PCE Written Exam Questions

What are the four ethical principles

1. Justice

2. Autonomy

3. Beneficence

4. Non-malfeasance

How do you manage adverse outcomes during controlled acts?

1. must know what to do if performing a controlled act results in an adverse outcome

2. must have written instructions that describe how to manage any reasonably foreseeable adverse outcomes

What are some physiotherapy restricted activities?

tracheal suctioning, spinal manipulation, acupuncture (dry needling), treating a wound below the dermis, assessing or rehabilitating pelvic musculature, administering a substance by inhalation

What restricted physiotherapy acts can be delegated?

tracheal suctioning, treating a wound below the dermis and administering a substance by inhalation (O2)

What should you ensure when delegating restricted activities?

1. the individual has the knowledge, skills and judgement to do the act

2. they know when they can do the activity, with whom and other limitations

3. they know how to manage adverse outcomes and has written instructions that describe how to manage any foreseeable adverse outcomes

What restricted activities can NOT be delegated?

1. acupuncture

2. communicating a diagnosis

3. spinal manipulation

4. internal assessment or rehabilitation of pelvic musculature

What are the components of informed consent?

1. information with regards to the treatment

2. the nature of the treatment

3. benefits

4. risks and side effects

5. consequences of not receiving the proposed treatment

6. alternative options

What are the components of consent?

1. capacity

2. voluntariness

3. disclosure

4. understanding

What is the hierarchy under the health care consent act for the SDM?

1. legal guardian

2. attorney for personal care

3. representative from the consent and capacity board

4. spouse/partner

5. parent or adult child

6. parent with right of access

7. brother or sister

8. any other relative

9. public guardian and trustee

In what scenario would it be appropriate to break patient confidentiality?

if there is imminent risk of harm or danger, duty to warn overrules ones duty to maintain confidentiality

1. there is clear risk to a person or group of people

2. there is risk of serious bodily harm or death

3. the danger is imminent

What does lock-box mean?

its a concept that describes the right of a patient to withhold or withdraw consent to the collection, use, or disclosure of their personal health information

How long do you need to keep records for?

patient records must be kept for a minimum 10 years after discharge OR 10 years after patient would have turned 18

How can you ensure the support personnel has the knowledge, skills and judgement to deliver safe and effective patient care?

1. review the roles and responsibilities with the support personnel

2. verify the support personnel's knowledge

3. learn about the support personnel's training and experience in order to ensure that it is adequate

4. watch the support personnel perform the task or the assigned care

5. train adn educate the support personnel as needed

What are the common types of mandatory reports?

1. sexual abuse

2. incompetence

3. incapacity

4. holding out as a physiotherapist

5. child abuse or neglect

6. abuse or neglect in a LTC or retirement home

7. privacy breaches

8. disclosure to prevent harm

9. termination of employment

What does the PT need to do if a conflict of interest is unavoidable?

1. disclose and discuss the situation with the patient prior to providing the service in question

2. inform the patient of practical alternatives if available

3. document the discussion in the patient's charts/records

What are the 6 keys to effective communication?

1. courtesy

2. clarity

3. listening

4. consider culture

5. get on the same page

6. body language

What are the components of inspection?

1. vital signs

2. mechanism of ventilation

3. thoracic shape

4. head, neck, extremities

5. speech, cough, sputum

What are the three ranges the rate of HR can be?

1. Bradycardia: <60bpm

2. Normal: 60-100 bpm

3. Tachycardia: >100 bpm

What are the three ranges of respiratory rate?

1. Bradypnea: <12 breaths/min

2. Eupnea: 12-20 breaths/min

3. Tachypnea: >20 breaths/min

What are the BP values?

Hypotension: <90/60

Normal: 120/80

Hypertension: >140/90

Orthostatic hypotension: drop of SBP by 20 mmHg from going from lying to upright*

What is a normal breathing pattern?

Diaphragmatic >70%, lateral costals <30%

What is the ratio of inspiration: expiration for normal, obstructive and restrictive diseases?

normal: 1:2

obstructive: 1:3

restrictive: 1:1

What condition has pink- frothy sputum?

pulmonary edema

What are the components of palpation?

1. chest wall expansion

2. diaphragmatic excursion

3. edema

4. pain and crepitus

5. tracheal positioning

6. tactile fremitus

What conditions could cause edema?

