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45. A 15-year-old football player sustained a knee injury. He attends a private physiotherapy clinic the next day. The physiotherapist's assessment shows that the coronary ligaments in his knee have been completely torn. Which structure would be directly affected by this tear? A. Medial meniscus. B. Patella. C. Fibular shaft. D. Head of fibula.

A 29-year-old right hand dominant construction worker attends physiotherapy at a rehabilitation centre. He fell onto his right elbow four weeks ago. The client reports symptoms of pain and numbness in the ring finger and little finger of the right hand and difficulty using this hand. 9. When examining the right upper extremity, which one of the following sustained movements should the physiotherapist expect to exacerbate the client's symptoms? A) Elbow flexion. B) Elbow extension. C) Wrist flexion. D) Forearm supination.

A 3-month-old baby boy with a diagnosis of congenital muscular torticollis requires physiotherapy in an out-patient department. 2. The physiotherapist teaches a home program to the baby's parents. Which of the following instructions should be emphasized? a) Incorporating the exercises into the child's daily routine. b) Pursuing the exercises intensively at frequent intervals during the day. c) Carrying out the exercises only when the child is awake and can participate. d) Doing the exercises only when the child is asleep.

A 3-month-old baby boy with a diagnosis of congenital muscular torticollis requires physiotherapy in an out-patient department. 3. The baby's torticollis improves with physiotherapy treatment. However, follow-up assessment at 8 months of age reveals a motor delay. Which of the following assessment tools should the physiotherapist use to determine the child's motor performance in relation to his peers? a) Alberta Infant Motor Scale (AIMS). b) Gross Motor Function Measure (GMFM). c) Ashworth Scale. d) Functional Independence Measure (FIM).

A 38-year-old man attends an out-patient physiotherapy clinic seeking treatment for insidious onset of right ankle and shin pain of two weeks' duration. The client states that the pain is now unrelenting, even at night, and has spread from the ankle into the shin. He is a regular jogger and has not changed his training regime. He thinks his pain is related to running. He has not seen his family physician about this problem because his physician is away for two weeks. He reports no past leg injuries and that he is in excellent health except for a recent tooth infection. The physiotherapist suspects the client may have osteomyelitis. 20. After completion of the assessment the physiotherapist has decided to treat the client's pain symptoms as part of his/her treatment plan. Which of the following modality treatments would be the most appropriate? A. Ice. B. Superficial heat. C. Short wave diathermy. D. Thermal dose of ultrasound.

A 50-year-old man comes to a private physiotherapy clinic for an aerobic exercise program. He has a 10-year history of insulin-dependent diabetes. 16. In designing the aerobic cycling program for this client, which of the following parameters of exercise should the physiotherapist recommend? A. 4 - 7 days a week for 20 - 60 minutes' duration. B. Daily at 20 - 40% of maximum heart rate. C. Daily at 80 - 90% of maximum heart rate. D. 3 - 5 days a week for 60 - 90 minutes' duration.

A 50-year-old man received full thickness burns to his face, upper body, and arms at work. He is admitted to an acute care facility. He has also been diagnosed with a restrictive pulmonary complication secondary to the burn. 4. What results would the physiotherapist expect to find on assessment with respect to the client's restrictive pulmonary complication? a) Decreased vital capacity and increased pulmonary resistance. b) Decreased vital capacity and decreased pulmonary resistance. c) Increased vital capacity and increased pulmonary resistance. d) Increased vital capacity and decreased pulmonary resistance.

A 54-year-old woman fell on an outstretched right hand while at work. She experienced immediate hand and wrist pain. A Colles' fracture was confirmed on x-ray. After six weeks in a cast, her x- rays showed poor callus formation and she was reporting right shoulder and elbow pain. She was recasted and referred to a private physiotherapy clinic. 11. Before initiating treatment, the physiotherapist describes the proposed treatment and possible outcomes to the client. Why should the physiotherapist do this? A) To allow the client to make an informed decision about her treatment. B) To allow the physiotherapist to justify the treatment intervention. C) To prevent the client from asking too many questions during treatment. D) To allow the physiotherapist to avoid litigation.

A 60-year-old man with post-polio syndrome is experiencing deterioration of his physical status. He is attending a rehabilitation centre as an out-patient for physiotherapy treatment. 8. The client has used crutches for eight years. He states that his ambulation has slowed and longer distances are more fatiguing. Which one of the following aids should the physiotherapist recommend for longer distances in the community? A) Four-wheeled walker. B) Two-wheeled walker. C) Manual wheelchair. D) Power scooter.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 25. During the first few days post-operatively, the client is allowed partial weight bearing on the operative side. Which of the following activities should the physiotherapist teach the client how to do? A. Transfer to a chair and toilet. B. Ambulate with two canes. C. Propel a wheelchair with his feet. D. Bear weight evenly on both feet.

Your 65 year old patient suffered a stroke 9 months ago. He is actively participating in weekly outpatient rehabilitation. Despite his efforts, he still has vision issues. He has also recently been diagnosed with right sided heart failure. What type of vision loss would occur with a lesion at the optic chiasm? A. Bitemporal hemianopsia B. Binasal hemianopsia C.Hemispatial neglect D. Hemianopsia

A A lesion at the optic chiasm would cause bitemporal hemianopsia aka tunnel vision. This is a type of partial blindness where vision is missing in the outer (temporal) half of both right and left visual field. -In binasal hemianopsia: vision is missing in the inner (nasal) half of both the right and left visual field. It is associated with certain lesions of the eye and of the central nervous system, such as congenital hydrocephalus -In hemispatial neglect: After damage to one hemisphere of the brain is sustained, a deficit in attention to and awareness of one side of the field of vision is observed. -Hemianopsia is a general term for blindness over half the field of vision

You are a new therapist at the community bone health clinic. You have been assigned to work with Terry, a patient who has had two fragility fractures in the past year. She is currently complaining of pain in her right sacroiliac joint, thoracic spine, and right hip. She is 80 years old, has a 20 year smoking history and has 3 daughters. After reading Terry's chart, you gather the following information: -Female -History of depression -Previous fractures -Chronic fatigue syndrome -Uveitis -Previous breast cancer -Smoker -Alcohol use -BMI > 25 -Inactive -Previous eating disorder Which of the following are ALL risk factors for osteoporosis? A. female, previous breast cancer, smoker, inactivity, eating disorder B. female, previous breast cancer, alcohol use, eastern European, BMI > 25 C. female, depression, alcohol use, BMI > 25, previous fractures D. female, depression, previous fractures, chronic fatigue syndrome, uveitis

A Being female increases risk, previous breast cancer increases risk because many drugs used to treat the cancer work by starving the cancer of estrogen therefore limiting the cancer's growth. Estrogen is important for maintaining bone strength in women, so breast cancer treatments that act against estrogen can lead to weakening of the bones. Smoking depletes bone mineral density and activity tolerance. Inactivity decreases bone loading and therefore weakens bones. Eating disorders are linked with weak bones due to decreased calcium and vitamin absorption. -It is more common in thin individuals, a BMI > 26 is not a risk factor -It is more common in older adults, 45 is not a risk factor -Uveitis is not a risk factor

Mr. and Mrs. Bower became worried about their 3 year old son after they noticed he was gradually becoming weaker than other boys his age. He had difficulty climbing stairs, moving from sitting to standing, and clumsy when walking. The child underwent several tests under the guidance of a pediatrician. Several weeks later their son, Charlie, was diagnosed with Duchene's muscular dystrophy. Which of the following correctly describes Gower's sign? A. Climbing up the legs to stand due to lumbar and gluteal weakness B. Enlarged calf muscles due to replacement of muscle tissue with connective tissue C. Rising from the floor using the lumbar and gluteal muscles and pushing on the knee caps D. Calf muscles which are larger due to overuse, as proximal muscles are weak.

