MSK2: 3rd Shifting Flashcards by Mind Med

Patient education after total hip arthroplasty using the posterolateral approach includes:

I. keep knees slightly lower than the hips when sitting

II. pivot on the sound extremity

III. avoid rotating the body toward the operated side

IV. sit on a soft and comfy sofa to decrease pain on the incision site

a. I and III
b. I II and III
c. II and IV
d. All

b I, II, and III are correct
● IV is wrong bc >90deg of hip flexion, not allowed in post-op

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A patient who had L THR using cementless fixation 2 days ago was referred to PT evaluation and treatment. Which of the following is NOT included in your initial treatment session?
a. Standing tolerance on both feet at bedside as tolerated
b. Bed positioning and turning observing precautions
c. Resistance ex to both UE
d. Breathing retraining with emphasis on diaphragmatic excursion

a. Standing tolerance on both feet at bedside as tolerated

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The following are non-impact activities you would advise your patient with hip pain to do at home EXCEPT:
a. Swimming
b. Stationary cycling
c. Walk in the park
d. Jogging

d. Jogging

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Which of the following should NOT be done if your patient had ORIF yesterday following comminuted fracture of the femoral neck?
a. Abductors sets
b. Gluteus maximus sets
c. Quads sets
d. Iliopsoas sets

a. Abductors sets
● Can displace the comminuted fx

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The surgeon’s referral states that the patient who had L hip ORIF should ambulate with partial weight bearing only. Which of the following will NOT result to partial weight bearing?
a. Negotiating a ramp using bilat axillary crutches and toe touch on L
b. Use of quad cane on R while gait training
c. Instructing pt to place minimal weight over L foot while walking wit the aid of a walker
d. None

b. Use of quad cane on R while gait training
● Cane is used for FWB

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Joint mobilization of the hip is prescribed to inhibit pain in a patient with hip OA, before applying joint oscillations, it is important to know first the resting position of the hip which is
Neutral in flex-ext, add-abd and rot
b. 55 abd, 30 flex, and slight IR
c. 30 abd, 30 flex, and some ER
d. 30 abd, 50 flex. And slight ER

c. 30 abd, 30 flex, and some ER

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Your 70 y/o patient s/p ORIF post hip fracture can now maintain standing independently from standing with minimal support. What should you do next to improve his standing balance?
a. Ask pt to perform marching in palace
b. Instruct pt to do small head movement
c. Tell him to stand on one leg as tolerated with standby assist
d. Instruct him to place one foot in front of the other

b. Instruct pt to do small head movements
● Standing indep → small head movements (least challenging)

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Your patient is presenting with decreased right hip flexion. You opted to use mobilization with movement. While the patient is doing the motion in supine, you should be applying glide in what direction?
a. Lateral
b. Posterior
c. Inferolateral
d. Superolateral

c. Inferolateral

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Which of the following activities should initially be avoided by a patient with hip flexor dysfunction?
a. Squats
b. Stair climbing
c. Jumping jacks
d. Stretching adductors

b. Stair climbing
● Highest degree of flexion initially

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You noted redness and swelling on the right calf of a patient who had right THR. Patient reported occurrence of pain and expressed desire to continue PT to relieve the pain. You would
a. Continue PT Rx including right LE exercises and ambulation, observing extra precaution on right calf
b. Continue PT Rx including right LE exercises but defer ambulation
c. Discontinue PT Rx and report finding to attending physician
d. Discontinue PT Rx for today and visit her the next day to check if pain and swelling have decreased

c. Discontinue PT Rx and report finding to attending physician

Redness and swelling on R calf can mean = possible DVT = dislodge thrombus and travel to different organs = adverse effects

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If you have a patient with psoas bursitis in the acute stage, which of the following hip motions should be avoided as this aggravates pain?
a. Flexion
b. Extension
c. Abduction
d. Adduction
e. All

a. Flexion

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Which of the following goals is correctly written to be a SMART Short-Term Goal for a patient with hip pain and mobility deficits?
a. Pt will report dec pain on R hip from 8/10 to 3/10 p 2 wks of PT sessions to
be able to walk on level surface c more ease
b. Pt will demonstrate inc AROM on R hip flexion by 10 deg p 2 wks of PT
session to be able to don and doff EL garment c more ease
c. Pt will exhibit dec difficulty, from mod to min, in negotiating stairs with dec time from 15 mins to 10 mins p 3 wks of PT session
d. All of these
e. None

d. All of these

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Components of the preoperative management of a patient in preparation for total hip replacement:

