Adult and Older Adult Musculoskeletal Sample Cases

Click here for Adult and Older Adult Musculoskeletal Answers to Sample Cases.

Case A

A 25-year-old female competitive field hockey player injured her right knee during a playoff game two days ago. The team physician suspects the patient has torn her anterior cruciate ligament and has prescribed crutches. He has referred her to an orthopaedic surgeon and to physical therapy.

1.  The patient arrives for her initial assessment dressed in tight blue jeans that do not roll above the knee. She did not bring a pair of shorts with her. How should the physical therapist proceed with assessment? (Select 2)

1 – Reschedule her appointment.

2 – Ask if she would be comfortable wearing a gown, to allow her knee to be seen.

3 – Assess as best as possible with her jeans on.

4 – Explain that, to be assessed thoroughly, her knee must be exposed.

5 – Take her history and give her advice based on subjective findings.

6 – Advise her to move to a curtained cubicle and remove her jeans.

2.  What tests and procedures should the physical therapist use in the initial assessment to confirm if the patient has an anterior cruciate ligament tear? (Select 3)

1 – Straight leg raise test.

2 – Anterior drawer test.

3 – Proprioceptive sensation testing of the leg.

4 – Lachman’s test.

5 – Pivot Shift test.

6 – Phalen’s test

3.  What treatment interventions should the physical therapist provide the patient for her acute anterior cruciate ligament injury? (Select 2)

1 – Ice.

2 – Transverse frictions.

3 – Elevation.

4 – Gait practice.

5 – Wall squats.

4.  After her treatment session, the patient asks the physical therapist on a date with her after work. What should the physical therapist tell the patient? (Select 1)

1 – He will go on the date with her, but will not discuss her treatment outside the clinic.

2 – They can meet for a drink as long as others are present.

3 – He cannot accept her offer.

4 – He will date her after she is discharged.

5.  The patient feels she is not progressing well, and asks to see her chart to better understand her injury. How should the physical therapist respond? (Select 2)

1 – She should submit a written request.

2 – She is not allowed access to the chart.

3 – She can take chart home with her immediately.

4 – The clinic will ensure she has access to the chart within 30 days of her request.

5 – The clinic will ensure she has access to the chart within 90 days of her request.

6 – She can only access the chart after discharge.

Case B

A physical therapist has completed a free presentation on pelvis malalignment to a marathon clinic to promote her physical therapy practice. After the presentation, a 55-year-old woman asks if the physical therapist would accept her as a patient, because she has the back and leg symptoms mentioned in the presentation. She is on unemployment insurance and cannot afford to pay any amount of the fee; however, she is an artist and offers to paint a picture for the physical therapist as payment.

1.  The physical therapist decides to accept the patient for treatment in exchange for the art work. How should the physical therapist treat this patient and document the treatment? (Select 1)

1 – Treat the patient as if she was any other paying patient, but do not document since there is no official payment.

2 – Save valuable clinic and staff time by treating the patient after hours and document the treatment, but not the payment.

3 – Treat the patient as if she was any other paying patient and document the trade for payment.

4 – Provide an abbreviated treatment and document as usual.

2. On examination it is determined that the patient’s back and leg symptoms centralize with back extensions. What treatment recommendations should the physical therapist provide for the patient? (Select 1)

1 – Perform bridging exercises: 10 repetitions x 10 second hold, twice per day.

2 – Perform back extensions: 10 repetitions x 10 second hold, every waking hour.

3 – Stretch the hamstrings: 2 repetitions x 30 second hold, twice per day.

4 – Stretch the piriformis: 2 repetitions x 30 second hold, twice per day.

3.  The patient has noticed her hamstrings have become extremely tight. She has begun stretching her hamstrings in a long sit position reaching for her toes, but has noticed this is increasing her leg and back pain. What instructions should the physical therapist provide the patient about hamstring stretches? (Select 2)

1 – Avoid all flexed back positions at this point.

2 – Stretch for only 10 seconds so there is not enough time for the disc to bulge.

3 – Touch her toes in standing position to get a traction effect on the spine.

4 – Point her toes while in the long sit position to take the stretch off the sciatic nerve.

5 – Stretch her hamstrings in supine with neutral spine, with the hip at 90 degrees and the knee extended to a position where she doesn’t get back symptoms.

6 – Do back extensions after stretching her hamstrings in a long sit.

4.  The patient informs the physical therapist that she forgot to do her back extension exercises, and she went for a 1 hour, 50 minute run that resulted in 8/10 back pain. She has been noticing in the last week that she has been soiling her underwear with urine and faeces. How should the physical therapist proceed? (Select 2)

1 – Determine when symptoms appear in the mileage and recommend training within that limit.

2 – Ask the patient if she has a urine sample to check for bladder infection.

3 – Assess the strength of the patient’s pelvic floor contraction.

4 – Complete a full reassessment before resuming exercises.

5 – Determine whether incontinence is caused by use of the valsalva manoeuvre while running.

6 – Contact the patient’s physician to inform him/her of a possible cauda equina compression.

Case C

A 56-year-old man is transferred to an inpatient rehabilitation unit two weeks following a right below knee amputation. He has not yet been fitted with a prosthetic limb. His past medical history includes having peripheral vascular disease and diabetes.

1. On initial examination, the physical therapist notices the patient has developed a right knee flexion contracture. How should the physical therapist proceed to decrease the patient’s contracture? (Select 1)

1 – Ask the nurse to prop up the patient’s stump on pillows when he is in bed at night.

