Variadas 12 Flashcards

1
Q

Charlie is a 6 year old boy. 2 weeks ago he jumped off the play structure at school, landing on his feet. He has had a sore L ankle ever since. It is exacerbated when walking up hill. You suspect a grade 2 high ankle sprain. You expect all of the objective signs except:

A. Reduced dorsiflexion due to swelling in the talocrural joint

B. Pain in the distal tib-fib with a squat which is relieved by compression over the medial and lateral malleoli prior to squatting

C. Pain in the distal tib-fib when the mid
Calf is squeezed

D. Pain in the distal tib-fib when the plantar flexed ankle is passively externally rotated over a fixed tibia and fibula

E. Increased anterior and posterior translation of the fibula on the fixed tibia

A

A

You do not expect swelling at 2 weeks post injury. The rest of the findings correlate with a positive grade 2 tear in the interosseous ligament attaching the distal tibia and fibula. This is known as a high ankle sprain.

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2
Q

What should you do when your patient is experiencing AD?

A

If standing, sit patient down for safety. If patient is sitting, keep them seated.

Keep head elevated - DO NOT LIE PATIENT FLAT.

Find the source of the noxious stimulus.

Monitor BP.

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3
Q

You are the physiotherapist in a traumatic brain injury unit. Your patient has been transferred from the emergeney room to the TBI unit after being involved in a car accident . You notice that the patient has bruising behind his ear. He is adamant that he did not get into a fight.
What is this most likely called?

a) Cushing’s disease
b) Raccoon eyes
c) Battle’s sign
d) Posturing syndrome

A

C

Bruising behind the ear is a sign of a basal skull fracture. Although it may appear to be a bruise this is a medical emergency.

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4
Q

Bethany Haber has Rheumatoid Arthritis. She has been referred to you from her physiatrist for a joint count. Which of the following is the correct order to perform a joint count?

a) swelling, tenderness, overpressure

b) overpressure, tenderness, swelling

c) 2 thumb technique; bulge sign

d) swelling, overpressure, bulge sign

e) tenderness, overpressure, swelling

A

correct answer is A!

Swelling, Tenderness, and OverPressure spell STOP!

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5
Q

What are the 5 P’s of the neurovascular assessment for Compartment Syndrome?

A

The 5 P’s of Neurovascular Assessment

  1. Pain: disproportionate to activity. Will have pain with passive stretching and/or pain out of proportion to the examination
  2. Pallor: pale color of the skin
  3. Pulselessness: muscle may feel tight or full.
    Take patients pulse in appropriate body area.
  4. Paresthesia: tingling or burning sensations (paresthesia) in the skin
  5. Paralysis: loss of use
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6
Q

You are a physiotherapist in the Cardiac Rehab unit. You are seeing a new patient today. Before meeting you read their chart and notice their most recent ABG’s to be as
follows:
•pH 7.45 •PaC02 30 •HCO3 19
Which of the following correctly describes their ABG’s?

a) Metabolic acidosis
b) Compensated metabolic acidosis
c) Metabolic alkalosis
d) Compensated metabolic alkalosis
e) Compensated respiratory alkalosis

A

E

Compensated Respiratory Alkalosis, because PaCO2 is low and HCO3 is low.

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7
Q

28 year old Beth has been having recurrent heaviness, fullness and clumsiness in her right hand. She is an office worker and is 1 year post-partum. She explains that when she is at the gym her symptoms increase with exercise.
Heaviness, fullness and clumsiness during what exercise would make you consider thoracic outlet syndrome as a possible diagnosis?

a) Frontal shoulder raises with palms facing each other
b) Rows with end retraction through shoulder blades
c) Latissumuss pull down with emphasis on the eccentric phase of motion
d) a and c

A

B

Rows with end retraction is recreating the military brace test, which is a diagnostic test for TOS. The military press, also known as costoclavicular test, specifically looks as the vascular type of TOS, which has symptoms like fullness, heaviness, clumsiness and weakness.

Edson/military test: palpate radial pulse. Draw pt sh down and back.
Positive: pulse will decrease ot symptoms

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8
Q

You are a physiotherapist in the emergency room at a community hospital. You arrive to find a patient complaining of chest pain. Upon reading his chart you find he has fractured his 10th rib after falling from a ladder. His history shows a 10 pack year of smoking. You notice when he is talking he is coughing up pink frothy sputum. You lay him down, but his coughing increases. He starts to get very anxious because he is unable to get in a full breathe. Which of the following of the above signs and symptoms leads you to believe this patient has pulmonary edema?

a) Chest pain
b) Unable to get full breathe of air in
c) Harder to breathe in laying than sitting
d) b and c
e) all of the above

A

D

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9
Q

Which of the following is a contraindication to ultrasound at 1.0 watts/cm2 with a 1 MhZ sound head ?

a) Over a non-cemented metal implant
b) Over a recent fracture site
c) Over a recently repaired tendon rupture
d) All are contraindications

A

correct answer is B!

