Material-de-Apoio-Va..
CR QUESTION LIST (WITH ANSWERS)
• Auscultate a patient at the bedside
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shirt off
deep breaths in and out, 4 at a time, ask about dizziness
9 points in front, 14 in back
side-to-side comparison
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• read a chart and chest xray and dsicuss the findings and plan on the
phone with the doctor (resp distress, CHF on xray)
• what does xray suggest?
• CHF
• what would you do with them?
• head up, ankles down, anti-embolism stockings, no isometrics/valsalva,
reduced activity level, DB+C, pacing
• Acute COPD exacerbation. Assess and treat appropriately (no medical
intervention required) (NPs off)
• NPs on
• sitting position
• support feet
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tripod over pillow
“smell a rose, blow out a candle”
ask about patient status
discuss future issues - tripod, wall supported standing
Diaphragmatic breathing
lie patient down
put rails up
• what controlled breathing program would you set them up with?
• relaxed positioning
• pursed lip expiration
• deep diaphragmatic breathing
• triggers
• pacing
• Educate a COPD (emphysema) patient about SOB managment.
• 5 Ps - plan, prioritize, pauses, pace yourself, posture - use a chair,
prepare things
• what phase of breathing would this paitent have the most
difficulty with?
• exhalation?
• take a focused history - COPD patient admitted for acute
exacerbation for discharge
• chart subjective and objective notes
• Do a chest assessment on a comatose patient in sidelying
• talk to patient, ask examiner about informed consent, ask for chart
• vitals, LOC
• inspect: cyanosis, JV distention, resp distress, type of breathing, symmetry
of chest and trunk, mobility of chest wall, deformities
• palpation: symmetry of chest wall expansion, depth of excursion,
mediastinal shift and fremtus - can’t really assess
• percussion
• auscultation
• 2d post-op gastrectomy. poor respiratory effort, shallow respiration, RR
20, decreased costal and diaphragmatic expansion with decreased breath
sounds to bases. no adventita, weak cough, O2 sitting there. Treat.
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• Post-operative paitent with a chest tube. Finding of RLL pneumonia. treat,
teach coughing
• ask about patient status
• take off shirt
• examine sx scar
• deep breathing
• demonstrate
• place pts hands on their abdomen and then chest wall, your hands on
top of their hands.
• splint surgical area
• in nose out mouth
• FITT 4 breaths, 10x/h, all day
• coughing
• splint surgical site
• deep breath in - close glottis - tight abs - open glottis
• bed exercises - 3-4x/day, 10-15 per session, within pain free range
• contraindications with the chest tube? what is the other end of
the tube attached to? what is the purpose of the water seal?
• don’t put the chest tube above the chest
• avoid crimping, clamping, pulling, tractioning tube
• don’t tip or lay the resevoir flat
• water seal - on inspiration, makes sure that fluid/air is not drawn
back towards chest.
• client is having laparatomy tomorrow. perform a pre-op assessment
•S
• how are you feeling? discomfort or pain? concerns? questions?
• is your asthma giving you any trouble?
• do you use any puffers or other devices for your asthma?
•O
• I/P
• pulse, rr, bp
• breathing pattern, symmetry, posture, deformities, operative site
issues
• signs of respiratory distress
• cough effectiveness
• P?
• A
• slowly but deeply through the mouth
• ask about status
• chart in SOAP format
RLL
pneumonia.
ABGs, O2 sats, decreased expansion on R, breath
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sounds absent in RLL. Treat - no DB, ROM, amb
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• a few days later, the person has calf pain. assess for a DVT
• warm, red, swollen
• ?fever
• Difficulty walking
• squeeze calf
• a few days later, the person has productive cough but still no air
entry to RLL and crackles are present. 3 interventions to improve
VQ matching
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• COPD pt - educate on beginning a walking program
• Pt with IHD and NIDDM referred for exercise program - take a detailed
cardiac history.
• ask about patient status
• age, occupation/work status
• general health?
• tell me about your heart issue
• does this affect your breathing or your muscle function
• diabetes?
• does this affect the way you sense things in your limbs?
• do you think your DM is well managed?
• does it affect your kidneys?
• any other systemic disease?
• any other symptoms that affect your life?
• how often do you get SOB?
• how long does it last?
• what makes it better?
• worse?
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do you get a cough or chest pain? cough productive?
chest pain 0-10?
how often? how long? intermittent or continuous? worse? better?
tell me about your home. live alone? stairs? walking aid?
hobbies? groceries?
how much exercise can you do? distance? time? blackouts? dizziness?
activity level now?
sleep?
smoker? pack history?
alcohol?
what does your doctor tell you about your SOB and chest pain?
medications?
stress test recently?
ECG recently?
• if you heard inspiratory crackles on examining this patient, what
pathology would you suspect? why?
exercise
induced asthma in a 7 year old boy. Mum wants him to play
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soccer. Advise her on pathology, managment at home/practice/school.
• Pathology: hyperresponsiveness of bronchial tubes to stimulus such as
exercise, pollen, mould, dust, animal hair, stress, temperature changes,
humidity, etc. causes intermittent wheezing, SOB, cough. this is because
the immune system reacts to the stimuli by releasing chemicals which in his
case, attack receptors in the airways, causing the airways to narrow
intermittently. smaller tube, same requirements - trying to get more air
through smaller tubes. in his case, because exercise is his major trigger, he
has to be careful when exercising. it is unlikely to affect him in adulthood.
