Child and Youth Answers to Sample Cases

Case A

 

Question 1. CORRECT: 3, 6, 8

1 – Incorrect because with a right torticolis, a lump or knot in the SCM can occur but would be on the right not the left.
2 – Incorrect because symmetrical face and skull is not indicative of torticollis. Plagiocephaly is a possibility as a result of the head constantly resting in one position.
3, 6, 8 – Correct because a tight right SCM would result in right neck side flexion and left rotation of the face/head, allowing for right lateral righting but not left.
4, 5, 7 – Incorrect because these are the result of a left torticollis, i.e. tightness in the left SCM.

Question 2. CORRECT: 2, 6

2+6 – Correct because with a right torticolis (right side flexion and left rotation) the goal is to minimize further shortening of the right SCM and increase rotation to the right, therefore placing toys, books, interesting things to the baby’s right side will help encourage right rotation.
1, 3, 5 – Incorrect because these positions would encourage the existing tightness rather than encourage the opposite range.
4 – Incorrect because carrying the baby over the left shoulder or on the right hip will encourage the baby to turn their head to the right, so those are the preferred positions, rather than spending time on the alternate side which will encourage tightness.
7 – Incorrect because turning the baby’s head to the right is best for sleeping; this would be awkward in left side lying.

Question 3. CORRECT: 2, 5

1, 3, 6 – Incorrect. The PT can make referrals to resources and other professionals that the mother may not be aware of or not have access to without the PT. These options do not require referral and would be best for the mother to contact herself.
2 – Correct because if the PT has concerns about the mother’s emotional state it is recommended that the PT refer the mother to the doctor for assessment, as she may be at risk for postpartum depression.
4 – Incorrect because there is no evidence that the baby is being neglected/abused and therefore there is no need to contact social services at this time.
5 – Correct because IDP service planning and delivery is a collaborative process between families and professionals. Specific services may include:
-providing emotional support, guidance, and advice regarding the impact of the child’s disability and/or developmental delay on the family;
– assisting the family to find and access community resources (including counselling);
– facilitating connections between families.

Question 4. CORRECT: 4

1, 2, 3 – Incorrect because professional association, society or body memberships are not credentials and must not be conveyed as such, e.g. MCPA (member of the Canadian Physiotherapy Association).
4 – Correct because the physical therapist’s use of credentials are limited to those that meet the following criteria:
-denotes an educational standard commonly understood by the public, e.g. BSc(PT), or
-Masters Degree (MPT), or DPT; granted from an accredited educational institution.

 

 

Case B

 

 

Question 1. CORRECT: 1

1 – Correct because the goal of physiotherapist in the school setting is to improve integration and inclusion and it is possible to find a pair of skates that fits a prosthesis.
2 – Incorrect because references show that there is no recreational prosthesis for skating. further, even if it were available, it would not be prudent financially to request funding for a prosthesis only to be used for specific field trips.
3+4 – Incorrect because the goal of the physiotherapist in the school setting is to improve integration and inclusion; these options suggest segregation and lack of accommodation.

Question 2. CORRECT: 1

1 – Correct because the role of the physical therapist involves advocating for client and providing education to school based team and classmates.
2 – Incorrect because it is not within PT role to lecture or punish other students for their actions.
3+4 – Incorrect because the goal of PT in the schools is to promote inclusion (physical and social) not segregation.

Question 3. CORRECT: 1, 3

1 – Correct because the PT has the obligation to report the incident to MCFD as per advisory statement #7
3 – Correct because the information must be documented as per Practice Standard #1 (Clinical Records).
2+4 – Incorrect because the PT’s responsibilities lie with the suspected abuse of the client not that of the mother as per advisory statement #7.
5 – Incorrect because the PT’s responsibility is to report not to investigate.
6 – Incorrect because providing recommendations to client regarding how to avoid abuse is outside PT’s scope of practice.

Question 4. 1 True 2 False 3 False

1 – True because shaving exposes hair follicles and increases risk of infection. The new behaviour (shaving legs) and signs and symptoms of possible folliculitis coincided.
2 – False because ensuring her stump is properly cleaned and dried before donning prosthetic would reduce infection risk.
3 – False because ensuring the prosthetic socket is properly cleaned regularly and dried before each use would reduce infection risk.