A In DMD - proximal-distal muscle weakness. Gower's sign indicates weakness of proximal muscles, namely those of the lower limb. The sign describes that a patient has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength. Calf pseudohypertrophy refers to the calf muscles in DMD, where the muscles appear hypertrophied while they are in fact weak.

19 year old soccer player Jack Doyle, reports pain in his groin after sliding into another player on a turf field. Three days post injury, he is having pain with walking, single leg stance and has pain in mid to outer range hip abduction. You begin your assessment by palpating the adductor group of muscles. Finish the following sentence with the correct statement. "When palpating the tendon of the adductor longus muscle, the tendon can be felt..." A. As a cord like structure that attaches to the bone immediately inferior to the pubic tubercle. B. Along the insertion site at the ischiopubic ramus when resisted adduction of the thigh C. By placing the muscle in a slackened position by extending the knee coupled with passive hip abduction D. At its distal insertion along the medial aspect of the knee

A Insertion site of adductor longus arises from the superior pubic ramus. Ischiopubic ramus= insertion of gracilis and adductor magnus. Muscle becomes more stretches with knee extended and hip abducted, not slackened. Distal insertion is along posterior surface of femur, along the linea aspera.

A Most appropriate given stage of healing. Pain and ROM should be full by 6 weeks (see fowler kennedy document under goals for 6-9 weeks). -Open kinetic chain exercises should only be performed up to 60 degrees of knee extension in early rehab. No terminal knee extension in OKC. -While sport specific cardio exercises are an important part of cross training they are not the most relevant goals for 6 weeks post ACL repair.

You are treating a 28 year old woman post FOOSH 2 weeks ago resulting in a broken wrist. She lacks the 30 degrees of supination in her distal radial ulnar joint. Which of the following mobilizations can help increase her ROM in the DRUJ in the direction of supination? A. Posterior glide B. Inferior glide C. Anterior glide D. Superior glilde

A PPP rule - at the proximal radioulnar joint, posterior glide creates pronation - use clinical reasoning to figure out the rest. Supination at the DRUJ will be a posterior glide and pronation at the DRUJ will be an anterior glide.

Mr. and Mrs. Bower became worried about their 3 year old son after they noticed he was gradually becoming weaker than other boys his age. He had difficulty climbing stairs, moving from sitting to standing, and clumsy when walking. The child underwent several tests under the guidance of a pediatrician. Several weeks later their son, Charlie, was diagnosed with Duchene's muscular dystrophy. What is the leading cause of death in patients with DMD? A. Respiratory insufficiency B. Intrinsic lung disease C. Cardiac dystrophic process D. Sepsis

A Respiratory insufficiency is the major cause of death in DMD with 90% of patient death related to chronic respiratory failure and its complications. Respiratory function can be compromised by a number of factors. Progressive muscle weakness interacts with spinal/thoracic deformities which results in severe decline in pulmonary function -Intrinsic lung disease is NOT present in DMD -Cardiac dystrophic process NOT the leading cause -Sepsis can be a complication of infection, but not the leading cause.

You are a physiotherapist in an outpatient rehabilitation center. You mostly see patients with spinal cord injuries. You have been give a physiotherapy student to help you for the week. They are not allowed to do any hands on work, so you give them the task of creating a community education program for prevention of spinal cord injuries. Who should she target with this campaign? A. Adolescent and Young Men B. Adolescent and Young Women C. The Elderly D. Elementary School Children

A SCI are highest in young adult males. The average age is between 15-30 years of age. This population sees higher amounts of risk takers. Other risk factors you may see around this question are people who have drug or alcohol abuse issues, people who participate in contact sports, and occupations that expose them to risk of trauma or violence.

Your 42 year old patient has recently been in a motor vehicle accident. They are experiencing pain in their left shoulder, radiating into their parascapular region. Range of motion testing reveals a decrease in motion in the frontal plane. Using a goniometer, you measure the patient's glenohumeral flexion. Which of the following correctly describes placement of the goniometer's axis? A. The axis is placed at the lateral aspect of the center of the humeral head, about 2.5 cm inferior to the lateral aspect of the acromion process. B. The axis is placed at the medial aspect of the center of the humeral head, about 2.5cm inferior to the lateral aspect of the acromion process. C. The axis is placed 2.5cm lateral to the coracoid process D. The axis is placed at the midline of the trunk

A The goniometers stationary arm is placed parallel to the lateral midline of the trunk. The moveable arm is parallel to the longitudinal axis of the humerus

You are a physiotherapist in an outpatient rehabilitation center. You mostly see patients with spinal cord injuries. Which of the following muscles would still be intact after a C2 spinal cord injury? A. Trapezius B. Latissimus Dorsi C. Levator Scapulae D. Serratus Anterior

A The trapezius muscle is innervated by the accessory nerve, which is a cranial nerve. A SCI at C2 would not affect the trapezius

A 74-year old woman is three days post-operative left total hip arthroscopy using a postero-lateral approach. The client complains of left calf pain What should be the physiotherapists next course of action? a) Tell the client to discontinue her bed exercises and inform the nursing staff and surgeon b) Tell the client to continue her bed exercises and inform the nursing staff and surgeon c) Tell the client that pain following surgery is normal and she should continue her bed exercises d) Order an x-ray to rule out any sinister pathology

A What could detect DVT? A doppler ultrasound. We want to discontinue any treatment that may be contraindicated. Continuing bed exercises increase risk of DVT dislodging and moving in circulation, this could result in a pulmonary embolism. Bed exercises are contraindicated for someone who has DVT if we do not know if it's stable. Although pain following surgery is normal, this is not the best answer - excessive pain is not normal. We need to pay close attention to and take calf pain seriously.

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. The patient is unaware of his deficits and often overestimates his abilities. He refuses to go for treatment, because he doesn't believe there is anything wrong that he would need treatment for. You realize he lacks insight, and that he is unable to perceive his illness. This is best described as: a) Anosognosia b) Somatoagnosia c) Ideomotor apraxia d) Ideational apraxia

A Keep in mind since he has left hemiparesis - this means he had a right CVA. Anosognosia: also known as lack of insight (common in patients with schizophenia or bipolar disease) This is a common symptoms of a R sided stroke. Patient may not think anything is wrong with them. -Somatagnosia: inability to recognize body parts/unaware of body parts of themself or others. Can't conceptualize how body parts interact with each other, lack awareness of certain body parts and body. Problem with spatial relationships. -Apraxia is motor disorder associated with planning and performing tasks with purposeful movement. More common in L hemisphere damage. -Ideomotor apraxia: Unable to perform purposeful movement on command, but can do it habitually or automatically -Ideational apraxia: can't do it on command AND can't do it habitually (think of person being asked to pick up phone vs. doing it automatically)

46. A 38-year-old woman is referred to physiotherapy following a fracture of the proximal shaft of the humerus with traumatic paralysis of the axillary nerve. During assessment, which of the following would the physiotherapist find? A. Paralysis of biceps, and anaesthesia in the territory of C6 nerve root. B. Paralysis of deltoid and teres minor, and anaesthesia at the tip of the shoulder. C. Paralysis of serratus anterior and pectoralis minor, and anaesthesia of the superior aspect of the scapula. D. Weakness of rotator cuff, and anaesthesia of the medial aspect of the arm.