• prevent attacks by noticing warning signs, breaking up vigorous activity,
avoid allergens, take medications as prescribed, regular exercise
• deal with an attack: sit down on a chair with arms on legs. diaphragmatic
breathing in order to reduce the urbulence in the airways, rest for an hour, if
symtpoms don’t subside use drugs
• yes he can play soccer
• what are the symptoms of an attack?
• Pt speaks only russian. Teach DB+C.
• technique, use paper and pen to draw a clock for FITT
NEURO QUESTIONS (WITH ANSWERS)
• Charles, 23 yo client C6 following MVA 8 weeks ago. perform an
assessment of the strength of each of the client’s right elbow flexors (in
sitting)
• biceps (forearm supinated)/brachialis(forearm pronated)/brachioradialis
(midway)
• correct position, palpate belly
• flex without resistance --> flex with resistance
• body mechanics!
• w: based on the assessment list muscles and findings using oxford
numerical scale
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• w: client is C6 quad - 4 functional expectations
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• c7 quad:
• independent self feeding, dressing, transfers, coughing, bowel
and bladder, w/c mobility, pressure relief
• assistive devices required for cooking and bathing
Suzie,
recently
diagnoed with ALS. assess the strength of her LEs
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• Eric, 55 yo, R MCA haemorrhage 2 weeks ago. has L hemiplegia/ flacid,
CV system stable, some confusion. PROM client’s UE, 1 rep of each
movement
• Correct client’s body position
• stop at point of pain
• Scapular retraction, protraction, elevation, depression
• Shoulder flex, ext, abd, add, IR, ER
• Elbow flex, ext, pro, sup
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wrist flex, ext, rad dev, uln dev
fingers flex, ext, abd
thumb flex, ext, abd, add, opposition
body mechanics!
• C5-6 SCI started sitting training in rehab. accident was 3 months
ago. has been in rehab for 6 weeks. Do ROM ex’s for LE. Pt is
received lying on floor on a mat.
• SCI T5 complete with flaccid paralysis of both LEs. PROM LEs, 1
rep ea
• correct body position
• talk about AD
• check for DVT, skin breakdown, deformity in joints, catheter
issues
• palpate belly
• hip SLR to 60˚, hip w knee flexion to 90˚, abd, add, IR, ER
• knee flex ext
• ankle pl flex, dorsiflex, inv, ev, circumduction
• toes
• DO not touch the ball of the great toe
• w: what limited testing full ROM?
• pain
• could also be
• tone
• clonus
• speed of movement
• capsular tightness
• w: 5 interventions in treatment program of the painful shoulder
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• assess the tone (no DTR/clonus)of R UE and LE in a client with
hemiplegia
• fix positioning, ask about pain, assess mental status
• vary the speed, apply a quick stretch
• shoulder, elbow, wrist, fingers and thumb
• hip, knee, ankle, toes
• grade each muscle
• 0 no tone
• 1 hypotonic
• 2 normal tone
• 3 mild/mod hypertonia
• 4 severe hypertonia (sustained)
• which muscle groups are spastic?
• 47 year old woman with MS (cerebellar stroke). Assess coordination (5
tests)
• finger to nose
• heel on shin
• pronation supination
• tap toes
• finger to thumb
CVA
with expressive aphasia: do proprioception on UE
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• movement and position sense
• position sense: up or down with eyes closed
• (if asked) position sense: put your other limb in similar position as the
therapist places the affected limb of the patient
• (if asked) movement sense: move the other limb in a similar
direction/fashion as the other.
• normal? impaired? absent?
• stand on their hemiplegic side
• look for shoulder subluxation - keep shoulder below 90
• 3-5 movements for each joint
• w: chart findings.
• w: how would you promote sensation retraining?
• active/passive ROM
• brushing, tapping
• approximation/traction
• pressure orthosis/splint
• deep tissue massage
• Daniel, 51 yo, post-polio syndrome. experiencing knee pain. take a history
including initial illness and present symptoms. Do not ask about ADLs
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• w: 2 principles for exercise program, based on answers from
client
• w: why would MMT be problematic for this client?
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• w: what are six signs of post polio
• w: what are 2 energy conservation techniques
woman after traumatic SCI. conduct a sensory assessment
Head injury patient has unrealistic expectations of walking. can be
irritable/loud. 1 step commands. L hemiparesis with no movement L UE
and small amount L LE. Do exercises that will work L hip extensors and
will facilitate gait in stance phase
• Bridging/gluteal contractions
GBS: in plateau stage. assess ability to roll supine to R sidelying.
• get them on the mat. pt weak and unwilling to roll. log roll - don’t overexert,
avoid dislocation, watch back pain
• report findings to examiner - 5 aspects of the roll he could do independently
Male with ALS: assess bed mobility and turn him onto side - narrow bed
• brakes - railings up
• quick AROM assesment UE/LE
• assess bridging side-to-side, up the bed, rolling side-to-side and to PRONE,
lie-sit
• use verbal cues, minimize hands on
• make sure bridges right to side of bed. light touch cue to posterior pelvic tilt
• in the lie-sit
• Csp sideflex
• lower arm abduction
• trunk lateral flexion
• legs lifted and lowered over side
look
for (in roll):
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• CSp flex and rotate toward one side
• upper arm scapula protracted and shoulder flexion
• pelvic rotation toward side
• hip and knee flexion
• put pillow under knee/ arm for comfort
• Assess the sitting balance of a 59 yo male with PD
• correct posture
• hands on knees then lift both up.