US is extremely painful over fracture sites, all other sites are okay.

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10
Q

78 year old Vince Lowit has been referred to physiotherapy for an update on mobility status. Past medical history reveals COPD, uncontrolled DMIl, left below knee amputation, Uncontrolled HTN and angina. He is currently in the emergency room after suffering a pulmonary embolism. Which of the following is the most common cause of pulmonary emboli?

a) DVT
b) Uncontrolled HTN
c) Chronic venous insufficiency
d) COPD

A

A

DVT is the most common cause of PEs. The other conditions may lead to DVTs.

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11
Q

78 year old Vince Lowit has been referred to physiotherapy for an update on mobility status. Past medical history reveals COPD, uncontrolled DMII, left below knee amputation, Uncontrolled HTN and angina. He is currently in the emergency room after suffering a pulmonary embolism. To reduce his risk of further complications while on bed rest you prescribe the following:

A) Heel slides with his intact limb followed by skin checks of his heel
B) Compression stockings and elevating his right ankle on a pillow when he sleeps
C) Low molecular weight heparin
D) A & B
E) All of the above

A

A

Compression stockings and elevation are contraindicated since he has uncontrolled HTN. Only heel slides are appropriate to prevent DVTs. We cannot prescribe drugs.

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12
Q

Craig is a 63 year old male who entered the emergency room last night due to an acute exacerbation of his Emphysema. He has a 47 pack yr history and was diagnosed with emphysema 15 years ago. He also has type Il diabetes. You are the PT on the Cardioresp unit and are called down to perform IPPA. What do the P’s in IPPA stand for?

a) Pulse and Pulmonary
b) Percussion and Pulse
c) Percussion and Palpation
d) Palpation and Pulse

A

answer is C

IPPA is the objective assessment of the pulmonary system and stands for Inspection, Palpation, Percussion and Auscultation.

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13
Q

OSGOOD SCHLATTER DISEASE
TREATMENT

A

The number one priority is to decrease loading of the knee by the quadriceps muscle/tendon

. We can do this by:

  • activity modification, limiting squatting, jumping and stairs
  • gentle pain free stretching of the quadriceps and hamstrings (progress to dynamic and PNF as pain allows)

We then want to manage pain: - bracing/taping (e.g. patellar strap)

  • ice
  • rest
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14
Q

Samantha Edwards is 46 years old and has a desk job. On the weekend she picked up her 3 year old daughter and felt a sharp pain in her back. She is unable to pick up her shoes without the pain shooting down her right leg and she has not attended work in 3 days as her pain is exacerbated by sitting at her desk. Which trunk position should Samantha avoid?

a) Extension
b) Extension + Rotation
c) Flexion
d) Flexion + Rotation

A

answer is D

Due to her age, aggravating factors, and the sudden nature of the pain, she likely experienced a disc herniation. Flexion and Rotation puts posterior pressure on the discs and strains the PCL.

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15
Q

A physiotherapist is working with a women’s hockey team. The coach is late for practice, so the physiotherapist starts the warm-up. One of the players states that she sees no benefit in a warm-up.

When explaining the benefits of a warm-up, which of the following statements would be incorrect?

a. There is an increase in muscle temperature which increases the efficiency of muscle contraction by reducing muscle viscosity and increasing the rate of nerve conduction.

b. There is dilation of the capillaries which increases circulation and augments oxygen delivery to the active muscles.

c. There is increased flexibility which makes the musculoskeletal system less susceptible to injury.

d. There is a decrease in venous return which occurs as blood is shifted centrally from the periphery.

A

The correct answer is D

There is an increase in venous return which occurs as blood is shifted centrally from the periphery due to increased muscle pumping action.

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16
Q

A student physiotherapist is starting their first placement at a seniors complex. During their orientation, they are required to sit in on a seminar to learn more about the older adult.

Which of the following statements is true regarding the older adult?

a. Resting heart rate decreases with age.
b. Stroke volume decreases with age.
c. Cardiac output increases with age.
d. Blood pressure decreases with age.