49. A 56-year-old female has been admitted to the intensive care unit with multiple trauma following a motor vehicle accident. The physiotherapy referral requests incentive spirometry and deep breathing. On assessment, the physiotherapist observes that the client is dyspneic, has severe chest pain, and has decreased breath sounds on the right. The chest x-ray reveals failure of the vascular markings to extend to the right chest wall, and mediastinal shift to the left. The physiotherapist suspects that the client has a tension pneumothorax. What should the physiotherapist do? A. Provide treatment for the client as requested. B. Discuss clinical findings with the physician. C. Reposition the client in high Fowler's for comfort. D. Delay the treatment until the client's pain is better managed.

50. A volunteer in an acute care facility reports to the physiotherapist that a 73-year-old man who has rheumatoid arthritis and who is receiving physiotherapy has been crying, is not eating well, and is worried about his family. The volunteer asks if the client is seeing a psychologist for counselling. How should the physiotherapist respond? A. With a description of the psychological supportive care that the client is receiving. B. That it is not possible to discuss the client's treatment. C. By offering to discuss the matter after consulting the psychologist. D. That the volunteer should concentrate on her assigned responsibilities.

A 22-year-old woman presents to an out-patient physiotherapy clinic after developing anterior left knee pain. She states that the pain began gradually about one month ago while training to run a half-marathon. Training has included running, weight-lifting, and swimming. She has not been able to increase her training lately due to increased pain. The physiotherapist suspects patellofemoral pain syndrome. 38. When assessing the client, what should the physiotherapist expect to find? A. Pain reproduced with patellar compression and decreased lateral glide of the patella. B. Pain reproduced with patellar compression and decreased medial glide of the patella. C. Decreased quadriceps angle (Q angle) and decreased medial glide of the patella. D. Increased quadriceps angle (Q angle) and decreased lateral glide of the patella.

A 38-year-old man attends an out-patient physiotherapy clinic seeking treatment for insidious onset of right ankle and shin pain of two weeks' duration. The client states that the pain is now unrelenting, even at night, and has spread from the ankle into the shin. He is a regular jogger and has not changed his training regime. He thinks his pain is related to running. He has not seen his family physician about this problem because his physician is away for two weeks. He reports no past leg injuries and that he is in excellent health except for a recent tooth infection. The physiotherapist suspects the client may have osteomyelitis. 18. Which one of the following clinical findings from the history most supports the physiotherapist's diagnosis of osteomyelitis in this client? A. Pain at night. B. Recent history of infection. C. Lack of mechanism of injury. D. Pattern and location of painful area.

A 38-year-old man attends an out-patient physiotherapy clinic seeking treatment for insidious onset of right ankle and shin pain of two weeks' duration. The client states that the pain is now unrelenting, even at night, and has spread from the ankle into the shin. He is a regular jogger and has not changed his training regime. He thinks his pain is related to running. He has not seen his family physician about this problem because his physician is away for two weeks. He reports no past leg injuries and that he is in excellent health except for a recent tooth infection. The physiotherapist suspects the client may have osteomyelitis. 19. After completing an assessment of the client, what would be the most appropriate course of action for the physiotherapist? A. Commence treatment and closely monitor his symptoms. B. Recommend immediate review by a physician. C. Suggest that the client contact his physician in two weeks. D. Contact the client's physician in two weeks to review the client's condition.

A 40-year-old woman who has rheumatoid arthritis is referred to out-patient physiotherapy at a rehabilitation centre. She has a long-standing history of extensive joint involvement and has an acute exacerbation of her symptoms. 43. The physiotherapist decides to use ice on this client's inflamed joints. Which of the following assessments should the physiotherapist perform prior to application of ice? A. Proprioception and light touch. B. Temperature sensation and circulation. C. Pin prick sensation and light touch. D. Vibration and temperature sensation.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 30. When this client is ready to be taught how to cough, which of the following techniques should the physiotherapist teach the client? A. Inhale deeply, then relax the abdominal muscles. B. Inhale deeply, then contract the abdominal muscles. C. Inhale shallowly, then relax the abdominal muscles. D. Inhale shallowly, then contract the abdominal muscles.

A 54-year-old woman fell on an outstretched right hand while at work. She experienced immediate hand and wrist pain. A Colles' fracture was confirmed on x-ray. After six weeks in a cast, her x- rays showed poor callus formation and she was reporting right shoulder and elbow pain. She was recasted and referred to a private physiotherapy clinic. 13. Which of the following treatments should be included in the physiotherapist's initial treatment for the client's shoulder? A. A sling for the arm, joint traction, and glides (grade III). B. Active-assisted range of movement, joint traction, and glides (grade I). C. Passive range of movement, joint traction, and glides (grade III). D. Complete shoulder immobilization, with elbow and finger exercises.

A 54-year-old woman fell on an outstretched right hand while at work. She experienced immediate hand and wrist pain. A Colles' fracture was confirmed on x-ray. After six weeks in a cast, her x- rays showed poor callus formation and she was reporting right shoulder and elbow pain. She was recasted and referred to a private physiotherapy clinic. 12. The physiotherapy assessment of this client reveals pain and muscle guarding in the shoulder, pain from the shoulder to the elbow, and restricted elbow extension. The pain is disturbing the client's sleep. The physiotherapist is concerned that the client may be developing adhesive capsulitis of the shoulder. Limitation in which movements would indicate that the client has a capsular pattern of restriction? A) External rotation > adduction > internal rotation. B) External rotation > abduction > internal rotation. C) Flexion > abduction > external rotation. D) Flexion > abduction > internal rotation.

A 62-year-old man presents to the emergency room at an acute care facility with chest pain and shortness of breath. An electrocardiogram (ECG) reveals that he has sustained a myocardial infarction. Once the client has been medically stabilized and transferred to the cardiac care unit, the physiotherapist is asked to assess him and provide treatment. 35. The client is concerned about the effect of his myocardial infarction on his planned vacation in six months' time. Which of the following factors should the physiotherapist discuss that might affect the client's exercise tolerance on his vacation? A. Altitude and change in diet. B. Altitude and cold temperature. C. Change in diet and time change. D. Cold temperature and time change.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 27. When the physiotherapist is instructing the client in negotiating stairs using a cane, which statement is correct? A. The right leg will lead when descending. B. The left leg will lead when descending. C. The left leg will lead when ascending. D. The cane will lead when ascending and descending.

