MOCK 3 - PT PREP

A 56-year-old woman suffered a stroke 3 weeks ago. She presents with sensation changes and limb ataxia on the right side. Her strength was unaffected and is within normal limits on testing.

Q1. The patient describes the changes in her sensation as a loss of pain and temperature sensation on the right side of her face and a loss of pain and temperature sensation throughout the left side of her body. What syndrome is the patient suffering from?

A. Horner’s syndrome

B. Wallenberg syndrome

C. Angelman syndrome

D. Korsakoff syndrome

B

a. Horner’s syndrome o Horner’s Syndrome: Lesion of the nerves of the sympathetic trunk that supply the head and neck. § Can be congenital or acquired as a result of disease, injury (eg. Tumor, stroke). § Presents with Ipsilateral: § Droopy eyelid (ptosis), constricted pupil (miosis), dry face (anhidrosis), red face. b. Wallenberg syndrome - CORRECT o The presentation of Wallenberg syndrome is explained by the anatomy of the brainstem. In the medulla, the ascending spinothalamic tract(which carries pain-temperature information from the opposite side of the body) is adjacent to the ascending spinal tract of the trigeminal nerve (which carries pain-temperature information from the same side of the face). A stroke which cuts off the blood supply to this area destroys both tracts simultaneously. The result is a loss of pain-temperature sensation from the ipsilateral side of the face and contralateral side of the body. c. Angelman syndrome o Angelman syndrome is a genetic disorder that mainly affects the nervous system. Symptoms include a small head and a specific facial appearance, severe intellectual disability, developmental disability, speaking problems, balance and movement problems, seizures, and sleep problems. d. Korsakoff syndrome o Korsakoff syndromeis an amnestic disorder caused by thiamine (vitamin B1) deficiency associated with prolonged ingestion of alcohol.

A 56-year-old woman suffered a stroke 3 weeks ago. She presents with sensation changes and limb ataxia on the right side. Her strength was unaffected and is within normal limits on testing.

Q2. The sensory loss presented by the patient is typical of a lesion to which area of the central nervous system?

• A. Brain stem

• B. Basal ganglia

• C. Cerebral cortex

• D. Cerebellum

A

a. Brainstem - CORRECT o Symptoms of crossed anesthesia (ipsilateral face and contralateral trunk/limbs) typify brainstem lesions.

b. Thalamus o Thalamus lesions typically present with more diffuse sensory loss to the side of the body contralateral to the lesion. Thalamic lesions can also lead to thalamic pain syndrome, which involves chronic burning or aching sensation.

c. Cerebral cortex o Typically present with localized areas of sensory loss.

d. Cerebellum o Damage to the cerebellum causes motor-related symptoms.

A 56-year-old woman suffered a stroke 3 weeks ago. She presents with sensation changes and limb ataxia on the right side. Her strength was unaffected and is within normal limits on testing.

Q3. The physiotherapist arrives for a rehabilitation session and the patient’s husband is present in the room. The patient appears quiet and upset. She states she would like to rest for another few hours before participating in physiotherapy, but her husband is insistent that the therapist proceed with treatment as she has not yet exercised today. How should the physiotherapist proceed?

• A. Agree with her husband and proceed with physiotherapy

• B. Ask her husband to leave the room so they can have a private conversation about physiotherapy with the patient

• C. Respect the patient’s wishes and agree to come back later in the afternoon

• D. Contact the team to discuss the patient’s possible depression

C

a. Agree with her husband and proceed with physiotherapy o The question has not stated anywhere that the patient has any type of cognitive issues and requires a substitute decision maker. For this reason, it is not appropriate to proceed with therapy based on the husbands wishes.

b. Ask her husband to leave the room so they can have a private conversation about physiotherapy with the patient o There is no reason to believe that the patient is in any type of distress or requires private conversations at this time. While this is not wrong, it is not the BEST answer as to how to manage this situation.

c. Respect the patient’s wishes and agree to come back later in the afternoon – CORRECT o There is not harm in returning later in the afternoon for therapy once the patient is feeling more energetic. This is the BEST answer as it respects the patient’s wishes and also still engages her in physiotherapy.

d. Contact the team to discuss the patient’s possible depression o While your concerns with her mood may be something to bring up to the team on the next team meeting, this is not the best answer as it does not provide a solution to the issue at hand which is to provide physiotherapy treatment to your patient

A 56-year-old woman suffered a stroke 3 weeks ago. She presents with sensation changes and limb ataxia on the right side. Her strength was unaffected and is within normal limits on testing.

Q4. Upon assessment, the physiotherapist notices mild balance impairments most likely due to decreased sensation on the left side of the patient’s body. The patient scores a 48/56 on the BERG balance measure.

What is the most appropriate gait aid for this patient?

• A. 2-wheel walker

• B. Standard walker

• C. Single point cane

• D. Wheelchair

C

a. 2-wheel walker

o While this is not an incorrect answer, it is not the BEST answer.

The 2-wheel walker will offer more stability than a single cane

but this patient only has mild balance deficits making a cane

the BEST answer.

b. Standard walker

o While this walker offers maximal stability, it needs to be picked

up and moved forwards with each step. This patient does not

require the stability offered by a standard walker and would

make ambulation very high in energy expenditure. It is not the

BEST option for this patient.

c. Single point cane - CORRECT

o This is the BEST answer as it is an appropriate aid to use with

mild balance deficits and compared to the other options

listed, it allows the patient the most normal reciprocal gait

pattern with arm swing.

d. Wheelchair

o The patient has normal strength and only mild balance deficits

– a walker is nor necessary for this patient.

A 56-year-old woman suffered a stroke 3 weeks ago. She presents with sensation changes and limb ataxia on the right side. Her strength was unaffected and is within normal limits on testing.

Q5. Based on the device chosen in the question above, which of the following gait patterns should the therapist teach her?

• A. 2-point gait pattern

• B. Modified 2-point gait pattern

• C. 3-point gait pattern

• D. Step-to gait pattern

B
a. 2-point gait pattern

o This pattern is only possible with 2 canes or 2 poles.

b. Modified 2-point gait pattern - CORRECT

o The most appropriate device to choose for the patient with

mild balance impairment is a single cane. Given the choice of a

cane and the patient’s mild balance deficits, the most

appropriate gait pattern would be a modified 2-point gait

pattern.

c. 3-point gait pattern

o This gait pattern is most often chosen when someone has

unilateral lower extremity weakness/injury with a non-weight

bearing or feather weight bearing status. The only gait aids

that can be used during a 3 point gait pattern include:

standard walker OR 2 crutches.

d. Step-to gait pattern

o This is not a specific gait pattern. It is a step pattern that can

be taught with a gait pattern. In this scenario, the patient

would not require a step to pattern and would be better

taught reciprocal step through ambulation with a single cane.

A physiotherapist is working in private practice. His caseload includes many high-level athletes. A new patient arrives for an assessment after a right knee injury while playing soccer. When asked about the mechanism of injury, the patient states that she planted and twisted her knee and heard a pop. The injury occurred 2 days ago, and since then she not been able to bear any weight through her knee since and is hopping on her left leg. She has not yet seen her doctor.

Q6. On assessment, her knee is bruised, hot, swollen and is very limited in range of motion in all directions. The physiotherapist suspects a hemarthrosis. How should the physiotherapist proceed?

• A. Provide the patient with ice and teach her a 3-point gait pattern

• B. Tell her to go to her doctor immediately

• C. Educate the patient about the suspected findings and teach her a 3-point gait pattern

• D. Teach the patient a 3-point gait pattern and refer her back to her

doctor for further investigations

D

a. Provide the patient with ice and teach her a 3-point gait pattern

b. Tell her to go to her physician immediately

c. Educate the patient about the suspected findings and teach her a 3- point gait pattern

d. Teach the patient a 3-point gait pattern and refer her back to her

physician for further investigations - CORRECT

o This is the BEST answer as it provides the patient with safe

mobility option while also ensuring they see their physician.

The nature of the injury and significance of the swelling

indicates a possible serious knee injury. Further investigations

are necessary to determine the extent of injury and if a

hemarthrosis is present.

A physiotherapist is working in private practice. His caseload includes many high-level athletes. A new patient arrives for an assessment after a right knee injury while playing soccer. When asked about the mechanism of injury, the patient states that she planted and twisted her knee and heard a pop. The injury occurred 2 days ago, and since then she not been able to bear any weight through her knee since and is hopping on her left leg. She has not yet seen her doctor.

Q7. The therapist suspects an ACL injury given the mechanism of injury. Which of the following options are correct with respect to the anatomy of the anterior cruciate ligament?

• A. Extends superiorly, anteriorly and laterally from tibia to femur

• B. Extends superiorly, posteriorly and laterally from tibia to femur

• C. Extends superiorly, anteriorly and medially from tibia to femur

• D. Extends superiorly, posteriorly and medially from tibia to femur

B

a. Extends superiorly, anteriorly and laterally from tibia to femur

b. Extends superiorly, posteriorly and laterally from tibia to femur -

CORRECT

o Collateral ligaments are named for the attachment on the tibia

– ACL attached anteriorly on the tibia.

o A trick to help remember ACL anatomy:

§ APEx = arises from Anterior condylar area of tibia,

directed Posteriorly and inserts on lateral (EXternal)

condyle of the femur

c. Extends superiorly, anteriorly and medially from tibia to femur

d. Extends superiorly, posteriorly and medially from tibia to femur

A physiotherapist is working in private practice. His caseload includes  many high-level athletes. A new patient arrives for an assessment after a  right knee injury while playing soccer. When asked about the mechanism  of injury, the patient states that she planted and twisted her knee and  heard a pop. The injury occurred 2 days ago, and since then she not been  able to bear any weight through her knee since and is hopping on her left  leg. She has not yet seen her doctor. 

Q8. The patient returns 5 days later after seeing her doctor. MRI’s revealed  a grade III ACL tear. Swelling is still present but is significantly less than  what was present on her last visit. The doctor has advised that she  continue to use crutches and begin physiotherapy treatment to improve  the strength and range of motion at her knee. Given her diagnosis, what  resting position would the therapist expect to find the patients knee in? 

• A. Full extension 

• B. 15-25 degrees of flexion correct 

• C. 5-15 degrees of flexion 

• D. 25-40 degrees of flexion

B

a. Full extension 

b. 15-25 degrees of flexion - CORRECT 

o With swelling, the knee assumes its resting position of 15-25  degrees of flexion, which allows the synovial cavity the  

maximum capacity for holding fluid. 

c. 5-15 degrees of flexion 

d. 25-40 degrees of flexion

A physiotherapist is working in private practice. His caseload includes  many high-level athletes. A new patient arrives for an assessment after a  right knee injury while playing soccer. When asked about the mechanism  of injury, the patient states that she planted and twisted her knee and  heard a pop. The injury occurred 2 days ago, and since then she not been  able to bear any weight through her knee since and is hopping on her left  leg. She has not yet seen her doctor. 

Q9. The therapist is goal oriented to improve the patient’s knee ROM over  the next few weeks of therapy. She is focused on improving knee  extension. Which of the following is most likely the rationale behind the  therapist’s focus on improving full knee extension ROM over full knee  flexion ROM? 

• A. Full knee flexion ROM is required for kneeling 

• B. Everyday functional activities only require around 60 degrees of  flexion 

• C. Knee extension is required for a normal gait pattern

• D. Knee extension of at least 20 degrees is important to facilitate the  screw home mechanism

C

a. Full knee flexion ROM is required for kneeling 

o Although this is a correct statement, it is not a goal of  treatment. 

b. Everyday functional activities only require around 60 degrees of  flexion 

o This statement is incorrect – Approximately 120 degrees of  flexion is required for pulling on sock and tying a shoelace.  Sitting in a chair requires 90 degrees of flexion and climbing  the stairs require approximately 80 degrees of flexion. 

c. Knee extension is required for a normal gait pattern - CORRECT

o This statement is the best rationale for the goal of increasing  extension ROM– normal gait and standing require full knee  extension which is why terminal knee extension is critical to  restore after knee injury. 

d. Knee extension of at least 20 degrees is important to facilitate the  screw home mechanism 

o The screw home mechanism of the knee occurs at the END of  full extension and is a key element of knee stability. 

A physiotherapist is working in private practice. His caseload includes  many high-level athletes. A new patient arrives for an assessment after a  right knee injury while playing soccer. When asked about the mechanism  of injury, the patient states that she planted and twisted her knee and  heard a pop. The injury occurred 2 days ago, and since then she not been  able to bear any weight through her knee since and is hopping on her left  leg. She has not yet seen her doctor. 

Q10. During a follow up appointment, the physiotherapist notices that the  patient is slurring her speech and appears intoxicated. When confronted  about this, she denies taking any drugs or alcohol and states she is just  really tired. The physiotherapist still feels uncertain as to the sobriety of  the patient. How should the physiotherapist proceed? 

• A. Gain consent from her boyfriend who is present for treatment as  the patient is unable to provide it for herself 

• B. Carry on with treatment as she has denied taking any drugs or  alcohol and the therapist is not introducing any new treatment  techniques today 

• C. Educate the patient that treatment cannot be carried out today as  the therapist is uncertain if she has the capacity to provide consent

• D. Discharge the patient from treatment as she is a risk to both the  therapist and herself 

C

a. Gain consent from her boyfriend who is present for treatment as  the patient is unable to provide it for herself 

o You do not know if her boyfriend is her power of attorney and  can even provide consent for the patient. This also does not  change the fact that if she is intoxicated, she cannot provide  

proper feedback which puts her at risk of injury during the  treatment. 

b. Carry on with treatment as she has denied taking any drugs or  alcohol and the therapist is not introducing any new treatment  techniques today

o While you are not introducing any new treatment, this does  not change the fact that if she is intoxicated, she cannot  provide proper feedback which puts her at risk of injury  during the treatment. 

c. Educate the patient that treatment cannot be carried out today as  the therapist is uncertain if she has the capacity to provide consent - CORRECT 

o Every time someone arrives for an appointment, you need to  decide if the person can provide consent. You start by  

assuming that they’re capable, unless the person is obviously  impaired. If the person is obviously impaired, either from non prescription or prescription medication, inform them that  you’re unable to provide treatment because you believe that  they’re impaired. 

o Educate them why you cannot treat them – they are not  capable of providing consent and the treatment would be  risky to them in their condition – they cannot provide proper  feedback during treatment and this could result in injury. 

d. Discharge the patient from treatment as she is a risk to both the  therapist and herself 

o There is no reason to discharge the patient immediately. 

o Reschedule and ask that they refrain from drinking or  ingesting before their next appointment. 

A physiotherapist is mentoring a student who is completing her first  placement for physiotherapy school. The placement is in an acute  neurological ward at the local hospital. The student is at the top of her  class and is keen, punctual and learning quickly. After a few weeks on  placement, the physiotherapist feels that the student is ready to perform  her own assessment. She suggests that she assess their new patient who  sustained a spinal cord injury and was diagnosed as a T9 ASIA A. 

Q11. How should the physiotherapist proceed in gaining consent from the  patient? 