A

The correct answer is B

a.Resting heart rate decreases with age. -
FALSE
• Resting heart rate is not influenced by age.
However, maximal heart rate is age related and decreases with age as it is calculated very generally by: 220 minus age.

b. Stroke volume decreases with age. - TRUE
• Stroke volume decreases with age as heart muscle weakens and stiffens and cannot pump as much blood out with each contraction.

c. Cardiac output increases with age. - FALSE Cardiac output (CO) decreases because it is
directly related to stroke volume (SV) which
decrease with age. CO = SV x HR.

d. Blood pressure decreases with age. - FALSE
• Blood pressure increases with age because of increased peripheral vascular resistance.

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17
Q

A physiotherapist is working with a new patient who is recovering from a total hip replacement. Prior to discharge, the physiotherapist is reviewing a home exercise program with the patient and his wife.
While the patient is eager and on board with the program, his wife is expressing doubts about the program and does not think the exercises should be performed without a physiotherapist present.

The physiotherapist recommends a pool program twice a week. Which of the following statements is true regarding the properties of water and its therapeutic benefits?

a. Viscosity provides the patient with relative weightlessness and joint unloading allowing for ease of active movement.
b. Approximately 80% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS.
c. Hydrostatic pressure can decrease venous return and improve blood flow to the limbs.
d. Increasing the surface area moving through water will increase resistance.

A

A. Viscosity provides the patient with relative weightlessness and joint unloading allowing for ease of active movement. - FALSE
• Buoyancy is what provides the patient with relative weightlessness and joint unloading.

b. Approximately 80% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS. - FALSE
Approximately 50% of a patient’s body weight is reduced when standing at a water depth at the level of the ASIS.

C. Hydrostatic pressure can decrease venous return and improve blood flow to the limbs. - FALSE
• Hydrostatic pressure can assist in venous return which centralizes blood flow and can assist in decreasing effusions.

d. Increasing the surface area moving through water will increase resistance. - TRUE
Waters viscosity creates resistance with all active movements. The larger the surface area moving, the more resistance and thus potential for strengthening of the muscles involved in that movement.

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18
Q

A patient developed frozen shoulder after being immobilized due to a humeral fracture. She is now three months post fracture which healed without incident. She has come to physiotherapy hoping to increase her shoulder range of motion. During treatment, the physiotherapist initiates manual therapy to increase her glenohumeral abduction range of motion.
Which glide would be the most appropriate to use?

a. Posterior glide
b. Anterior glide
c. Superior glide
d. Caudal glide

A

The correct answer is D

a. Posterior glide
• Used to increase flexion and internal rotation
b. Anterior glide
• Used to increase extension and external rotation

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19
Q

During an initial assessment, the physiotherapist is assessing the gait pattern of their patient post anterior tibiofibular ligament. You notice they are experiencing early push off in stance phase.
Which of the following is false regarding the ranges required during the stance phase of gait.

a. Knee joint: requires a maximum of 60 degrees of flexion

b. 1st MT joint: requires a maximum of 70 degrees of extension

c. Hip joint: requires a maximum of 30 degrees of hip flexion

d. Ankle joint: requires a maximum of 20 degrees of plantar flexion

A

The correct answer is A

a.Knee joint: requires a maximum of 60
degrees of flexion - FALSE
• Only require up to 40 degrees of knee flexion in terminal stance. Up to 60 degrees is required for midswing.
b. 1st MTP joint: requires a maximum of 70 degrees of extension - TRUE
• During toe off, 70 degrees of extension is required for push off.
c. Hip joint: requires a maximum of 30 degrees of hip flexion - TRUE
• Requires 30 degrees of hip flexion at heel strike.
d. Ankle joint: requires a maximum of 20 degrees of plantarflexion - TRUE
Requires 20 degrees plantarflexion for toe
off.

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20
Q

During an initial assessment, the physiotherapist is assessing the gait pattern of their patient post anterior tibiofibular ligament. You notice they are experiencing early push off in stance phase.
You determine your next step in treatment is to provide dorsiflexion mobilization to help improve their range of motion. Which of the following statements is false regarding grade 2 joint mobilizations?

a. Grade ll oscillations decrease pain by stimulating mechanoreceptors that inhibit the perception of pain at the spinal cord level.

b. Grade ll oscillations improve range of motion by stretching the joint capsule.

c. Grade ll oscillations are used when pain is experienced concurrently with tissue limitation.

d. Grade ll oscillations are large amplitude performed within available range, not reaching the limit.

A

B

Grade Il oscillations improve range of motion by stretching the joint capsule. - FALSE
Grade Il oscillations are used primarily for treating joint pain which can in turn improve ROM.
There is no stretched placed on the joint capsule because the oscillations are not within a range that places any stress onto the joint capsule.