I. gait training with assistive device

II. weight-bearing simulation

III. positioning recommendations

IV. bed mobility and transfers

a. I and III
b. IV
c. II and III
d. I, II, III, and IV

d. I, II, III, and IV

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Your 20 y/o patient, a varsity player, who had L THR following a vehicular accident 2 weeks ago, asked you if he could play for UAAP basketball. Your response would be?
a. I am sorry to tell you that you cannot involve yourself in strenuous activities, you can still play basketball though only as a leisure activity
b. Of course, since you are still young and you had biologic fixation, you can
play for your UAAP team as soon as your hip heals
c. I am not really sure about this, but i will try my very best to help you regain enough strength to play basketball in the UAAP again
d. Oh well, it depends upon the recommendation of your surgeon, I do not
know anything about it

a. I am sorry to tell you that you cannot involve yourself in strenuous activities, you can still play basketball though only as a leisure activity

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If your patient has right hip OA, it is best to use cane on
a. Left
b. Right
c. Both
d. Either Right or Left

a. Left

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True about the use of ultrasound in patients with hip arthritis based on Clinical Practice Guidelines:
a. An intensity of 1.5 MHz should be used for 10 PT session in 4 wks for it to
be effective in the reduction of pain
b. The recommended treatment duration is 15 mins for the hip joint; 5 mins each on the anterior, lateral, and posterior aspects of the hip
c. Its use to decrease pain with exercise and hot packs is based on strong
evidence
d. All
e. None

b. The recommended treatment duration is 15 mins for the hip joint; 5 mins each on the anterior, lateral, and posterior aspects of the hip

●Not A. because 1MHz for frequency only; 2 wks
●Not C. because it is not strong evidence

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To strengthen the R gluteus medius in a patient with Trendelenburg gait, you would instruct your patient to do which of the following for a task-specific program?
a. Side lie on R leg and do active hip abd on L hip
b. Side lie on L leg and do active hip abd on the R hip
c. Stand on L leg and do open chain hip movements on the R hip
d. Stand on R leg and do open chain hip movements on the L hip

d. Stand on R leg and do open chain hip movements on the L hip

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Which of the following is included in the set criteria for a patient with hip replacement to be discharged from formal rehabilitation in the hospital?
a. Negotiate stairs with alternating feet with or without AD
b. Ability to transfer in and out of bed
c. Ambulate for a distance of 100 feet
d. Perform sit-to-stand independently
e. All

e. All

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You will have to design a strengthening program for this muscle if the fracture site involves the lesser trochanter:
a. Iliopsoas
b. Gluteus medius
c. Gluteus maximus
d. Rectus femoris

a. Iliopsoas

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Your patient has right hip OA. She said that she usually carries her bag of groceries using her left hand.
a. It is the right thing to do
b. I will advise her to carry the bag using her right hand
c. I will inform her to transfer the bag from one hand to the other as she walks
d. I will teach her that it is best to carry the bag using both hands

b. I will advise her to carry the bag using her right hand

● Cane = Contralateral
● Functional = Ipsilateral

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Which of the following is NOT a closed-chain exercise for a patient with hip dysfunction?

a. Pelvic bridging
b. Lunges
c. Weight shifting
d. SLR
e. None

d. SLR

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JR, a 22 y/o female occupational therapist asked your expert opinion regarding a discomfort she is experiencing in her low back area. She said pain intensifies every time she bends forward to pick the toys and equipment she used for her patients with cerebral palsy. Backward bending seems to reduce her pain. Condition started 2 months ago soon after she was hired as staff of the rehab clinic.

