quiz 1 Flashcards
A 55-year-old patient presents to your clinic with complaints of lower extremity weakness, decreased balance, and recent history of increased falls. They report insidious onset of symptoms and gradual worsening over the last month. They exhibit 3+ deep tendon reflexes for patellar and Achilles reflexes bilaterally, 10 repetitions on the 30 Second Sit to Stand Test, normal hip, knee, and ankle ROM, 3+/5 strength for bilateral hip flexors and abductors, knee extension and flexion, ankle dorsiflexion, eversion, and plantarflexion, and positive Babinski. What type of lesion and diagnosis do you suspect the patient has?
A) Upper motor neuron and lumbosacral trunk plexopathy
B) Upper motor neuron and cervical myelopathy
C) Lower motor neuron and cervical myelopathy
D) Lower motor neuron and lumbosacral trunk plexopathy
B) Upper motor neuron and cervical myelopathy
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A patient with active cancer presents to physical therapy two weeks after falling and suffering a tibial plateau fracture. The physician ordered strict non-weight bearing on her involved lower extremity with a knee immobilizer in place. The patient has been primarily bedridden due to her injury. Which of the following complications is the patient MOST likely to develop? (Hint: from the chapter reading The Users’ Guide to the Musculoskeletal Examination: Fundamentals for the Evidence-based Clinician)
A) Deep vein thrombosis (DVT)
B) Arterial insufficiency ulcer
C) Venous insufficiency ulcer
D) Baker’s cyst (popliteal cyst)
A) Deep vein thrombosis (DVT)
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Why DVT (Deep Vein Thrombosis) is the most likely complication
Hypercoagulability in cancer patients:
Patients with cancer often exhibit a hypercoagulable state (sometimes referred to as Trousseau’s syndrome or cancer-associated thrombosis). Tumor cells can activate the coagulation cascade, increasing the risk of clot formation.
Prolonged immobilization and bed rest:
The patient has been “primarily bedridden” due to the injury. Immobility leads to stagnation of blood flow in the deep veins of the lower extremities—one of the classic elements of Virchow’s triad (stasis, endothelial damage, and hypercoagulability).
When a patient is non-weight-bearing (NWB) and bedridden, the venous return from the lower extremities is greatly reduced. This promotes pooling of blood and increases the risk for thrombus formation.
Lower limb injury and immobilization:
The tibial plateau fracture and the knee immobilizer further reduce active muscle pumping action in the leg. Muscle pumps (especially the calf muscles) normally aid in pushing blood back toward the heart. Lack of movement or muscle contractions significantly increases clot risk in the deep veins.
Because of these synergistic risk factors—active cancer, immobilization, and local trauma/immobilization of the lower extremity—DVT is the most likely complication.
- Why the other options are less likely
A) Arterial Insufficiency Ulcer
Pathophysiology:
Arterial insufficiency ulcers are typically due to poor arterial blood supply (often from peripheral arterial disease, atherosclerosis, or other vascular pathologies).
These ulcers commonly occur on the distal portions of the foot/toes, where arterial blood flow is already compromised.
Why it is less likely here:
The patient’s main issues—cancer, bed rest, immobilization—do not primarily point to blocked arterial flow in the leg. There is no mention of peripheral arterial disease or symptoms like claudication, decreased pulses, or trophic changes in the foot.
Lack of weight bearing alone does not typically cause arterial ulcers. Arterial ulcers stem from inadequate arterial blood supply, not from venous stasis or clotting per se.
B) Venous Insufficiency Ulcer
Pathophysiology:
Venous insufficiency ulcers occur due to chronic venous hypertension from incompetent valves in the veins, leading to pooling and edema that over time causes skin breakdown—most often around the medial malleolus.
Why it is less likely here:
Although the patient is immobile, there is no indication of chronic venous insufficiency. Venous ulcers typically develop over a prolonged period with a history of edema, varicose veins, or longstanding venous disease, rather than in an acute, two-week timespan.
While immobility can worsen venous return, an acute venous insufficiency ulcer would be unusual in this short timeframe.
C) Baker’s Cyst (Popliteal Cyst)
Pathophysiology:
A Baker’s cyst is a fluid-filled swelling that develops behind the knee (in the popliteal space), often in conjunction with knee joint pathology such as arthritis, meniscal tears, or chronic joint inflammation.
Why it is less likely here:
Although knee injuries or chronic knee inflammation can lead to Baker’s cysts, the short timeframe and the specific risk factors (cancer, bed rest, strict immobilization) weigh much more heavily toward thrombosis rather than a popliteal cyst.