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21
Q

A patient sustained right cerebellar damage after a stroke. She has positive findings for dysdiadochokinesia.
Which of the following would be an expected finding?

a. Difficulty with right upper limb finger to nose accuracy

b. Difficulty with left upper limb finger to nose accuracy

c. Difficulty with right upper limb rapid alternating supination/pronation

d. Difficulty with left upper limb rapid alternating supination/pronation

A

The correct answer is C

a. Difficulty with right upper limb finger to nose accuracy
• This is a test for dysmetria.

b. Difficulty with left upper limb finger to nose accuracy

c. Difficulty with right upper limb rapid alternating supination/pronation - CORRECT
Dysdiadochokinesia is the medical term for difficulty with rapid alternating movements. It is tested in the upper limb with alternating supination/pronation. Because the patient has sustained a right cerebellar injury, we would anticipate right sided coordination deficits as the cerebellum is connected to ipsilateral body function.

d. Difficulty with left upper limb rapid alternating supination/pronation

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22
Q

A physiotherapist is working with a new patient who sustained a grade Ill ATFL sprain and is non-weightbearing post injury.
What is the most important component of the initial treatment for the physiotherapist include in their plan?

a. Ankle pump exercises
b. Education about weightbearing status
c. Wrap the ankle in a tensor to manage edema
d. Initiate a hip strengthening program to maintain strength in proximal muscle groups

A

The correct answer is B
a. Ankle pump exercises
b. Education about weightbearing status -
CORRECT
• While all of the other options are acceptable, education is the BEST answer here as it ensures the patient avoids further injury.

c. Wrap the ankle in a tensor to manage edema
d. Initiate a hip strengthening program to maintain strength in proximal muscle groups

23
Q

A patient is complaining of numbness down the lateral leg into the dorsum of the foot after lifting a heavy box. The physiotherapist suspects a disc herniation.
Which disc is most likely involved?

a. L3
b. 14
c. L5
d. SI

A

The correct answer is B!

The dermatomal distribution provide in the question indicates L5 nerve root is affected. Due to a weak spot in the disc, lumbar disc herniations are typically posterolateral.

24
Q

A physiotherapist is working with a patient who is complaining of pain radiating into the top of his right foot. The pain increases when he is sitting and is relieved when he is standing and walking. The physiotherapist suspects a herniated disc.
Which of the following special tests would be the best option to aid the physiotherapist in confirming his suspected diagnosis?

a. Prone Knee Bend Test
b. Sharp-Purser Test
c. Slump Test
d. Spurling’s Foraminal Compression Test

A

The correct answer is C!

a. Prone Knee Bend Test• Assesses higher lumber nerve roots L2-L4.

b. Sharp-Purser Test • Assesses the presence of cervical instability not nerve root involvement.

c. Slump Test - Correct
• Given the location of the pain (dorsum of foot), we suspect L5 nerve root involvement which will most accurately be tensioned with a slump test.

d. Spurling’s Foraminal Compression Test • Assesses presence of cervical nerve involvement

25
Q

A patient who sustained a wrist fracture was casted for 6 weeks and is now attending physiotherapy to regain functional use of their hand. The physiotherapists assesses the patient and notices significant lumbrical stiffness. The physiotherapist decides to create a home stretching program.

When teaching the patient how to passively stretch their lumbricals at home, which of the following correctly describes the position of the fingers?

a. MCP flexion, PIP flexion
b. MCP flexion, PIP extension
c. MCP hyperextension, PIP extension
d. MCP hyperextension, PIP flexion

A

D

26
Q

A patient with Type 2 Diabetes is starting a new exercise program. The physiotherapist wants to ensure that the patient has a good understanding of the effects of exercise on blood sugar. He teaches the patient about the signs and symptoms of hypoglycemia.
Which of the following signs would not be present if the patient was experiencing a hypoglycemic episode?

a. Profuse sweating
b. Excessive thirst
c. Cold, clammy skin
d. Unsteadiness

A

The correct answer is B!

b. Excessive thirst - Correct
• Excessive thirst (polydipsia) is a sign of hyperglycemia NOT hypoglycemia

27
Q

A young man suffered a C4 spinal cord injury several months ago. He is now working on weaning off the ventilator during the day. His respiratory rate is 10 breaths per minute.
Given his current condition, which of the following would most likely be found with an arterial blood gas sample?

a. Respiratory acidosis
b. Metabolic alkalosis
c. Respiratory alkalosis
d. Metabolic acidosis