• A. The student can gain consent to assess the patient as long as the  physiotherapist is in the room 

• B. The physiotherapist should not allow the student to assess the  patient as they do not have enough experience 

• C. The physiotherapist should ask the patient if they give consent to  be assessed by the student

• D. Consent is implied as they are working in a public hospital and  providing care that is in the best interest of the patient 

C

a. The student should gain consent to assess the patient as long as the  physiotherapist is in the room 

o While the student should ask for consent before proceeding,  this is not the BEST answer as the physiotherapist should gain  consent first. 

b. The physiotherapist should not allow the student to assess the  patient as they do not have enough experience 

o The physiotherapist should stay in the room to aid the student  during the assessment, but there is no reason that they  

cannot allow them to practice an assessment for learning  purposes. It is the job of the physiotherapist to ensure the  safety of the patient by observing. This is a great learning  opportunity for the student.

c. The physiotherapist should ask the patient if they give consent to be  assessed by the student - CORRECT 

o It is up to the physiotherapist to educate the patient that they  will be assessed by a student for learning purposes so that the  patient can make an informed decision if they want to  proceed. 

d. Consent is implied as they are working in a public hospital and  providing care that is in the best interest of the patient 

o You cannot assume implied consent just because your patient  is in a hospital. You still need to inform them of the treatment  plan and gain consent.

A physiotherapist is mentoring a student who is completing her first  placement for physiotherapy school. The placement is in an acute  neurological ward at the local hospital. The student is at the top of her  class and is keen, punctual and learning quickly. After a few weeks on  placement, the physiotherapist feels that the student is ready to perform  her own assessment. She suggests that she assess their new patient who  sustained a spinal cord injury and was diagnosed as a T9 ASIA A. 

Q12. During the assessment, the patient asks if they will ever walk again.  The student does not know what to say so she looks to the  physiotherapist for an answer. How should the physiotherapist respond? 

• A. Patients with complete T9 injuries will never walk again but will be  able to stand with HKAFO’s and parallel bars 

• B. Patients with complete T9 injuries will walk short distances but  only with HKAFO’s and parallel bars 

• C. Patients with complete T9 injuries will never be able to walk or  stand again 

• D. Patients with complete T9 injuries will be able to walk short  distances but only with KAFO’s and a walker or bilateral forearm  crutches

a. Patients with complete T9 injuries will never walk again but will be  able to stand with HKAFO’s and parallel bars 

b. Patients with complete T9 injuries will walk short distances but only  with HKAFO’s and parallel bars 

o This is true for patients with high T-sp lesions (T2-T6). 

c. Patients with complete T9 injuries will never be able to walk or stand  again 

d. Patients with complete T9 injuries will be able to walk short  distances but only with KAFO’s and a walker or bilateral forearm  crutches – CORRECT

o Patients with SCI T7-T12 have the potential to ambulate with  KAFO’s and a gait aid such as a walker or bilateral forearm  crutches.

A physiotherapist is mentoring a student who is completing her first  placement for physiotherapy school. The placement is in an acute  neurological ward at the local hospital. The student is at the top of her  class and is keen, punctual and learning quickly. After a few weeks on  placement, the physiotherapist feels that the student is ready to perform  her own assessment. She suggests that she assess their new patient who  sustained a spinal cord injury and was diagnosed as a T9 ASIA A. 

Q13. The student is asking the physiotherapist about ventilator settings.  While this is something that the physiotherapist has learned a bit about  over the last year while working on the ward, it is not something they feel  100% confident in answering. How should the physiotherapist proceed  with answering the student’s questions? 

• A. Set up a day for her to shadow the respiratory therapists to learn  more about that area of practice

• B. Tell her that it is beyond our scope of practice and she should not  pay attention to ventilator settings as a student 

• C. Answer ventilator setting questions that she feels comfortable  answering 

• D. Provide her with some respiratory therapist resources for home  study 

A
a. Set up a half day for her to shadow the respiratory therapists to  learn more about that area of practice - CORRECT 

o While respiratory therapy (RT) is not part of the physiotherapy  scope of practice, learning about the other disciplines that  work along with the physiotherapists is a great learning  

opportunity for a student. A half day will not significantly alter  the course of the placement and will give the student a better  overall understanding of what RT’s do.

b. Tell her that it is beyond our scope of practice and she should not  pay attention to ventilator settings as a student 

o While ventilator settings are beyond the scope of PT practice,  simply telling the student not to pay attention to them is not  the best learning opportunity. Fostering an understanding of  the multidisciplinary team is important for students early in  their placements and that learning opportunity should be  supported, not ignored. 

c. Answer ventilator setting questions that she feels comfortable  answering 

o Although this is not wrong, if the option is available, education  about ventilator settings are best provided by an RT. 

d. Provide her with some respiratory therapist resources for home  study 

o While this answer is not wrong, it is not the BEST answer. The  student does not need to go home and study RT based topics,  an interactive day of learning will be more beneficial.

A physiotherapist is mentoring a student who is completing her first  placement for physiotherapy school. The placement is in an acute  neurological ward at the local hospital. The student is at the top of her  class and is keen, punctual and learning quickly. After a few weeks on  placement, the physiotherapist feels that the student is ready to perform  her own assessment. She suggests that she assess their new patient who  sustained a spinal cord injury and was diagnosed as a T9 ASIA A. 

Q14. While practicing standing with the patient, the physiotherapist and  her student have been using off-the-shelf bracing from the hospital  storage room. The physiotherapist feels that custom bracing would be  best for this patient. What is the best approach when referring a patient  for custom bracing? 

• A. Provide the patient with a list of local orthotists from which they  can choose 

• B. Provide the patient with the name of a local orthotist with whom  you refer back and forth with 

• C. Let the patient search for a local orthotist on their own 

• D. Provide the patient with the names of a few local orthotists who  come highly recommended

D
a. Provide the patient with a list of local orthotists from which they can  choose 

o This answer is correct but is not the BEST answer. 

b. Provide the patient with the name of a local orthotist with whom  you refer back and forth with 

o This is incorrect as you are limiting your patient’s choice of  orthotists and picking someone for them for your own benefit. 

o Based on the core standards of practice under “Conflict of  Interest”, the physiotherapist must identify and manage any  situations of real, potential or perceived conflicts of interest.  This includes but is not limited to:

▪ Providing and/or accepting incentives to/from others to  generate referrals, provide services, or sell products 

c. Let the patient search for a local orthotist on their own 

o This is an option, but not the BEST answer. Providing your  patient with a list of orthotists from which to choose is helpful  and will benefit the patient so that they don’t have to spend  time searching. 

d. Provide the patient with the names of a few local orthotists who  come highly recommended - CORRECT 

o This is the BEST option. It gives the patient choice, but they will  also benefit from your insight of which orthotists have been  highly recommended. There is no financial or referral gain  here for you. 

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q15. The first referral the clinic receives is for a 3-year child with spastic  quadriplegia. On assessment, the therapist notices that the child still has a  strong tonic labyrinthine reflex (TLR). Which of the following accurately  describes the TLR? 

• A. When head is in flexion, arms are flexed and legs are extended.  When head is in extension, arms are extended and legs are flexed 

• B. When the head is turned to one side, the arm and leg on the face  side extend and the arm and leg on the scalp side flex 

• C. In supine position, the body and extremities are held in extension.  In the prone position, body and extremities are held in flexion

• D. The child will open their arms (abduction), open their hands and  cry out loudly. This is followed by bringing the arms back to their  chest (horizontal adduction) with clenched fists 

C

a. When head is in flexion, arms are flexed and legs are extended.  When head is in extension, arms are extended and legs are flexed 

o This is describing the Symmetrical Tonic Neck Reflex (STNR) 

b. When the head is turned to one side, the arm and leg on the face  side extend and the arm and leg on the scalp side flex 

o This is describing the Asymmetrical Tonic Neck Reflex (ATNR) 

c. In supine position, the body and extremities are held in extension. In  the prone position, body and extremities are held in flexion - CORRECT 

o This is describing the Tonic Labyrinthine Reflex (TLR) 

d. The child will open their arms (abduction), open their hands and cry  out loudly. This is followed by bringing the arms back to their chest  (horizontal adduction) with clenched fists

o This is describing the Moro reflex which is likely to occur if the  infant's head suddenly shifts position in relation to the trunk.

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q16. The physiotherapist is explaining to the mother that her daughter’s  abnormal movements are due to primitive reflexes that are not properly  integrated as a result of her brain injury. Which of the following  statements regarding primitive reflexes is false? 

• A. Primitive reflexes are inhibited as the cortex develops 

• B. Primitive reflexes lay the foundation for higher-level motor and  cognitive skills 

• C. Non-integrated reflexes impact the fluidity and smoothness with  which an individual moves 

• D. Once a primitive reflex has been integrated, it will never return

a. Primitive reflexes are inhibited as the cortex develops 

b. Primitive reflexes lay the foundation for higher-level motor and  cognitive skills 

c. Non-integrated reflexes impact the fluidity and smoothness with  which an individual moves 

d. Once a primitive reflex has been integrated, it will never return – FALSE 

o This statement is false. An adult with a brain injury (e.g. CVA,  TBI) may exhibit primitive reflexes affecting voluntary movement control and posture.

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q17. A new mother arrives with her 3-month-old son who has been  diagnosed with right torticollis. Which of the following correctly describes  the position of stretch you want to teach his mother? 

• A. The head is rotated towards the right and side flexed towards the  left 

• B. The head is rotated towards the left and side flexed towards the  right wrong 

• C. The head is rotated towards the right and side flexed towards the  right 

• D. The head is rotated towards the left and side flexed towards the  left 

A
a. The head is rotated towards the right and side flexed towards the  left - CORRECT 

o Right torticollis refers to the right sternocleidomastoid (SCM)  muscle being tight. If the right SCM is tight, the baby’s head  will be positioned into left rotation and right side flexion. The  head is always rotated away and side flexed towards from the  side of tightness. In order to stretch this muscle, you would do  the opposite of its action, right rotation and left side flexion. 

b. The head is rotated towards the left and side flexed towards the  right

c. The head is rotated towards the right and side flexed towards the  right 

d. The head is rotated towards the left and side flexed towards the left 

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q18. Upon a follow up appointment with your patient with torticollis, you  notice a few burn marks on his back that appear to be cigarette burns.  You ask the mother about the burns and she states that she was cooking  and some hot oil accidently splattered on his back. She appears loving  during the session but the therapist is not sure if she is telling the truth.  How should the physiotherapist proceed? 

• A. Continue with the therapy session, document the observations as  well as the interaction with the mother and monitor the baby for  any future marks 

• B. Continue with the therapy session, document the observations as  well as the interaction with the mother and then contact social  services after the sessions for investigation into the welfare of the  child

• C. Stop the physiotherapy session and demand that the mother tells  you what has really happened to the child 

• D. Stop physiotherapy session and call social services immediately  as the child’s life may be in danger 

B
a. Continue with the therapy session, document the observations as  well as the interaction with the mother and monitor the baby for  any future marks

o It is mandatory that you report suspected child abuse to the  proper authorities. This can be the local police or child  

protective services. 

b. Continue with the therapy session, document the observations as  well as the interaction with the mother and then contact child  protective services after the sessions for investigation into the  welfare of the child - CORRECT 

o A physiotherapist who has reason to believe that a minor has  been or is likely to be abused or neglected, has a legal duty to  report the matter. 

o It is mandatory that you report any and all suspected child  abuse to the proper authorities. The exact authority of where  you report will differ province to province so you will not be  asked that in specific detail. You must, however, know that  even suspected child abuse is mandatory to report to proper  authorities. 

c. Stop the physiotherapy session and demand that the mother tells  you what has really happened to the child 

o You do not want to put yourself in a dangerous position where  the mother could get aggressive with you. It is best to follow  through with reporting in the least combative manner. 

d. Stop physiotherapy session and call social services immediately as  the child’s life may be in danger 

o While you must report the suspected child abuse, you can  finish the session, unless you felt that the child’s life was in  imminent danger, then you would called 911 immediately.

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q19. A 3-year-old child with Erb’s palsy arrives for an assessment. Both of  the physiotherapists working at the clinic are unfamiliar with this  condition. One of the physiotherapists agrees to assess the child after  doing some research online about the condition. Upon entering the  treatment room, which position would the therapist expect the child’s arm  to be in? 

• A. Adduction and internal rotation of the glenohumeral joint;  extension of the elbow; pronation of the forearm; flexion of the  wrist

• B. Adduction and internal rotation of the glenohumeral joint; flexion  of the elbow; pronation of the forearm; extension of the wrist 

• C. Abduction and external rotation of the glenohumeral joint; flexion  of the elbow; pronation of the forearm; extension of the wrist 

• D. Adduction and external rotation of the glenohumeral joint;  extension of the elbow; pronation of the forearm; flexion of the  wrist 

A
a. Adduction and internal rotation of the glenohumeral joint; extension  of the elbow; pronation of the forearm; flexion of the wrist - CORRECT 

o This correctly describes the characteristic for Erb’s palsy. 

b. Adduction and internal rotation of the glenohumeral joint; flexion of  the elbow; pronation of the forearm; extension of the wrist 

c. Abduction and external rotation of the glenohumeral joint; flexion of  the elbow; pronation of the forearm; extension of the wrist 

d. Adduction and external rotation of the glenohumeral joint;  extension of the elbow; pronation of the forearm; flexion of the  wrist

A new pediatric private practice clinic has opened and has hired several  physiotherapists. One of the physiotherapists has extensive experience in  plagiocephaly and torticollis. The other physiotherapist has extensive  experience working with children with Cerebral Palsy. 

Q20. Which spinal segments are affected in Erb’s palsy? 

• A. C8-T1 

• B. C5-6  

• C. C5-T1 

• D. C5-C7 

B
a. C8-T1 

b. C5-6 - CORRECT 

o Results from an injury to the superior trunk of the brachial  plexus. 

o The most commonly involved root is C5 (aka Erb's point: the  union of C5 & C6 roots) as this is mechanically the furthest  point from the force of traction, therefore, the first/most  affected. 

o Erb's palsyis frequently caused by shoulder dystocia during a  difficult birth. Infants with this condition usually can't move  the affected shoulder or upper arm, but they may be able to  wiggle their fingers. 

o The most commonly involved nerves are: 

▪ Suprascapular nerve – supraspinatus/infraspinatus  

weakness (loss of abduction and external rotation) 

▪ Musculocutaneous nerve – biceps/brachialis weakness  (loss of elbow flexion) 

▪ Axillary nerve – Teres Minor and deltoid weakness (loss  of abduction and external rotation) 

o The signs of Erb's palsy include loss of sensation in the arm  and paralysis and atrophy of the deltoid, biceps, and brachialis 

muscles. The muscle paralysis results in a characteristic  position commonly called "waiter's tip": the arm hangs by the  side and is rotated medially; the elbow is extended; the  forearm is pronated and the wrist flexed. 

c. C5-T1 

d. C5-C7 

A physiotherapist is working with a patient who was referred to  physiotherapy by their physician. The family physician requested 4  sessions a week for treatment of patellofemoral pain syndrome. The  patient’s history includes an increase in running distance as he is training  for a marathon. His medical history is otherwise remarkable. Upon  assessment, the physiotherapist notes that the patient has pronating feet,  bilateral gluteus medius weakness and tight iliotibial bands. 

