Adult and Older Adult Musculoskeletal Answers to Sample Cases

Case A

 

 

Question 1. CORRECT: 2, 4

2+4 – Correct because they explain to the patient the need to observe and assess the knee joint directly and offer her the option of appropriate draping in the form of a gown.
1 – Incorrect because it isn’t as good an answer as #2 or #4. It could be an option if the patient prefers.
3 – Incorrect because it is clear from the question that the knee can’t be observed and it is possible that the tightness of the jeans will limit the PT’s ability to assess movement and joint stability.
5 – Incorrect because Minimal Treatment Standards require that both a subjective and objective assessment be completed prior to providing intervention.
6 – Incorrect because the patient isn’t given the opportunity to consent to the arrangement, which is required by both Practice Standard #4 and Practice Standard #11.

Question 2. CORRECT: 2, 4, 5

2, 4, 5 – Are correct as they can all be used to assess the anterior cruciate ligament. It must be acknowledged that of the 3, the Lachman’s is more widely supported in the literature and the pivot shift can be difficult to use in more acute situations.
1+3 – These are incorrect because, while possibly valid components of the assessment, do not answer the question which is whether the patient has an ACL tear.
6 – Is incorrect because Phalen’s test is a test for neurological dysfunction at the wrist.

Question 3. CORRECT: 1, 3

1+3 – Are correct because they are generally accepted interventions in the acute phase. Research on the use of ice and other modalities that limit the inflammatory response may change this in future.
2 – Is incorrect because the ACL cannot be accessed by transverse frictions.
4 – Is incorrect because while early mobility is appropriate, ‘practice’ suggests that this would be a repetitive activity, as opposed to ‘gait education’, that would not be indicated at this stage.
5 –  Is incorrect because it is a strengthening exercise that is not indicated at this stage of rehabilitation.

Question 4. CORRECT: 3

3 – Correct because a date, i.e. a romantic relationship, with a current patient would cross a professional boundary.
1+2 – These are incorrect because in both situations the professional boundary is crossed.
4 – Incorrect because although the patient will have been discharged by the time the date occurs, the Bylaws require a ‘reasonable’ amount of time to elapse before pursuing a romantic relationship with a (former) patient.

Question 5. CORRECT: 1, 4

1+4  – Are correct because they involve procedures that are written into PIPA/FOIPPA and by which physical therapists must abide. Patients are allowed to have access to their clinical record and the PT may require that the request be in writing and must provide access within 30 days.
2 – Incorrect because the patient is allowed access to her clinical record.
3 – Incorrect because the original clinical record should not leave the clinic.
5+6 – Are incorrect because the times mentioned are not consistent with the privacy laws.

 

 

Case B

 

 

Question 1. CORRECT: 3

3 – Correct because regardless of the method of payment, the PT must abide by the College Bylaws and practice standards in their interventions with the patient.

Question 2. CORRECT: 2

2 – Correct because back extensions as prescribed should maintain/ increase the centralization of the pain that the PT has observed during assessment.
1 – Is incorrect because bridging does not promote specific back extension.
3+4 – Are incorrect because stretching, while possibly indicated by other assessment findings, is not indicated by the assessment findings presented in this question, and is therefore not the best answer.

Question 3. CORRECT: 1, 5

1+5 – Are correct because they address the patient’s need for hamstring stretches in positions that will not aggravate the patient’s symptoms.
2, 4, 6 – Are incorrect because they do not get the patient out of long sitting, which encourages lumbar flexion and aggravates her pain.
3 – Is incorrect because touching her toes in standing will put her lumbar spine into significant flexion.

Question 4. CORRECT: 4, 6

4+6 – Are correct because the physical therapist recognizes that incontinence in this situation is a possible sign of cauda equine compression, which necessitates a full reassessment and the family doctor must be informed, with the patient’s consent. While patient consent is not mentioned in answer option 6, answer options 1, 2, 3, and 5 do not provide better alternatives. 1, 3, and 5 do not recognize the severity of the symptom and 2 is incorrect because testing for a urinary tract infection is outside the PT’s scope of practice.

 

 

Case C

 

 

Question 1. CORRECT: 3

3 – Correct – knee extension board will promote knee extension thereby helping to reduce the knee flexion contracture.
4 – Incorrect – side lying with hip extension does not reduce knee flexion contracture; the patient’s knee can remain flexed in side lying.
2 – Incorrect – supine with pillow between knees may address hip adduction/abduction but doesn’t affect knee flexion/extension.
1 – Incorrect – placing only the stump on pillows is not a good position because it leaves the knee joint itself unsupported and propping the stump – including the knee joint – on a pillow will increase knee flexion.