1. right sided heart failure

2. pregnancy

3. lymphedema

4. systemic diseases

What is subcutaneous emphysema?

when bubbles of air occur within subcutaneous tissue, a crackling sensation can be palpated

air under skin

for tactile fremitus - what results in an increase in sound transmission and a decrease in sound transmission?

increase sound transmission = more dense tissue or consolidation

decrease in sound transmission = hyperinflation or increased distance between lungs and chest wall

What are the components of percussion?

1. diagnostic percussion

2. diaphragmatic excursion

What is the purpose of diagnostic percussion?

to determine the density of the underlying tissue

What are the three components you can hear with auscultation?

1. breath sounds

2. voice sounds

3. heart sounds

What are normal breath sounds?

1. vesicular

2. bronchovesicular

3. bronchial

what are types of abnormal breath sounds?

1. crackles (rales)

2. wheezes (rhonchi)

3. pleural friction rub

4. stridor

What are characteristics of coarse crackles?

etiology: air moving retained secretions causing intermittent opening and closing of airway

Wet vs. dry: wet

phase of respiration: inspiration and/or expiration

area of lung: any area

what are characteristics of fine crackles?

etiology: sudden opening of collapsed alveoli

wet vs. dry: dry

phase of respiration: inspiration

Area of lung: typically, in basal lung

What is pleural friction rub?

produced by frictional resistance between layers - creates a long, low-pitched, leathery creaking sound

What is stridor?

it is a loud, musical, high-constant pitch

most prominent during inspiration

due to turbulent air flow (upper airway obstruction or narrowed airways)

What are the three different voice sound tests? Why are voice sounds produced?

egophony, whispered pectoriloquy, bronchophony

voice sounds are produced as a result of a loss of selective filtering of high frequency sounds - helps you determine if there is consolidation in the area

What is obstructive lung disease?

respiratory disorder characterized by increased airway resistance and obstruction affecting expiratory airflow

Name types of obstructive lung diseases

1. chronic bronchitis

2. emphysema

3. asthma

4. bronchiectasis

what is chronic bronchitis?

productive cough on most days for 3 months/year for 2 consecutive years

what are the IPPA findings for chronic bronchitis?

Inspection: obese and cyanotic "blue bloater", possible increase in JVP and ankle edema

Palpation: decrease in tactile fremitus over air trapping, increase over areas of secretion retention

Percussion: hyper-resonant over areas of air trapping, dull over secretions

Auscultation: decrease breath sounds, early inspiratory wet crackles, possible wheezing

What is emphysema?

enlargement of the airway distal to the terminal bronchioles, accompanied by destruction of their wall

(compliant floppy lung)

what are the two types of emphysema?

Centrilobar (more common) - affects respiratory bronchioles

Panlobar - affects terminal and respiratory bronchioles

What are the IPPA findings for emphysema?

Inspection: thin and wasted "pink puffer", barrel chest, pursed lip breathing, accessory muscle use

Palpation: decrease tactile fremitus and decrease chest wall expansion

Percussion: hyper-resonant

Auscultation: decrease BS, may have dry crackles

What is asthma?

chronic inflammatory condition of the airways characterized by hyper-responsiveness of the airways (trachea and bronchi) to various stimuli which results in narrowing of the airways

What are the IPPA findings for asthma?

Inspection: increased accessory respiratory muscle use

Palpation: decrease in tactile fremitus, decrease in chest wall expansion

Percussion: hyper-resonant

Auscultation: decrease breathing sounds, WHEEZING, possible crackles

What is Bronchiectasis?

irreversible, abnormal dilation of medium-sized bronchi and bronchioles resulting in airflow obstruction and secretion retention

What are the IPPA findings for bronchiectasis?

inspection: thin and fatigued, clubbing, increased accessory muscle use, severe cough, increased mucus (foul smelling)

palpation: tactile fremitus - depends on area, chest wall excursion = decreased bc of air trapping

percussion: depends on specific lung changes present

auscultation: decrease BS, wheezing, possible coarse crackles

What is the definition for restrictive lung diseases?

diseases that restrict the lung from expanding fully

have a decrease in compliance -> decrease in negative pressure -> decrease air entry

this is an INSPIRATORY problem

this results in an increased work of breathing

What are types of restrictive diseases?