Q21. The physiotherapist decides to measure the patient’s Q-angle. Which  of the following statements properly describes measurement of the Q angle? 

• A. A line is drawn from ASIS to the midpoint of the patella on the  same side and from the tibial tubercle to the midpoint of the patella.  The angle formed by the crossing of these two lines is called the Q angle

• B. A line is drawn from ASIS to the midpoint of the patella on the  same side. This line is compared to a vertical line and the angle  formed is called the Q-angle 

• C. A line is drawn from the ASIS to the tibial tubercle on the same  side. This line is compared to a vertical line and the angle formed is  called the Q-angle 

• D. A line is drawn from ASIS to the tibial tubercle on the same side  and from the tibial tubercle to the midpoint of the patella. The angle  formed by the crossing of these two lines is called the Q-angle 

A
a. A line is drawn from ASIS to the midpoint of the patella on the same  side and from the tibial tubercle to the midpoint of the patella. The  angle formed by the crossing of these two lines is called the Q angle – CORRECT 

o The Q-angle (quadriceps angle) is defined as the angle  between the quadriceps muscle and the patellar tendon and  represents the angle of quadriceps muscle force. This  

describes the correct way to measure this angle.

b. A line is drawn from ASIS to the midpoint of the patella on the same  side. This line is compared to a vertical line and the angle formed is  called the Q-angle 

c. A line is drawn from the ASIS to the tibial tubercle on the same side.  This line is compared to a vertical line and the angle formed is called  the Q-angle 

d. A line is drawn from ASIS to the tibial tubercle on the same side and  from the tibial tubercle to the midpoint of the patella. The angle  formed by the crossing of these two lines is called the Q-angle 

A physiotherapist is working with a patient who was referred to  physiotherapy by their physician. The family physician requested 4  sessions a week for treatment of patellofemoral pain syndrome. The  patient’s history includes an increase in running distance as he is training  for a marathon. His medical history is otherwise remarkable. Upon  assessment, the physiotherapist notes that the patient has pronating feet,  bilateral gluteus medius weakness and tight iliotibial bands. 

Q22. The physiotherapist measures the patients Q-angle as 17 degrees.  Which of the following statements is true regarding the Q-angle? 

• A. Normal Q-angle is 8 degrees for men and 12 degrees for women 

• B. Femoral neck retroversion and medial tibial torsion increase the  Q-angle and lead to lateral tracking of the patella 

• C. Femoral neck anteversion and lateral tibial torsion increase the Q angle and lead to lateral tracking of the patella

• D. Women often have a larger Q-angle than men because of narrow  hips 

C

a. Normal Q-angle is 8 degrees for men and 12 degrees for women - FALSE 

o Normal Q-angle is 13 degrees for men and 18 degrees for  women. 

b. Femoral neck retroversion and medial tibial torsion increase the Q angle and lead to lateral tracking of the patella -FALSE 

o Femoral neck retroversion and medial tibial torsion decrease  the Q-angle and tends to centralize the tracking of the patella. 

c. Femoral neck anteversion and lateral tibial torsion increase the Q angle and lead to lateral tracking of the patella- TRUE 

o Femoral anteversion results in internal rotation of the femur  which places the patella significantly more medial than the  ASIS. The internal rotation of the femur also influences the  tibia resulting in external torsion of the tibia in relation to the 

femur. The external rotation of the tibia displaces the tibial  tubercle laterally further increasing the Q-angle. 

d. Women often have a larger Q-angle than men because of narrow  hips – FALSE 

o Women have a wider pelvis than men which contributes to a  larger Q-angle. 

A physiotherapist is working with a patient who was referred to  physiotherapy by their physician. The family physician requested 4  sessions a week for treatment of patellofemoral pain syndrome. The  patient’s history includes an increase in running distance as he is training  for a marathon. His medical history is otherwise remarkable. Upon  assessment, the physiotherapist notes that the patient has pronating feet,  bilateral gluteus medius weakness and tight iliotibial bands. 

Q23. The physiotherapist provides the patient with a home exercise  program that includes stretching and strengthening exercises. They  educate the patient on cross training and suggest custom orthotics to help  improve foot alignment. The physiotherapist feels that weekly  appointments are adequate as long as the patient is diligent about activity  modification and their home exercise program. How should the  physiotherapist proceed with scheduling follow up appointments? 

• A. Schedule the patient for 4 sessions a week as per the physician  referral 

• B. Compromise with the physician by scheduling them 2-3 times a  week and notify the referring physician about the rational and plan 

• C. Schedule the patient once a week and notify the referring  physician about the rational and plan

• D. Determine how much the patient’s insurance will cover before  deciding on the number of treatment sessions per week 

C

a. Schedule the patient for 4 sessions a week as per the physician  referral 

o This is an incorrect statement. Treatments should be based on  the client’s needs. It is up to the physiotherapist to use their  discretion as to the number of sessions the patient needs for  follow up to ensure that they are only providing sessions that  are required and beneficial for the patient. 

b. Compromise with the physician by scheduling them 2-3 times a  week and notify the referring physician about the rational and plan

o This is an incorrect statement. Treatments should be based on  the client’s needs, not solely based on a physician referral. 

c. Schedule the patient once a week and notify the referring physician  about the rational and plan – CORRECT 

o If 4 sessions a week is excessive, the physiotherapist must  maintain open communication with the referring physician as  to the rationale behind 1x/week sessions. This is to ensure  that the focus is always a client centered. 

d. Determine how much the patient’s insurance will cover before  deciding on the number of treatment sessions per week 

o This is an incorrect statement. Treatments should be based on  the client’s needs, not solely based on how much the  

insurance will cover. You would never continue with 4x/week  just because insurance will cover the sessions if those sessions  are not necessary. 

A physiotherapist is working with a patient who was referred to  physiotherapy by their physician. The family physician requested 4  sessions a week for treatment of patellofemoral pain syndrome. The  patient’s history includes an increase in running distance as he is training  for a marathon. His medical history is otherwise remarkable. Upon  assessment, the physiotherapist notes that the patient has pronating feet,  bilateral gluteus medius weakness and tight iliotibial bands. 

Q24. The physiotherapist decides to trial neuromuscular electrical  stimulation (NMES) to increase the activation of the patient’s vastus  medialis muscle. Which of the following parameters should the  physiotherapist choose? 

• A. Frequency: 65Hz; Pulse Width: 300µs

• B. Frequency: 10Hz; Pulse Width: 200µs 

• C. Frequency: 300Hz; Pulse Width: 65µs 

• D. Frequency: 150Hz; Pulse Width: 60µs 

A
a. Frequency: 65Hz; Pulse Width: 300µs - CORRECT 

o This is the correct setting for a tetanic muscle contraction  required for strengthening. 

b. Frequency: 10Hz; Pulse Width: 200µs 

o This is the correct setting for stimulating a muscle twitch  which is used in acupuncture-like TENS when treating chronic  pain. 

c. Frequency: 300Hz; Pulse Width: 65µs 

o This is not a correct setting for any condition/treatment. d. Frequency: 150Hz; Pulse Width: 60µs 

o This is the correct setting for stimulating sensory nerves  (tingle) which is used in conventional TENS when treating  acute pain.

A 70-year-old patient with Parkinson’s disease arrives for his  physiotherapy appointment with his wife. He was diagnosed 3 years ago  and has noticed an increase in his Parkinson’s symptoms which include:  decreased balance, episodes of freezing, akinesia, dyskinesia, tremor and  rigidity. Both the patient and his wife are concerned about his recent falls  which have occurred when walking alone in the house. 

Q25. Which of the following functional examples correctly describes  akinesia? 

• A. Loss of arm swing while walking

• B. Slowness of movement when asked to reach for an object • C. Small, cramped handwriting 

• D. Uncontrolled body sway and arm movements in static sitting

A
a. Loss of arm swing while walking - CORRECT 

o Akinesia refers to a lack of spontaneous movement. The lack  of arm swing while walking is an example of this. 

b. Slowness of movement when asked to reach for an object 

o Bradykinesia describes the slowness of a performed  movement. Slowness during reach is an example of  

bradykinesia, not akinesia. 

c. Small, cramped handwriting 

o Micrographia is an example of hypokinesia. 

o Hypokinesia refers to the fact that, in addition to being slow,  the movements are also smaller than desired, as in the  micrographia of patients' handwriting.

▪ i.e. there is a reduction in theamount of spontaneous  movement. 

d. Uncontrolled body sway and arm movements in static sitting o This is an example of dyskinesia. 

o Dyskinesiasare abnormal, uncontrolled, involuntary  

movements.

A 70-year-old patient with Parkinson’s disease arrives for his  physiotherapy appointment with his wife. He was diagnosed 3 years ago  and has noticed an increase in his Parkinson’s symptoms which include:  decreased balance, episodes of freezing, akinesia, dyskinesia, tremor and  rigidity. Both the patient and his wife are concerned about his recent falls  which have occurred when walking alone in the house. 

Q26. What is the main cause of the patient’s dyskinesia? 

• A. High levels of dopamine 

• B. Side effect of long-term use of Parkinson’s medication (Levodopa)

• C. Low levels of dopamine 

• D. There is no specific cause, it is the natural progression of  Parkinson’s 

B

a. High levels of dopamine 

b. Side effect of long-term use of Parkinson’s medication (Levodopa) - CORRECT 

o Dyskinesia means abnormal movement. Parkinson’s  

dyskinesia, often referred to as levodopa-induced dyskinesia,  can be described as uncontrolled jerking, dance-like or  

wriggling movements. 

o Symptoms range from minor ticks to full-body movements. In  people with PD, it is most often associated with long-term use 

of levodopa, a drug that increases levels of dopamine in the  brain. 

o As PD progresses, deteriorating dopamine brain cells have  increasing difficulty in managing normal movement. Over  time, it may be necessary to take more frequent doses of  levodopa to manage movement problems such as akinesia.  When levodopa is administered frequently throughout the  day, the levels in the blood vary significantly (highs and lows).  This has the potential to damage dopamine receptors over the  years, eventually causing PD dyskinesia. 

c. Low levels of dopamine 

d. There is no specific cause, it is the natural progression of Parkinson’s 

A 70-year-old patient with Parkinson’s disease arrives for his  physiotherapy appointment with his wife. He was diagnosed 3 years ago  and has noticed an increase in his Parkinson’s symptoms which include:  decreased balance, episodes of freezing, akinesia, dyskinesia, tremor and  rigidity. Both the patient and his wife are concerned about his recent falls  which have occurred when walking alone in the house. 

Q27. The physiotherapist gathers more information from the patient as to  the cause of his falls in order to create an appropriate home exercise  program that can help decrease his falls. The patient states that  frequently, when walking in his home, he has episodes of freezing where  he feels stuck. This causes him to lose his balance and fall. Which of the  following should the physiotherapist choose to help decrease the patients  falls? 

• A. Teach the patient dual task exercises while walking • B. Provide the patient standing static balance exercises 

• C. Provide the patient with a cane 

• D. Teach the patient temporal cue strategies while walking

D
a. Teach the patient dual task exercises while walking 

o This would not assist in the freezing which is the source of his  falls and would only further increase his falls risk due to the  increase in challenge. 

b. Provide the patient standing static balance exercises 

o This is not the BEST option as it does not address the freezing  issues. 

c. Provide the patient with a cane 

o This is not the BEST option as it does not address the freezing  issues. The patient may still have episodes of freezing even  with a cane and could still lose his balance. 

d. Teach the patient temporal cue strategies while walking - CORRECT

o Counting, chanting, singing and the use of a metronome are  examples of temporal cues that can help with episodes of  freezing. 

o The use of visual cues are also helpful such as a placing tape  on the ground where freezing usually happens – these are  special cues that help inform PD patients where to step. 

A 70-year-old patient with Parkinson’s disease arrives for his  physiotherapy appointment with his wife. He was diagnosed 3 years ago  and has noticed an increase in his Parkinson’s symptoms which include:  decreased balance, episodes of freezing, akinesia, dyskinesia, tremor and  rigidity. Both the patient and his wife are concerned about his recent falls  which have occurred when walking alone in the house. 

Q28. What outcome measure would be most appropriate in assessing this  patient’s balance? 

• A. Timed up and go

• B. 6-minute walk test 

• C. Unified Parkinson’s Disease Rating Scale (UPDRS) 

• D. Parkinson’s Disease Questionnaire (PDQ-39) 

A
a. Timed up and go - CORRECT 

o This the most appropriate measure for testing the patients  balance as it looks at functional movements from sit to stand  and can evaluate ambulation and turning which may be  problematic and reveal his episodes of freezing. 

b. 6-minute walk test 

o This is more appropriate when looking at cardiopulmonary  function and endurance. 

c. Unified Parkinson’s Disease Rating Scale (UPDRS) 

o This is a measure that can provide information about the  patient’s disease severity and track the progression of the  disease. It can also provide information as to the effectiveness  of drug therapy. 

o This is not however, the best measure for assessing a patient’s  balance. The UPDRS is more of a global assessment of all  areas of function.

d. Parkinson’s Disease Questionnaire (PDQ-39) 

o 39 item questionnaire that focuses on the subjective report of  the impact of PD on daily life. 

o While this is an important measure, it is not an option that  allows for the measurement of a patient’s balance. 

A 70-year-old patient with Parkinson’s disease arrives for his  physiotherapy appointment with his wife. He was diagnosed 3 years ago  and has noticed an increase in his Parkinson’s symptoms which include:  decreased balance, episodes of freezing, akinesia, dyskinesia, tremor and  rigidity. Both the patient and his wife are concerned about his recent falls  which have occurred when walking alone in the house. 

Q29. The patient’s wife pulls the physiotherapist aside and tells her that  she is feeling extremely burned out and does not feel like she can  continue to provide the amount of care that her husband requires. She is  terrified that she may have to put him in a care home. How should the  physiotherapist respond? 

• A. Encourage the wife to continue to stay strong as physiotherapy  will help improve his function 

• B. Suggest options for home care support through local community  companies

• C. Encourage the wife to talk to someone else about the matter as it  is not related to physiotherapy services 

• D. Tell the wife that she should definitely put him in a home as his  condition will continue to deteriorate 

B
a. Encourage the wife to continue to stay strong as physiotherapy will  help improve his function 

o This is not the BEST answer as PD is a progressive disease and  you do not know the exact impact physiotherapy will have on  his function. 

b. Suggest options for home care support through local community  companies - CORRECT 

o This is the BEST answer as it provides the wife with an option  that she may not have known about that could increase her  support while also allow her husband to stay at home 

c. Encourage the wife to talk to someone else about the matter as it is  not related to physiotherapy services

o This is not the correct answer as it provides no solution.  Ensuring that that patient and his wife are managing safely at  home is part of the physiotherapist’s role. Collaborating with  other health care workers and suggesting community support  options are definitely within the scope of practice. 

d. Tell the wife that she should definitely put him in a home as his  condition will continue to deteriorate 

o This is not the correct answer. As a physiotherapist, our job is  to support our patients and their families, not to make  decisions for them.