• reach within base of support, then outside
• expected perturbation
• unexpected perturbation
• eyes closed
• weight shifting
• assess 2 and 4 point kneeling balance in a patient with TBI. pt lying in
supine
• introduce, purpose, explain, ASK EXAMINER FOR PERMISSION
• stand on affected side during explanation to overcome neglect
• correct body position
• do you have pain? how are you feeling?
• where are you? what’s your full name? what time is it?
• stop me if you feel pain or need to stop
• look for shoulder subluxation, look for deformity in arm/hand
• transfer belt
• roll to prone position
• prone on elbows
• straddle and support shoulders??
• prone on hands
• hands and knees
• 2pt
• w: what determines quality of movement?
• coordination, strength, ROM, balance, initiation
• 25 yo with TBI. assess standing balance
• correct posture
• reach within base of support, then outside
• expected perturbation
• unexpected perturbation
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• eyes closed
• weight shifting
• look over shoulders
• turn 360
• feet together
• tandem
Emily, recently diagnosed with MS. transferring w/c to chair and has
fallen frequently during her transfers. watch her transfer using a transfer
board and make corrections as necessary (L leg much weaker than R,
impulsive).
• use the transfer belt
• w: what was the major problem with the transfer?
• w: how could you treat this problem? what are three interventions
that could assess this?
• w: if she had grade 2 strength of LEs, list two other ways she could
transfer independently.
TBI 1 step commands. Analyze gait. name 3 faults. give 2 exercises to
improve her gait.
• use transfer belt that’s there
• measure walking aid, sit them down, change it, stand again
• explain you’d like to see them walking with an assistant so you could see it
from three planes
• exercises: ataxic movement - weight extremeties or the walker
• therabands to work muscles
• What type of gait does she exhibit
• ?ataxic
Mike, hemiplegic patient. teach him to use a w/c. need to use R UE/LE.
teach turning, backing up, going in a circle (small room)
• w: what are the obstacles/skills mike will need in the community
• curbs, ramps, speed required
teach a hemiplegic patient to transfer and instruct family how to do this
• ask about previous transfers, assess LE strength quickly (bridge/quads)
• transfer toward strong side, support hemi shoulder, remember breaks
• simple language if aphasic, watch for impulsivity if L sided
• what is the important differences at each level of the CMSA?
• what are some common features of clients with stroke that could
cause problems during transfers?
• neglect, sensory problems, cognitive problems
C6 SCI: teach 3 pressure relief techniques and explain their importance?
• w/c pushups
• leaning forward (hook elbow and pull)
• hook on push handle (safety) and lateral bend to opposite wheel
• advise about skin care
Pt has paraplegia at T10. teach a patient how to transfer from the
wheelchair to the floor and back to the wheelchair
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• put feet on floor, slightly to one side. put opposite (R) fist on floor, lock
elbow, L arm on wheelchair
• face away from chair pull heels in close, get hands on seat, tricep pushup,
lean forward and push on arm rests to get into chair.
A lady suffered a R CVA. Has poor siting balance. SHe is not in room but
her chart is. read a chart and teach a PTA 3 sitting balance exercises for
her.
• explain client’s condition
• explain that the patient is unrealistic and overestimates abilities
• explain that you are going to teach the PTA how to teach the client
• explain limitations of PTAs role
• teach a truncal ataxia patient balance exercises: sitting, standing,
lying.
Alzheimer’s paitent fell yesterday. teach walking using walker
• w: what would you assess at home?
CVA: progress patient from quad cane to SPC.
• w: 4 gait deviations
• w: 4 things you need to be a community ambulator
Mrs. Stick, 68 yo woman with R MCA CVA. Mild receptive aphasia. CMSA
4 posture, 3 arm, 3 hand, 6 leg, 5 foot. Teach her to climb stairs
• introduce, purpose, consent.
• is there a railing? what side? do you use a walking aid? will you have help at
home?
• demonstrate using correct railing and assistive device
• unaffected leg up, affected leg down
• simple language
• stay on her left
Do a CMSA assessment of a patient’s leg
be prepared for written stations on:
• stroke
• PD
• list six signs and symptoms of SC compression
• list 3 ways to improve communication with TBI
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----Stage a child on the GMFM
21 month old can stand for 5 seconds independently. 3 strategies to
increase walking, 4 strategies to improve balance, 2 outcome measures
for a CP kid
• w: what’s the average age of walking?
• w: how would a typical child respond compared to a child with CP
when given perturbations?
Sarah, 14 month old baby with bilateral congenital hip dislocations.
immobilization procedure completed post-surgery. take a subjective
history. mum asks: will PT be helfpul?
• ask where the baby is
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pathophys: improper formation of hip socket
age, sex, age of sx onset, worse or better since?
family history of CDH?
pregnancy normal? labour? fetal distress? birth weight?
any other abnormaility? leg length discrepancy? folds of thighs different?
clicks?
• what developmental milestones has the child hit? early? late?