Six weeks ago, your patient injured their leg while performing straight leg dead lifts. Since then, they have walked with an antalgic gait. They have decreased hip extension and stand with their leg externally rotated. You re-assess gait and notice the patient has improved hip extension but has a positive Trendelenburg sign on the right. Which of the following is true? A. The patient has left sided hip weakness B. The patient leans to decrease the moment arm of gravitational forces pulling on the swing side, and decreasing the load on the weak abductor C. To compensate for hip weakness, the patient will lean contralaterally during stance. D. The patient will have right side flex during left stance phase

You are a physiotherapist in an outpatient rehabilitation center. You mostly see patients with spinal cord injuries. April is your first patient of the day. She states that she cannot extend her right shoulder. Upon testing you find extension, adduction and medially rotation of her right shoulder. Which muscle is most likely involved? A. Trapezius B. Latissimus Dorsi C. Levator Scapulae D. Serratus Anterior

You are a physiotherapist in an outpatient rehabilitation center. You mostly see patients with spinal cord injuries. Elizabeth comes to see you for active rehabilitation. You cannot find her chart. Which level of SCI would she be if she presented with the following: - Paralysis in hands, trunk and legs, typically - Should be able to bend wrists back - Can speak and use diaphragm, but breathing will be weakened - Can move in/out of wheelchair and bed with assistive equipment - May also be able to drive an adapted vehicle - Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment A. C5 B. C6 C. C7 D. C8

B A slow heart rate is NOT indicative of a pneumothorax. A pneumothorax is characterized by SOB, tachycardia, cough, and fatigue.

Your 65 year old patient suffered a stroke 9 months ago. He is actively participating in weekly outpatient rehabilitation. Despite his efforts, he still has vision issues. He has also recently been diagnosed with right sided heart failure. Which of the following signs and symptoms is not associated with both left and right sided heart failure? A. Kidney and brain issues due to decreased perfusion B. Pink, frothy sputum C. Shortness of breath D. Lethargy

B All are found in both except B. Pink frothy sputum is a hallmark sign of left heart failure only because it is due to pulmonary edema that occurs with left heart failure

You are a physiotherapist in the Intensive Care Unit at your local hospital. You work extensively with a Nurse named Jody. She has been a Nurse for over 20 years. An 89 year old patient is admitted to the unit with a diagnosis of bacterial pneumonia. Nurse Jody takes the initial assessment and learns that along with bacterial pneumonia, the patient also has osteoarthritis and follows a strict vegan diet. The nurse is concerned that this diet is not ideal for recovery at this stage of her illness. Nurse Jody pulls you aside and asks you to talk to the patient about re-considering this lifestyle choice. What would you do? A. Talk to the patient and educate them on how the vegan diet may not be giving her enough nutrients to aid in optimal healing B. Explain to the nurse that this is outside your scope of practice and you will refer the patient to a Nutritionist C. Encourage the patient to perform some light reading on the benefits of a more well-balanced eating plan. D. Leave a few brochures in the patients room regarding well-balanced diet, but do not talk to the patient directly about it

B As a PT we have a duty to act within our scope of practice. The vegan diet and its health risks and benefits lay outside our scope; therefore it is best to refer to a Nutritionist. Although the others are not wrong, not the best answer - keep in mind nutritional education falls outside our scope of practice.

A 46‐year‐old woman who has rheumatoid arthritis (RA) is referred to out‐patient physiotherapy at a rehabilitation centre by her rheumatologist. She is currently experiencing an acute exacerbation of her symptoms. Which of the following is not indicative of an active joint in the Standardized Assessment of Joint Inflammation? a) Effusion b) Crepitus c) Stress pain d) Joint line tenderness

B Crepitus does not always mean a damaged joint, but in RA may be indicative of a damaged joint. However, a damaged joint is NOT an active joint. Active joint count: STOP signs S (swelling), T (joint line tenderness, OP (overpressure- stress pain)

At which level of injury do the following muscles become key muscles? -Trapezius -Latissimus Dorsi -Levator Scapulae -Serratus Anterior A. C5 B. C6 C. C7 D. C8

B Latissimus Dorsi, innervated by the Thoracodorsal nerve (C6, C7, C8): C6 SCI injury the latissimus dorsi is a key muscle that helps to lift the pelvis towards shoulder when weight bearing on their arms.

19 year old soccer player Jack Doyle, reports pain in his groin after sliding into another player on a turf field. Three days post injury, he is having pain with walking, single leg stance and has pain in mid to outer range hip abduction. Which of the following correctly describes the innervation to the muscle group of the medial thigh? A. Lumbar plexus T10-L4 B. Lumbar plexus T12-L4 C. Sacral plexus L4-S4 D. Sacral plexus L5-S5

B Lumber and sacral plexus arise from ventral rami of spinal roots of T12-S4. Nerves arising from lumbar plexus (T12-L4) innervate anterior and medial thigh. Nerves from sacral plexus from from L4-S4 and innervate muscles of the posterior and lateral hip, posterior thigh, and entire lower leg.

19 year old soccer player Jack Doyle, reports pain in his groin after sliding into another player on a turf field. Three days post injury, he is having pain with walking, single leg stance and has pain in mid to outer range hip abduction. After you are finished assessing Jack you determine he has a grade 2 adductor longus strain. Before beginning therapy, you explain your proposed treatment. Physiotherapists are duty bound to disclose all of the following related to a proposed technique except: A. Nature and purpose of treatment B. Common misconceptions around proposed treatment C. Material risks D. Special risks

B Material risks are those known to be associated with procedure and commonly occur (pain, bruising, bleeding, drowsiness, post treatment pain) Special risks are highly unlikely but have severe consequence/special relevance to patient (ex pneumothorax)

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. During examination, you ask the patient to copy a drawing of a clock. You notice that the patient only copies the right side of the clock and the left side of his clock drawing is missing. You believe this patient has: a) Right unilateral neglect b) Left unilateral neglect c) Right homonymous hemianopia d) Left homonymous hemianopia

B Neglect: lack of awareness of a part of one's own body and external environment. -Homonymous hemianopia: same side loss of visual field of half of eye. This means the person is missing the same side of the visual field in each of their eyes. But if they were doing a task, they are aware of their deficit and can turn their head to be able to see the rest.

A 52‐year‐old female assembly worker is referred to a private physiotherapy clinic for assessment and treatment of right arm and neck pain. The patient reports a gradual onset of paresthesia in the right arm. The physiotherapists suspects thoracic outlet syndrome. One test the physiotherapist could use to evaluate for thoracic outlet syndrome is to passively elevate the patient's shoulder girdle up and forward (elevation) and hold the patient in this position for 30 seconds or more. Which of the following indicates a positive test? a) Report of dizziness b) Decrease in numbness, tingling, or pain in upper extremity c) Decrease in the radial pulse d) Increase cyanosis

B Shoulder girdle passive elevation task (similar to cyriax test). This causes relief of symptoms, so +ve test will relieve symptoms. If arteries being compressed in BP, this may cause arterial relief - but this will cause stronger pulse (not a weaker pulse) Venous relief in this maneuver may cause a decrease in cyanosis

Your 42 year old patient has recently been in a motor vehicle accident. They are experiencing pain in their left shoulder, radiating into their parascapular region. Range of motion testing reveals a decrease in motion in the frontal plane. Which movement in the shoulder would we expect to see decreased? A. Flexion B. Abduction C. Internal rotation D. Scaption

B The frontal (coronal) plane divides the body into anterior and posterior sections. Since the patient is experiencing a decrease in range of motion in the frontal plane, we would expect to see a decrease in shoulder abduction and adduction.