2 – Ask the physical therapy support worker (PTSW) to position the patient in supine with a pillow between the knees.

3 – Ask the occupational therapist to provide a knee extension board for the patient’s wheelchair.

4 – Ask the care aide to position the patient in side-lying, with the right hip extended.

2. The prosthetist has measured the patient for his prosthesis and is coming to the gym for the patient’s first prosthetic trial. What interventions should the physical therapist provide for the patient during this first session with the prosthetic limb? (Select 2)

1 – Bed exercises.

2 – Stump bandaging.

3 – Standing in parallel bars.

4 – Check stump for reddened areas.

5 – Scar mobilisation.

6 – Gait training.

3. Four weeks following the commencement of prosthetic training, the patient is now able to ambulate with stand-by assistance for 100 metres using a walker. The patient states his goal is to walk independently without a gait aid. During rounds, what team members and activities should the physical therapist suggest to assist the patient achieve his goal? (Select 2)

1 – The nurse to start ambulating the patient from his room to the dining room.

2 – The physical therapist support worker to trial the patient using a cane.

3 – The occupational therapist to do a kitchen assessment.

4 – The physician to do a competency assessment.

5 – The patient’s family to walk with the patient around the ward.

6 – The patient to practise ambulation in his room without a gait aid.

4. The patient has participated in prosthetic training for seven weeks and is able to ambulate independently for 200 metres. He is occasionally unsteady when turning. The patient states his long-term goal is to walk his dog on a one-kilometre trail. What activities should the physical therapist prescribe to assist this patient in achieving his goals? (Select 2)

1 – Walking on a treadmill.

2 – Walking through an obstacle course.

3 – Sitting on an exercise ball.

4 – Lower extremity stretching exercises.

5 – Reaching exercises in his wheelchair.

6 – Throwing/catching a ball in sitting position.

5. The patient has been discharged from the rehabilitation unit and is now going to the out-patient physical therapy department for treatment. The patient says he developed severe pain and fever over the weekend, after periods of prolonged ambulation. The physical therapist observes an area of redness and extensive skin breakdown. How should the physical therapist proceed? (Select 2)

1 – Limit ambulation to short distances.

2 – Continue ambulating with the prosthesis.

3 – Refer the patient to his family practitioner.

4 – Increase the number of stump socks.

5 – Reassess prosthetic fit with the prosthetist.

6 – Review stump bandaging.

Case D

An 85-year-old woman sustained a right hip fracture four weeks ago. She is referred to an outpatient clinic for physical therapy. The patient’s medical history includes osteoarthritis, hypertension, and type 2 diabetes. She reports a long standing history of pain in her right knee, shoulders, cervical, and lumbar regions. Prior to her injury, she ambulated with a single point cane, and now uses a two-wheeled walker. The patient has attended the group pool exercise class at this clinic recently for her right knee osteoarthritis and is keen to participate once again.

1. The patient arrives 30 minutes late for her initial assessment. She reports that it took her a long time to walk from the parking lot. The patient is eager to resume the pool program. How should the physical therapist proceed? (Select 1)

1 – Ask the patient if her health status has changed, assess her hip range of motion and strength, then send her for pool therapy.

2 – Assess what is possible in the time available, and ask the physical therapist support worker to finish the assessment.

3 – Complete parts of the assessment in the time available, and schedule another session before commencing pool therapy.

4 – Use the information from the patient’s previous referral to the clinic to complete the initial assessment before commencing pool therapy.

2. What outcome measures should the physical therapist use to evaluate the patient’s mobility? (Select 2)

1 – Motor Assessment Scale.

2 – Ten-metre Walk Test.

3 – Timed Up and Go (TUG).

4 – Fullerton Advanced Balance Test.

5 – Functional Independence Measure (FIM).

6 – Gross Motor Function Measure (GMFM).

3. The physical therapist referred the patient to the exercise class run by the physical therapist support worker (PTSW). What can the physical therapist direct the physical therapist support worker to do with the patient? (Select 3)

1 – Follow the exercise protocol for fractured hips.

2 – Discharge the patient when treatment goals are reached.

3 – Follow the prescribed exercise program.

4 – Record the patient’s attendance in the medical record.

5 – Decide when the client can progress from using the walker to using a cane.

6 – Reassess the patient and report the results back to the physical therapist.

7 – Increase difficulty level of exercises when the PTSW feels the patient is ready.

4. The physical therapist support worker reports she overheard the patient telling another class member that she fell last week. The patient said she was afraid to tell her daughter because her daughter has threatened to put her in a nursing home if she fell one more time. How should the physical therapist use this information? (Select 1)

1 – Inform the daughter her mother fell and may not be safe at home.

2 – Contact the patient’s family physician to provide information about the patient’s fall.

3 – Talk with the patient about home safety and discuss available treatment options.

4 – Ask the social worker to discuss nursing home options with the patient.

5. What should the physical therapist include in the patient’s comprehensive treatment plan to address the patient’s risk of falling and to maintain her functional independence at home? (Select 3)

          1 – Implement a progressive strengthening program.

          2 – Implement balance training.

          3 – Request a medication review.

          4 – Recommend a stationary bicycling and arm ergometry program.

          5 – Prescribe a chair exercise program.

          6 – Prescribe hip protectors.

          7 – Refer to a physiatrist.

          8 – Install a personal alert system.