What is the most appropriate PT Dx?
A. Difficulty in job performance due to mechanical back pain
B. Job dissatisfaction leading to discomfort & pain that intensifies with forward trunk bending
C. Struggle in performing job requirements due to inflammatory back pain
D. Inability to accomplish the task due to cerebral palsy
E. Any of these

A. Difficulty in job performance due to mechanical back pain

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Only the major curve of the scoliosis should be treated with exercises. Correction of the major curve will lead to correction of the minor curve
a. First is correct
b. Second is correct
c. Both are correct
d. Both are incorrect

d. Both are incorrect

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You would expect a patient with lordotic posture will show tightness in the following muscles, EXCEPT:
a. Iliopsoas
b. Rectus femoris
c. TFL
d. Rectus abdominis

d. Rectus abdominis

Which of the following is NOT part of the McKenzie Exercises? a. Double knee to chest b. SLR c. Prone on hands d. Seated floor reach e. None

b. SLR

Which of the following positions in Klapp's exercises will be least effective in stretching the spine of a patient with lumbar levoscoliosis? a. Prone b. Quadruped c. Heel sitting d. Standing e. None of these

c. Heel sitting

Reduction of lumbar stenosis is the goal of your conservative management. Which of the following exercise should NOT be included in your treatment plan? a. Crunches b. Posterior pelvic tilting c. Pelvic bridging d. William’s flexion exercises e. None of these

c. Pelvic bridging Lumbar stenosis - relieved by flexion activities

Which of the following exercises is meant to increase strength of the trunk extensors? a. Prone push ups b. Bilat arm elevation in prone c. McKenzie extension exercises d. All

b. Bilat arm elevation in prone Prone push ups - strengthens triceps not trunk extensors McKenzie - not strengthening exercise, these are positional/directional exercises

You decided to use NMES to strengthen the muscles of a patient with T10 levoscoliosis. Where will you place the pair of electrodes? a. On the convex side b. On the concave side c. On both sides of the scoliosis d. Below the apex vertebra e. Above the apex vertebra

a. On the convex side

In using the Thomas Test stretch, if your patient is asked to flex the right hip and knee, and leave the left LE straight, what muscle is primarily lengthened? a. Left quads b. Right quads c. Left iliopsoas d. Right iliopsoas

c. Left iliopsoas

True about the neutral spine position: I. at zero degrees of flexion and extension, rotation, and side bending II. also the functional position of the spine III. the slightest amount of stress to the spine IV. does not change as tissues heal a. I and II b. II and III c. III and IV d. I II III and IV

b. II and III Not I. because not 0 degrees Not IV. because it changes as pt heals

This segment of the lumbar vertebra is primarily the weight bearing and shock absorbing component of the spine: a. Anterior segment b. Posterior segment c. Lateral segment d. Spinal canal

a. Anterior segment

What is the unilateral action of the multifidus? a. Trunk side flexion and rotation to the opposite side b. Trunk extension and rotation to the contralateral side c. Trunk forward flexion and rotation to the same side d. Trunk forward flexion and rotation to the ipsilateral side

b. Trunk extension and rotation to the contralateral side

In dextroscoliosis, the vertebral bodies rotate towards the right. The spinous processes move towards the left. a. First is correct b. Second is correct c. Both are correct d. Both are incorrect

c. Both are correct

Significant decrease in the capacity of the stabilizing system to maintain the neutral spine results to pain and disability. Contraction of limb girdle musculature will transmit forces proximally and will cause motions that will place excessive stresses on spinal structures and the supporting soft tissues. a. First is correct b. Second is correct c. Both are correct d. Both are incorrect

c. Both are correct

Based on the Clinical Practice Guidelines on Low Back Pain, what is the evidence for the use of intermittent lumbar traction (ILT) for patients with acute inflammatory back pain? a. The evidence is strong for ILT to be included in the treatment plan b. Whether to use ILT or not will be dependent on the experience of the PT c. Pt will benefit from supine ILT d. ILT should not be used in this case

d. ILT should not be used in this case ILT is contraindicated for acute cases

Based on Clinical Practice Guidelines, there is a need to initiate referral to an appropriate medical practitioner for patients with low back pain exhibiting the following, EXCEPT: a. The interventions are not resolving the symptoms of the pt normally b. Pt is showing signs and symptoms that are not consistent with the medical diagnosis c. Clinical presentation of the pt suggests more serious medical or psychological pathology d. Centralization of the symptoms from the posterior leg to the low back area was noted e. None

d. Centralization of the symptoms from the posterior leg to the low back area was noted