You are treating a 28 year old woman post FOOSH 2 weeks ago resulting in a broken wrist. She lacks the 30 degrees of supination in her distal radial ulnar joint. During one of your treatment sessions, Ariel confesses to you that the reason she has constant inflammation is because her husband often will twist and turn her wrist. She begs you not to tell anyone, because if her husband finds out, he will beat her even more. Your patient has just told you that she is getting abused; as a professional, it is your responsibility to do the following: A. Call the police and inform them and write it in the chart B. Do nothing. Write down the patient's comments in the chart. C. Stop treating this patient - as you do not want the husband entering the clinic. D. Increase the number of treatments per week, in order to create a better relationship with them in hopes they will take your advice to get help.

B This patient is a cognitively intact adult. It would be a breadth of confidentiality to disclose information that they gave you in confidence, even to the police. Your duty is to chart the nature of their injuries and the conversation in case your records are needed in court. The only exceptions are: -If the adult is not cognitively intact (developmental disorder, elderly person with dementia, etc.) -This life is in imminent danger - they tell you that they believe they are going to be killed, or you feel that way from an observed escalation in violence -They are a child

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. Prior to performing passive hamstring stretches on the patient's legs, you decide to place heat packs on the patient's hamstrings for 15 minutes. What should you test prior to applying this modality? a) Sharp/dull discrimination and proprioception awareness b) Temperature awareness and circulation c) All cortical sensations d) Light touch and deep sensations

B Temperature awareness is important so patient can tell if it is too hot and might burn them. Circulation should be tested because putting on a hot pack may cause vasodilation, cold pack may cause vasoconstriction. -Sharp/dull discrimination better before using an electrical modality (IFC/TENS) -Proprioception/awareness good to test if working on proprioception or balance -Cortical sensations (ex stereoognosis, barognosis) - you don't need these higher level sensations for a hot pack though. -Light touch and deep sensation tested if your procedure may cut them/is putting pressure on them.

A 22-year-old woman presents to an out-patient physiotherapy clinic after developing anterior left knee pain. She states that the pain began gradually about one month ago while training to run a half-marathon. Training has included running, weight-lifting, and swimming. She has not been able to increase her training lately due to increased pain. The physiotherapist suspects patellofemoral pain syndrome. 37. When taking the client's history, which of the following would the physiotherapist most likely expect the client to report? A. Increased knee pain with ascending stairs, significant knee swelling, and occasional "clicking" in the knee. B. Increased knee pain with ascending stairs, mild knee swelling, and locking of the knee. C. Increased knee pain with descending stairs, mild knee swelling, and occasional "clicking" in the knee. D. Increased knee pain with descending stairs, significant knee swelling, and locking of the knee.

A 29-year-old right hand dominant construction worker attends physiotherapy at a rehabilitation centre. He fell onto his right elbow four weeks ago. The client reports symptoms of pain and numbness in the ring finger and little finger of the right hand and difficulty using this hand. 10. The physiotherapist performs the test for a Tinel's sign on this client. Which of the following locations would be most likely to test positive? A) Carpal tunnel. B) Lateral epicondyle. C) Cubital tunnel. D) Cubital fossa.

A 40-year-old woman who has rheumatoid arthritis is referred to out-patient physiotherapy at a rehabilitation centre. She has a long-standing history of extensive joint involvement and has an acute exacerbation of her symptoms. 44. The client is having an exacerbation of inflammation in her knees and wrists. Which of the following walking aids should the physiotherapist recommend? A. Axillary crutches. B. A four-wheeled walker. C. A forearm-support wheeled walker. D. Two standard canes.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 29. The client has difficulty coughing. Which of the following explanations should the physiotherapist provide to the client's family as the most likely cause? A. Pain. B. Thick secretions. C. Muscle weakness. D. A depressed respiratory centre.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 33. Yesterday the client was able to tolerate the head of the bed being raised to 45°. Today the physiotherapist notes a pressure sore on the client's sacrum, despite regular position changes. What is the most probable cause? A. Stress loading. B. Poor nutrition. C. Shearing forces. D. Exposure to moisture.

A 49-year-old female truck driver is referred to a private physiotherapy clinic for assessment and treatment of left arm and neck pain. The client reports a gradual onset of paraesthesia in the left upper extremity. The physiotherapist suspects thoracic outlet syndrome. 39. One test the physiotherapist could use to evaluate for thoracic outlet syndrome is to rotate the client's head towards the left shoulder. The client then extends the head and neck while the physiotherapist passively laterally rotates and extends the left shoulder. The client is then instructed to take a deep breath and hold it. What is the most likely positive finding for thoracic outlet syndrome using this test? A. Report of dizziness. B. Presence of strabismus. C. Decrease in the radial pulse. D. Deep ache in the cubital fossa.

A 50-year-old man comes to a private physiotherapy clinic for an aerobic exercise program. He has a 10-year history of insulin-dependent diabetes. 15. Which signs and symptoms of hypoglycemia should the physiotherapist be aware of that the client may demonstrate while participating in an aerobic exercise program? A. Manic mood, increased energy level. B. Increased temperature, flushed face. C. Weakness, excessive sweating. D. Nystagmus, ringing in the ears.

A 51-year-old man has a history of ALS (amyotrophic lateral sclerosis) and frequent falls. He is in an acute care hospital with aspiration pneumonia. 42. Which of the following should the physiotherapist recognize as the most likely cause of this client's aspiration pneumonia? A. Impaired cough. B. Impaired inspiratory effort. C. Dysphagia. D. Dysphasia.

A 54-year-old woman fell on an outstretched right hand while at work. She experienced immediate hand and wrist pain. A Colles' fracture was confirmed on x-ray. After six weeks in a cast, her x- rays showed poor callus formation and she was reporting right shoulder and elbow pain. She was recasted and referred to a private physiotherapy clinic. 14. Six weeks later, the client has had her cast removed. She has had a bone density study and has been diagnosed with osteoporosis. Which one of the following intervention should the physiotherapist use with caution in the treatment of this client's wrist and hand? A. LASER. B. Interferential current. C. Joint mobilization. D. Soft tissue manipulation.

A 60-year-old man with post-polio syndrome is experiencing deterioration of his physical status. He is attending a rehabilitation centre as an out-patient for physiotherapy treatment. 6. During assessment, the physiotherapist notes weakness of the erector spinae muscle group. Which of the following postures is the physiotherapist likely to observe? A) Decreased thoracic kyphosis. B) Increased lumbar lordosis. C) Decreased lumbar lordosis. D) Thoracic scoliosis.