A

correct answer is A!
a. Respiratory acidosis - Correct
• We know it will be a respiratory issue given that his diaphragm and breathing has been disrupted. • Normal respiratory rate is between 12-20 breaths per minute

28
Q

A physiotherapist is working on a respiratory ward and is gathering information about their patient using spirometry. They ask their patient to take a maximal expiration after a maximal inspiration.
Which of the following correctly identifies what the physiotherapist is measuring?

a. Vital capacity
b. Tidal volume
c. Expiratory reserve volume
d. Inspiratory reserve volume

A

correct answer is A!
a. Vital capacity - Correct
• Volume of maximal inspiration and expiration.
Patient expires maximally after taking a maximal inspiration [.]

29
Q

A physiotherapist is working with a patient with hemophilia who was recently diagnosed with an active joint bleed in her right knee. She arrives to physiotherapy with a red, hot, swollen knee and presents with an antalgic gait.
Which of the following describes the first course of action the physiotherapist should take?

a. Encourage pain free AROM of the affected joint.

b. Teach the patient how to use crutches to avoid weight bearing on the affected joint.

c. Encourage the patient to use ice and elevate the affected leg.

d. Wrap the knee using a tensor bandage.

A

B

30
Q

A physiotherapist is working with a patient who suffered a left grade I anterior talofibular ligament
(ATFL) sprain 1 day ago. Due to his pain while ambulating, the physiotherapist would like to teach the patient how to use a cane.
Which of the following statements is correct regarding the use of the cane for this patient?

a. Hold the cane in the left hand; step the left leg and move the cane at the same time.
b. Hold the cane in the left hand; step the right leg and move the cane at the same time.
c. Hold the cane in the right hand; step the left leg and move the cane at the same time.
d. Hold the cane in the right hand; step the right leg and move the cane at the same time.

A

C

The cane should go on the opposite side of
the affected/injured limb.
• The cane and the affected limb should move together which will help to unload the painful limb.

31
Q

A patient suffered a stroke several days ago which resulted in right hemiplegia and Broca’s aphasia.

He is now stable and will be seeing the physiotherapist for the first time.
What should the physiotherapist expect regarding his communication abilities?

a. He is able to verbalize but cannot comprehend verbal communication.

b. He is unable to verbalize but is able to comprehend verbal communication.

c. He is unable to verbalize or comprehend verbal communication.

d. He is able to verbalize and comprehend verbal communication.

A

B

32
Q

A physiotherapist is treating a patient with De Quervain’s tenosynovitis. They have concluded that the tendons of extensor pollicis brevis and abductor pollicis longus are involved.
Which of the following correctly states the innervation of abductor pollicis longus (APL)?

a. Posterior interosseus nerve
b. Radial nerve
c. Anterior interosseus nerve
d. Ulnar nerve

A

The correct answer is A!

a. Posterior interosseus nerve - Correct
• Posterior interosseus nerve (C7, C8) is a deep motor branch of the radial nerve that directly innervates APL.

33
Q

A physiotherapy student is on her first placement at a local private practice clinic. Her preceptor is teaching her about surface anatomy and palpation. The student palpates the T7 vertebral spinal process.
Which of the following correctly identifies the anatomical structure that lines up with T7?

a. Superior angle of the scapula
b. Spine of the scapula
c. Inferior angle of the scapula
d. Nipples

A

The correct answer is C!
a. Superior angle of the scapula
• The superior angle of the scapula is at the level of T2
b. Spine of the scapula
• The spine of the scapula is at the level of T3

34
Q

QUESTION MONDAY
VIGNETTE
A physiotherapist has been asked to assess a new patient on her ward. The patient is a 60 year-old woman of German descent who suffered a fractured distal radius as a result of a fall.
A physiotherapist suspects that their patient has strained their right flexor carpi radialis (FCR). What movement should the physiotherapist ask the patient to perform during resisted isometric testing to properly engage and assess FCR?

a. Wrist flexion
b. Wrist radial deviation
c. Wrist flexion and radial deviation
d. Wrist flexion with finger flexion

A

C

35
Q

A physiotherapist is working with a patient who suffered a left middle cerebral artery stroke. They have decided to incorporate PNF patterns into their session to facilitate right upper limb activation.
The therapist begins with the Diagonal 1 (D1) pattern.
Which of the following correctly describes the arm in a position of Di flexion?

a. Flexion, adduction, external rotation
b. Flexion, abduction, external rotation
c. Flexion, adduction, internal rotation
d. Flexion, abduction, internal rotation

A

The correct answer is: A!
A. Flexion, adduction, external rotation •
This
correctly describes the starting position for a limb in D1 flexion.