A physiotherapist is working on a cardiac rehabilitation unit. Before  prescribing an exercise program to their patient, they are required to  screen the patient to ensure they are ready and safe to start an exercise  program. The first patient that the physiotherapist is screening is a 58- year-old woman who suffered a myocardial infarction 1 week ago. Her  past medical history includes diabetes, high cholesterol, angina and  hypertension which is controlled with medication. 

Q30. The goal of exercise prescription is to find a safe training zone for  patients. Which of the following statements clearly describes the training safety zone? 

• A. Minimum intensity to increase the heart rate. Maximum intensity  that should not be exceeded to ensure pain free exercise 

• B. Minimum intensity of 2 on the BORG scale. Maximum intensity  that should not be exceeded to ensure safe training 

• C. Minimum intensity to provide an effective training program.  Maximum intensity that should not be exceeded to ensure safe  training

• D. Minimum intensity of 2 on the BORG scale. Maximum intensity  that should not exceed 7 on the BORG scale 

C
a. Minimum intensity to increase the heart rate. Maximum intensity  that should not be exceeded to ensure pain free exercise 

o Minimum intensity to increase the heart rate does not define  the lower limit as this could be only a few beats above the  resting heart rate and thus does not clearly define if this  increase in heart rate is enough to provide effective  

cardiovascular training. 

b. Minimum intensity of 2 on the BORG scale. Maximum intensity that  should not be exceeded to ensure safe training 

o A 2 on the BORG is described as “easy” and is the correct  intensity for warming up and is not the intensity at which you  want to exercise for training benefits.

c. Minimum intensity to provide an effective training program.  Maximum intensity that should not be exceeded to ensure safe  training - CORRECT 

o This statement defines the training-safety zone 

o This ensures that the prescribed exercise is below the upper  limit that could potentially elicit a negative response and  above the lower limit that would induce a training response. 

d. Minimum intensity of 2 on the BORG scale. Maximum intensity that  should not exceed 7 on the BORG scale 

o A 2 on the BORG is described as “easy” and is the correct  intensity for warming up and is not the intensity at which you  want to exercise for training benefits. 

o A 7 on the BORG scale is described as being “very hard” which  may be an intensity that is not safe to sustain for some  

patients. 

A physiotherapist is working on a cardiac rehabilitation unit. Before  prescribing an exercise program to their patient, they are required to  screen the patient to ensure they are ready and safe to start an exercise  program. The first patient that the physiotherapist is screening is a 58- year-old woman who suffered a myocardial infarction 1 week ago. Her  past medical history includes diabetes, high cholesterol, angina and  hypertension which is controlled with medication. 

Q31. If the physiotherapist had to predict the patient’s maximum heart  rate based solely on her age, which of the following would best represent  her maximum heart rate? 

• A. 145 

• B. 150 

• C. 130 

• D. 162

D

a. 145 

b. 150 

c. 130 

d. 162 - CORRECT 

o Exercise prescription in healthy people is often based on the  age-predicted maximal heart rate, which can be estimated by  the equation: 

▪ Age-predicted max HR = 220 - Age (years) 

o Note: Age-predicted max HR is not very specific and should  not be used for people with illness or patients who are on  medication that could alter their HR. For these individuals,  exercise prescription needs to be estimated from their  

response to exercise rather than using a % of their age 

predicted max HR.

A physiotherapist is working on a cardiac rehabilitation unit. Before  prescribing an exercise program to their patient, they are required to  screen the patient to ensure they are ready and safe to start an exercise  program. The first patient that the physiotherapist is screening is a 58- year-old woman who suffered a myocardial infarction 1 week ago. Her  past medical history includes diabetes, high cholesterol, angina and  hypertension which is controlled with medication. 

Q32. Before participating in an exercise program, patients need to be  screened to determine their risk(s). The physiotherapist has access to the  patient’s past medical history which reveals absolute contraindications to  commencing an exercise training program. Which of the following is not  an absolute contraindication to commencing an exercise training  program? 

• A. Hypoglycemia 

• B. Recent myocardial infarction (within 2 days) 

• C. Acute angina 

• D. Hyperglycemia

D
a. Hypoglycemia 

b. Recent myocardial infarction (within 2 days) 

c. Acute angina 

d. Hyperglycemia - CORRECT 

o Hyperglycemia is a precaution to commencing an exercise  training program, not an absolute contraindication. All others  are absolute contraindications to commencing an exercise  training program.

A physiotherapist is working on a cardiac rehabilitation unit. Before  prescribing an exercise program to their patient, they are required to  screen the patient to ensure they are ready and safe to start an exercise  program. The first patient that the physiotherapist is screening is a 58- year-old woman who suffered a myocardial infarction 1 week ago. Her  past medical history includes diabetes, high cholesterol, angina and  hypertension which is controlled with medication. 

Q33. Based on the patient’s history, the physiotherapist has deemed her  as high risk. A patient is deemed as high risk if they have a known  cardiovascular, pulmonary, or metabolic disease OR one or more  signs/symptoms that is suggestive of these diseases. How should the  physiotherapist proceed? 

• A. Proceed with creating a vigorous exercise program with minimal  supervision 

• B. Proceed with creating a moderate intensity exercise program with  some monitoring or minimal supervision 

• C. Proceed with creating a moderate intensity exercise program with  monitoring or minimal supervision during the initial stages of  training 

• D. Proceed with creating a moderate intensity exercise program with  mandatory monitoring and supervision during the initial stages of  training

D
a. Proceed with creating a vigorous exercise program with minimal  supervision 

o This would be appropriate for a person who is deemed low  risk. 

o Low risk = Young (men younger than 45yrs; women younger  than 55yrs) and no more than one cardiovascular risk factor. 

b. Proceed with creating a moderate intensity exercise program with  some monitoring or minimal supervision

o This would be appropriate for a person who is deemed  moderate risk. 

o Moderate risk = Older OR 2 or more cardiovascular risk  factors. 

c. Proceed with creating a moderate intensity exercise program with  monitoring or minimal supervision during the initial stages of  training 

d. Proceed with creating a moderate intensity exercise program with  mandatory monitoring and supervision during the initial stages of  training - CORRECT 

o This would be appropriate for a person who is deemed high  risk. 

o High risk = They have a known cardiovascular, pulmonary, or  metabolic disease OR one or more signs/symptoms that is  suggestive of these diseases. 

A physiotherapist is working on a cardiac rehabilitation unit. Before  prescribing an exercise program to their patient, they are required to  screen the patient to ensure they are ready and safe to start an exercise  program. The first patient that the physiotherapist is screening is a 58- year-old woman who suffered a myocardial infarction 1 week ago. Her  past medical history includes diabetes, high cholesterol, angina and  hypertension which is controlled with medication. 

Q34. After several days of participation in the new exercise training  program (a walking program), the physiotherapist has deemed the patient  safe to continue without any supervision or monitoring. The  physiotherapist wants the patient to continue to walk at a moderate  intensity to ensure they stay within a safe training zone. Which of the  following statements should the physiotherapist use when educating the  patient about the BORG rating of perceived exertion (RPE) scale? 

• A. Exercise at an intensity of 1-2/10. This is an intensity where you  are able to sing uninterrupted while exercising 

• B. Exercise at an intensity of 3-4/10. This is an intensity where you  are able to maintain an uninterrupted conversation while exercising

• C. Exercise at an intensity of 5-6/10. This is an intensity where you  are able to maintain an uninterrupted conversation while exercising 

• D. Exercise at an intensity of ≥7/10. This is an intensity that generally  cannot be sustained for longer than 10 minutes

B

a. Exercise at an intensity of 1-2/10. This is an intensity where you are  able to sing uninterrupted while exercising 

o This is defined as light intensity. 

b. Exercise at an intensity of 3-4/10. This is an intensity where you are  able to maintain an uninterrupted conversation while exercising - CORRECT 

o This is defined as moderate intensity.

c. Exercise at an intensity of 5-6/10. This is an intensity where you are  able to maintain an uninterrupted conversation while exercising 

o Working at a 5-6/10 is defined as vigorous intensity. This is an  intensity where you are not able to maintain a conversation  uninterrupted while exercising. 

d. Exercise at an intensity of ≥7/10. This is an intensity that generally  cannot be sustained for longer than 10 minutes 

o This is defined as high intensity. 

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q35. While reviewing literature on lumbar spine anatomy, he finds  information about the vertebra of the spine. Which of the following  statements is true regarding the vertebra in the lumbar spine? 

• A. In the lumbar spine, the transverse processes are at the same  level as the spinous processes

• B. Because of the shape of the lumbar facet joints, side flexion of the  lumbar spine is minimal 

• C. The closed packed position of the facet joints in the lumbar spine  is flexion 

• D. The capsular pattern of the lumbar spine is side flexion and  extension equally limited followed by rotation 

A

a. In the lumbar spine, the transverse processes are at the same level  as the spinous processes - TRUE 

o This is a true statement. In the lumbar spine, the transverse  processes and spinous processed are virtually at the same  level. 

b. Because of the shape of the lumbar facet joints, side flexion of the  lumbar spine is minimal - FALSE 

o The shape of the lumbar facet joints results in limited rotation.  Side flexion, extension and flexion can all occur at in the  lumbar spine but the direction of movement is controlled by  the shape of the facet joints.

c. The closed packed position of the facet joints in the lumbar spine is  flexion - FALSE 

o The closed pack position of the facet joints in the lumbar spine  is extension. 

d. The capsular pattern of the lumbar spine is side flexion and  extension equally limited followed by rotation - FALSE 

o The capsular pattern of the lumbar spine is side flexion and  rotation equally limited followed by extension. 

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q36. After comparing his patient’s presentation to some literature, he  determines his patient’s physiotherapy diagnosis. Which diagnosis has the  physiotherapist chosen? 

• A. Facet joint dysfunction 

• B. Disc herniation with nerve root irritation 

• C. Minor disc herniation without nerve root involvement

• D. Spinal stenosis 

C
a. Facet joint dysfunction 

o Location of worst pain: Back/buttocks 

o Myotomes/dermatomes: Myotomes seldom affected;  Dermatomes not affected 

o Aggravating movements: Extension/Rotation 

o Relieving movements: Flexion 

o Onset: Minutes to hours 

b. Disc herniation with nerve root irritation 

o Location of worst pain: Leg (usually below the knee) 

o Myotomes/dermatomes: Myotomes commonly affected; Pain  in dermatomes 

o Aggravating movements: Flexion

o Relieving movements: Extension 

o Onset: Hours to days 

c. Minor disc herniation without nerve root involvement - CORRECT o Location of worst pain: Back/buttocks 

▪ This is true in this patient’s case 

o Myotomes/dermatomes: Myotomes seldom affected;  Dermatomes not affected 

▪ This is true in this patient’s case 

o Aggravating movements: Flexion; Stiff in morning 

▪ This is true in this patient’s case – difficulty with  

prolonged sitting (a flexed position) 

o Relieving movements: Extension 

▪ This is true in this patient’s case – relieved by  

walking/standing (extended positions) 

o Onset: Hours to days 

▪ This is true in this patient’s case – acute onset over a few  days 

d. Spinal stenosis 

o Location of worst pain: Leg (usually below the knee); May be  bilateral 

o Myotomes/dermatomes: Myotomes commonly affected; Pain  in dermatomes 

o Aggravating movements: Extension (walking) 

o Relieving movements: Flexion (sitting) 

o Onset: Usually with walking 

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q37. Based on the patient’s diagnosis and current condition, what is the  first piece of education that the physiotherapist should include when he  sees this patient next? 

• A. Sleeping positions 

• B. Sitting posture

• C. Standing posture 

• D. Pacing and planning 

B
a. Sleeping positions 

o This is not the BEST answer as it does not state anywhere in  the vignette that this patient is having trouble sleeping. 

b. Sitting posture - CORRECT 

o Given that this patient is experiencing pain with prolonged  sitting, it is critical to educate them about correct sitting  posture to improve their condition. Prolonged sitting with a  flexed lumbar spine can further exacerbate the condition and  delay recovery. 

c. Standing posture 

o This is not the BEST answer as the patient feels good when  standing/walking because his lumbar spine is positioned into  relative extension. 

d. Pacing and planning

o While this is an important aspect of education, it is not the  BEST answer as education on sitting posture is the first priority  and thus the BEST answer.

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q38. Based on the literature the physiotherapist read, he wants to  educate his patient about the function of the intervertebral discs. Which of  the following would not be included when educating the patient about  intervertebral discs? 

• A. The shape of an intervertebral disc corresponds to the vertebral  body to which it is attached 

• B. Intervertebral discs have an extensive nerve supply

• C. Intervertebral discs allow for the passage of the nerve roots out  from the spinal cord through the intervertebral foramina 

• D. Intervertebral discs initially contain approximately 85-90% water,  but this decreases to 65% with age 

B

a. The shape of an intervertebral disc corresponds to the vertebral  body to which it is attached - TRUE 

b. Intervertebral discs have an extensive nerve supply - FALSE 

o The intervertebral disc has virtually no nerve supply except  the peripheral posterior aspect of the annulus fibrosus which  is innervated by a few nerve fibers. 

o The pain sensitive structures around the intervertebral discs  include the following: anterior longitudinal ligament, posterior  longitudinal ligament, vertebral body, nerve root and cartilage  of the facet joint.

c. Intervertebral discs allow for the passage of the nerve roots out  from the spinal cord through the intervertebral foramina - TRUE 

d. Intervertebral discs initially contain approximately 85-90% water, but  this decreases to 65% with age - TRUE

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q39. There are 4 types of possible intervertebral disc herniations. Which  of the following is correct with respect to the extent of damage to the disc  starting with least amount of disc damage moving to the most extensive  disc damage? 

• A. Protrusion; Extrusion; Sequestration; Prolapse 

• B. Protrusion; Prolapse; Extrusion; Sequestration

• C. Extrusion; Prolapse; Sequestration; Protrusion 

• D. Sequestration; Protrusion; Prolapse; Extrusion 

B

1. Protrusion; Extrusion; Sequestration; Prolapse 

2. Protrusion; Prolapse; Extrusion; Sequestration - CORRECT 

o Disc protrusion: Disc (nucleus pulposus) bulges posteriorly  without rupture of the annulus fibrosus. 

o Disc prolapse: Only the outermost fibers of the annulus  fibrosus contain the nucleus pulposus. 

o Disc extrusion: The annulus fibrosus is perforated and part of  the nucleus pulposus moves into the epidural space. 

o Disc sequestration: Fragments from the annulus fibrosis and  nucleus pulposus collect outside of the disc proper. 

3. Extrusion; Prolapse; Sequestration; Protrusion 

4. Sequestration; Protrusion; Prolapse; Extrusion

A new graduate physiotherapist has been working for 3 months in private  practice. He is seeing a lot of patients with back pain and is finding  problems in the lumbar spine are difficult to diagnose. He decides to  review the literature on the lumbar spine to aid in the diagnosis of one of  his current patients. This patient is a 40-year-old male with an acute onset  of low back pain. His pain gradually increased over a few days and is  localized mostly to the lower back and upper buttocks. He feels stiff and  sore in the morning and finds prolonged sitting to be bothersome.  Standing and walking tend to relieve his pain. No fatigable weakness was  noted on examination. 