A 62-year-old man presents to the emergency room at an acute care facility with chest pain and shortness of breath. An electrocardiogram (ECG) reveals that he has sustained a myocardial infarction. Once the client has been medically stabilized and transferred to the cardiac care unit, the physiotherapist is asked to assess him and provide treatment. 34. As a part of the treatment process the physiotherapist discusses risk factor reduction with the client. The client explains that he is unwilling to consider quitting smoking or changing his diet. How should the physiotherapist respond? A. Discuss the need for change with the client's family. B. Discuss the client's reluctance to change with the physician. C. Explain the risks of these behaviours, but respect the client's decision. D. Explain to the client that change is essential, or his health will deteriorate.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 22. In the immediate post-operative period, which movement of his left hip should the physiotherapist instruct the client to avoid? A. Flexion to 60 degrees. B. Medial rotation to neutral. C. Adduction across midline. D. Extension beyond neutral.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 23. Post-operative day one, the physiotherapist visits the client to assess his respiratory status. The client is confused and pulls up his hospital gown several times. What should the physiotherapist do? A. Report the client's behaviour to the health team. B. Defer the assessment until the client's confusion clears. C. Drape the client appropriately and continue with the assessment. D. Inform the client that he will not receive treatment if the behaviour does not stop.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 26. When the physiotherapist measures a cane for the client, which of the following markers should be used to determine the height of the cane? A. Result in full elbow extension. B. Result in 50° of elbow flexion. C. Be at the level of the greater trochanter. D. Be at the level of the anterior superior iliac spine (ASIS) of the pelvis.

Monica is a 65 year old patient with COPD. She has a 40 year history of smoking. She lives alone and does not exercise. Her house is a 2-story home located in a rural community. Given her history, which of the following risk factors likely lead her to develop COPD? A. 65 years old B. Female C. 40 year smoking history D. No exercises

A 52‐year‐old female assembly worker is referred to a private physiotherapy clinic for assessment and treatment of right arm and neck pain. The patient reports a gradual onset of paresthesia in the right arm. The physiotherapists suspects thoracic outlet syndrome. Which of the following is not a common cause of thoracic outlet syndrome? a) Poor posture b) Excessive overhead activities c) Muscle atrophy of scalene muscles, subclavius, or pectoralis minor d) Cervical rib

C Atrophy aka muscles getting smaller will not compress nerve more - hypertrophy would cause compression. -Poor posture may cause adaptive shortening of scalene muscles or pec minor, causing them to become tight and put pressure on brachial plexus -Excessive overhead activity is common in hyperabduction syndrome -Cervical rib is the only true TOS

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. What outcome measure would you use to assess this patient's gait? a) 6 minute walk test (6MWT) b) Timed up and Go test (TUG) c) Dynamic Gait Index (DGI) d) Functional Independence Measure (FIM)

C Dynamic gait index assesses gait, balance, falls risk. -6MWT used to assess aerobic capacity and endurance - but this is not assessing gait (good to assess patient who fatigues easily or has cardiorespiratory compromise) -TUG helps determine fall risk, not necessarily observing gait. -FIM assesses the patient's level of disability - does not really assess gait (looks at change in patient status in response to rehab and other medical intervention) and looks at their independence.

C Epley's maneuver is used to treat BPPV (specific type of vertigo) -Halstead's, Adson's, Allen's all are tests for thoracic outlet syndrome

A 52‐year‐old female assembly worker is referred to a private physiotherapy clinic for assessment and treatment of right arm and neck pain. The patient reports a gradual onset of paresthesia in the right arm. The physiotherapists suspects thoracic outlet syndrome. Which of the following classifications of thoracic outlet syndrome is related to a tight pectoralis minor? a) Scalenus Anterior Syndrome b) Costoclavicular Syndrome c) Hyperabduction Syndrome d) Coracoid Syndrome

C Hyperabduction syndrome is behind the coracoid process and under the pec minor -Scalenus anterior: brachial plexus compressed between anterior and middle scalenes -Costoclavicular syndrome: space between clavicle and 1st rib (subclavicular)

Six weeks ago, your patient injured their leg while performing straight leg dead lifts. Since then, they have walked with an antalgic gait. They have decreased hip extension and stand with their leg externally rotated. On resisted testing he has weak and pain free hip extension. Which of the following is a false statement regarding innervation to the posterior compartment of the thigh? A. Both the lumbar and sacral plexus supply innervation to the lower extremity B. The sciatic nerve innervates the semimembranosus, semitendinosus and the adductor magnus C. The posterior femoral cutaneous nerve supplies sensation to the skin of the perineum and posterior surface of the thigh and lower leg D. All of the hamstring muscles except the short head of the biceps femoris are innervated by the tibial nerve (L5-S2)

C It innervates the skin of the posterior region of the thigh until the popliteal fossa.

C Others are less common.

A 46‐year‐old woman who has rheumatoid arthritis (RA) is referred to out‐patient physiotherapy at a rehabilitation centre by her rheumatologist. She is currently experiencing an acute exacerbation of her symptoms. Which of the following is false in regards to RA? a) Morning stiffness lasts at least 1 hour b) RA presents with symmetrical arthritis c) RA typically affects the distal interphalangeal joints of the hand d) RA patients have an increased risk of morbidity and mortality

C RA does not typically affect the DIPs. Others are true.

C The muscle length assessment technique for pectoralis minor is contraindicated is the patient has a history of posterior dislocation of the glenohumeral joint. The starting position for this test has the patient supine with the scapula over the side of the plinth, with the shoulder in external rotation and 80 degrees of flexion. The elbow is also flexed. This is the position of apprehension for a posterior shoulder dislocation.

Six weeks ago, your patient injured their leg while performing straight leg dead lifts. Since then, they have walked with an antalgic gait. They have decreased hip extension and stand with their leg externally rotated. The physiotherapist would like to perform a joint glide to assist in increasing their hip range of motion. What position should the physiotherapist position their hip? A. 30 degrees of abduction, 55 degrees of flexion and slight internal rotation B. 20 degrees of abduction, 70 degrees of flexion C. 30 degrees of flexion, 30 degrees of abduction and slight external rotation D. 30 degrees of abduction, slight flexion

C This is the resting position/open pack position of the hip. This position is used for joint glides because: -It is the position with the least amount of joint surface congruency -Capsule and support ligaments are lax -Accessory motion/joint play is maximized

When creating an inclusive clinic environment, which of the following would you not do? A. Use of non-binary options on intake forms B. Ask for preferred pronouns on intake forms C. Provide separate forms for men and for women D. Provide a gender neutral washroom

C This would not serve to create an inclusive environment - others allow us to ask them what they prefer, rather than assuming a pronoun

47. An 8-month-old baby girl is referred to a physiotherapy out-patient clinic for treatment of her poor head control. Physiotherapy evaluation demonstrates abnormal muscle tone and strong primitive reflexes. When asked by the parents about her diagnosis, what should the physiotherapist reply? A. The child has symptoms of cerebral palsy. B. The child has symptoms of Werdnig-Hoffmann disease. C. It is too early to discuss a diagnosis for this child. D. They should seek this information from the treating doctor.

48. A physiotherapist is assessing a 46-year-old woman with systemic lupus erythematosus. On examination of the client, what should the physiotherapist expect to find? A. Skin thickening. B. Symmetrical joint inflammation. C. Discolouration and pitting of nails. D. Butterfly rash on face.