36
Q

A 75 year-old male has been diagnosed with left congestive heart failure. He has been referred to physical therapy to aid in improving his overall mobility.
What is the most common symptom associated with left sided heart failure?

a. Pulmonary edema
b. Adventitious breath sounds
c. Pink frothy sputum
d. Shortness of breath

A

D

A. Pulmonary edema
• While pulmonary edema is a common complication of left sided heart failure, it is a sign and not a subjective symptom. A symptom is the patient’s subjective complaint while a sign is an objective measure.

B. Adventitious breath sounds
• While adventitious breath sounds such as coarse crackles can be noted in patient’s with left sided heart failure, they are a sign and not a subjective symptom of heart failure.

C. Pink frothy sputum
Pink frothy sputum is another sign of pulmonary edema which can result from left sided heart failure. This is a sign and not a symptom.

D. Shortness of breath
Shortness of breath is a common symptom associated with left sided heart failure due to the pulmonary edema that develops as a result of the heart failure. This was the only symptom listed in the possible answers.

37
Q

A 45-year-old man has had surgery to repair a fracture in his right distal tibia. He is now non-weight bearing for 6-8 weeks. A physiotherapist has been asked to teach him how to use crutches before his discharge home.

The patient is sitting at the edge of his bed when the physiotherapists arrives. Which of the following depicts the best instructions for teaching this patient to stand with crutches?

a. Crutches are placed vertically on left side. Patient holds the crutches with left hand, pushes down into the bed with right hand to come up into a standing position. Once upright, one crutch is brought over to the right side.

b. Crutches are placed vertically on right side. Patient holds the crutches with right hand, pushes down into the bed with left hand to come up into a standing position. Once upright, one crutch is brought over to the left side.

c. Both crutches remain against bed on right side. Patient pushes up into standing using both hands and, once in standing, grabs the crutches and places one under each armpit.

d. Both crutches remain against bed on left side. Patient pushes up into standing using both hands and, once in standing, grabs the crutches and places one under each armpit.

A

B

This depicts the correct technique for moving from sit to stand when the right leg is affected. • The crutches should always be on the same side as the affected/injured limb to aid in balance.

38
Q

A tennis player suffered a left shoulder injury while playing a match and was taken out of the match. During observation, the therapist noticed a ‘hollow’ beneath the acromion posteriorly. While assessing the shoulder in supine, the therapist passively abducts the left shoulder to 90* and slowly rotates it externally however the patient resists the motion firmly and does not allow it any further.
What is the inference from the above assessment?

A) Posterior internal impingment
B) Posterior dislocation of shoulder
C) 3* Infraspinatus tear
D) Anterior dislocation of shoulder

A

Correct answer = D, Anterior dislocation of
shoulder.

The above mechanism is an example of anterior shoulder dislocation.
Mechanism - Abduction + External rotation, sometimes extension as well.

On observation - there is a hollow under the acromion, posteriorly & humeral head will be palpable anteriorly (not asked in the question) —- these are unique to anterior dislocation

The therapist is performing an anterior apprehension test here which is positive due to the above given response by the patient.

39
Q

A 60 year old male complaints of chronic shoulder pain with limited ROM. He is diagnosed as shoulder osteoarthritis with cuff arthropathy. He has undergone Reverse total shoulder arthroplasty (TSA) and is currently in phase 1 of rehabilitation.

Q2.Which of the following is appropriate for this patient currently?

A) Shoulder sling worn compulsorily
B No GH extension past neutral
C) Isotonics for scapulothoracic muscles and deltoid
D) Can lift 2-5 lb weight

A

Q2.Answer: B

No GH extension past neutral is allowed till 6 weeks postoperatively.
Incorrect: A - Sling is not compulsory unless rotator cuff is repaired. It is only worn when shoulder is unsupported or in crowded places.
C - Only light, NWB isometrics of ST and deltoid muscles with shoulder in scapular plane is allowed in phase 1.
D - Lifting is limited to 1lb (cup of coffee or glass of water) till 6 weeks.

40
Q

A 60 year old male complaints of chronic shoulder pain with limited ROM. He is diagnosed as shoulder osteoarthritis with cuff arthropathy. He has undergone Reverse total shoulder arthroplasty (TSA) and is currently in phase 1 of rehabilitation.

Q1 Which of the following is NOT an indication of Reverse tsa?