Question 2. CORRECT: 3, 4

4 – Is correct since on the first trial of a prosthesis it’s important to check for correct fit; reddened areas on the skin would indicate greater pressure in some areas, which is not a good fit.
3 – Correct – standing is the initial goal for the first time with a prosthesis.
6 – Incorrect – patients are not generally ready to walk on the first trial of a prosthesis.
1, 2, 5 – Incorrect – scar mobilization, stump bandaging and bed exercises would not be relevant during a session when the focus is a trial of the new prosthesis.

Question 3. CORRECT: 1, 5

1+5 – Are correct since this will increase frequency of walking during the day, and increase the patient’s walking endurance and confidence.
6 – Incorrect – the patient requires stand-by assist with a walker so walking alone without a gait aid is unsafe.
4 – Incorrect – the physician is usually not involved in gait competency assessment; the physical therapist has already determined the assistive device and supervision required.
2 – It is the physical therapist’s responsibility to assess the patient with different assistive devices; this is a task that cannot be transferred to a PTSW (See Practice Standard #3).
3 – Incorrect – an occupational therapy kitchen assessment will not help in achieving the patient’s goal of walking without a gait aid.

Question 4. CORRECT: 1, 2

1+2 – Are correct since they both involve walking, in conditions that match and slightly challenge his current level of function; the obstacle course would simulate conditions on a trail, which is the patient’s goal.
3, 4, 5, 6 – Incorrect – These activities are not specific to the desired goal and are not at a level that will help the patient improve his walking/balance abilities.

Question 5. CORRECT: 3, 5

5 – Correct because redness and skin breakdown suggest that the prosthesis is not fitting well.
3 – Correct because the family practitioner should see the patient since pain and fever could indicate infection.
2 – further ambulation will cause additional skin breakdown and is contra-indicated if there is an infection in the stump.
1 – Incorrect because not appropriate with skin breakdown and fever.
4+6 – Incorrect because increasing the number of stump socks will not change the pressure being put on the area of skin breakdown, and while a review of stump bandaging might be important, it is not going to address the current problem of skin breakdown.

 

 

Case D

 

 

Question 1. CORRECT: 3

1 – Incorrect since full assessment is required prior to treatment and this would not be a full assessment.
2 – Incorrect since a physical therapist must not assign the task of assessment to a PTSW (See Practice Standard #3).
3 – Correct – as full assessment is required prior to commencing treatment.
4 – Incorrect see College Bylaws 56 (2) (c) state once treatment is initiated a complete reassessment of the client, including objective findings is required to re-evaluate the treatment regime.

Question 2. CORRECT: 2, 3

2+3 – Correct because both the TUG test  and ten-metre walking tests can be used to asses mobility for someone who uses a walking aid.
4 – Is incorrect because the Fullerton Advanced Balance Test is used in high functioning older adults.
6 – Is incorrect because the GMFM is a paediatric outcome measure.
5 – Is incorrect because the FIM evaluates ADL.
1 – Is incorrect because the Motor Assessment Scale is used with patients who have had strokes.

Question 3. CORRECT: 1, 3, 4

1, 3, 4 – Correct since a Physical Therapist Support Worker works under the direction and supervision of a physical therapist who will prescribe the exercises.
2 – Incorrect because discharge is a decision and task that the physical therapist cannot assign to the PTSW.
5, 6, 7 – Incorrect since physical therapists must not assign any physical therapy task which has an evaluation component that immediately influences the treatment program.

Question 4. CORRECT: 3

3 – Is correct because it acknowledges the potential risk a patient faces and seeks to inform the patient about mitigating it, so that she can make her own decisions.
1, 2, 4 – Incorrect because the patient must give consent for information to be shared with other parties i.e. daughter, family physician, social worker, etc.

Question 5. CORRECT: 1, 2, 3

1+2 – Are correct because balance training and and progressive strengthening programme will improve this patient’s balance reactions and minimize risk of falls.
3 – Correct because some medications increase the risk of falling. A medication review may result in adjustments that may be effective in reducing falls.
4+5 – Are incorrect because seated exercises are less effective for fall prevention as they do not address the muscle groups that are typically implicated in people who are at high risk of falling i.e. lower extremity.
6 – Is incorrect because hip protectors reduce risk of fractures but not of falls.
7 – Is incorrect because unless a physiatrist is already involved, this would be an unnecessary referral.
8 – Is incorrect because while personal alert systems are a good idea, they do not decrease risk of falling; they ensure help is summoned after a fall.