PCE Certified Breastfeeding Counselor Exam Questions
and Answers
Neurapraxia - ANSWERInjury to nerve that causes a transient loss of function
(conduction block ischemia); nerve dysfunction may be rapidly reversed or persist a
few weeks, e.g., compression.
Axonotmesis - ANSWERInjury to nerve interrupting the axon and causing loss of
function and Wallerian degeneration distal to the lesion; with no disruption of the
endoneurium, regeneration is possible, e.g., crush injury.
Neurotmesis - ANSWERCutting of the nerve with severance of all structures and
complete loss of function; reinnervation typically fails without surgical
intervention because of aberrant regeneration (failure of regenerating axon to find
its terminal end).
Wallerian degeneration - ANSWERTransection (neurotmesis) results in degeneration
of the axon and myelin sheath distal to the site of
axonal interruption to allow for regeneration.
Clinical symptoms LMN syndrome - ANSWER(1) Weakness/paresis of denervated
muscle,
hyporeflexia and hypotonia, (rapid) atrophy,
fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity
may yield limb trauma. (3) Autonomic dysfunction: vasodilation and loss of
vasomotor tone (dryness, warm skin, edema, orthostatic hypotension).
(4) Hyperexcitability of remaining nerve
fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms.
(5) Muscle pain (myalgia) with inflammatory
myopathies (e.g., post polio syndrome).
Trigeminal neuralgia - ANSWERDegeneration/compression of trigeminal nerve (CNV),
most commonly mandibular or maxillary branches. Abrupt onset, mean age of 50.
Causes sharp, shooting pain, worse with stress, heat, cold, touch (brushing teeth),
movement (chewing/talking), eased with relaxation. Motor fxn remains normal.
Bell's Palsy - ANSWERUnilateral facial paralysis dt virus causing inflammatory
response in facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste,
tears, and saliva. Recover in weeks to months.
Charcot Marie Tooth Disease - ANSWERHereditary Motor and Sensory Neuropathy
(HMSN). Symptoms begin in adolescence or early adulthood. Extensive
demyelination of m&s nerves. Begins in foot/lower leg and progresses to hand and
forearm. Pes cavus or extremely flat footed, with hammer toes.
,Segmental Demyelination - ANSWERMyelin breakdown for a few segments but
axons preserved. Mostly reversible because Schwann cells make new myelin, but
some axons may be permanently lost. Example: GBS
Axonal degeneration (distal) - ANSWERDegeneration of axon cylinder and myelin.
Possibly d/t inability of neuronal body to keep up with metabolic demands. Distal to
proximal. Example: peripheral neuropathy.
Tendons consist of - ANSWERtenocytes (tendon-specific fibroblast cells that produce
collage molecules, crave mechanical load)
ECM (collagen, glycosaminoglycan)
Why load tendons? - ANSWERincreased collagen synthesis, cellular proliferation,
alignment
Tendonopathy/tendonosis - ANSWERchronic microtrauma = loss of collagen
organization, no inflammation
- collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased
vessel/nerve
Tendonitis - ANSWERinflammation, dt overloading --> pain, swelling, from tears
Achilles Tendonopathy - ANSWERChronic/insidious onset of pain over Achilles
tendon d/t microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts
to offload, stretching/man ther (DTF)
DDx - partial tear (doesn't respond well to loading program)
De Quervain's Tenosynovitis - ANSWERMicrotrauma of APL and EPB btn radius and
extensor retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of
tendons. Ax: Finkelstein Test. Rx: offload, PRICE, edu, --> man ther, strengthen
Sever's Disease - ANSWERCalcaneal apophysitis. Inflammation of calcaneal growth
plate. Common in active kids (9-14, 7-15) boys > girls. Spontaneous recovery with
maturation. Rx: offload tissues, education, stretch calf muscles and plantar fascia
Tennis Elbow - ANSWERLateral epicondylalgia - 90% of cases involve ECRB. Worse
with gripping, repetitive reach tasks.
Tests: Mills, Resisted extension of D3, Cozen's.
Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt
Rotator cuff tendinopathy - ANSWERCommonly long head of biceps + supraspinatus
impingement. Primary: older, degen, posture, etc. Secondary: younger (<35)
microtrauma --> instability --> subluxation --> impingement. Ant capsule lax, post
capsule tight
Patellar tendinopathy - ANSWERRepetitive loading of extensor mechanism of knee
(quad, patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial
,tuberosity of children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of
patella in adolescents)
Gluteal tendinopathy - ANSWERAKA greater trochanteric pain syndrome. Mix of
bursitis and tendinopathy of abductors. Caused by trauma, repetitive movements,
increased loading, previous injury, hip instability/biomechanics.
2 Ant horns of SC - ANSWERcontains cell bodies giving rise to efferent motor
neurons: alpha motor neurons (to muscle) and gamma motor neurons (to muscle
spindles)
2 Post horns of SC - ANSWERcontains afferent sensory neurons with cell bodies
located in the dorsal root ganglia (fine touch, proprio, vibration)
Lateral horn of SC - ANSWEROnly in T and upper L-spine: pre-ganglionic fibers of the
autonomic nervous system
Dorsal columns of SC: info it carries - ANSWER- fine touch/2 point discrimination
- vibration
- conscious proprioception
Fasciculus gracilis: L/E, medial
Fasciculus cuneatus: U/E, lateral
Dorsal columns of SC: path + lesion - ANSWERDecussates at medulla, finishes in
parietal lobe
Lesion above medulla: contralat loss of fine touch, proprio, vibration
Lesion below medulla: ipsilat loss of fine touch, proprio, vibration
Lateral spinothalamic tract of SC: fxn, path - ANSWERpain, hot/cold
decussates within 1-2 segments at anterior commissure, goes to thalamus and
parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Anterior spinothalamic tract of SC: fxn, path - ANSWERcrude touch and pressure
(lateral spinothalamic is pain and temperature)
decussates within 1-2 segments in ant commissure of SC, goes to thalamus then
parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Lateral corticospinal tract - ANSWEROr pyramidal tract. Main voluntary motor
pathway.
90% cross in pyramids in medulla, pyramidal decussation.
Start in frontal lobe, synapse in ant horn of SC
Anterior corticospinal tract - ANSWER10% that crosses at level of innervation, travels
in ventral white column. Innervates trunk muscles.
Lesion cannot be clinically detected
, Myofascial pain syndrome - ANSWERTrigger points caused by sudden
overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor
dysfunction, autonomic phenomena. Rx: dry needling, stretching, soft tissue
massage, modalities, manual therapy if joints affected
TUBS (shoulder dislocation) - ANSWERTraumatic onset, Unidirectional, Bankart
lesion, Surgery
- MOI: abd/er
AMBRI (shoulder dislocation) - ANSWERAtraumatic, Multidirectional, Bilateral
shoulder findings, Rehab appropriate, Inferior capsule shift (if surgery performed)
Bankart Lesion - ANSWERAvulsion of ant/inf capsule and ligaments.
S/S:clicking, apprehension, deep vague pain
Hill-Sachs Fracture - ANSWERCompression fracture posterior/lateral humeral head,
associated w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid)
Stabilization of the acromion (ligaments) - ANSWERCoracoclavicular ligament (conoid
and trapezoid ligaments)
Coracoacromial ligament - controls vertical stability
Acromioclavicular ligament - controls horizontal stability
SLAP lesion - ANSWERSuperior Labrum Anterior-Posterior
- elevated position with sudden (concentric or eccentric) biceps contraction
- throwers
Colles Fracture - ANSWERMOI: FOOSH into extension, distal radius + ulna
subluxation.
Extra-articular dorsal angulation + radial deviation/shortening
Dinner fork deformity
Smith's Fracture - ANSWERMOI: FOOSH with wrist flexed
Extra-articular + palmar angulation/ulnar deviation
Reverse Colles
Barton's Fracture - ANSWERIntra-articular distal radius fracture
Which areas are at a high risk of avascular necrosis with fracture? - ANSWERProximal
femur, 5th metatarsal, scaphoid, talus neck, proximal humerus
How long does it take an adult to heal from a fracture? - ANSWER10-12 weeks
(Kids = 4-6, adolescents = 6-8 weeks)
What is a hip hemiarthroplasty? - ANSWEROnly femoral head is replaced (not
acetabulum)
and Answers
Neurapraxia - ANSWERInjury to nerve that causes a transient loss of function
(conduction block ischemia); nerve dysfunction may be rapidly reversed or persist a
few weeks, e.g., compression.