• surgery was when? surgeon’s instructions? splinted? age? position? how
long?
4
year
old girl with developmental delay and visual impairment. assess
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gross motor skills
• 17 year old with CP (paraplegia) received in WC. teach hamstring
stretching (two methods) and plantar flexor stretching in sitting independently. teach positioning for hamstrings in his chair.
• Hamstrings
• test to see how tight they are
• fingerst to toes, keeping one knee bent, back straight, knees straight
• lying with ankle on wall
• lying with ankle on wall with isometric contraction
• use an SLR ?weighted
• sit against wall and use towel to lift leg
• prevent posterior pelvic tilt
• give guidelines for stretching (15-30s, 10s rest, 10-15 min at a time, 34x/day)
• calf
• sit with back to wall, one knee straight and towel around foot
• advise to do it when watching tv, etc.; rationalize exercise
• no balistics, no pain
• Do a functional analysis for a CP spastic diplegia kid to work at a grocery
store lifting waist height and lower
• use what’s in the room
ORTHO QUESTIONS (WITH ANSWERS)
RA, osteoporosis, pregnancy, anky spond, fibro/poly
• Anne Saunders - old T5 compression #. assess posture and report to
examiner, correct posture, teach importance.
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• 25yo female with headaches and neck pain. works in an office
and spends a lot of time at a desk. assess the picture of the
work station and educate the patient on how to correct it
• RA patient with an acute flare if right hand. assess.
• w: 3 contraindications during flare
• avoid stress/fatigue
• no MREs
• no stretching of the joints
• no strong pinching/grasping
• no heat modalities
• no gr III/IV mobs
• w: list several things for a home program
• AROM within P free range, aquatics, heat, ice, splints, energy
conservation
• w: what are 3 signs teliing you progression is ok.
• reduced inflammation from flare up, reduced fatigue, etc.
• w: common hand deformities and their mechanism.
• boutonniere: DIP extension/PIP flexion. rupture of central slip of extensor
tendon to base of middle phalanx OR lateral bands of ext digitorum slide
volarly and force PIP into flexion
• Swan neck: PIP hyperextension/DIP flexion. synovitis of MCP - reflex
spasm of intrinsics - force of intrinsics pulls DIP with loosening of PIP
w:
common
splint to use for each
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• ring splints
Mother
with child who has juvenile arthritis in acute flare - pain and
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stiffness in knees and ankles. Teach two modalities she could use to help
reduce pain and stiffness
• Lise, 30 yo, 6 months pregnant. teach resting position, rationale
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• teach a woman post-partum the following exercises: pelvic floor, ab
exercises, pelvic tilts
• check diastasis recti
• three exercises for an ankylosing spondylitis patient
• back extension, costal expansion (feedback on ribs), chin tucks
• 5 things to reassess to monitor progression
• chest expansion, lumbar flexion, tragus to wall, cervical rotation, side
flexion
common
signs and symptoms of anky spond
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• slow, insidious onset of LBP
• less than 40 yo
• greater than 3 months of back pain
• morning stiffless greater than 30 min
• LBP unrelieved by rest but improves with exercise.
• management strategies:
• regular exercise, rest periods throughout day, avoid flexion, frequent
position changes, community support, heat and cold, no contact
supports, assistive devices, breathing exercises
• 3 long term management problems
• decreased chest expansion, increased risk for contracture,
decreased mobility
Ms.
Myalgia,
47 yo stay at home mom. General exercise program referal.
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concerned abotu the ten pounds of excess weight she’s gained in the
past year, an overwhelming sense of fatigue and pain that roams around
her whole body. Assess, tell the examiner what you think her diagnosis
might be at the doctor next week
• ask about the pain - onset, location, duration, characterized by, aggravated
by, relieved by; morning stiffness, allodynia
• polymyalgia is focussed on neck, shoulders and hips and may be
associated with autoimmune arterial inflammatory disease
• fibromyalgia is all over, less predictable and more likely to include
symptoms like allodynia
• take a focussed history of a woman with fibromyalgia
upper limb
• Pt presents with ++ R shoulder pain due to subdeltoid bursitis. PA R GH,
teach two home exercises to maintain ROM.
• what are 3 characteristics of a gr I PA?
• 3 things to help with pain relief?
• she is progressing, but still has abduction limitation -- what to do?
• inferior glide
• rotator cuff exercises: forward flexion ROM, IR strengthening
• Assessment of shoulder ROM after humeral head fracture. Give HEP
• shoulder assessment: AROM - do not stress fracture site
• do a quick check of neck, elbow, wrist
• swelling, skin temp, colour, pulse - RSD
• HEP
• ROM for all joints (P free)
• scapular strengthening
• pendulums
• AAROM for shoulder
• elbow and wrist strength
• Pt injured his L shoulder playing baseball. Do AROM and PROM. Which
structure is most likely involved? Rx plan?
• remove shirt
• AROM all shoulder movements, PROM shoulder and elbow
• what could it be?
• supraspinatus tendonitis (painful arc)
• RC impingement (painful resisted abduction)
• infraspinatus tendonitis (painful passive IR)
• biceps tendonitis (Painful resisted ER)
• Rx: Ice, reduce activity, maintain mobility of elbow, wrist and hand, painfree
AROM
• Mary Love, 29 yo tennis player. Pain with serving in her right shoulder.