1. parenchymal diseases

2. pleural diseases

3. chest wall diseases

4. neuromuscular diseases

what are the types of parenchymal diseases

1. interstitial pulmonary fibrosis

2. sarcoidosis

3. atelectasis

4. ARDS

what is interstitial pulmonary fibrosis?

thickening of the interstitium of the alveolar walls which progress to fibrosis or scarring

what are the IPPA findings for interstitial pulmonary fibrosis?

Inspection: dyspnea, increased RR, dry unproductive cough, clubbing, cyanosis, decrease chest wall expansion

Palpation: increase in tactile fremitus (BC THICK LUNG)

Percussion: dull (BC THICK)

Auscultation: late fine inspiratory crackles

What are the IPPA findings for atelectasis?

Inspection: dyspnea, cyanosis, increased RR + shallow breathing, ipsilateral tracheal deviation

Palpation: decrease in tactile fremitus and chest wall expansion

Percussion: dull directly over compressed tissue

Auscultation: decreased BS or absent, fine inspiratory crackles

What is ARDS?

an acute lung injury which is characterized by respiratory distress, severe hypoxemia, and increased permeability of the alveolar-capillary membrane

what are the IPPA findings for ARDS?

Inspection: severe dyspnea, cyanosis, increased RR

Palpation: increased tactile fremitus

Percussion: dull

Auscultation: inspiratory crackles diffuse wheezes

What are the types of pleural diseases?

1. pneumothorax

2. pleural effusion

what is a pneumothorax?

an abnormal collection of air in the pleural space

what are the types of pneumothoraxes?

1. spontaneous pneumothorax

2. traumatic pneumothorax

3. tension pneumothorax (DANGEROUS ONE)

What are the IPPA findings for a pneumothorax?

Inspection: signs of respiratory distress, dyspnea, increased RR, CHEST PAIN, dry cough

Palpation: decreased tactile fremitus

Percussion: hyper-resonant

Auscultation: decreased or absent BS

what is a pleural effusion?

an abnormal collection of fluid in pleural space

what are the types of pleural effusions?

exudative - increased permeability of the pleural surface leading to increased fluid, proteins, WBC and immune cells into the pleural space

Transudative - increased hydrostatic pressure in pleural capillaries

what are the IPPA findings for pleural effusions?

Inspection: may have dyspnea, increased RR, may have chest pain (ESP WITH DEEP BREATHING OR COUGHING)

Palpation: decreased tactile fremitus and chest wall excursion (on side of effusion)

Percussion: dull

Auscultation: decreased, absent directly over effusion, MAY HEAR PLEURAL FRICTION RUB

What are the muscles of ventilation?

1. diaphragm

2. intercostals (external ones are primary muscles for vent)

3. abdominals

what are the accessory muscles of ventilation?

erector spinae, pec major and minor, serratus anterior, scalenes, SCM and traps

What are the normal ABG values?

pH: 7.35-7.45

PaCO2: 35-45mmHg

HCO3-: 22-26 mEq/L

PaO2: 80-100 mmHg

define uncompensated, partially compensated, and compensated

uncompensated: pH is abnormal with one component abnormal and the other normal

partially compensated: pH is abnormal and all the other components are abnormal as well

compensated: pH is normal but the other components are abnormal

what is cystic fibrosis?

a systemic hereditary disease of the exocrine glands of the body

this results in copious amount of thick secretions

What are the IPPA findings for cystic fibrosis?

inspection: low weight, increased RR, barrel chest, clubbing, chronic productive cough, copious amounts of mucopurulent, or purulent mucus

palpation: tactile fremitus depends on if its obstructive, restrictive or mixed

percussion: depends on if its obstructive, restrictive or mixed

auscultation: decreased breath sounds, inspiratory/expiratory crackles, wheezes

what are the types of infectious lung diseases?

1. pneumonia

2. tuberculosis

what is pneumonia?

an acute inflammation of the lungs associated with alveolar filling by exudated (consolidation)

can be viral or bacterial

what are the IPPA findings for pneumonia?

inspection

- increased RR + shallow breathing

- cough (productive = bacterial, non-productive = viral)

- fever (high fever = bacterial, medium = viral)

- dyspnea

- cyanosis

palpation: increased tactile fremitus

percussion: dull

auscultation: wet inspiratory crackles, bronchial or bronchovesicular BS

what is tuberculosis?

an infectious, systemic, inflammatory disease that primarily affects the lungs and other organs

it is an airborne precaution

most infections don't have symptoms (latent TB) - may lay dormant then reactive when immune system weakens (post-primary tuberculosis)

what are the respiratory clinical presentations for tuberculosis?