A) Severe Osteoarthritis of shoulder
B) Rotator cuff arthropathy
C) Axillary nerve palsy
D) Irreparable Rotator cuff tear

A

Q1) Answer : C
Axillary nerve palsy is a contraindication for reverse TSA since deltoid is necessary for shoulder function post reverse TSA.
Incorrect: A, B & D - These are indications for reverse TSA.

41
Q

Anna is 6 year-old female who has been referred for Physical Therapy 7 weeks after sustaining a supracondylar fracture of her elbow. Her fracture has been fixed with two pins which have now been removed. The doctor has asked for range of motion (ROM) exercises and strengthening.

The Physical Therapist notices after 4 weeks of treatment that Anna is reporting increasing pain. Her mother thinks that it is because she is doing more activities during her day. The Physical Therapist’s assessment should include:

A- Isometric testing of strength

B- Her joint end feel in extension and flexion

C-Observation of swelling

D An objective measure of pain

A

D

42
Q

Poor fitting crutches will lead to compression of which nerve?

A

compression of the radial nerve due to poor fitting crutches.

The radial nerve is also known as the
“great extensor nerve” due to its innervation of the triceps, wrist and finger extensors.

43
Q

The increased respiratory rate that accompanies an anxiety attack will result in increased CO2 being
exhaled

A

= respiratory
alkalosis

44
Q

9 breaths per minute =
hypoventilation (retaining CO2) =

A

respiratory acidosis

45
Q

During sensory assessment of a patient, the therapist places objects with different weights in different hand and asks the patient to identify the heavier one. If the patient is unable to do so after repetitive attempts, it is suggestive of?

A) Lesion of dorsal column tract
B) Lesion of anterior spinothalmic tract
C) Lesion of lateral spinothalamic tract
D) Lesion of anterior corticospinal tract

A

Correct answer = A, Lesion of dorsal
column tract (DCML)
The above is an example of barognosis which is as a result of DCML pathway.
DCML is responsible for discriminative touch, vibration, pressure, proprioception, kinesthesia, vibration, 2 point discrimination, texture identification.
Incorrect options-

B - anterior spinothalamic tract carries crude touch & pressure
C - Lateral spinothalamic tract carries pain & temperature
D - corticospinal is a descending tract and is responsible for motor control.

46
Q

A Physical Therapist is treating a patient with Multiple Sclerosis. The Physical Therapist has observed that the patient showed steady deterioration in symptoms since onset with occasional acute attacks. Between the attacks the patient’s disease continued to progress.
The Physical Therapist can document this subtype of MS as:

1- Progressive relapsing MS

2Primary Progressive MS

3- Relapsing Remitting MS

4-Secondary Progressive MS

A

1

Progressive relapsing MS is characterized by steady deterioration in disease from onset but with occasional acute attacks. Intervals between the attacks are characterized by continuing disease progression.

Primary Progressive MS is characterized by disease progression and steady functional decline from onset. Patients may experience modest fluctuations in neurological disability but discrete attacks do not occur.

Relapsing remitting MS is characterized by discrete attacks of neurological deficit with either full or partial recovery during remission. The periods between relapses are characterized by lack of disease progression.

Secondary progressive MS is characterized by initial relapsing remitting course followed by change in clinical course with progression to steady and irreversible decline with or without continued acute attacks.

47
Q

What is cardiac output?

A

Cardiac output (CO) is the amount of blood pumped by the heart minute and is the mechanism whereby blood flows around the body, especially providing blood flow to the brain and other vital organs.

48
Q

Mr X was taking neuro rehab in a PT clinic and was discharged 1 year back. His daughter, who is also his substitute decision maker (SDM) called in the clinic and requested for a copy of discharge summary of the patient. What should the PT do?

A) Refuse to give the discharge summary as the daughter did not have the patient’s consent.

B) Call the patient and take his consent before releasing the discharge summary to his daughter

C) Tell the daughter to take consent from her father before requesting any health information

D) Give the requested information to the daughter by charging a nominal fee.

A

Answer: D
SDM has all rights to receive or give any information related to the patient. The health information custodians can provide this information to the SDM by charging or nominal fee.

Incorrect: A- as the daughter is the patient’s
SDM she need not require patient’s consent

B- there is no need to call the patient as the information is requested by the SDM.

C - the daughter does not need patient’s consent as she is Patient’s SDM.
REF - College of Physiotherapy, Ontario.