Which of the following should not be included in the exercise program for a patient with ankylosing spondylitis? a. Endurance training b. William’s exercises c. Breathing retraining d. Postural re-education e. None

b. William’s exercises No to flexion because it will be the postural deformity

Which of the following Short-Term Goals (STG) is most appropriately written for a patient with low back pain due to lordotic posture? a. Pt will report decreased LBP form 8/10 to 4/10 p 2 wks of PT sessions in order to perform bed mobility s pain and discomfort b. Pt will report a decrease in lordotic curve as exemplified by a flatter abdominals p 2 wks of PT sessions to be able to wear fitted shirt c. Pt will demonstrate increased AROM on B hip extension from 0-10 deg to 0-20 deg p 2 wks of PT sessions to be able to walk c more ease d. Pt will demonstrate increased strength of trunk flexors form ⅖ to ⅘ p 2 wks of PT sessions to be able to do more abdominal crunches e. All of these

c. Pt will demonstrate increased AROM on B hip extension from 0-10 deg to 0-20 deg p 2 wks of PT sessions to be able to walk c more ease

The following are true about non-structural scoliosis, EXCEPT: a. Due to impingement of the nerve root b. Reversed or corrected in the side lying position c. The left leg is 3 inches shorter than the right d. Also known as postural scoliosis e. None

b. Reversed or corrected in the side lying position only corrected in supine and prone

Which of the following Long-Term Goals (LTGs) is most appropriate for a 35 y/o patient with structural scoliosis? a. Pt will demonstrate a decrease in the angle of curvature from 50º to 25º after 3 mos of PT sessions b. Pt will report a decrease in mid back pain from 6/10 to 2/10 p 2 wks of PT sessions to be able to do household chores s pain c. Pt will demonstrate increased strength of trunk flexors and extensors from ⅗ to ⅘ p 2 wks of PT sessions to assume work s difficulty d. Pt will demonstrate increased CV endurance from 10 mins to 30 mins to be able to resume leisure walking at the park p 3 mos of PT sessions e. All of these

d. Pt will demonstrate increased CV endurance from 10 mins to 30 mins to be able to resume leisure walking at the park p 3 mos of PT sessions

Which of the following positions will put the hamstrings muscles at its MOST passive insufficiency position? a. Pelvis Tilted Anteriorly, Hip Flexed, and Knee Extended b. Pelvis Tilted Posteriorly, Hip Flexed, and Knee Extended c. Hip Flexed, and Knee Extended d. Hip Flexed, and Knee Flexed e. None of the above

a. Pelvis Tilted Anteriorly, Hip Flexed, and Knee Extended -Anteriorly tilted pelvis is achieved by stabilizing opposite leg

What is normal arthrokinematics of the tibio-femoral joint during CKC knee extension during sit-to-stand activity? a. Rolls anteriorly & Glides anteriorly b. Rolls posteriorly & Glides posteriorly c. Rolls anteriorly & Glides posteriorly d. Rolls posteriorly & Glides anteriorly

c. Rolls anteriorly & Glides posteriorly

Which among the following is/are considered the dynamic stabilizer of the patella for medial stability: I. Lateral Patellofemoral Ligament, II. Medial Patellofemoral Ligament, III. ITB, IV. VMO? a. I & III b. II & IV c. I, II & III d. IV only e. None of the above

d. IV only

Based on the screw home mechanism, during the last degree of OKC knee extension the tibial produces medial rotation accessory movement. Knee extension is considered as the closed pack position of the knee.? a. First statement is TRUE and Second statement is FALSE b. First statement is FALSE and Second statement is TRUE c. Both statements are TRUE d. Both statements are FALSE

b. First statement is FALSE and Second statement is TRUE

The following biomechanical adaptation will happen during weight bearing on a pronated foot: a. External Rotation of Femur b. Internal Rotation of Femur c. Increase Knee Varus d. Increase Knee Valgus e. Increase Q-angle f. Decrease Q-angle g. External Tibial Rotation h. Internal Tibial Rotation

B, D, E, G

d. Moderate difficulty in amb NOTE: Goal must be functional first as it is compensatory.

Pt. had undergone ACL reconstruction 7 weeks ago and is consistently attending to his rehabilitation program. You noted the following: Pain gr. 2/10 on the ® knee, (-)Swelling on the right knee, LOM on the ® knee flexion and extension, Weakness of the ® knee and hip musculature, Min difficulty in ambulation. What will be your TOP most problem list for the case? a. Pain b. LOM on the Knee c. Weakness on the Knee and Hip d. Difficulty in amb e. None of the above

c. Weakness on the Knee and Hip PIS is restorative. Improve immediately the strength of the mms so pt can be functional Not LOM bc he is attending rehab consistently. LOM is on target, it's addressed. But if pt wasn’t compliant to his rehab, they would have secondary complication of LOM, making LOM more significant and the top most problem.