Q40. When performing a lumbar spine scan, it is critical to ensure the  patient does not have a serious spinal pathology. Which of the following  questions is asked when ruling out cauda equina syndrome? 

• A. Do you have difficulty with urination?

• B. Are you suffering from widespread unilateral leg weakness?

• C. Do you suffer from constipation? 

• D. Do you have decreased sensation in the groin area?

A

a. Do you have difficulty with urination? - CORRECT 

o Difficulty with micturition (urination) is one of the cauda  equina questions. The other questions include: 

1. Loss of anal sphincter tone or fecal incontinence? 

2. Saddle anesthesia? 

3. Widespread or progressive motor weakness in both legs  OR gait disturbances? 

b. Are you suffering from widespread unilateral leg weakness? 

o Incorrect – It is important to ask about  

widespread, bilateral motor weakness in the legs. 

c. Do you suffer from constipation? 

o Incorrect – It is important to ask about fecal incontinence NOT  if they are constipated.

d. Do you have decreased sensation in the groin area? 

o Incorrect – It is important to ask about saddle anesthesia  which is a complete loss of sensation restricted to the area of  the buttocks, perineum and inner surfaces of the thighs NOT  decreased sensation. 

A physiotherapist who was trained abroad has just become qualified to  work in Canada. She has started at a new private practice clinic and is  being oriented by the clinic manager to the policies and procedures  around charting and record keeping. 

Q41. The physiotherapist is fluent in English but feels more confident with  charting in her native language, Mandarin, as she feels that her records  are more detailed and thorough. When asking the clinic manager if she  can continue to chart in Mandarin, how should the manager respond? 

• A. The language she chooses to chart in does not matter as long as  the chart is legible, accurate and complete 

• B. She must look at the CPA website to determine if Mandarin is on  the list of eligible languages that are acceptable to use when  charting in Canada 

• C. She must chart in either English or French

• D. She can only chart in Mandarin if charting with paper, all  electronic records must be in English

C
a. The language she chooses to chart in does not matter as long as the  chart is legible, accurate and complete 

b. She must look at the CPA website to determine if Mandarin is on the  list of eligible languages that are acceptable to use when charting in  Canada 

c. She must chart in either English or French - CORRECT 

o In Canada, all aspects of client care need to be documented in  either French or English. 

d. She can only chart in Mandarin if charting with paper, all electronic  records must be in English

A physiotherapist who was trained abroad has just become qualified to  work in Canada. She has started at a new private practice clinic and is  being oriented by the clinic manager to the policies and procedures  around charting and record keeping. 

Q42. The manager is explaining the storage and retainment of patient  records to the physiotherapist. Which of the following statements is true  regarding the destruction of records? 

• A. The length of time records should be retained is 10 years from  the date of last entry and is standard across all of Canada 

• B. All charts of deceased patients can be destroyed 

• C. The length of time records should be retained is 5 years from the  date of last entry and is standard across all of Canada 

• D. The length of time records should be retained is specified by the  Province in which the physiotherapist works

D

a. The length of time records should be retained is 10 years from the  date of last entry and is standard across all of Canada 

b. All charts of deceased patients can be destroyed 

c. The length of time records should be retained is 5 years from the  date of last entry and is standard across all of Canada 

d. The length of time records should be retained is specified by the  Province in which the physiotherapist works - TRUE 

o The physiotherapist must retain records (e.g., client,  

equipment, financial) according to the length of time specified  by applicable legislation and regulatory requirements. 

o For example, in BC, for an adult, records should be retained  for 16 years after the last date of entry. In Alberta, they need  to be kept for 10 years. 

▪ Note: This is a Canadian exam so the exact detailed that  vary between Provinces will not be examined.

A physiotherapist who was trained abroad has just become qualified to  work in Canada. She has started at a new private practice clinic and is  being oriented by the clinic manager to the policies and procedures  around charting and record keeping. 

Q43. The physiotherapist is about to see her first patient. Prior to the  assessment, she gathered information from a faxed record from the  family physician. Where should this information go in the patient’s chart  note? 

• A. Subjective

• B. Objective 

• C. Assessment 

• D. Plan 

A
a. Subjective - CORRECT 

o Any information gathered indirectly from medical records as  well as information gathered during the patient’s interview  should be documented in the “S” of the SOAP note. 

b. Objective 

o Any objective information gathered during the assessment  goes into the “O” of the SOAP note. For example, outcomes  measures, treatment, home exercises. 

c. Assessment 

o The ”A” in the SOAP note is the location where the  

physiotherapist puts their impression. 

d. Plan 

o The “P” of the SOAP note is for future follow up plans.

A physiotherapist who was trained abroad has just become qualified to  work in Canada. She has started at a new private practice clinic and is  being oriented by the clinic manager to the policies and procedures  around charting and record keeping. 

Q44. The physiotherapist sees her first patient. She suspects her patient  has a torn meniscus. After the assessment, while charting her first SOAP  note, the physiotherapist is unsure as to where she should put her  patient’s diagnosis. 

• A. Subjective 

• B. Objective 

• C. Assessment 

• D. Plan

C
a. Subjective 

b. Objective 

c. Assessment - CORRECT 

o The ”A” in the SOAP note is the location where the  

physiotherapist puts their impression. What does the  

physiotherapist think? This can be in relation to a potential  diagnosis, how the patient tolerated treatment or the  

expected outcomes for example. 

d. Plan 

A 29-year-old male is receiving treatment for his scoliosis at a scoliosis  clinic. On examination, the patient presents with a thoracolumbar C-curve  and, on forward flexion, he presents with a posterior rib hump on the  right side of the ribcage. 

Q45. Based on the information gathered from the observations, which of  the following would correctly describe the patient’s scoliosis? 

• A. Structural right thoracolumbar curve

• B. Structural left thoracolumbar curve 

• C. Functional right thoracolumbar curve 

• D. Functional left thoracolumbar curve

A
a. Structural right thoracolumbar curve - CORRECT 

o The patient has a rib hump on forward flexion which indicates  that the scoliosis is structural NOT functional. A functional (aka  non-structural) scoliosis has no bony deformity and  

disappears of forward flexion. 

o The patient also demonstrates a rib hump on the right side  with forward flexion indicating that the side of convexity is the  right side. Because the vertebral bodies rotate towards the  side of convexity, the ribs rotate with the vertebrae and are  prominent posteriorly on the side of the convexity. 

o Now that we know the right side is the convex side, spinal  curves are named after the side of convexity so this is a right  scoliosis. 

b. Structural left thoracolumbar curve 

c. Functional right thoracolumbar curve

d. Functional left thoracolumbar curve

A 29-year-old male is receiving treatment for his scoliosis at a scoliosis  clinic. On examination, the patient presents with a thoracolumbar C-curve  and, on forward flexion, he presents with a posterior rib hump on the  right side of the ribcage. 

Q46. A structural scoliosis involves an irreversible lateral curvature with  fixed rotation of the vertebrae. Which of the following is correct with  respect to the rotation of the vertebral bodies? 

• A. Rotation of the vertebral bodies varies on the location of the  scoliosis 

• B. Rotation of the vertebral bodies is towards the concavity of the  curve 

• C. Rotation of the vertebral bodies is towards the convexity of the  curve

• D. Rotation of the vertebral bodies results in the spinous process  aiming towards the side of convexity 

C
a. Rotation of the vertebral bodies varies on the location of the  scoliosis 

b. Rotation of the vertebral bodies is towards the concavity of the  curve 

c. Rotation of the vertebral bodies is towards the convexity of the  curve - CORRECT 

o The vertebral bodies rotate towards the side of convexity. In  the thoracic spine, the ribs rotate with the vertebrae and are  prominent posteriorly on the side of the convexity.

d. Rotation of the vertebral bodies results in the spinous process  aiming towards the side of convexity

A 29-year-old male is receiving treatment for his scoliosis at a scoliosis  clinic. On examination, the patient presents with a thoracolumbar C-curve  and, on forward flexion, he presents with a posterior rib hump on the  right side of the ribcage. 

Q47. Which of the following is true regarding the effects of a scoliosis on  the musculoskeletal system? 

• A. Nerve root irritation on the side of the convexity can result in pain • B. Muscles of concave side would be elongated and weak 

• C. Decreased flexibility in the musculature on the concave side

• D. Rib hump will be observable during forward flexion on concave  side 

C
a. Nerve root irritation on the side of the convexity can result in pain - FALSE 

o Nerve root irritation on the side of the concavity can result in  pain. 

b. Muscles of concave side would be elongated and weak - FALSE o Muscles of convex side would be elongated and weak. c. Decreased flexibility in the musculature on the concave side - TRUE 

o Tissue on concave side will be shorted and tight = decreased  flexibility on concave side. 

d. Rib hump will be observable during forward flexion on concave side  – FALSE 

o Rib hump will be observable during forward flexion on convex.

A 29-year-old male is receiving treatment for his scoliosis at a scoliosis  clinic. On examination, the patient presents with a thoracolumbar C-curve  and, on forward flexion, he presents with a posterior rib hump on the  right side of the ribcage. 

Q48. Which of the following does not cause a structural scoliosis? 

• A. Trauma 

• B. Leg length discrepancy

• C. Neuromuscular diseases 

• D. Idiopathic disorders 

B
a. Trauma 

o Can result in a structural scoliosis 

b. Leg length discrepancy - CORRECT 

o Leg length discrepancies, either structural or functional, will  cause a non-structural (functional) scoliosis. 

o Non-structural (aka functional scoliosis) may be caused by any  of the following: habitual postural faults, painful nerve root  irritation or inflammation with compensatory trunk  

positioning, or compensation caused by a leg length  

discrepancy or contracture. 

c. Neuromuscular diseases 

o Can result in a structural scoliosis 

d. Idiopathic disorders 

o Structural scoliosis primarily involves bony deformity which  may be due to congenital or acquired neuromuscular diseases  or disorders, trauma, osteopathic disorders (e.g. rickets) or  idiopathic disorders where the exact cause is unknown.

A 29-year-old male is receiving treatment for his scoliosis at a scoliosis  clinic. On examination, the patient presents with a thoracolumbar C-curve  and, on forward flexion, he presents with a posterior rib hump on the  right side of the ribcage. 

Q49. Another patient arrives for treatment who has a scoliosis due to a leg  length discrepancy. The right leg is shorter than the left by 1 inch. Upon  observation, what should the physiotherapist anticipate seeing with  respect to posture and alignment in standing? 

• A. Pelvis elevated on the left; Shoulder/scapula elevated on the right

• B. Pelvis elevated on the left; Shoulder/scapula elevated on the left 

• C. Pelvis elevated on the right; Shoulder/scapula elevated on the  right 

• D. Pelvis elevated on the right; Shoulder/scapula elevated on the left 

A
a. Pelvis elevated on the left; Shoulder/scapula elevated on the right - CORRECT 

o The pelvis on the short right leg drops down --> to  

compensate, the patient drops the contralateral left shoulder  to keep their head midline/oriented. 

o This results in convexity in spine on the side of the short  leg. (See image below) 

b. Pelvis elevated on the left; Shoulder/scapula elevated on the left c. Pelvis elevated on the right; Shoulder/scapula elevated on the right d. Pelvis elevated on the right; Shoulder/scapula elevated on the left

A patient has been diagnosed with vestibular dysfunction by her otolaryngologist. The report forwarded by her otolaryngologist reveals a history of post-concussion syndrome. She arrives for physiotherapy treatment complaining of dizziness and a feeling of mild unsteadiness while walking. She has a difficult time watching sports on TV and is afraid to drive because quickly turning her head increases her dizziness.

Q50. Given this patient’s symptoms, what is the most likely diagnosis?

• A. Benign Paroxysmal Positional (BPPV)

• B. Unilateral vestibular loss (UVL)

• C. Bilateral vestibular loss (BVL)

• D. Central nervous system dysfunction

B
a. Benign Paroxysmal Positional (BPPV)

o Typically presents with episodes of transient vertigo and

nausea which are induced with positional changes.

b. Unilateral vestibular loss (UVL) - CORRECT

o This patient’s presentation is typical of unilateral peripheral

vestibular dysfunction. These patients have difficulty with

visual fixation (gaze stability) due to the imbalances between

the left and right vestibular systems. Because of this, activities

that include motion (e.g. head turning) can be quite

challenging and bring on a sensation of dizziness.

o Post-concussion syndrome is associated with unilateral

vestibular loss.

c. Bilateral vestibular loss (BVL)

o These patients have extremely poor balance often with a

history of falls due to the lack of vestibular system input. They

will feel very unsteady and are a high falls risk who often

require a gait aid for stability.

d. Central nervous system dysfunction

o Vestibular dysfunction due to central nervous system lesions

such as CVA, TBI, Multiple Sclerosis lesions. Presentation can

vary but one defining feature is the presence of vertical

nystagmus.

A patient has been diagnosed with vestibular dysfunction by her otolaryngologist. The report forwarded by her otolaryngologist reveals a history of post-concussion syndrome. She arrives for physiotherapy treatment complaining of dizziness and a feeling of mild unsteadiness while walking. She has a difficult time watching sports on TV and is afraid to drive because quickly turning her head increases her dizziness.

Q51. Which outcome measure should the physiotherapist use to track her patient’s balance?

• A. Dizziness Handicap Inventory (DHI)

• B. 6-minute walk test

• C. Functional reach test

• D. Dynamic Gait Index (DGI)

D
a. Dizziness Handicap Inventory (DHI)

b. 6-minute walk test

c. Functional reach test

d. Dynamic Gait Index (DGI) - CORRECT

o This is the BEST answer to track the patient’s balance over

time. The DGI was developed to assess gait, balance and falls

risk. It evaluates balance in a dynamic way which is an

excellent way to track the progress of someone recovering

from UVL as they often struggle with the dynamic tasks such

as walking with head turns for example.

A patient has been diagnosed with vestibular dysfunction by her otolaryngologist. The report forwarded by her otolaryngologist reveals a history of post-concussion syndrome. She arrives for physiotherapy treatment complaining of dizziness and a feeling of mild unsteadiness while walking. She has a difficult time watching sports on TV and is afraid to drive because quickly turning her head increases her dizziness.

Q52. The physiotherapist is educating their patient about the role and anatomy of the vestibular system. Which of the following is false with respect to the anatomy of the vestibular system?

• A. The semicircular canals detect rotational movements such as

cartwheels

• B. The semicircular canals detect acceleration such as speeding up in the car

• C. The otolith organs sense static head positions relative to gravity

• D. The otolith organs detect deceleration such as slowing down in

the car wrong

B
a. The semicircular canals detect rotational movements such as

cartwheels - TRUE

b. The semicircular canals detect acceleration such as speeding up in the car - FALSE

o The otolith organs detect both acceleration and deceleration

c. The otolith organs sense static head positions relative to gravity -

TRUE

d. The otolith organs detect deceleration such as slowing down in the car - TRUE

A 35 year old woman is attending physiotherapy for buttocks pain that

began after falling while playing soccer. After a thorough assessment, the

physiotherapist suspects right sacroiliac (SI) dysfunction.