Question 5. CORRECT: 1, 2

1 – Correct because gait analysis can provide useful information regarding knee alignment, movement and dynamic function.
2 – Correct because Obers test tests tensor fasciae latae / iliotibial band flexibility, tightness would pull laterally on the patella causing pain.
6 – Incorrect because asymmetry would be expected due to her amputation. Thigh girth measurement doesn’t provide information on lateral knee pain.
5 – Incorrect because the MABC2 is not a valid test for people with amputations. The MABC2 is a test for functional motor development.
4 – Incorrect because Thompson test is a test of Achilles tendon rupture.
3 – Incorrect because the FABER test identifies hip pathology.

 

 

Case C

 

 

Question 1. 1 False

1 – This is false because the PT must respect client’s right to keep all personal  information confidential. If the student is present for the PT’s initial contact, then the PT would not have had the opportunity to explain the purpose of the student’s presence to the patient and his family – in private – and ask for their consent then.

Question 2. CORRECT: 1, 2, 7

1 – Correct because the physical therapist must recognize the severity of the symptoms and act to ensure the well being of client by preventing further weightbearing and potential damage to the fracture site.
2 – Correct because the physical therapist must inform client/guardian of effects of treatment.
3 – Incorrect because based on the situation (‘pop’ following increased weight bearing, patient suddenly crying), the PT must know that a full assessment of the leg cannot be completed before the orthopedic surgeon’s assessment.
4 – Incorrect because this will not be effective.
5 – Incorrect because the patient’s pain is likely not routine postoperative pain.
6 – Incorrect because continuing with the treatment session will likely cause further damage.
7 – Correct because physical therapist must recognize that immediate referral to, and evaluation by, orthopedic surgeon is primary recommendation and in best interests of client following change of status during PT treatment.

Question 3. CORRECT: 2, 5

1 – Incorrect because it is unsafe for all parties if a parent carries child up and down stairs. Physiotherapy goal is to improve functional mobility.
2+5 – Correct because the physical therapist must ensure parents are aware of safety hazards such as child’s distractibility, and provide recommendations to deal with this.
3 – Incorrect because mobility is necessary to improve function, strength, circulation, etc.
4 – Incorrect because the child’s distractibility unlikely to change over short term – child has been assessed as being safe on stairs with standby supervision, when he concentrates.
6 – Incorrect because the physical therapist has not observed child sufficiently in variety of environments to determine if he should be assessed for ADD.

Question 4. CORRECT: 2, 5

1 – Incorrect because walking is one of goals for child with this history. Mother is not reporting a new injury.
2 – Correct because the child/parent may not be compliant with recommended dosage of pain medication. This would be a first step in looking for reasons for increased pain.
3- Incorrect because the physical therapist is not addressing parental concerns and child’s needs.
4 – Incorrect because the mother is not reporting additional/more concerning signs/symptoms that would necessitate need for emergency visit.
5 – Correct because the child and parent might benefit from physical therapy review of mobility guidelines. Physical therapist would assess to ensure no other concerns are evident.

 

 

Case D

 

 

Question 1. CORRECT: 1, 3

1 – Correct because the PT is a neighbour, there is potential to cross a professional boundary so it is preferable to refer to another PT. In addition, this PT does not work in pediatrics so can suggest the mother approach a PT who does work in pediatrics. The objective way to suggest PTs to a potential patient is to provide a list of three from which the patient can choose.
2+4 – Incorrect because each child should be assessed as an individual, even if there is a family history.
3 – Correct because the PT can support the mother to express her concerns with her GP. This would not be crossing a professional boundary.
5 – Incorrect because this addresses neither the mother’s nor the PT’s concerns.

Question 2. CORRECT: 1

1 – Correct because the PT provides education to gain informed consent.
2, 3, 4 – Incorrect because it is the responsibility of the PT to educate the family regarding the benefits and risks of PT and to respect the mother’s wished around consent.

Question 3. CORRECT: 2, 4

1 – Incorrect – TUG is not an age appropriate tool for a 14 month old.
2 – Correct – The Bayley is an age appropriate outcome measure for general development.
3 – Incorrect – The GMFM is an outcome tool for children who have cerebral palsy.
4 – Correct – Increasing ROM and strength are treatment goals post hip spica removal so these would be valid outcome measures.
5 – Incorrect – Gower’s sign is an indication of muscular dystrophy.
6 – Incorrect – The Ortolani test identifies developmental hip dysplasia, but is not used after the dysplasia has been corrected.