Pt. had undergone ACL reconstruction 7 weeks ago and is consistently attending to his rehabilitation program. You noted the following: Pain gr. 2/10 on the ® knee, (-)Swelling on the right knee, LOM on the ® knee flexion and extension, Weakness of the ® knee and hip musculature, Min difficulty in ambulation. What will be your PRIMARY INTERVENTION SCENARIO for the case? a. Restorative b. Compensatory c. Preventive

a. Restorative

b. Compensatory

B, C, D Pain can only be controlled rather than be eliminated

a. AAROM Exercises on ® Knee

b. Weight-bearing as tolerated with AD & knee brace

The following are correct procedures for doing joint mobilization to increase knee extension: I Position: Patient in prone with the knee in resting position, II. Therapist Handling: Stabilizing hand hold the distal leg to position the knee in resting position and mobilizing hand at the posterior aspect of the distal thigh, III. Patient comfort: towel at the distal thigh IV. Glide direction: posteriorly? a. I & III b. II & IV c. I, II & III d. IV only e. None of the above

a. I & III Not distal thigh, should be the proximal leg. Towel at distal thigh to prevent compression. Glide direction should be anteriorly

The following are correct procedures of gentle passive stretching for the hamstring muscles: I Position: Patient in supine, II. Therapist Handling: Hold the opposite thigh against the treatment bed to stabilize the pelvis and prevent anterior tilt during the stretching maneuver III. Stretching Maneuver: Bring the involved lower extremity into hip flexion with knee extended IV. Parameters: 6 seconds hold X 5 repetitions? a. I & III b. II & IV c. I, II & III d. IV only e. None of the above

a. I & III

The following are POSSIBLE procedures of gentle passive stretching for the rectus femoris muscle: a. Position: Patient in supine b. Stabilization: Patient hold the opposite thigh against the chest to stabilize the pelvis and prevent anterior tilt during the stretching maneuver c. Stretching Maneuver: Bring the involved lower extremity into hip extension with knee flexed d. Parameters: 6 seconds hold X 5 repetitions

A, B, C

To ensure patient safety and comfort, the following are TRUE about the weight bearing considerations and use of knee brace & assistive device of a patient with ACL reconstruction? a. Braces should be worn by the patient all throughout day except during range of motion exercises and bathing b. During the early phase of rehabilitation, the patient can ambulate with weight bearing as tolerated and with the use bilateral axillary crutches. c. Full weight bearing will only be allowed after achieving full active knee extension, pain free weight bearing and sufficient control of quadriceps muscles on the affected knee d. All of the above

d. All of the above

Pt. had undergone ACL reconstruction 2 days ago and was referred to you for rehabilitation. You noted the following: Pain gr. 5/10 on the ® knee at the incision site, (+) Swelling on the right knee, (+) Knee brace locked in extension, LOM on the ® knee flexion and extension, Moderate difficulty in ambulation c AD. What will be your appropriate documentation for your intervention for the LOM problem on the case below? a. AAROM Exercises X 10 repetition X 2 sets on the ® knee towards flexion and extension in supine to maintain soft tissue mobility b. Gentle Passive Stretching X 6 seconds hold X 3 repetitions on the ® knee towards knee flexion in supine to increase range of motion of the knee c. Gr. II Oscillatory Mobilization Exercise X 2mins X 2 sets on the ® Knee towards posterior glide in supine to increase range of motion of the knee d. PNF stretching X 6 seconds hold X 30 seconds hold X 3 reps on the ® knee towards knee flexion in supine to increase range of motion of the knee

a. AAROM Exercises X 10 repetition X 2 sets on the ® knee towards flexion and extension in supine to maintain soft tissue mobility

Which of the following interventions for a patient with total knee arthroplasty shall require a close coordination with the surgeon: I. Application of Cryotherapy Exercise, II. Tibiofemoral mobilization, III. Performing patellar mobilization IV. Initiation of light resistance exercises? a. I & III b. II & IV c. I, II & III d. IV only e. None of the above

b. II & IV