Perform special tests to rule in/out shoulder impingement syndromes of
the upper limb. identify which structures you are testing
• neck scan
• HK impingement test
• painful arc
• empty can
• yergason’s/ speed’s
• palpation
• what structure is likely to be impinged based on findings?
• 3 immediate interventions?
• decrease the pain/modalities
• cessation of aggravating activities
• maintenance of cardio fitness
• Patient dislocated his AC joint. Assess his ROM and isometric strength.
Teach exercises for isometric strength
• 6 weeks post radial head fracture, cast off. Assess the accessory
movements of the elbow
• no pain
• PRUJ for pronation supination - 70˚ elbow flexion, 35˚ of supination
• humeroradial - supination and full extension
• humeroulnar - 70˚ elbow flexion, 10˚ supination
• 3 precautions for patient to avoid?
• avoid lifting
• pain free ROM
• don’t try to force movements
• common complications of this # would prevent you from doing
manual Rx?
• myositis ossificans of brachialis and brachioradialis
• Use ultrasound to treat R lateral epicondylitis. give them 3 exercises to do
at home
• pathophysiology of lateral epicondylitis?
• physiological effects of US?
• sends a sound wave into tissue to decrease inflammation and stimulate
repair of tissues
• unidirectional flow of cells removes inflammatory and damaged cells and
brings in other cells to repair the tissues
• 6 relative contraindications?
• US for: post-op back laminectomy
• clear for fracture healing, do 2 doses each side.
• MCL sprain
• acute .5-.8 w/cm2, 20-50% pulsed for 10-25 min;
• chronic .8-1.0 w/cm2 5 min continuous (heating)
chronic
L3-4 facet syndrome
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• .8-1.0 w/cm2 5 min continuous (heating)
• Name and demonstrate 2 assessments of CTS
• tinel’s, phalen’s
• S&S of CTS?
• pain, tendernes, circulation/edema, decreased ROM, decreased grip
strength, paraesthesias in median N distribution, decreased
sensation, symptoms worse at night, wasting of thenars
• causes of CTS?
• overuse, poor posture, structural changes, trauma, vibration,
physiological disorders
treatment
of CTS?
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• protection, RICE, meds, modalities, resting splints, nerve flossing,
stretching, ergonomics
• MCP resting position? type of joint? test? glide to improve
extension? abduction?
• slight flexion/synovial/traction for general mobility/dorsal glide/radial
glide
• Pt with gradual onset of numbness and tingling in left hand. Do an
assessment to determine if it is a peripheral or cervical nerve (TOS has
been ruled)
• Patient has an injury to the radial N secondary to healed fracture,
MMT muscles innervated by the radial nerve
• triceps, wrist extensors, brachioradilais, supinator
• teach him how to apply a splint. precautions regarding care of
splint and nerve injury.
• peripheral neuropathy - sensory testing to determine which
peripheral n is involved Laura, 28 yo. had a fall yesterday and
fractured olecranon process - closed reduction, casted. program
for next 4 weeks for UE, warning signs, don’t talk about ADLs
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• NO ACTIVE EXTENSION
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• Pt fractured 4th metacarpal on right hand while boxing six weeks ago. He
just came out of his cast. Use 3 different techniques to progress
physiological range. Do not use accessory movements.
• passive/ AAROM/ putty squeeze and spread
• prayer stretch
• cupping/splaying
• what 6 things to add to treatment if he comes back with increased
pain and swelling? what would be clinical impression if his hand
presented as red, swollen and shiny?
• ice/TENS/US/stretching/traction/etc/
• CRPS/DVT/infection
• Teach three exercises for post-op wrist flexor surgery
• AAROM, gentle stretching, tendon gliding, isometrics, scar massage, PROM
• teach 3 home exercises for flexor digitorum superficialis 4/52 ago.
neck/back
• Cspine scan for a patient who is post-MVA. Test the OA joint
• 5Ds and 2Ns, sharp purser, VA test, active, myotomes, reflexes, direct PAs
• ???
• take a focused history of a whiplash patient 1/52 post MVA.
• MOI - car stopped or moving? head turned? LOC? VA signs?
headaches? pain? PMHx? meds?
• what two treatments are contraindicated right now?
• Pierre, 50 yo. sudden onset of LBP while lifting a box 6 weeks ago. for 3
weeks, developped LE weakness. 3 weeks, no change. assess LE
myotomes and reflexes. verbalize levels.
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• 43 yo pt with sciatica. what level is her sciatica at?
• neural tension - SLR and corssed SLR
• sensation testing: sharp/dull (lateral spinothalamic); light touch (dorsal
columns)
• patient with poor posture and pain in upper thoracic and cervical area.
teach 4 exercises and explain rationale. theraband, gym ball, bed
available
• chin tucks (deep neck flexor/counteract cervical tightness), scap retraction
(optimize scapular position), sitting on ball (core strength), pec stretch
(reduce anterior translation of humeral head)
get
informed consent to start using L4/5 mobilizations.
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• what are 4 components of informed consent?
1.
2.
3.
4.
Capacity: The patient cannot participate in consent without the ability to understand and
appreciate the consequences of a decision
Voluntariness: The individual should not be manipulated or coerced into choosing a given
option
Disclosure: The patient should be told of available treatment options, the nature of the
treatment(s), the risks and benefits of each and the consequences of refusing treatment.