Q53. With a diagnosis of SI joint dysfunction, which of the following

represents the patient’s pain presentation?

• A. Unilateral pain; increases with left step up; deep and dull

• B. Bilateral pain; increases with left step up; deep and dull

• C. Unilateral pain; increases with right step up; deep and dull

• D. Bilateral pain; increases with right step up; deep and dull

C

a. Unilateral pain; increases with left step up; deep and dull

b. Bilateral pain; increases with left step up; deep and dull

c. Unilateral pain; increases with right step up; deep and dull -

CORRECT

o SI joint dysfunction presents in the following way:

§ Deep, dull, undefined pain that tends to be unilateral

§ Pain can refer to the following areas: Posterior thigh,

iliac fossa and buttocks on affected side

§ Pain increases with twisting (e.g. rolling in bed; supine to

sit); standing on one leg (e.g. during walking or when

ascending/descending stairs – especially when stepping

up with affected leg).

d. Bilateral pain; increases with right step up; deep and dull

A 35 year old woman is attending physiotherapy for buttocks pain that began after falling while playing soccer. After a thorough assessment, the physiotherapist suspects right sacroiliac (SI) dysfunction.

Q54. Which special test would be the least appropriate when assessing the integrity of the sacroiliac joints?

• A. Gillet’s test

• B. Gaenslen’s test

• C. Trendelenburg’s test

• D. Supine to long sitting test

C
a. Gillet’s test

o Determines if the SI joints are moving normally or if they are

hypomobile

b. Gaenslen’s test

o Determines if pain is originating from the SI joint.

c. Trendelenburg’s test - CORRECT

o This test does not specifically assess the SI joint.

o Assesses the strength of the gluteus medius muscle of the

stance leg.

d. Supine to long sitting test

o Determines if SI joint dysfunction is contributing to an

apparent/functional leg length discrepancy.

A 35 year old woman is attending physiotherapy for buttocks pain that began after falling while playing soccer. After a thorough assessment, the physiotherapist suspects right sacroiliac (SI) dysfunction.

Q55. Which of the following statements indicates a positive finding with Gillet’s test?

• A. The PSIS on the testing limb (the limb that is pulled to into flexion towards the body) moves down or inferiorly

• B. The PSIS on the testing limb (the limb that is pulled to into flexion towards the body) moves minimally or up

• C. The ASIS on the testing limb (the limb that is pulled to into flexion towards the body) moves down or inferiorly

• D. The ASIS on the testing limb (the limb that is pulled to into flexion towards the body) moves minimally or up

B

a. The PSIS on the testing limb (the limb that is pulled to into flexion

towards the body) moves down or inferiorly

b. The PSIS on the testing limb (the limb that is pulled to into flexion

towards the body) moves minimally or up - CORRECT

o Testing procedure: The examiner palpates the PSIS of the

tested side with one hand and the S2 spinous process with the

other. The patient flexes the hip past 90 degrees. The

examiner should feel the PSIS move inferiorly relative to the

sacrum. A positive test is when this motion is absent, minimal

or the PSIS moves upwards. The examiner should compare

findings to the opposite side.

c. The ASIS on the testing limb (the limb that is pulled to into flexion

towards the body) moves down or inferiorly

d. The ASIS on the testing limb (the limb that is pulled to into flexion

towards the body) moves minimally or up

A 35 year old woman is attending physiotherapy for buttocks pain that began after falling while playing soccer. After a thorough assessment, the physiotherapist suspects right sacroiliac (SI) dysfunction.

Q56. The physiotherapist observes that the patient’s right innominate is anteriorly rotated. How should the physiotherapist proceed with documenting this?

• A. The right innominate is in relative nutation compared to the

sacrum

• B. The right innominate is in relative counternutation compared to

the sacrum

• C. The sacrum is in relative nutation compared to the right

innominate

• D. The sacrum is in relative counternutation compared to the right

innominate

D
a. The right innominate is in relative nutation compared to the sacrum

o Incorrect. When referencing nutation/counternutation we are

discussing the sacrum is.

b. The right innominate is in relative counternutation compared to the sacrum

c. The sacrum is in relative nutation compared to the right innominate

d. The sacrum is in relative counternutation compared to the right

innominate - CORRECT

o If the right innominate is anteriorly rotated compared to the

sacrum, the sacrum is in relative counternutation.

o Counternutation is defined as a movement that occurs when

the sacral base tips posteriorly in relation to the ilium.

Therefore, it may occur when the sacrum rotates posteriorly,

the ilium rotates anteriorly, or both.

A 35 year old woman is attending physiotherapy for buttocks pain that began after falling while playing soccer. After a thorough assessment, the physiotherapist suspects right sacroiliac (SI) dysfunction.

Q57. If the patient’s right innominate is anteriorly rotated, what will the findings be when assessing their leg length in the supine to long sitting test?

• A. The right leg will appear shorter in supine and longer in long

sitting

• B. The right leg will appear shorter in supine and shorter in long

sitting

• C. The right leg will appear longer in supine and shorter in long

sitting correct

• D. The right leg will appear longer in supine and longer in long

sitting

C
a. The right leg will appear shorter in supine and longer in long sitting

b. The right leg will appear shorter in supine and shorter in long sitting

c. The right leg will appear longer in supine and shorter in long sitting - CORRECT

o The side with an anterior innominate will result in the limb

appearing longer in supine and shorter in long sitting. (See

image below)

d. The right leg will appear longer in supine and longer in long sitting

A physiotherapist is working in the intensive care unit at a local hospital.

His first patient of the day is a 65-year-old man who, while suffering from

an exacerbation of his COPD, fell and hit his head resulting in a mild

traumatic brain injury. The patient was admitted 2 days ago and is stable.

He is awake and oriented but very fatigued. He has an IV in situ and is on

low flow oxygen via nasal prongs.

Q58. The patient is on 4L/min of oxygen. Which of the following correctly

identifies the fraction of inspired oxygen (FiO2)?

• A. 0.21

• B. 0.37

• C. 0.24

• D. 0.33

D
a. 21

b. 37

c. 24

d. 33 - CORRECT

o Fraction of inspired oxygen (FiO2) is defined as the percentage

or concentration of oxygen that a person inhales.

o Natural air includes 21% oxygen, which is equivalent to FiO2of

0.21.

o 1L/min of O2 delivery increases the FiO2 by ~0.03%

o Therefore, 4L/min would increase the FiO2 by (0.03x4) = 0.12%

o 12% (4L/min) + 0.21% (natural air) = 0.33%

A physiotherapist is working in the intensive care unit at a local hospital. His first patient of the day is a 65-year-old man who, while suffering from an exacerbation of his COPD, fell and hit his head resulting in a mild traumatic brain injury. The patient was admitted 2 days ago and is stable. He is awake and oriented but very fatigued. He has an IV in situ and is on low flow oxygen via nasal prongs.

Q59. The physiotherapist decides to dangle the patient at the edge of the bed and transfer them to an upright chair if they tolerate a dangle well. During the session, the physiotherapist monitors the patient’s oxygen levels using a pulse oximeter to ensure they are safe during the interaction. What is the physiotherapist monitoring?

• A. SpO2 levels

• B. SaO2 levels

• C. PaO2 levels

• D. PaCO2 levels

A

a. SpO2 levels - CORRECT

o SpO2 is peripheral oxygen saturation and is measured using a

pulse oximeter.

o Pulse oximetry is a method used to estimate SaO2 - the

percentage of oxygen bound to hemoglobin in the blood.

o A pulse oximeter relies on the light absorption characteristics

of saturated hemoglobin to give an indication of oxygen

saturation.

b. SaO2 levels

o SaO2 is the percentage of available binding sites on

hemoglobin that are bound with oxygen in arterial blood

(arterial oxygen saturation).

o SaO2 is measured directly using arterial blood samples.

c. PaO2 levels

o PaO2 is the partial pressure of oxygen in arterial blood - the

concentration of O2 dissolved in plasma.

o PaO2 is measured directly using arterial blood samples.

d. PaCO2 levels

o PaCO2 is the partial pressure of carbon dioxide in arterial

blood - the concentration of CO2 dissolved in plasma.

o PaCO2 is measured directly using arterial blood samples.

A physiotherapist is working in the intensive care unit at a local hospital. His first patient of the day is a 65-year-old man who, while suffering from an exacerbation of his COPD, fell and hit his head resulting in a mild traumatic brain injury. The patient was admitted 2 days ago and is stable. He is awake and oriented but very fatigued. He has an IV in situ and is on low flow oxygen via nasal prongs.

Q60. When treating patients with chronic respiratory conditions such as COPD, the goal of O2 therapy is to maintain the SpO2 levels between which percentages?

• A. 80 – 100%

• B. 88 – 92%

• C. 90 – 98%

• D. 95 – 100%

a. 80 – 100%

b. 88 – 92% - CORRECT

o Patients with chronic cardiorespiratory conditions, such as

COPD, develop long term impairments in gas exchange that

enable the respiratory system to cope and compensate over

the years. In these patients, PaCO2 levels gradually increase

and PaO2 levels gradually decrease. They live in a chronic

state of hypercapnia and hypoxemia and their system

becomes used to this state. Low levels of O2 aids in the

stimulation of breathing.

o Therefore, during episodes of acute exacerbation, it is critical

NOT to provide these patients with high levels of oxygen as

high levels of O2 can result in a decrease in their drive to

breathe which can exacerbate their respiratory issues.

c. 90 – 98%

d. 95 – 100%

A physiotherapist is working in the intensive care unit at a local hospital. His first patient of the day is a 65-year-old man who, while suffering from an exacerbation of his COPD, fell and hit his head resulting in a mild traumatic brain injury. The patient was admitted 2 days ago and is stable. He is awake and oriented but very fatigued. He has an IV in situ and is on low flow oxygen via nasal prongs.

Q61. During an acute COPD exacerbation, what would the physiotherapist most likely hear on auscultation?

• A. Bronchial breath sounds

• B. Fine crackles

• C. High pitched wheezes

• D. Absent breath sounds

C

a. Bronchial breath sounds

o These are more associated with pneumonia.

b. Fine crackles

o These are more associated with atelectasis and pulmonary

fibrosis.

c. High pitched wheezes - CORRECT

o High and medium pitched breath sounds are commonly

associated with bronchospasm and seen with asthma and

COPD.

d. Absent breath sounds

o There would not be an absence of breath sounds during an

exacerbation of COPD as you would always hear breath

sounds such as wheezes.

A physiotherapist is working in the intensive care unit at a local A physiotherapist is working in the intensive care unit at a local hospital. His first patient of the day is a 65-year-old man who, while suffering from an exacerbation of his COPD, fell and hit his head resulting in a mild traumatic brain injury. The patient was admitted 2 days ago and is stable. He is awake and oriented but very fatigued. He has an IV in situ and is on low flow oxygen via nasal prongs.

Q62. The patient has developed pneumonia and the physiotherapist arrives to provide chest physiotherapy that is critical to the patient’s health. The patient is refusing chest physiotherapy. How should the physiotherapist proceed?

• A. Educate the patient on the risks associated with the refusal of

chest physiotherapy

• B. Continue with chest physiotherapy as it in the best interest of the patient

• C. Provide the patient with alternative options for physiotherapy

• D. Ask a family member for consent to provide chest physiotherapy

A
a. Educate the patient on the risks associated with the refusal of chest

physiotherapy - CORRECT

o This is the BEST answer and the first step when a patient is

refusing treatment. It is critical that they understand the risks

involved with the refusal of such as critical treatment.

b. Continue with chest physiotherapy as it in the best interest of the

patient

o This is not an appropriate step for the physiotherapist. Given

that the patient is oriented and alert, we have to respect that

he is making decisions of sound mind.

o Every adult who is capable of giving or refusing consent to

health care has the right to give consent or to refuse consent

on any grounds, including moral or religious grounds, even if

the refusal will result in death.

o The Health Care (Consent) and Care Facility (Admission)

Act presumes that a person is capable of giving, refusing, or

revoking consent. The questions to consider are: Does my

patient demonstrate understanding of the information I have

given them and the treatment I am proposing for them? If so,

that patient is capable of giving consent, on that day.

c. Provide the patient with alternative options for physiotherapy

o This is a correct statement but not the BEST answer. The

physiotherapist should ensure the patient knows the risks

involved in refusing care/treatment BEFORE suggesting

alternative options that may not be as beneficial as the initial

treatment.

d. Ask a family member for consent to provide chest physiotherapy

o This patient is capable of making his own decisions and is

therefore going to make the final decision. If he was not of

sound mind and did require a substitute decision maker, you

cannot assume that any family member is the substitute

decision maker for the patient. You must find out exactly who

the substitute decision maker is before gaining consent from

them.

A patient is attending physiotherapy after having a baby 2 months ago. She would like to receive a general assessment and start with a general strengthening program that is safe postpartum. Since giving birth, she has noticed some episodes of urine leakage when going up the stairs or when lifting anything heavy off the ground. She feels generally deconditioned and mildly depressed given that she used to be very physically active and the changes to her body are difficult to accept.

Q63. Which of the following statements is false regarding the changes associated with pregnancy?

• A. Heart rate increases in pregnancy

• B. Cardiac output decreases in pregnancy correct

• C. Center of gravity shifts upwards and forwards

• D. Weight shifts towards the heels to bring the center of gravity to a

more posterior position

B
a. Heart rate increases in pregnancy – TRUE

o Heart rate usually increases 10-20 beats per minute by full

term.

b. Cardiac output decreases in pregnancy – FALSE

o Cardiac output increases 30-60% in pregnancy.

c. Center of gravity shifts upwards and forwards – TRUE

o This is due to the enlargement of the uterus and breasts.

d. Weight shifts towards the heels to bring the center of gravity to a

more posterior position – TRUE

o This occurs as a compensation for the shift of COG forwards

and up.

A patient is attending physiotherapy after having a baby 2 months ago. She would like to receive a general assessment and start with a general strengthening program that is safe postpartum. Since giving birth, she has noticed some episodes of urine leakage when going up the stairs or when lifting anything heavy off the ground. She feels generally deconditioned and mildly depressed given that she used to be very physically active and the changes to her body are difficult to accept.

Q64. The physiotherapist performs testing for diastasis recti. Which of the following minimum requirements would suggest the patient has diastasis recti?

• A. A separation of greater than 1 finger width

• B. A separation of greater than 2 finger widths

• C. A separation of greater than 3 finger widths

• D. The testing requires exact measurements (in cm) for a diagnosis

B
a. A separation of greater than 1 finger width

b. A separation of greater than 2 finger widths - CORRECT

o Any separation larger than 2 finger widths is considered

significant.

c. A separation of greater than 3 finger widths

d. The testing requires exact measurements (in cm) for a diagnosis

A patient is attending physiotherapy after having a baby 2 months ago. She would like to receive a general assessment and start with a general strengthening program that is safe postpartum. Since giving birth, she has noticed some episodes of urine leakage when going up the stairs or when lifting anything heavy off the ground. She feels generally deconditioned and mildly depressed given that she used to be very physically active and the changes to her body are difficult to accept.