Axonotmesis - ANSWERInjury to nerve interrupting the axon and causing loss of
function and Wallerian degeneration distal to the lesion; with no disruption of the
endoneurium, regeneration is possible, e.g., crush injury.
Neurotmesis - ANSWERCutting of the nerve with severance of all structures and
complete loss of function; reinnervation typically fails without surgical
intervention because of aberrant regeneration (failure of regenerating axon to find
its terminal end).
Wallerian degeneration - ANSWERTransection (neurotmesis) results in degeneration
of the axon and myelin sheath distal to the site of
axonal interruption to allow for regeneration.
Clinical symptoms LMN syndrome - ANSWER(1) Weakness/paresis of denervated
muscle,
hyporeflexia and hypotonia, (rapid) atrophy,
fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity
may yield limb trauma. (3) Autonomic dysfunction: vasodilation and loss of
vasomotor tone (dryness, warm skin, edema, orthostatic hypotension).
(4) Hyperexcitability of remaining nerve
fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms.
(5) Muscle pain (myalgia) with inflammatory
myopathies (e.g., post polio syndrome).
Trigeminal neuralgia - ANSWERDegeneration/compression of trigeminal nerve (CNV),
most commonly mandibular or maxillary branches. Abrupt onset, mean age of 50.
Causes sharp, shooting pain, worse with stress, heat, cold, touch (brushing teeth),
movement (chewing/talking), eased with relaxation. Motor fxn remains normal.
Bell's Palsy - ANSWERUnilateral facial paralysis dt virus causing inflammatory
response in facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste,
tears, and saliva. Recover in weeks to months.
Charcot Marie Tooth Disease - ANSWERHereditary Motor and Sensory Neuropathy
(HMSN). Symptoms begin in adolescence or early adulthood. Extensive
demyelination of m&s nerves. Begins in foot/lower leg and progresses to hand and
forearm. Pes cavus or extremely flat footed, with hammer toes.
,Segmental Demyelination - ANSWERMyelin breakdown for a few segments but
axons preserved. Mostly reversible because Schwann cells make new myelin, but
some axons may be permanently lost. Example: GBS
Axonal degeneration (distal) - ANSWERDegeneration of axon cylinder and myelin.
Possibly d/t inability of neuronal body to keep up with metabolic demands. Distal to
proximal. Example: peripheral neuropathy.
Tendons consist of - ANSWERtenocytes (tendon-specific fibroblast cells that produce
collage molecules, crave mechanical load)
ECM (collagen, glycosaminoglycan)
Why load tendons? - ANSWERincreased collagen synthesis, cellular proliferation,
alignment
Tendonopathy/tendonosis - ANSWERchronic microtrauma = loss of collagen
organization, no inflammation
- collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased
vessel/nerve
Tendonitis - ANSWERinflammation, dt overloading --> pain, swelling, from tears
Achilles Tendonopathy - ANSWERChronic/insidious onset of pain over Achilles
tendon d/t microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts
to offload, stretching/man ther (DTF)
DDx - partial tear (doesn't respond well to loading program)
De Quervain's Tenosynovitis - ANSWERMicrotrauma of APL and EPB btn radius and
extensor retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of
tendons. Ax: Finkelstein Test. Rx: offload, PRICE, edu, --> man ther, strengthen
Sever's Disease - ANSWERCalcaneal apophysitis. Inflammation of calcaneal growth
plate. Common in active kids (9-14, 7-15) boys > girls. Spontaneous recovery with
maturation. Rx: offload tissues, education, stretch calf muscles and plantar fascia
Tennis Elbow - ANSWERLateral epicondylalgia - 90% of cases involve ECRB. Worse
with gripping, repetitive reach tasks.
Tests: Mills, Resisted extension of D3, Cozen's.
Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt
Rotator cuff tendinopathy - ANSWERCommonly long head of biceps + supraspinatus
impingement. Primary: older, degen, posture, etc. Secondary: younger (<35)
microtrauma --> instability --> subluxation --> impingement. Ant capsule lax, post
capsule tight
Patellar tendinopathy - ANSWERRepetitive loading of extensor mechanism of knee
(quad, patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial
,tuberosity of children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of
patella in adolescents)
Gluteal tendinopathy - ANSWERAKA greater trochanteric pain syndrome. Mix of
bursitis and tendinopathy of abductors. Caused by trauma, repetitive movements,
increased loading, previous injury, hip instability/biomechanics.
2 Ant horns of SC - ANSWERcontains cell bodies giving rise to efferent motor
neurons: alpha motor neurons (to muscle) and gamma motor neurons (to muscle
spindles)
2 Post horns of SC - ANSWERcontains afferent sensory neurons with cell bodies
located in the dorsal root ganglia (fine touch, proprio, vibration)
Lateral horn of SC - ANSWEROnly in T and upper L-spine: pre-ganglionic fibers of the
autonomic nervous system
Dorsal columns of SC: info it carries - ANSWER- fine touch/2 point discrimination
- vibration
- conscious proprioception
Fasciculus gracilis: L/E, medial
Fasciculus cuneatus: U/E, lateral
Dorsal columns of SC: path + lesion - ANSWERDecussates at medulla, finishes in
parietal lobe
Lesion above medulla: contralat loss of fine touch, proprio, vibration
Lesion below medulla: ipsilat loss of fine touch, proprio, vibration
Lateral spinothalamic tract of SC: fxn, path - ANSWERpain, hot/cold
decussates within 1-2 segments at anterior commissure, goes to thalamus and
parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Anterior spinothalamic tract of SC: fxn, path - ANSWERcrude touch and pressure
(lateral spinothalamic is pain and temperature)
decussates within 1-2 segments in ant commissure of SC, goes to thalamus then
parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Lateral corticospinal tract - ANSWEROr pyramidal tract. Main voluntary motor
pathway.
90% cross in pyramids in medulla, pyramidal decussation.
Start in frontal lobe, synapse in ant horn of SC
Anterior corticospinal tract - ANSWER10% that crosses at level of innervation, travels
in ventral white column. Innervates trunk muscles.
Lesion cannot be clinically detected
, Myofascial pain syndrome - ANSWERTrigger points caused by sudden
overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor
dysfunction, autonomic phenomena. Rx: dry needling, stretching, soft tissue
massage, modalities, manual therapy if joints affected
TUBS (shoulder dislocation) - ANSWERTraumatic onset, Unidirectional, Bankart
lesion, Surgery
- MOI: abd/er
AMBRI (shoulder dislocation) - ANSWERAtraumatic, Multidirectional, Bilateral
shoulder findings, Rehab appropriate, Inferior capsule shift (if surgery performed)
Bankart Lesion - ANSWERAvulsion of ant/inf capsule and ligaments.
S/S:clicking, apprehension, deep vague pain
Hill-Sachs Fracture - ANSWERCompression fracture posterior/lateral humeral head,
associated w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid)
Stabilization of the acromion (ligaments) - ANSWERCoracoclavicular ligament (conoid
and trapezoid ligaments)
Coracoacromial ligament - controls vertical stability
Acromioclavicular ligament - controls horizontal stability
SLAP lesion - ANSWERSuperior Labrum Anterior-Posterior
- elevated position with sudden (concentric or eccentric) biceps contraction
- throwers
Colles Fracture - ANSWERMOI: FOOSH into extension, distal radius + ulna
subluxation.
Extra-articular dorsal angulation + radial deviation/shortening
Dinner fork deformity
Smith's Fracture - ANSWERMOI: FOOSH with wrist flexed
Extra-articular + palmar angulation/ulnar deviation
Reverse Colles
Barton's Fracture - ANSWERIntra-articular distal radius fracture
Which areas are at a high risk of avascular necrosis with fracture? - ANSWERProximal
femur, 5th metatarsal, scaphoid, talus neck, proximal humerus
How long does it take an adult to heal from a fracture? - ANSWER10-12 weeks
(Kids = 4-6, adolescents = 6-8 weeks)
What is a hip hemiarthroplasty? - ANSWEROnly femoral head is replaced (not
acetabulum)