Disclosure normally includes the physiotherapist's recommended treatment and rationale
Understanding: The physiotherapist should take steps to ensure that the patient has not
misinterpreted the information.
• 3 courses of action if she declines?
• document it
• exercises instead
• let her know she can change her mind
• Steve, 32 yo. constant and severe LBP following MVA 2 days ago.
Difficulty with most movements. assessment shows extension worst,
flexion relieves, no neurological deficits, soft tissue injury. instruct in
pain management and resting positions in lying
•
• Pt has Gr I spondylolysthesis who experiences pain on extension and
prolonged flexion. give instructions on how to manage symptoms with
HEP including posture and body mechanics. Review precautions
• teach a man with LBP to properly lift a box from the floor to a shelf
lower limb
• Janet, 65 yo 1 day post op THA. WBAT. teach supine exercises
•
•
• Pt with THA post-op 4 weeks. give 3 exercises to progress him in
standing.
• w: list 6 things that would let you know he is overdoing it at home
• w: what 6 things would cause you to call his physician
assess
the gait of a man 6 weeks post TKA, state 3 gait deviations,
•
assess need for gait aid
• check footwear, DVT, strength. transfer to standing, check walker height,
correct gait with walker
• program 6 weeks post
• what would you teach them when using an exercise bike?
• monitor HR, ROM > 110˚, sufficient balance
Sandra,
17 yo patella L lateral dislocation 3h ago. immediate self•
reduction, heard a pop after quickly pivoting. still very painful. explain
factors and mechanisms that may have contributed to her injury. discuss
prevention of recurrence.
•
• patient has pain at the back of the thigh. Assess and tell examiner what it
is.
• ask about pain, MOI
• AROM of hip and knee (and ankle?)
• PROM of hip and knee
• Resisted
• palpation
• how long will it take to heal? (assume hamstring strain)
• Pat Nun has R knee pain. complete a brief subjective and objective
assessment of the joint
• AROM (goniometer), PROM (goniometer), resisted
• end feels, DDx
• what are the normal end feels of knee flexion and extension?
• tissue approximation, tissue stretch
• what does a bone on bone end feel in knee flexion suggest?
• ?osteophytes
• what are the two contractile structures that may cause knee pain?
• tendons and ligaments
how
did you rule these in/out by your exam?
•
• resisted isometric testing
home
program if it occured yesterday?
•
• RICE
• name some abnormalities you would see on an xray of knee OA.
• reduced joint space
• osteophytes
• subchondral bone formation
• genu valgum/varum
• take a focussed history from a patient experiencing knee
pain - do not ask about PMHx
• what is the most likely problem with their knee? give your
reasons for this?
• what would you do for treatment today?
•
•
•
•
•
•
•
• what are the characteristics of a haemarthrosis?
Neil, 34 yo man who injured his knee while deeking a defender 1/52 ago.
Planted his left foot and twisted his knee. Xray shows no fracture. Brief
history about MOI, perform 3 tests and provide a rationale
• Anterior drawer for ACL
• McMurray’s for the meniscus
• Valgus stress for MCL
• verbalize what a positive result would be
Pt with grade 3 quads weakness secondary to Gr2 MCL sprain 3/52 ago.
Use muscle stim. TENS is also in the room!! choose the right one
• 8 min: how would you proceed with treatment today?
patient has an MCL sprain. wrap it, apply ice and teach the patient how to
minimize swelling
teenage boy with PFPS of left leg. assess the strength of his glut med.
assess range of TFL and assess patella gliding. Pt lying on high plinth
• sidelying abduction/ OBER’s/ glide patella
• what would he have trouble with?
• squatting, stairs, running
three
outcome measures?
•
• LEFS, MMT, P4
Post #: perform a focussed assessment of the right leg. Check for DVT it’s positive. explain why you wouldn’t continue with assessment
• what would your immediate actions be?
• inform doctor, advise patient to move as little as possible, chart
• what if she wants to put heat on it?
• no
take a focussed history on the injury of a client that is going to have an
ankle arthrodesis. Why would this be indicated based on the client’s
problems? what movements would be limited if the client had a triple
fusion?
• how did all this start? trauma, insidious/acute, onset, etc., how has this
affected work/leisure time?
• Tibiotalar arthrodesis: fuses talus to tibia - no pf/df. intact eversion and
inversion. relieves P in tibiotalar joint, increases stability
• triple arthrodesis: fuses talus/calcaneus, calcaneocuboid, talonavicular, no
inv/eversion, intact pf/df, increase med/lat stability
Daniel, 41 yo with painful L foot. Take a focused history. 2 q’s at 8 minute
mark.
•
•
• Pt with plantar fasciitis has got some stretches from the internet. assess
the exercises. towel in room
• w: how do you isolate soleus
• w: list 2 things to decrease stress on fascia
• Pt R ankle injury 2 days ago playing soccer. Take a quick history focusing
on MOI, examine patient’s ankle
• anterior drawer (20˚ of plantar flexion), talar tilt - bilateral
• goniometry?
• ottawa ankle rules
• indications for xray: if there is bone tenderness at A or B (ankle series)
or C or D (foot series) or if there is inability to bear weight both
immediately after injury and during examination (four steps, regardless
of limping).