Q65. Based on the patients’ history of pregnancy and urinary leakage,

which of the following types of incontinence does she most likely have?

• A. Urgency incontinence

• B. Functional incontinence

• C. Stress incontinence

• D. Overflow incontinence

C
a. Urgency incontinence

o Leakage due to overactive bladder.

b. Functional incontinence

o Mental or physical condition that prevents the individual from

getting to the bathroom in time.

c. Stress incontinence - CORRECT

o Leakage due to weakened pelvic floor which is common post

pregnancy.

d. Overflow incontinence

o Difficulty with fully emptying the bladder which results in

leakage.

A patient is attending physiotherapy after having a baby 2 months ago. She would like to receive a general assessment and start with a general strengthening program that is safe postpartum. Since giving birth, she has noticed some episodes of urine leakage when going up the stairs or when lifting anything heavy off the ground. She feels generally deconditioned and mildly depressed given that she used to be very physically active and the changes to her body are difficult to accept.

Q66. Which nerve contributes to innervation of the pelvic floor muscles?

• A. Phrenic nerve

• B. Hypogastric nerve

• C. Pudendal nerve correct

• D. Splanchnic nerves

C
a. Phrenic nerve

o The phrenic nerve (C3-C5) innervates the diaphragm.

b. Hypogastric nerve

o Hypogastric nerves are responsible for innervating viscera of

the pelvic cavity.

c. Pudendal nerve - CORRECT

o Pudendal nerve (S2-S4) is the main nerve of the perineum

providing both motor and sensory function to the pelvic floor.

d. Splanchnic nerve

o The splanchnic nervesare paired visceral nerves (nerves that

contribute to the innervation of the internal organs).

A patient is attending physiotherapy after having a baby 2 months ago. She would like to receive a general assessment and start with a general strengthening program that is safe postpartum. Since giving birth, she has noticed some episodes of urine leakage when going up the stairs or when lifting anything heavy off the ground. She feels generally deconditioned and mildly depressed given that she used to be very physically active and the changes to her body are difficult to accept.

Q67. Which of the following would be the most appropriate home

exercises for this patient?

• A. Posterior pelvic tilt; Leg slide

• B. Pelvic floor contract-relax; Posterior pelvic tilt

• C. Pelvic floor contract-relax; Trunk curl up/down

• D. Trunk curl up/down; Posterior pelvic tilt

B

a. Posterior pelvic tilt; Leg slide

b. Pelvic floor contract-relax; Posterior pelvic tilt - CORRECT

o Given that this patient is post partum and has both diastasis

recti (DR) and incontinence due to pelvic floor weakness, it

would be important to include a basic starter pelvic floor

exercise such as contract-relax as well as a beginner

abdominal exercise such as posterior pelvic tilt. Trunk curls

(sit-ups) are too aggressive at this time due to the patient’s

diastasis recti and should not be performed yet.

c. Pelvic floor contract-relax; Trunk curl up/down

d. Trunk curl up/down; Posterior pelvic tilt

A physiotherapist is working on a burn ward. A patient was brought up to

the ward after sustaining burns to his right arm, anterior trunk and half of

the left leg.

Q68. Based on the rule of nines, what percentage of his body has been

burned?

• A. 54%

• B. 45%

• C. 36%

• D. 27%

C
a. 54%

b. 45%

c. 36% - CORRECT

o Right arm (9%) + Anterior trunk (18%) + 1⁄2 left leg (9%) = 36%

o See Rule of Nines % below

d. 27%

o Rule of Nines for Adult:

§ Head = 9%

§ Anterior trunk = 18%

§ Posterior trunk = 18%

§ One arm = 9%

§ One leg = 18%

§ Groin = 1%

A physiotherapist is working on a burn ward. A patient was brought up to

the ward after sustaining burns to his right arm, anterior trunk and half of

the left leg.

Q69. How would the percentage change if a 10-year-old child sustained

the same burns?

• A. 54%

• B. 50%

• C. 41%

• D. 34%

D
a. 54%

b. 50%

c. 41%

d. 34% - CORRECT

o Right arm (9%) + Anterior trunk (18%) + 1⁄2 left leg (7%) = 34%

o See Rule of Nines % for child below

• Rule of Nine’s for Child (under 12 years old):

o Head = 18%

o Anterior trunk = 18%

o Posterior trunk = 18%

o One arm = 9%

o One leg = 14%

o Groin = 1% (some texts include, others don’t, use your

discretion when answering questions)

A physiotherapist is working on a burn ward. A patient was brought up to the ward after sustaining burns to his right arm, anterior trunk and half of the left leg.

Q70. The patient was classified as having a combination of partial and full thickness burns. Which of the following tissue layer was not damaged?

• A. Papillary dermis

• B. Epidermis

• C. Subcutaneous tissue

• D. Reticular dermis

C
a. Papillary dermis

o Most superficial layer of the dermis and is affected in both

partial thickness and full thickness burns.

b. Epidermis

o Most superficial layer of skin and is affected in both partial

thickness and full thickness burns.

c. Subcutaneous tissue - CORRECT

o Subcutaneous tissues (muscle, bone) are not burned in partial

or full thickness burns.

o Subdermal burns go through the entire layers of skin

(epidermis, dermis) and then into subcutaneous tissues.

d. Reticular dermis

o Deeper layer of the dermis and is affected in both partial

thickness and full thickness burns.

A physiotherapist is working on a burn ward. A patient was brought up to the ward after sustaining burns to his right arm, anterior trunk and half of the left leg.

Q71. In order to prevent contractures in the right elbow, how should the physiotherapist position the patient while he is resting in bed?

• A. Full elbow extension; forearm supination

• B. Full elbow extension; forearm pronation

• C. Elbow flexed to 30 degrees; forearm supination

• D. Elbow flexed to 30 degrees; forearm pronation

A
a. Full elbow extension; forearm supination - CORRECT

o Common deformity of the elbow is a flexion and pronation

deformity therefore, positioning should be in elbow extension

and full supination.

b. Full elbow extension; forearm pronation

c. Elbow flexed to 30 degrees; forearm supination

d. Elbow flexed to 30 degrees; forearm pronation

A physiotherapist is working on a burn ward. A patient was brought up to the ward after sustaining burns to his right arm, anterior trunk and half of the left leg.

Q72. The physiotherapist wants to get the patient mobilizing as soon as possible. Which of the following would be an absolute contraindication to initiating exercise after a burn?

• A. Infection

• B. Low blood pressure

• C. Deep vein thrombosis

• D. Heterotopic ossification

C
1. Infection

o This is a precaution not an absolute contraindication to

exercise.

2. Low blood pressure

o This is a precaution not an absolute contraindication to

exercise.

3. Deep vein thrombosis – CORRECT

o This is an absolute contraindication to exercise.

4. Heterotopic ossification

o This is a precaution not an absolute contraindication to

exercise.

A physiotherapist is working on a burn ward. A patient was brought up to the ward after sustaining burns to his right arm, anterior trunk and half of the left leg.

Q73. Which of the following is true regarding secondary complications of burn injuries?

• A. Pleural effusions are common complications that result from

inhalation injuries

• B. Hyperthermia is a complication that can result in temperature

dysregulation

• C. Decreased metabolic activity after a burn can result in weight gain

• D. Patients with burns are susceptible to developing heterotopic

ossification

D
a. Pleural effusions are common complications that result from

inhalation injuries - FALSE

o Pulmonary edema is a complication of inhalation injuries, not

pleural effusions. This is due to increased capillary

permeability that occurs secondary to the tissue damage in

the lungs. This results in a net loss of fluid out of the vessels

and into the surrounding interstitium of the lungs.

b. Hyperthermia is a complication that can result in temperature

dysregulation - FALSE

o Due to the skin barrier being injured, patients with extensive

burns are at risk of hypothermia due to heat loss. Therefore,

hypothermia is a major complication after extensive burns

and patients are often in rooms with a higher temperature

than normal (30 degrees Celsius).

c. Decreased metabolic activity after a burn can result in weight gain -

FALSE

o There is a significant increase in metabolic activity after an

extensive burn that can result in rapid weight loss. It is critical

that patients who have suffered extensive burns are

supported from a nutritional standpoint.

d. Patients with burns are susceptible to developing heterotopic

ossification - TRUE

o The is a true statement. The exact reason is uncertain but

immobilization and metabolic changes after a burn play a role.

A patient is attending physiotherapy after noticing a gradual increase in weakness in his thumb, index and middle finger after dislocating his elbow 3 weeks ago. Pinching has become increasingly difficult and he is having a hard time at his job as a graphic designer because writing and drawing are challenging. He reports no sensory changes. The physiotherapist suspects anterior interosseous nerve syndrome.

Q74. Which special test confirms his diagnosis of anterior interosseous nerve syndrome?

• A. Tinel’s Sign

• B. Pinch Grip Test

• C. Bunnel-Littler Test

• D. Froment’s Sign

B

a. Tinel’s Sign

o Tapping over a nerve to reproduce tingling or paresthesia into

distribution of nerve. This can be performed at wrist for

median nerve or elbow for ulnar nerve.

o AIN does not have a sensory distribution so this test would not

be relevant for testing its integrity.

b. Pinch Grip Test - CORRECT

o The patient is asked to pinch the tips of the index finger and

thumb together. Normally, there should be a tip-to-tip pinch. If

the patient is unable to pinch tip to tip and instead, has an

abnormal pulp-to-pulp pinch, this is a positive sign for anterior

interosseous nerve pathology.

c. Bunnel-Littler Test

o This is a common RA hand exam test that examines if PIP joint

flexion PROM is limited due to intrinsic muscle tightness or

capsule tightness.

d. Froment’s Sign

o This is a test that examines the integrity of the ulnar nerve.

The patient is asked to hold a piece of paper between thumb

and index. A positive test is indicated if, when the examiner

attempts to pull the paper away, the patient’s terminal

phalanx of the thumb flexes because of paralysis of adductor

pollicis muscle.

A patient is attending physiotherapy after noticing a gradual increase in weakness in his thumb, index and middle finger after dislocating his elbow 3 weeks ago. Pinching has become increasingly difficult and he is having a hard time at his job as a graphic designer because writing and drawing are challenging. He reports no sensory changes. The physiotherapist suspects anterior interosseous nerve syndrome.

Q75. The anterior interosseous nerve is a branch off which major nerve?

• A. Musculoskeletal nerve

• B. Ulnar nerve

• C. Radial nerve

• D. Median nerve correct

D
a. Musculoskeletal nerve

b. Ulnar nerve

c. Radial nerve

d. Median nerve – CORRECT

o The anterior interosseus nerve is a branch off the median

nerve and supplies deep muscles of the anterior forearm

including: Flexor pollicis longus; pronator quadratus; radial 1⁄2

of flexor digitorum profundus

A patient is attending physiotherapy after noticing a gradual increase in weakness in his thumb, index and middle finger after dislocating his elbow 3 weeks ago. Pinching has become increasingly difficult and he is having a hard time at his job as a graphic designer because writing and drawing are challenging. He reports no sensory changes. The physiotherapist suspects anterior interosseous nerve syndrome.

Q76. Where is the anterior interosseous nerve commonly entrapped?

• A. Between the two heads of flexor carpi ulnaris

• B. Under the tendon of brachioradialis

• C. Between the two heads of pronator teres

• D. Between the two heads of supinator

C

a. Between the two heads of flexor carpi ulnaris

o Common site for ulnar nerve compression

b. Under the tendon of brachioradialis

o Common site for superficial radial nerve compression

c. Between the two heads of pronator teres – CORRECT

o Common site for anterior interosseous nerve

compression/entrapment

d. Between the two heads of supinator

o Common site for posterior interosseous nerve compression (a

branch of the radial nerve)

A 50-year-old female patient is complaining of medial elbow pain that occasionally extends into the forearm. Her history reveals a recent change in jobs where she is now working in a warehouse and is required to lift, stack and carry boxes of all sizes. On assessment, active and passive elbow movements in all directions are within normal limits.

Q77. On assessment, the physiotherapist checks the patient’s carrying angle. What is the normal carrying angle for females?

• A. 5 – 10 degrees

• B. 10 – 15 degrees

• C. 15 – 20 degrees

• D. 20 – 25 degrees

B

a. 5 – 10 degrees

o This is the normal carrying angle for males.

b. 10 – 15 degrees - CORRECT

o This is the normal carrying angle for females.

c. 15 – 20 degrees

d. 20 – 25 degrees

A 50-year-old female patient is complaining of medial elbow pain that occasionally extends into the forearm. Her history reveals a recent change in jobs where she is now working in a warehouse and is required to lift, stack and carry boxes of all sizes. On assessment, active and passive elbow movements in all directions are within normal limits.

Q78. In order to differentiate between medial epicondylitis and ulnar neuritis, the physiotherapist asks about altered sensation. If the patient has ulnar neuritis, how would the patient most likely respond?

• A. Paresthesia on the dorsal surface of the lateral one and a half

fingers

• B. Paresthesia on the palmar surface of the medial one and a half

fingers

• C. Paresthesia on the dorsal and palmar surface of the medial one

and a half fingers

• D. Paresthesia on the dorsal and palmar surface of the lateral one

and a half fingers

C
a. Paresthesia on the dorsal surface of the lateral one and a half

fingers

b. Paresthesia on the palmar surface of the medial one and a half

fingers

c. Paresthesia on the dorsal and palmar surface of the medial one and a half fingers - CORRECT

o This correctly identifies the sensory distribution of the ulnar

nerve.

d. Paresthesia on the dorsal and palmar surface of the lateral one and a half fingers

A 50-year-old female patient is complaining of medial elbow pain that occasionally extends into the forearm. Her history reveals a recent change in jobs where she is now working in a warehouse and is required to lift, stack and carry boxes of all sizes. On assessment, active and passive elbow movements in all directions are within normal limits.

Q79. If the patient had ulnar neuritis, what passive movements would increase their pain and discomfort the most?

• A. Elbow flexion and wrist extension

• B. Elbow flexion and wrist flexion

• C. Elbow extension and wrist extension

• D. Elbow extension and wrist flexion

A
a. Elbow flexion and wrist extension - CORRECT

a. Based on the anatomical position of the ulnar nerve, this

position will put the most tension on the ulnar nerve and thus

cause the most irritation and discomfort.

b. Elbow flexion and wrist flexion

c. Elbow extension and wrist extension

d. Elbow extension and wrist flexion

A 50-year-old female patient is complaining of medial elbow pain that occasionally extends into the forearm. Her history reveals a recent change in jobs where she is now working in a warehouse and is required to lift, stack and carry boxes of all sizes. On assessment, active and passive elbow movements in all directions are within normal limits.

Q80. From what cord of the brachial plexus does the ulnar nerve arise?

• A. Lateral cord

• B. Posterior cord

• C. Medial cord

• D. Anterior cord

C
a. Lateral cord

o The lateral cord gives rise to musculoskeletal nerve and

contributes to median nerve.

b. Posterior cord

o The lateral cord gives rise to axillary and radial nerve.

c. Medial cord - CORRECT

o The medial cord gives rise to ulnar nerve and contributes to

median nerve.

d. Anterior cord

o This cord does not exist.

