MSK2: 3rd Shifting Flashcards
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
โ IV is wrong bc >90deg of hip flexion, not allowed in post-op
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
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
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
โ Can displace the comminuted fx
The surgeonโs 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
โ Cane is used for FWB
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
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
โ Standing indep โ small head movements (least challenging)
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
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
โ Highest degree of flexion initially
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
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
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
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
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
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
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
โNot A. because 1MHz for frequency only; 2 wks
โNot C. because it is not strong evidence
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
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
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
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
โ Cane = Contralateral
โ Functional = Ipsilateral
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
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
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