cough > 2 weeks

- dry cough (early)

- productive cough (mucus/blood)

what are the systemic clinical presentations for tuberculosis?

fever, fatigue, night sweats, weight loss (poor appetite), may have swollen lymph nodes

CXR for tuberculosis

infiltrates and cavitation typically in the upper lobes

what is myocardial ischemia?

insufficient blood flow to myocardium

when no symptoms are present it is referred to as silent myocardial ischemia

what is stable angina?

precipitated by activities that increase myocardial oxygen demand - relieved by rest or nitroglycerin

what is unstable angina?

occurs at rest without any obvious precipitating factors or with minimal exertion.

Not relieved by rest - may not be relieved by nitgroglycerin.

requires immediate medical attention

what is a myocardial infarction?

death of cardiac muscle cells due to lack of blood flow

what does the ECG look like if ischemia is present

ST segement depression

inverted Q-wave

what does the ECG look like for small acute MI with small injury to myocardial cells?

no ST-segment change

NSTEMI or NGMI

what does ECG look like for large acute MI with injury to myocardial tissue?

ST-segment elevation

Pathological Q-wave

STEMI or QMI

what is cardiac rehabilitation?

a comprehensive exercise, education and lifestyle modification program designed to optimize physical, psychological, social and vocational functioning

what are the 4 phases to cardiac rehab?

phase 1: acute/inpatient

phase 2: subacute/conditioning phase

phase 3: intensive rehabilitation phase

phase 4: maintenance phase

what phase of cardiac rehab does resistance training occur?

phase 3 - intensive rehabilitation phase

what are S/S for left sided HF

- dyspnea

- fatigue

- weakness

- PULMONARY EDEMA

- PAROXYSMAL NOCTURNAL DYSPNEA

- ORTHOPNEA

what are the S/S for right sided HF

- dyspnea

- fatigue

- weakness

- JUGULAR VEIN DISTENTION

- PERIPHERAL EDEMA

- PITTING EDEMA

- FLUID WEIGHT GAIN

- ASCITIES

what are the types of pulmonary edema?

cardiogenic and non-cardiogenic

what are the IPPA findings for pulmonary edema?

Inspection: dyspnea, increased WOB, cyanotic, ORTHOPNEA, cough with PINK FROTHY SPUTUM (cardiogenic)

Palpation: normal or increased tactile fremitus

Percussion: dull

Auscultation: decreased BS, fine inspiratory crackles and coarse crackles

what do you find on inspection for someone with pulmonary embolism?

- acute onset of dyspnea

- increased RR

- CHEST PAIN

- may have cough with BLOODY SPUTUM

S/S of peripheral vascular disease

- leg pain

- coldness in affected leg

- decreased pulses in lower limb

- decreased mobility and function in the limb

- possible numbness

- possible pain and paleness of leg with elevation

- decreased hair growth

- skin breakdown

- ulceration

- gangrene (type of necrosis)

what is intermittent claudication?

pain or cramping that occurs in the buttock or legs as a result of poor circulation to the affected area

get a decrease in pain when you stop activity

interventions for intermittent claudication?

1. progressive increase activity and aerobic exercise

2. education on risk factors and self-management

3. self-assessment of skin and education on skin-care

what is the most common procedure for thoracotomies and what muscles are impacted?

posterolateral approach - 4th intercostal

muscles: SA, internal and external intercostals, traps, rhomboids, lats

S/S for DVT

- leg pain

- tenderness

- ankle edema

- calf swelling

- dilated veins

- positive homan's sign

what are sternal precautions?

sternum takes 6-8 weeks to heal

no pushing, pulling, lifting one arm above 90 degrees, no hand behind back, no driving for 4 weeks, no lifting >10 lbs for 6 weeks

what are the 4 indications for MV?

1. severe hypoventilation, hypoxia, or hypoxemia

2. central depression (CNS has slowed down)

3. decrease work of breathing and respiratory muscle fatigue

4. poor pulmonary hygiene (secretion clearance)

what are complications to MV?

1. barotrauma

2. volutrauma

3. ventilatory acquired pneumonia (VAP)

4. diaphragm atrophy

5. hemodynamic compromise

what is continuous mandatory ventilation (CMV)

the tidal volume and preset respiratory rate delivered by the ventilator. Vent provides total support (patient has no control)