• what is your priority with this patient?
• rule out fracture, pain control
• teach 3 proprioceptive exercises to a patient who is 4 weeks post
ankle sprain
• what muscles would you strengthen if he has chronic
plantarflexion inversion sprains?
• give 3 more advanced proprio exercises?
teach
how to wrap a tensor around an ankle
•
• Jeremy, 45 yo with IDDM and PVD. He comes in complaining of calf pain
after walking 2 blocks. educate on proper foot care and provide
intervention to manage calf pain.
• ask about heat, redness -- DVT
• only brought on by exercise, no signs of DVT -- vascular claudication.
insufficient blood supply to muscle
• management: good lifestyle (no smoking, healthy diet); improve exercise
tolerance through graded endurance exercise 3-5 days a week
Diabetes
pt - educate on foot care. shoes? vacation on sandy beach?
•
• inspect feet daily, wash and dry thoroughly, make sure to test water with
hands (reduced sensation), check bottom of feet with mirror
• proper footwear: good fit, good stability, try them out around the house first
• wear footwear at the beach - sharp objects, sand into crevices
gait aids and amps
• Martha, 68 yo. had a fall and was brought to the ED by her family for a
scalp lac. no other injuries. take a focused history to assess the need for
a gait aid.
•
•
•
•
•
•
• take a focussed history regarding falls.
• what is the single most important reason for falls?
• what 5 parts of the objective examination would you do? Teach
cane walking
Teach walking with a 4ww/2ww
teach crutch walking - 3 pt and 2 pt and up and down stairs.
33 yo female who fell 5 feet from a ladder 3 days ago and landed on both
heels. Comminuted calcaneus fracture in L calcaneus and hairline
fracture of R calcaneus. Left is NWB, R is WBAT. Teach an appropriate
gait pattern - crutches, walker and 2 canes are there
Teach BKA (or AKA??) stump wrapping/prosthesis care/ lying positions/
exercises for pre-prosthetic training
Gait video - amputee walking
• lateral bending - prosthesis too short, abduction contracture, short residual
limb, poor cup construction
• abducted gait - prosthesis to long, adductor roll, abduction contracture,
prosthesis abducted
• circumducted gait - too long, too much knee friction, small socket, weak hip
flexors
STUDY QUESTIONS FOR JUNE PNE
March 12 IEP OSCE baseline
1) R MCA, L Hemi, 35 yo, demonstrate 3 test to Ax, UL coordination
 Intro, check breaks, explain procedure, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 Finger to nose
 Alternating hand flips
 Index and thumb tapping
2) T5 complete SCI, 6 months ago, teach client relevant PROM exercise
 Intro, Check breaks, explain procedure, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 Mentioned autonomic disreflexia symptoms
 Use belt to tie pt onto plinth, move plinth so pt is in long sitting
 Passively move LL for PROM hip flexion, knee flexion and ankle DF 
to be taught to family members
3) 35 to, twisted right knee, playing ultimate Frisbee, Ax ACL and explain RICE
protocols and teach 2 exercises.
 Intro, check breaks, explain procedure, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 ACL tests, explain RICE, teach isometric knee extension, knee flexion
4) Gladys Hertz, 64 yo, severe OA, assess AROM, abd, flexion in supine, teach pt
movements to avoid and how she should get out of the chair
 Intro check brakes, explain procedure, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 Ax AROM ABD, Flex w/ goni- flexion not passed 90, abd don’t pass
neutral
 Hip precautions don’t cross legs, don’t cross midline, flexion don’t
pass 90
 Exercise- isometric glut squeeze, bridging , including frequency and
duration
 Get in and out of chair- PT show pt
5) Betty Schmultz, 5 yo supraspinatus tendon injury, Ax contractile structures
and teach 2 shoulder exercises
 Intro, check brakes, explain purpose, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 Ax isometrics of all directions
 Exercise- ER with weights, isometrics – include reps and sets
 Desk ergo- keyboard height, mouse pad, arm rest
 Safety and body mechanics- feet supported, lower bed, tripod
position, stool behind chair
6) 53 yo, pt day 2 pt thoracotomy R lobectomy, Sat 96, on 3l O2, L lobe
atelectasis. Position to max O2 flow and teach relevant exercise to max O2
flow – TEQ
 intro, check brakes, explain purpose, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/tests
 check IV, O2, chest tubes- verbalized
 Positioning- sit on edge of bed, high sitting
 Exercise- DBE, incentive spirometry (3 to 4x every hr WHEN YOU ARE
AWAKE )
 Huff, cough, brace with towel
 Ask pt to repeat what is being taught
 Confirms the pt understands what is being asked to do
7) Mod-severe emphysema, outpatient to start resp rehab. Measure HR, BP, RR,
explain RPE
 intro, check brakes, explain purpose, consent
 ask pt if he has did this before
 ask if he has any pain before begin
 tell pt he should stop therapist should they feel any pain during the
procedure/testsS
 HR – brachial 10s x6
 BP- using cuff
 RR- arm across chest, measure for 15s x 4
 RPE- Borge Scale- measure how much you are exerting whilst you do
the exercises, will periodically ask you how you are doing, give scale,
then I can modify exercise accordingly
8) Pt w/ exacerbation of MS, demo STS reinforcing normal biomechanics
 Intro,
 ask pt if he has did this before







ask if he has any pain before begin
tell pt he should stop therapist should they feel any pain during the
procedure/tests
Check knee extension and flexion strength
STS mechanics- block knee, wgt equally on both feet
Give feedback on neutral sitting and standing posture
Repeat tasks, reduce cues, intro variety
Safety- say it and do it
May 14th, IEP OSCE final
5+5 mins stations
1) Pt has chronic lung disease and is going to outpatient PT for the 1st time.