A 3-month-old baby boy with a diagnosis of congenital muscular torticollis requires physiotherapy in an out-patient department. 1. On palpation, the physiotherapist finds tightness of the left sternocleidomastoid muscle. Which of the following positions would the baby most probably maintain his head in? a) Right lateral flexion and rotation to the right. b) Right lateral flexion and rotation to the left. c) Left lateral flexion and rotation to the left. d) Left lateral flexion and rotation to the right.``

A 38-year-old man attends an out-patient physiotherapy clinic seeking treatment for insidious onset of right ankle and shin pain of two weeks' duration. The client states that the pain is now unrelenting, even at night, and has spread from the ankle into the shin. He is a regular jogger and has not changed his training regime. He thinks his pain is related to running. He has not seen his family physician about this problem because his physician is away for two weeks. He reports no past leg injuries and that he is in excellent health except for a recent tooth infection. The physiotherapist suspects the client may have osteomyelitis. 21. In addition to the findings noted above, the physiotherapist finds that the client is lacking active and passive dorsiflexion range of motion in his right ankle. Which of the following manual therapy treatments would be most appropriate for this client? A. Posterior manipulation of talus on tibia. B. Grade 4 anterior glide mobilizations of talus on tibia. C. Grade 4 posterior glide mobilizations of talus on tibia. D. Mobilizations would be contraindicated with this patient.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 28. When assessing this client, which of the following should the physiotherapist expect to observe? A. A decreased respiratory rate due to muscle weakness. B. A decreased respiratory rate due to respiratory acidosis. C. An increased respiratory rate due to respiratory alkalosis. D. An increased respiratory rate due to a decreased tidal volume.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 32. When suctioning the client, the physiotherapist notices blood-tinged secretions. Which of the following is the most likely cause? A. Epistaxis. B. Haemothorax. C. Lung contusion. D. Tracheal trauma.

A 48-year-old woman with Guillain-Barré syndrome had a tracheostomy two weeks ago and is no longer ventilated. The client is unable to clear thick secretions independently and requires suctioning. Her arterial blood gases on room air are: PaO2 90, PaCO2 35, pH 7.4, HCO-3 22.6, SaO2 95%. 31. When should the physiotherapist suction this client? A. Routinely, every 2 hours. B. Following administration of bronchodilators. C. When respiratory rate is noticeably decreased. D. When coarse upper airway sounds are present.

A 50-year-old man comes to a private physiotherapy clinic for an aerobic exercise program. He has a 10-year history of insulin-dependent diabetes. 17. What part of this client's intervention could the physiotherapist assign to the physiotherapist assistant? A. Progression of the exercise program. B. Examination of the feet. C. Assessment of the fitness level. D. Monitoring of the exercise program.

A 50-year-old man received full thickness burns to his face, upper body, and arms at work. He is admitted to an acute care facility. He has also been diagnosed with a restrictive pulmonary complication secondary to the burn. 5. The physiotherapist's caseload has doubled today because of the illness of a colleague. What should the physiotherapist do? A. Complete full treatment for all clients before leaving work. B. Shorten all treatments in order to see all clients within work hours. C. See only the clients who were not seen yesterday. D. Prioritize the clients who would deteriorate without treatment.

A 51-year-old man has a history of ALS (amyotrophic lateral sclerosis) and frequent falls. He is in an acute care hospital with aspiration pneumonia. 41. The physiotherapist recognizes that ALS primarily affects which of the following components of the nervous system? A. Upper motor neurons and peripheral nerves. B. Lower motor neurons and peripheral nerves. C. Peripheral nerves and cranial nerve nuclei. D. Both upper and lower motor neurons.

A 60-year-old man with post-polio syndrome is experiencing deterioration of his physical status. He is attending a rehabilitation centre as an out-patient for physiotherapy treatment. 7. The client has greater paralysis of his left lower extremity. This may be contributing to right knee and ankle pain secondary to overuse. Which one of the following devices should the physiotherapist recommend for the left lower extremity? A) Neoprene knee sleeve. B) Ankle splint (air-cast splint). C) Hinged knee brace. D) Knee-ankle-foot orthosis.

A 62-year-old man presents to the emergency room at an acute care facility with chest pain and shortness of breath. An electrocardiogram (ECG) reveals that he has sustained a myocardial infarction. Once the client has been medically stabilized and transferred to the cardiac care unit, the physiotherapist is asked to assess him and provide treatment. 36. After five days of successful treatment in the acute care facility, the client is ready to be discharged home. Prior to the discharge, which of the following should the physiotherapist complete? A. Graded exercise testing and complete VO2 Max test. B. Review home exercise program and complete VO2 Max test. C. Graded exercise testing and complete a referral to occupational therapy. D. Review home exercise program and encourage participation in an out-patient rehabilitation program.

A 76-year-old man fell and sustained a sub-capital fracture of his left hip. He was admitted to an acute care facility for a total hip replacement using a posterolateral surgical approach. 24. On post-operative day two, the physiotherapist visits the client in his room to continue mobilization. The client seems fearful, reports tiredness, and refuses to get up. Which of the following is the most appropriate course of action for the physiotherapist to take? A. Discuss with nursing staff the need for anti-depressants. B. Acknowledge the client's complaints and initiate treatment. C. Refer him to a geriatrician for psychological evaluation. D. Acknowledge the client's wishes and agree to come back later.

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. The patient's two sons explain to you that their uncle, the patient's brother, had a CVA 5 years ago. The patient's sons ask you what they should do in order to reduce their risk of having a CVA. Which of the following are risk factors for CVA? a) Diabetes, Obesity, Low socio-economic status b) Hypertension, Obesity, high risk behavior c) Diabetes, Excessive alcohol consumption, Low socio-economic status d) Diabetes, Hypertension, heart disease

D -Low SES is more correlated with infectious diseases (HIV/AIDS) -High risk behaviour is more of a risk factor for SCI

You are treating a 28 year old woman post FOOSH 2 weeks ago resulting in a broken wrist. She lacks the 30 degrees of supination in her distal radial ulnar joint. Inflammation is still a factor with Ariel, as she seems to constantly be re-injuring her wrist. Which of the following is not a component of inflammation? A. Swelling B. Redness C. Loss of function D. Edema E. Pain

D 5 pillars of inflammation are pain, redness, heat, swelling, and loss of function. Inflammation is an acute response. Edema is not a part of inflammation - it simply means an accumulation of fluid which could be from an acute trauma, but also from other issues such as cardiac, leakage of capillaries/lymph ducts etc. It can be pitting or non pitting.

Mr. and Mrs. Bower became worried about their 3 year old son after they noticed he was gradually becoming weaker than other boys his age. He had difficulty climbing stairs, moving from sitting to standing, and clumsy when walking. The child underwent several tests under the guidance of a pediatrician. Several weeks later their son, Charlie, was diagnosed with Duchene's muscular dystrophy. Which of the following is not a common change seen in non ambulatory patients with DMD? A. Knee flexion contractures B. Posterior pelvic tilt C. Ankle plantar flexion contracture D. Adductor contracture

D Adductor contracture not often seen, as you typically see DMD patients in a position of hip abduction and external rotation -Knee flexion contracture: commonly seen as less antigravity knee extension strength places an individual at risk for knee flexion contractures, particularly if they spend the majority of their time seated with the knee joint flexed. -PPT: commonly seen, caused by an asymmetrical loss of spinal hyperextension by asymmetrical tightness in hamstrings -Ankle PF contractures: commonly seen as lack of weight bearing causes tight plantar flexors

You are a new therapist at the community bone health clinic. You have been assigned to work with Terry, a patient who has had two fragility fractures in the past year. She is currently complaining of pain in her right sacroiliac joint, thoracic spine, and right hip. She is 80 years old, has a 20 year smoking history and has 3 daughters. You create an exercise program to help increase bone lay down for Mrs. Elderly. All of the following are components you would want to include in Terry's program. Which would be the least likely to include in your exercise program? A. Regular weight bearing activities B. Strength training C. Novel patterns of loading D. Cardio exercises

D Cardio exercise is least likely to aid in bone lay down. While cardiovascular endurance is an important part of overall health it is the least appropriate to aid in bone lay down. Cardio could even be done in a pool which will not load bones. Weight bearing, strength training (muscles pull on bone causing focal loading) and novel patterns of loading have all been shown to increase bone mineral density.

