Domain 2 Clinical
Evaluation and Diagnosis
Special Tests NATA BOC
Goniometry
Pathophysiology and
Patho BOC Questions and
Answers
Pain types
✓~ Nerve pain➖ sharp, bright, burning.
Bone pain➖piercing and localized
Vascular pain➖aching, poorly localized, and referred.
Muscle pain➖ dull, aching, and referred.
Pain stops during activities ➖ chronic inflammation
Pain increases in joint throughout the day➖ progressive edema.
Endpoints
,✓~ Normal➖ soft tissue: soft and spongy, painless, gradual stop. Capsular: abrupt, hard,
firm with a little give. Bone to Bone: distinct and abrupt, two hard surfaces come into contact.
Muscular: springy feel with some discomfort.
Abnormal➖ empty feel: movement beyond abnormal limit, pain before end of ROM
(complete ligament rupture). Spasm: involuntary muscle contraction that prevents motion
due to pain (guarding, back spasm). Loose: extreme hyper mobility (sprained ankle). Springy
block: rebound at end point ( meniscus tear).
Manual muscle testing
✓~ Normal 5 Complete ROM against gravity with maximal resistance
Good 4 Complete ROM against gravity with moderate resistance
Fair + 3 + Complete ROM against gravity with minimal resistance
Fair 3 Complete ROM against gravity with no resistance
Fair - 3 - Some, but not complete, ROM against gravity
Poor + 2 + Initiates motion against gravity
Poor 2 Complete ROM with some assistance and gravity eliminated
Poor - 2 - Initiates motion if gravity is eliminated
Trace 1 Evidence of slight muscular contraction; no joint motion
Zero 0 No muscle contraction palpated
Cranial Nerves
,✓~ 1-Olfactory: smell
2-Optic: vision
3-Oculomotor: eye movement
4-Trochlear: inferior and lateral eye movement
5-Trigeminal: sensation of the face and mastication
6-Abducens: lateral eye movement
7-Facial: facial expressions, taste
8-Vestibulecochlear: hearing and equilibrium
9-Glossopharyngeal: swallowing, salivation, and gag reflex
10-Vagus: swallowing and speech
11-Accessory: swallowing, sternocleidomastoid
12-Hypoglossal: tongue movement.
Neurological exam
✓~ Cerebral➖ questions that assess level of consciousness, intellectual performance,
emotional status, thought content, sensory, and language skills.
Cerebellar➖ coordination (finger to nose, heel toe walking)
Sensory Testing➖ peripheral nerves. Dermatomes (area of skin activated by a
single nerve). Myotomes (muscle group or a muscle innervated by a specific motor
nerve)
Reflex Testing➖ deep tendon (stimulation of stretch reflex and results in involuntary
muscle contraction when tendon is stretched) superficial (skin stimulation at specific
sites which produce muscle contraction)
, Inflammatory process
✓~ Inflammatory response, fibroblastic repair, maturationremodeling phase
Inflammatory response
✓~ Redness (rumor), swelling (tumor), tenderness (dolor), increased temperature (calor),
loss of function (functio laesa).
This is critical to the entire process.
Fibroblastic repair
✓~ Healing of proliferative and regenerative activity leading to scar formation and repair.
Scar formation begins within the first few days and lasts as long as 4-6 weeks. May be
tender to touch.
Maturation Remodeling phase
✓~ A long term process. Realignment/ remodeling of cologne fibers that make up scar
tissue. May require several years to complete.
What is a clot made out of?
✓~ Fibrin
Edema
Evaluation and Diagnosis
Special Tests NATA BOC
Goniometry
Pathophysiology and
Patho BOC Questions and
Answers
Pain types
✓~ Nerve pain➖ sharp, bright, burning.
Bone pain➖piercing and localized
Vascular pain➖aching, poorly localized, and referred.
Muscle pain➖ dull, aching, and referred.
Pain stops during activities ➖ chronic inflammation
Pain increases in joint throughout the day➖ progressive edema.
Endpoints
,✓~ Normal➖ soft tissue: soft and spongy, painless, gradual stop. Capsular: abrupt, hard,
firm with a little give. Bone to Bone: distinct and abrupt, two hard surfaces come into contact.
Muscular: springy feel with some discomfort.
Abnormal➖ empty feel: movement beyond abnormal limit, pain before end of ROM
(complete ligament rupture). Spasm: involuntary muscle contraction that prevents motion
due to pain (guarding, back spasm). Loose: extreme hyper mobility (sprained ankle). Springy
block: rebound at end point ( meniscus tear).
Manual muscle testing
✓~ Normal 5 Complete ROM against gravity with maximal resistance
Good 4 Complete ROM against gravity with moderate resistance
Fair + 3 + Complete ROM against gravity with minimal resistance
Fair 3 Complete ROM against gravity with no resistance
Fair - 3 - Some, but not complete, ROM against gravity
Poor + 2 + Initiates motion against gravity
Poor 2 Complete ROM with some assistance and gravity eliminated
Poor - 2 - Initiates motion if gravity is eliminated
Trace 1 Evidence of slight muscular contraction; no joint motion
Zero 0 No muscle contraction palpated
Cranial Nerves
,✓~ 1-Olfactory: smell
2-Optic: vision
3-Oculomotor: eye movement
4-Trochlear: inferior and lateral eye movement
5-Trigeminal: sensation of the face and mastication
6-Abducens: lateral eye movement
7-Facial: facial expressions, taste
8-Vestibulecochlear: hearing and equilibrium
9-Glossopharyngeal: swallowing, salivation, and gag reflex
10-Vagus: swallowing and speech
11-Accessory: swallowing, sternocleidomastoid
12-Hypoglossal: tongue movement.
Neurological exam
✓~ Cerebral➖ questions that assess level of consciousness, intellectual performance,
emotional status, thought content, sensory, and language skills.
Cerebellar➖ coordination (finger to nose, heel toe walking)
Sensory Testing➖ peripheral nerves. Dermatomes (area of skin activated by a
single nerve). Myotomes (muscle group or a muscle innervated by a specific motor
nerve)
Reflex Testing➖ deep tendon (stimulation of stretch reflex and results in involuntary
muscle contraction when tendon is stretched) superficial (skin stimulation at specific
sites which produce muscle contraction)
, Inflammatory process
✓~ Inflammatory response, fibroblastic repair, maturationremodeling phase
Inflammatory response
✓~ Redness (rumor), swelling (tumor), tenderness (dolor), increased temperature (calor),
loss of function (functio laesa).
This is critical to the entire process.
Fibroblastic repair
✓~ Healing of proliferative and regenerative activity leading to scar formation and repair.
Scar formation begins within the first few days and lasts as long as 4-6 weeks. May be
tender to touch.
Maturation Remodeling phase
✓~ A long term process. Realignment/ remodeling of cologne fibers that make up scar
tissue. May require several years to complete.
What is a clot made out of?
✓~ Fibrin
Edema