Auscultate
PEPCondition
Mechanism
Distinguish
Possible Causes
Characteristics
Wheezing
-increased
-heard on
Asthma
airway resistance expiration
emphysema
-high pitch sound
-musical noise
Inspiratory and
-consolidation
-coarse crackles
Pneumonia
expiratory
-decrease
hear on
COPD
crackles
secretion
inspiration and
removal
expiration in
isolated lung
regions
- can be cleared
with a cough
Late inspiratory
- early alveolar
-fine crackles
-cystic fibrosis
crackles
collapse
-more diffused
- atelectasis
-Decrease AW
-pneumonia
entry
-COPD
-pulmonary
edema
What of the above can you use an intervention for treat the condition;
-Atelectasis
-Pneumonia
2) 61 yo Mr myers had a CVA 2 weeks ago. Stage 3 on UE, stage 2 on LL. Ax joint
position sense in elbow and wrist. Report finding to patient.
PEPa) Based on the information that you have found. Indicate the 3 most
important you should consider for this patient. Protect the shoulder
b) What 3 other test can you use to test somatosensory – temperature, 2
point discrimination, pin prick, light touch
c) What is a dermatome
3) Jill played Frisbee, injury knee 2 days ago. Ax ACL and PCL, educate RICE
principle and give 2 exercise for the knee
Feedback- be precise, read the question, underline the words to help and
make sure you don’t miss anything. Don’t forget to give the time from for ICE
( 10 to 15 mins every 2 hrs)
PEPa) Name and describe 2 stages of soft tissue healing.
Feedback- detailed characteristics of each stages and time frame given
 Inflammation
 Proliferation
 Recovery
b) Give proprioceptive exercise for this patient throughout the stages of
healing
Key points to focus- change in BOS, change in surface, eyes open and eyes
closed
 Acute
 Sub-acute
 Recovery
4) Pt 14 yo post # of femur 8 weeks with ORIF in place, knee ext = -20 degrees,
flex= 95 degrees. Ax Quad and hamstring strength. Give 2 ROM exercises and
ways to help with walking/gait.
Feedback- did well
PEPa) Based on your findings, what are the 3 goals for treatment for this
patient?
 Increase range of motion for the knee
 Increase strength for the quads and hamstring
 Regain normal reciprocal gait mechanics
b) List 2 exercises for the quadriceps and 2 for the hamstrings?
 Quads- QOR, mini wall squats with swiss ball on back
 Hamstrings- prone H/S curl, prone H/S with ankle weight
10 Minute stations
5) Mr Evans, 40 yo recovery from exacerbation of MS. Ax ability to transfer from
lying to sitting. Demo and re-educate the transfer from lying to sitting, reenforced normal body mechanics.
Feedback- biomechanics- push off with both hand and elbow, encourage the
use of momentum, place hand on scapula to assist pt and not the shoulder.
Transfer belt is NOT used for lying to sitting
6) Pt awaiting for THR , on 6 month waitlist, now having pain on right hip and
has an antalgic gait, sleep is disturbed. Ax AROM of hip and do a test for the
hip flexion contracture. Suggest gait aid and touch a hip stretch for hip flexor.
Feedback- ran out of time, make sure to measure all AROM with GONI! And
stabilize the joint to be measured. Do the Thomas test for flexor contractor.
Walking aid suggestion- crutches to decrease WB on hip so you can walk
better.
7) Pt 20 yo comes in with back pain radiating to popliteal fossa. Ax reflex,
sensation and L4 myotome. Question regarding Red Flags. Obtained consent
to perform manual traction.
Feedback:
Reflex- missed plantar response
Myotome- make sure to clear above and below
Red Flag- missed sexual dysfunction
Consent- also indicate the risks as well as advantages- increase pain, increase
pins and needles, Agg of symptoms
8) Pt 55 yo was admitted in the hospital due to S-T Depression (non-STEMI),
day 2 admission. Possible D/C within 2 to 3 days. Demo the importance of
gradual activity progression and educate regarding activity to do if similar
situation occur again at home.
Feedback:
-Sx to stop exercise- SOB, chest pain, dizziness, nausea
-indicate walking program time- 6 wks so the heart can get used to the
walking task before progression
-nitro spray- if it does not work in 10 mins then call 911
-make sure the pt understand so ask pt to repeat/demo what you just said or
did
LINKS
1) Órgão para Validação do Diploma e realização das provas prática e teórica:
http://www.alliancept.org/
2) College de acordo com a Província para atuar. Ex: British Columbia: http://cptbc.org/
Demais províncias, a busca pode ser realizada pelo Google: college of physiotherapy in (nome
da província)
3) Livros pra estudar para a prova: http://www.happyschools.com/best-npte-exam-books/
4) Curso da UBC (University of British Columbia): http://iepbc.ca/
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