A 74-year old woman is three days post-operative left total hip arthroscopy using a postero-lateral approach. The client complains of left calf pain Which of the following is the most likely cause of pain? a) Femoroacetabular referral pain b) Vascular claudication c) Neurogenic claudication d) Deep vein thrombosis

D Increased risk of DVT post hip surgery and when patient is in bed for long periods. -Referral pattern for femoroacetabular joint would cause pain in GROIN, or around hip and around glutes and in low back. Pain from this joint does not refer down past the knee. This already is out since they don't have a true femoroacetabular joint -Claudication=leg pain, often in calf. Vascular claudication is a result of poor blood flow towards tissues/muscles in that area, becoming ischemic, releasing lactic acid to meet these demands. This causes pain when muscle is active (ex: walking around) -Neurogenic claudication is leg pain from a nerve source. Often spinal stenosis may cause this, especially if the patient is in a more extended position (largely based on posture)

You are a physiotherapist in the Intensive Care Unit at your local hospital. You work extensively with a Nurse named Jody. She has been a Nurse for over 20 years. After a few days in the ICU, your 89 year old patient becomes cyanotic. This is a common occurrence in bacterial pneumonia. What is the most likely cause of cyanosis in this patient? A. Decreased cardiac output B. Pleural effusion C. Inadequate peripheral circulation D. Decreased oxygenation of the blood

D Patients with pneumonia have less surface area available for the diffusion of gases since the inflammatory pulmonary response creates exudates, which results in decreased oxygenation of blood. The patient would become cyanotic because the blood is not properly oxygenated in the lungs before it enters peripheral circulation. Although decreased cardiac output is a co-morbidity in some patients with pneumonia, it is not the best answer as it is important to distinguish it from being the cause of cyanosis.

A 71 year old man has suffered a cerebral vascular accident (CVA) resulting in left hemiparesis 2 weeks ago. The patient lives with his wife who is 5 years younger than him. The patient is now able to weight shift onto both sides and is ready for ambulation. He enjoys walking on the grass in the park. Which gait aid prescription is most appropriate? a) Standard walker b) Two wheel walker c) Rollator d) Walking cane on right side

D Right side would be appropriate for cane (opposite the weak side). Walking cane would be most appropriate to walk on uneven surface (grass). Perceptual deficits most common in MCA syndrome where they have more U/E weakness than L/E (think of homunculus), so they may not need as much stability to walk as a two wheeled walker. -Standard walkers are very stable but not very mobile. May have weakness in hand especially when lifting up walker to advance it. -Two wheeled walkers are typically prescribed for stroke - good balance of mobility and stability, they don't need much upper extremity strength to lift it -Rollators are indicated if someone fatigues easily - not as good for stability (they have seats for break)

You are a new therapist at the community bone health clinic. You have been assigned to work with Terry, a patient who has had two fragility fractures in the past year. She is currently complaining of pain in her right sacroiliac joint, thoracic spine, and right hip. She is 80 years old, has a 20 year smoking history and has 3 daughters. During your first treatment session, you explain to Terry the differences between the stages of osteoporosis. According to her chart, her bone mineral density is -2.6 standard deviations from the norm. What type of osteoporosis is she classified as? A. Normal bone density B. Low bone mass - osteopenia C. Osteoporosis D. Severe osteoporosis

D She has had fragility fractures in the past. Scale: 0 to -1 is the normal age related bone density loss -1 to -2.5 is osteopenia below -2.5 is osteoporosis below -2.5 with fragility fractures is severe osteoporosis

Your 65 year old patient suffered a stroke 9 months ago. He is actively participating in weekly outpatient rehabilitation. Despite his efforts, he still has vision issues. He has also recently been diagnosed with right sided heart failure. Given that the patient suffered an injury to the optic chiasm due to a stroke, which of the following structures was most likely also injured due to its close proximity to the optic chiasm? A. Frontal lobe B. Brainstem C. Occipital lobe D. Hypothalamus

D The optic chiasm is located at the bottom of the brain immediately inferior to the hypothalamus. Brainstem does not lie in as close proximity as the hypothalamus. -Hypothalamus: keeps body in homeostasis through regulation of hormones -Frontal lobe: speech, cognition, movement -Brainstem: flow of messages between rest of body, basic body functions (breathing, swallowing, heart rate, blood pressure, consciousness, alertness) -Occipital lobe: responsible for vision

One of your colleagues specializes in pelvic health care. When working with the Aboriginal population in Pelvic Health care it is important to know about historical trauma because: A. It informs you as a practitioner in knowing the likelihood or possibility that your patient may present with symptoms of PTSD B. You can understand the inter-generational impacts of sexual trauma and help you place resistance from patients along the trauma spectrum of understanding. C. It is not appropriate to ask about historical trauma D. A and B

D When working with this population it is important to be professional while ensuring you understand their history, this will allow you to appropriately treat this population. Pelvic health care is a sensitive area of practice that is only successful when you understand their full health history

E 2 joint muscles become shortened first. As the soleus is a single joint muscle, you would not likely see it shorten before the gastrocnemius and iliopsoas. Therefore, both Gastrocnemius and Iliopsoas are correct.

A 24 year old female athlete fell while training for the world cup ski cross and was taken to the hospital for investigation of chest and left knee pain. Diagnostic testing revealed several fractured ribs and a left ACL partial tear. Six weeks later she has been medically cleared to start outpatient therapy. The physical therapist reviews the chart and notices that the client lives in close proximity to the physical therapist. This athlete has been in the media for her recent successes in ski cross. The physical therapist and client 'hit it off' at the first encounter. The physical therapist subsequently sees in the clinical record that the client's marital status is 'single'. They share personal information and the physical therapist states he lives close to the client. Which of the following regarding professional boundaries in a therapeutic relationship are true? (CHOOSE ALL THAT APPLY) i. Providing the client with a home address in the context of establishing a personal relationship is a warning sign for boundary crossings. ii. Romantic encounters that occur during a therapeutic relationship are sometimes appropriate depending on the situation. iii. It its the physical therapist duty to establish boundaries and take action if a boundary has been crossed. iv. A boundary is a static line, which if crossed, will constitute professional behaviours and appropriate use of power.

i and iii It is not appropriate to supply the client with the therapist's home address. It is never appropriate to have a personal relationship with a client during the therapeutic relationship. It is always the therapist's duty to establish and maintain the boundaries. If boundaries are crossed, it constituted unprofessional behaviour and inappropriate use of power.

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