49
Q

A Physical Therapist was demonstrating transfer techniques to the patient. The Physical Therapist observed that the patient has difficulty following the instructions and is unable to imitate the necessary steps. The chart review showed a lesion in the dominant parietal lobe of the patient. The Physical Therapist can document the condition as:

1-Anosognosia

2-Somatoagnosia

3- Visual agnosia

4-Astereognosis

A

2

Anosognosia is lack of awareness or denial of a paretic extremity belonging to that person or lack of insight of paralysis.

Somatoagnosia is impairment of body scheme or lack of awareness of the body structure and the relationship of body parts to oneself or to others.
Patients with this deficit may display difficulty following instructions that require distinguishing body parts and are unable to imitate movements.
The patient for example may have difficulty with transfer activities because they do not perceive the meaning of terms related to the body parts. The lesion site is often the dominant parietal lobe.

Visual agnosia is the inability to recognize familiar objects despite normal functioning of the eyes and optic tracts. The patient can identify an object once it is handled. The lesions are most common in the occipito-temporo-parietal association area of either hemisphere.

Astereognosis is the inability to recognize forms by handling them although tactile, proprioceptive and thermal sensations are intact. These impairments commonly cause difficulties in ADL skills including self-care activities that are normally done in the absence of constant visual feedback. The lesion is most common in the parieto-temporo-occipital lobe of either hemisphere.

50
Q

A patient with Complex regional pain syndrome (CPRS) will show all of the following features EXCEPT -

A) Symptoms which are more marked distally

B) CPRS symptoms progress in intensity but will not spread to proximal areas

C) Symptoms can be completely disproportionate with respect to the causative event

D) CPRS can be of non-neural origin

A

Correct answer - B, CPRS symptoms progress in intensity but will not spread to other areas
CPRS symptoms can vary with time.
Although symptoms progress in intensity, CPRS symptoms may also spread proximally opposite to their distal engagement.

Other features will be present in CPRS

51
Q

79-year-old patient has been admitted to the hospital with pneumonia. He is quite ill and is unable to mobilize due to fever, low oxygen saturation and decreased energy levels. The physiotherapist arrives to perform percussions and vibrations in combination with postural drainage to aid in secretion removal. Prior to the session, the physiotherapist reads that the patient’s pneumonia is in the apical segment of the right upper lobe.

Which of the following is the correct postural drainage position for this patient given the location of the secretions?

a. Patient lies in a supine position with the head of the bed 30 degrees lower than the hips.

b. Patient lies in a prone flat position with pillow under hips and ankles for comfort.

c. Patient lies on the left side with bed flat then rolls the right shoulder forwards 45 degrees with pillow placed for comfort.

d. Patient sits upright and leans back on bed at a 60-degree angle.

A

D

52
Q

A 50 year-old patient is attending an outpatient physiotherapy clinic for hand related issues. Upon observation, the physiotherapist notes a fixed flexion deformity of the MCP and PIP joints on the ring and little finger of the left hand. When asked to move the fingers actively, the patient is able to move into full flexion but is limited in active extension due to the contractures. There are no reports of altered sensation or pain but he does complain of functional challenges such as grasping large objects.

What condition is the patient most likely presenting with?

a. Dupuytren s
b. Osteoarthritis of the MCP and PIP joints
c. Claw hand
d. Benediction hand deformity

A

The correct answer is: A!

A.Dupuytren’s • This is a condition that results in the contracture of the palmar fascia and creates fixed flexion deformities of the MCP and
PIP joints. The most commonly affected fingers are the 4th and 5th digits. Patients will be able to move the digits but are limited by the contractures. There are no sensory issues associated with this condition.

53
Q

A physiotherapist is providing home therapy for a 65 year old woman who suffered a stroke 3 months ago. She has left sided hemiplegia and is dependent on her son for all of her care.
She sold her home and moved into her son’s single level home because of her high care needs. While she has significant physical deficits, her cognition and speech are unaffected.
During a home visit, the physiotherapist notices significant bruising around her left arm. When the physiotherapist asks the patient what happened, she says that her son was frustrated the other day and acted aggressively when getting her into her wheelchair. She appears fearful and says she does not want to discuss the matter any further.
The physiotherapist suspects abuse. How should they proceed?

a. Say nothing to the authorities as the woman is cognitively intact and has not consented to, or asked for, assistance.

b. Immediately report the suspected abuse to the proper authorities.

c. Try to connect with the patient and find out if there have been other instances of abuse.

d. Chart what was observed and the conversation that was had to ensure you have documentation if future incidents occur.

A

B

Immediately report the suspected abuse to the proper authorities.•
In this scenario, the
patient is dependent on her son given her physical disability and it is therefore critical that the physiotherapist report the suspected abuse.