tendon junction

D. At the muscle tendon junction

Trauma Study: Which of the following pairs of synonyms is a mismatch a) Traction epiphyses and apophyses b) Osteochondritis dissecans and osteochondrosis c) Luxations and dislocations d) Neuroglia and neurilemma

D. Neuroglia and neurilemma

Trauma Study: Numbness, prickling and tingling sensation is referred to as a) Hypoesthesia b) Hyperesthesia c) Paresthesia d) None of the above

C. Paresthesia

Trauma Study: A positive external rotation stress test on the ankle may indicate an injury to a) Syndesmosis b) Jones fracture c) Deltoid ligament d) Posterior talofibular ligament

A. Syndesmosis

Trauma Study: The following ligaments provide stability of ankle mortise EXCEPT a) Anterior tibiofibular ligament b) Posterior tibiofibular ligament c) Anterior talofibular ligament d) Interosseous membrane between tibia and fibula

C. Anterior talofibular ligament

Trauma Study: A soccer player receives a bruise to the right thigh. What type of force might have produced this injury? What type of injury resulted? a) Low mass, high velocity, diffuse b) Low mass, low velocity, focal c) High velocity, low mass, focal d) Low velocity, high mass, diffuse

C. High velocity, low mass, focal (intended answer)

Trauma Study: The functional strength of ___ is important for preventing ankle sprain a) Tibialis anterior b) Peroneus longus and brevis c) Soleus d) Gastrocnemius

B. Peroneus longus and brevis

Trauma Study: Jones fracture should be ruled out in treating injury to a) Achilles tendon b) Medial ankle sprain c) Lateral ankle sprain d) Posterior talofibular ligament

C. Lateral ankle sprain

Trauma Study: Which one of the following ligaments is most likely to be injured around ankle joint a) Anterior talofibular ligament b) Calcaneofibular ligament c) Calcaneocuboid ligament d) Deltoid ligament

A. Anterior talofibular ligament

Trauma Study: According to the West Point grading system of ankle injury, the ligament injury that resulted in positive talar tilt test in a sprained ankle should be classified as a) Class 1 b) Class 2 c) Class 3 d) Class 4

C. Class 3 (Grade III)

Trauma Study: The following structures are found on the lateral ankle EXCEPT a) ATFL b) Peroneus brevis and longus c) Tibialis posterior d) CFL

C. Tibialis posterior

Trauma Study: The talar test is designed to stress the a) Anterior talofibular ligament b) Calcaneocuboid ligament c) Posterior talofibular ligament d) None of the above

D. None of the above IF this means talar tilt (tests CFL); wording is ambiguous

Trauma Study: T/F? Tendinosis may involve tendon degeneration, necrosis, or calcification and can sometimes cause minimal symptoms

True

Trauma Study: T/F? Tenosynovitis refers to inflammation of the tendon sheath

True

Trauma Study: T/F? Overtraining can be associated with persistent soreness, frequent upper respiratory infections, and reduced libido/sex hormones

True

Trauma Study: T/F? Pain with significant functional impairment is classified as Grade III?

True

Trauma Study: T/F? Overuse injury grading is based only on the amount of pain, not on functional impairment

False

Trauma Study: T/F? In RICE, the C stands for compression

True

Trauma Study: Which of the following is typically varied during periodization a) Volume b) Intensity c) Technique emphasis d) All of the above

D. All of the above

Trauma Study: Closed kinetic chain exercises can provide a) Joint compressive forces b) Exercise multiple joints c) Control velocity/torque d) All of the above

D. All of the above

Trauma Study: Closed kinetic chain exercises can provide a) Joint compressive forces b) Exercise multiple joints c) And control velocity/torque d) All of the above

D. All of the above

What helps establish a pathoanatomic diagnosis? Transition, pain quality, biomechanics, and physical exam

All of the above

Trauma Study: Pyramid order: diagnosis → control inflammation → promote healing → increase fitness → control abuse → sport participation

Diagnosis → control inflammation → promote healing → increase fitness → control abuse → sport participation

Trauma Study: Rehabilitation principles EXCEPT: stick to one routine

Sticking to one routine is NOT an appropriate rehabilitation principle

What is an example of a diagnostic sign?

Edema (swelling)

Trauma Study: NOT part of HOPS: physical therapy

Physical therapy is not part of HOPS

Trauma Study: ‘Fair’ muscle strength is not moderate resistance; fair = holds position without resistance

True as written using standard 0-5 muscle testing; the PDF's False answer contradicts its wording

Trauma Study: Normal/mild alignment testing should have a solid endpoint

True

Trauma Study: The P in SOAP = plan

True

Trauma Study: The following will increase the risk of stress fracture a) Female athletes with irregular menstrual cycle b) Sudden increase in running distance c) Female athletes with eating disorder/low energy availability d) All of the above

D. All of the above

Trauma Study: T/F? Stress fracture can be ruled out if x-ray radiograph is negative

False

Trauma Study: Ultrasound therapy can be applied to lessen pain in both acute and chronic tendonitis

False (answer given in Trauma Study; clinical evidence is condition-dependent)

Trauma Study: Hyperemia is a) Raynaud's phenomenon b) Hemoglobinuria c) Cyanosis d) A condition of increased blood flow to a local area

D. A condition of increased blood flow to a local area

Trauma Study: Penetrating heat therapy includes a) Shortwave diathermy, microwave diathermy, and ultrasound therapy b) Water immersion bath and whirlpool bath c) Contrast baths d) Paraffin bath

A. Shortwave diathermy, microwave diathermy, and ultrasound therapy

Trauma Study: T/F? Ultrasound therapy can be applied to lessen pain in both acute and chronic tendonitis

False (answer given in Trauma Study; clinical evidence is condition-dependent)

Trauma Study: Reflex contraction of hamstring muscle when it is being passively stretched is caused by a) Pain receptors in the muscle b) Muscle spindles c) Golgi tendon organs d) None of the above

B. Muscle spindles

Trauma Study: Voluntary contraction of a stretched muscle at the end of a stretch can lead to relaxation of the same muscle due to a) Golgi organ initiated reflex b) Muscle spindle initiated reflex c) Stress relaxation in connective tissue d) None of the above

A. Golgi tendon organ initiated reflex (traditional explanation; mechanism is more complex)

Trauma Study: T/F? Injuries to the lower extremities are less frequent when playing on smooth artificial turf as compared with natural grass playing field

False