Baker’s cysts also do not typically arise simply from NWB status; they are more associated with underlying knee joint pathology or chronic swelling rather than acute immobilization.
3. Key Takeaways
Cancer → Hypercoagulable state: The presence of an active malignancy substantially increases the risk for a blood clot.
Prolonged bed rest + Immobilization: Reduced venous return and lack of muscle pump activity are major contributors to DVT development.
Timeframe & Clinical Setting: Within two weeks of strict NWB status in the setting of a fracture and knee immobilizer, DVT risk is high and can present acutely.
Thus, combining a hypercoagulable state (cancer) with immobility and lower-extremity trauma/immobilization makes deep vein thrombosis (DVT) the most likely complication.
A patient in the hospital has an order for PT evaluation and treatment. Upon reviewing the chart, the therapist discovers abnormal vital signs. Which of the following vital signs would contraindicate the initiation of physical therapy?
A) SpO₂ of 90% on room air
B) Oral temperature of 102 degrees Fahrenheit (Fever)
C) Heart Rate of 90 beats/min
D) Respiratory Rate of 18 breaths/min
B) Oral temperature of 102 degrees Fahrenheit (Fever)
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A physical therapist performs an examination on a patient complaining of left shoulder pain. The examination findings suggest the shoulder pain is not amenable to physical therapy intervention. Which of the following conditions is MOST likely to cause shoulder pain?
A) Myocardial ischemia
B) Acromioclavicular joint dysfunction
C) Subacromial bursitis
D) Cholecystitis (inflammation of the gallbladder)
A) Myocardial ischemia
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A patient arrives at outpatient physical therapy complaining of neck pain for 2 days. She reports a headache, neck stiffness, nausea, and fever. What is the MOST appropriate therapist action?
A) Cancel the physical therapy examination, and contact the referring physician
B) Reschedule the physical therapy examination, and contact the referring physician
C) Complete the physical therapy examination, and contact the referring physician
D) Instruct the patient to go to the emergency department (or arrange transport)
D) Instruct the patient to go to the emergency department (or arrange transport)
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A patient with type 1 diabetes mellitus has generalized osteoporosis. What is the BEST exercise to include in the patient’s plan of care?
A) Partial squats in standing
B) Bilateral quadriceps presses against resistance in sitting
C) Aquatic exercises
D) Running on a treadmill
A) Partial squats in standing
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In the treatment of CVA/stroke, involving a patient with weak/flaccid shoulder muscles, which of the following is a red flag?
A) Emphasize compensation strategies
B) Strengthen available and low-tone muscles
C) Avoid traction or overhead activity
D) Avoid PROM
C) Avoid traction or overhead activity
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A patient returns to an outpatient physical therapy clinic (and now is on your schedule) complaining of worsening back pain, urinary incontinence, and severe left lower extremity weakness with saddle paresthesia. The patient was evaluated and treated by a covering physical therapist for low back pain three days ago, at which time he was treated with lumbar traction at 40% body weight. The patient did have abnormal lower-extremity deep tendon reflex and sensory deficits on initial evaluation. What is the MOST appropriate physical therapist action?
A) Cancel the session and contact the referring physician to discuss the patient’s plan of care
B) Continue with the current plan of care
C) Refer the patient to the emergency department
D) Reduce traction force to 25% body weight
C) Refer the patient to the emergency department
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A 37-year-old male presents to a physical therapy clinic with a chief complaint of right-sided low back pain. The symptoms started three days ago. The patient denies injury or history of back pain. He states the pain is throbbing and radiating to his right lower abdomen and groin. The symptoms are constant and not relieved with rest. He reports nausea with vomiting. Examination discloses right flank pain and tenderness. Lumbar range of motion is normal. Lower extremity strength is 5/5. Lumbar central posterior-anterior mobility assessments (P–As) do not reproduce pain. Which of the following actions is the MOST appropriate?
A) Perform intermittent lumbar traction for 20 minutes in prone at 25% patient’s body weight
B) Perform TENS for 8 minutes to the right lumbar paraspinals
C) Perform grade II lumbar joint mobilizations
D) Refer the patient to their primary care physician
D) Refer the patient to their primary care physician
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A patient recovering from stroke is ambulatory without an assistive device and demonstrates a consistent problem with an elevated and retracted pelvis on the affected side. Which manual therapeutic exercise procedure is the BEST choice to remediate this problem?
A) Utilize light resistance to anterior pelvic rotation during swing
B) Provide inferior compression during stance
C) Utilize light resistance to posterior pelvic elevation during swing
D) Provide anterior-directed pressure during swing
A) Utilize light resistance to anterior pelvic rotation during swing
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