A physiotherapist is working in the intensive care unit (ICU) at a local hospital. She is working with a 75-year-old patient who was found unresponsive at her home 3 days ago after suffering a stroke. As per her records, her overall heath was poor with a history of congestive heart failure, diabetes and high cholesterol. The patient is a 6 on the Glasgow Coma Scale (GCS) and is not following or responding to verbal commands.

Q81. The patient has developed pneumonia in her right lower lobe. What position should the therapist chose to maximize gas exchanges and thus oxygen saturation (SpO2)?

• A. Prone

• B. Right side-lying

• C. Left side-lying

• D. Supine

C
a. Prone

b. Right side-lying

c. Left side-lying - CORRECT

o Patients with unilateral lung pathology will benefit from

positions in which the unaffected lung is in a dependent

position (e.g. left side-lying for right lung pathology) to

maximize gas exchange.

o The dependent (lowermost) lung will be preferentially

ventilated and thus gas exchange is optimized and so is SpO2.

d. Supine

A physiotherapist is working in the intensive care unit (ICU) at a local hospital. She is working with a 75-year-old patient who was found unresponsive at her home 3 days ago after suffering a stroke. As per her records, her overall heath was poor with a history of congestive heart failure, diabetes and high cholesterol. The patient is a 6 on the Glasgow Coma Scale (GCS) and is not following or responding to verbal commands.

Q82. The patient has been deemed medically stable and the physiotherapist would like to perform percussions and vibrations to aid in secretion clearance. Which of the following includes the correct parameters for percussions and vibrations?

• A. Percussion applied over affected lung segment for 60 seconds;

vibrations performed during the exhalation of 10 breaths

• B. Percussion applied over affected lung segment for 60 seconds;

vibrations performed during the inhalation of 3 breaths

• C. Percussion applied over affected lung segment for 30 seconds;

vibrations performed during the exhalation of 3 breaths • D. Percussion applied over affected lung segment for 30 seconds;

vibrations performed during the inhalation of 10 breaths

C

a. Percussion applied over affected lung segment for 60 seconds;

vibrations performed during the exhalation of 10 breaths

b. Percussion applied over affected lung segment for 60 seconds;

vibrations performed during the inhalation of 3 breaths

c. Percussion applied over affected lung segment for 30 seconds;

vibrations performed during the exhalation of 3 breaths - CORRECT

o Percussion applied over affected lung segment for 30 to 60

seconds; vibrations performed during the exhalation of 3

breaths

d. Percussion applied over affected lung segment for 30 seconds;

vibrations performed during the inhalation of 10 breaths

A physiotherapist is working in the intensive care unit (ICU) at a local hospital. She is working with a 75-year-old patient who was found unresponsive at her home 3 days ago after suffering a stroke. As per her records, her overall heath was poor with a history of congestive heart failure, diabetes and high cholesterol. The patient is a 6 on the Glasgow Coma Scale (GCS) and is not following or responding to verbal commands.

Q83. The patient begins to become more alert and can follow basic commands for movement, but she requires multiple prompts due to her mild confusion. Given these changes, what would be the best treatment for secretion clearance?

• A. Assist the patient into a dangle at the edge of the bed

• B. Teach the patient how to perform active cycle of breathing

technique

• C. Continue with percussions and vibrations

• D. Provide the patient with an incentive spirometer

A
a. Assist the patient into a dangle at the edge of the bed - CORRECT

o Mobilizing a patient is an excellent way to enhance airway

secretion clearance.

o Mobilizing patients increases their metabolic demands which

in turn increases their minute ventilation (Tidal volume x RR).

An increase in minute ventilation serves to increase expiratory

flow and assists with the removal of secretions in the airways.

b. Teach the patient how to perform active cycle of breathing

technique

o Given their confusion, this would not be the most appropriate

technique to teach them.

c. Continue with percussions and vibrations

o While this is not incorrect, answer A, dangle, is the BEST

answer for this patient.

d. Provide the patient with an incentive spirometer

o Given their confusion, this would not be the most appropriate

technique to teach them.

A physiotherapist is working in the intensive care unit (ICU) at a local hospital. She is working with a 75-year-old patient who was found unresponsive at her home 3 days ago after suffering a stroke. As per her records, her overall heath was poor with a history of congestive heart failure, diabetes and high cholesterol. The patient is a 6 on the Glasgow Coma Scale (GCS) and is not following or responding to verbal commands.

Q84. After several days in the hospital, the patient starts to demonstrate increased shortness of breath. The physicians on the team documents that the pneumonia has stressed her cardiovascular system resulting in worsening of her congestive heart failure signs and symptoms. What is the most likely finding on X-ray?

• A. Pleural effusion

• B. Pulmonary edema

• C. Atelectasis

• D. Pneumothorax

B
a. Pleural effusion

b. Pulmonary edema - CORRECT

o Based on her heart condition resulting in lung pathologies, we

can assume that she is suffering from left congestive heart

failure (CHF).

o Left CHF can result in elevated pulmonary pressure as blood

cannot be pumped into the heart from the pulmonary system.

o The pulmonary hypertension results in fluid leaking out from

the pulmonary vessels and into the interstitium of the lungs =

pulmonary edema.

c. Atelectasis

d. Pneumothorax

A physiotherapist is working in the intensive care unit (ICU) at a local hospital. She is working with a 75-year-old patient who was found unresponsive at her home 3 days ago after suffering a stroke. As per her records, her overall heath was poor with a history of congestive heart failure, diabetes and high cholesterol. The patient is a 6 on the Glasgow Coma Scale (GCS) and is not following or responding to verbal commands.

Q85. Pulmonary edema disrupts ventilation and perfusion (V/Q) matching. Which of the following statements is true regarding pulmonary edema and V/Q matching?

• A. A low V/Q ratio due to poor perfusion

• B. A high V/Q ratio due to poor perfusion

• C. A low V/Q ratio due to poor ventilation

• D. A high V/Q ratio due to poor ventilation

C
a. A low V/Q ratio due to poor perfusion

b. A high V/Q ratio due to poor perfusion

c. A low V/Q ratio due to poor ventilation - CORRECT

o Pulmonary edema is abnormal accumulation of fluid in the

extravascular space that can initially occur in the interstitium

and then progress to the alveolar spaces.

o The excess fluid in the lungs prevents normal ventilation

resulting in a low V/Q ratio. Poor ventilation and a the

resulting lack of inhalation of oxygen is the primary issue

stemming from pulmonary edema.

d. A high V/Q ratio due to poor ventilation

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q86. What pattern of muscle paralysis occurs with Guillain-Barre Syndrome?

• A. Asymmetrical; progresses from lower extremities to upper

(ascending pattern) and from distal to proximal

• B. Symmetrical; progresses from upper extremities to lower

(descending pattern) and from distal to proximal

• C. Symmetrical; progresses from lower extremities to upper

(ascending pattern) and from proximal to distal

• D. Symmetrical; progresses from lower extremities to upper

(ascending pattern) and from distal to proximal

D
a. Asymmetrical; progresses from lower extremities to upper

(ascending pattern) and from distal to proximal

b. Symmetrical; progresses from upper extremities to lower

(descending pattern) and from distal to proximal

c. Symmetrical; progresses from lower extremities to upper (ascending

pattern) and from proximal to distal

d. Symmetrical; progresses from lower extremities to upper (ascending

pattern) and from distal to proximal - CORRECT

o GBS is an acute, ascending symmetrical polyneuropathy that

involves cranial and peripheral nerves (lower motor neuron

disease).

o It involves both motor and sensory systems.

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q87. Guillain-Barre is often associated with bulbar palsy. Which of the following signs are not linked to bulbar palsy?

• A. Dysphagia

• B. Dysphasia

• C. Dysarthria

• D. Dysphonia

B
a. Dysphagia

o Difficulty swallowing due to loss of gag reflex and weakness of

tongue, lip and throat muscles.

b. Dysphasia - CORRECT

o This is not directly linked to bulbar palsy.

o Dysphasia is a language disorder marked by deficiency in the

generation of speech, and sometimes also in its

comprehension, due to brain disease or damage.

c. Dysarthria

o Slurred speech due to weakness of tongue muscles as well as

muscles of lip, jaw, larynx and pharynx.

d. Dysphonia

o Dysphonia is a defective use of the voice, inability to produce

sound due to laryngeal weakness.

Bulbar palsy is a lower motor neuron disease that affects the following

cranial nerves: glossopharyngeal (IX), vagus (X), accessory (XI)

and hypoglossal nerves (XII).

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q88. The physiotherapist would like to initiate a PROM program. A new physiotherapy assistant (PTA) has started working in the critical care unit. The PTA has 10 years of experience working in the hospital. The physiotherapist asks the PTA if they are comfortable performing PROM and the PTA states that they are very comfortable with the task. How should the physiotherapist initially proceed with designating a task to the PTA?

• A. The physiotherapist obtains consent from the patient to work

with the PTA and allows the experienced PTA to perform PROM

• B. The physiotherapist has the PTA obtain consent from the patient

before teaching the PTA a PROM program

• C. The physiotherapist explains what the role of a PTA is to the

patient before obtaining consent from the patient

• D. The physiotherapist educates the PTA on how to properly

perform a PROM program and then watches them perform the

program to ensure their competency

C
a. The physiotherapist obtains consent from the patient to work with

the PTA and allows the experienced PTA to perform PROM

o It is critical that the physiotherapist ensure the PTA is

competent to perform the PROM. Just because the PTA states

they are experienced, does not mean that they are. If the PT

has never worked with the PTA before, they need to teach the

PTA the PROM program and watch them perform it to ensure

they are competent.

b. The physiotherapist has the PTA obtain consent from the patient

before teaching the PTA a PROM program

o The PT must gain consent from the patient to ensure they are

comfortable working with a PTA once they have been

educated on the differences between the role of the PTA and

the PT.

c. The physiotherapist explains what the role of a PTA is to the patient

before obtaining consent from the patient - CORRECT

o This is the best answer.

o The physical therapist is responsible and accountable for the

physical therapy services provided by personnel working

under their supervision (supervisees).

o Before starting a PTA program, the PT needs to do the

following:

§ Communicate to clients the roles, responsibilities, and

accountability of supervisees participating in the delivery

of physical therapy services.

§ Obtain clients’ informed consent for the delivery of

services by supervisees.

§ Assess the knowledge and skills of supervisees to

ensure they are competent.

d. The physiotherapist educates the PTA on how to properly perform a

PROM program and then watches them perform the program to

ensure their competency

o There is no mention of gaining consent in this option.

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q89. Strengthening is a critical element of rehabilitation for someone with Guillain-Barre. Which of the following strengthening exercises is most important in the acute stages of rehabilitation?

• A. Muscle stimulation using NMES settings to assist in regaining strength

• B. Assisted standing to encourage loading and weight bearing into limbs

• C. Deep breathing exercises to maintain healthy lung function

• D. Core activation and postural stability in sitting

C
a. Muscle stimulation using NMES settings to assist in regaining

strength

o Use of NMES will not benefit a patient with Guillain-Barre due

to the demyelination of the peripheral nerves. Electrical

stimulation for muscle strengthening does not benefit

individuals with lower motor neuron injury.

b. Assisted standing to encourage loading and weight bearing into

limbs

o While this is extremely beneficial, it is not the most important

focus acutely. This strengthening comes into play more into

the later stages of rehabilitation once the patient is out of

critical care and stabilized.

c. Deep breathing exercises to maintain healthy lung function -

CORRECT

o This is the BEST answer for strengthening in the acute stages.

o Deep breathing exercises are strengthening the respiratory

muscles such as the diaphragm. Maintaining respiratory

function is critical early in rehabilitation as the muscles of

respiration are affected by the Guillain-Barre.

o Patients may be ventilated due to muscles weakness which

makes deep breathing even more essential once they begin

their early recovery and wean off the ventilator.

d. Core activation and postural stability in sitting

o This is correct and important in rehabilitation but not the BEST

answer.

o Pulmonary function and prevention of secondary

complications through positioning and PROM are critical

acutely.

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q90. After 5 days, the patient is transferred from the Critical Care unit to a neurological rehabilitation ward. During physiotherapy, he asks if he is going to recover from the disease. How should the physiotherapist respond?

• A. The prognosis for recovery is unknown at this time

• B. There is no certainty that he will recovery from his current state

• C. There will be some recovery, but he will have permanent deficits

• D. He will have complete recovery from this illness

A
a. The prognosis for recovery is unknown at this time - CORRECT

o Given the other options listed, this is the BEST answer.

o Recovery from GBS can vary from full recovery to permanent

deficits.

b. There is no certainty that he will recovery from his current state

o Given that the patient is still only 5 days post GBS attack, he

will most certainly have ongoing recovery from this point.

o The recovery period can vary from weeks to years.

c. There will be some recovery, but he will have permanent deficits

o While some patients have residual permanent deficits that can

impair function (~30%), the majority have complete recovery.

Therefore, this is not the statement the PT should tell the

patient as it is too early to determine if the patient will have

permanent deficits or will recover fully.

d. He will have complete recovery from this illness

o The majority of individuals have complete recovery from this

illness, but this is not something the physiotherapist should

tell the patient as there is no way to be certain this patient will

have full recovery.

A 55-year-old male has been admitted to the hospital with acute motor paralysis due to Guillain-Barre Syndrome (GBS). He felt generally unwell for a day or two prior to the onset of the paralysis which came on suddenly. He is now ventilated and stable in the Critical Care Unit.

Q91. The patient complains of both numbness and tingling in her hands bilaterally. The altered sensation, in addition to motor weakness, is making it very challenging to do anything functionally with her hands. Which of the following techniques should the therapist implement to aid in the patient’s symptoms of peripheral neuropathy?

• A. Hot and cold baths for desensitization throughout the day

• B. Gentle hand massage several times a day

• C. Transcutaneous electrical nerve stimulation (TENS) several times a day

• D. Passive ROM exercises daily

B
a. Hot and cold baths for desensitization throughout the day

o Hot and cold baths are contraindicated in patients with altered

sensation.

b. Gentle hand massage several times a day - CORRECT

o This is the BEST answer. There are many exercises to

encourage sensory re-education and gentle massage is an

excellent option. This is an easy exercise that requires no

equipment and can be done throughout the day to encourage

stimulation of the sensory system.

c. Transcutaneous electrical nerve stimulation (TENS) several times a

day

o Given that this patient has altered sensation, the use of TENS

would be contraindicated.

d. Passive ROM exercises daily

o While ROM exercises are important, passive ROM won’t be the

most direct and effective way to help manage the patients

issues with numbness/tingling.

A physiotherapist took a course on gait analysis over the weekend and is now utilizing his skills to assess the gait pattern of three of his patients.

Q92. While watching the first patient, he notices that the left pelvis drops as the left leg swings through. The patient received a total hip replacement with a posterolateral surgical approach 6 months ago. Given the patients gait pattern, which of the following statements is true?

• A. The patient reveals a right Trendelenburg gait due to a right total

hip replacement

• B. The patient reveals a left Trendelenburg gait due to a right total

hip replacement

• C. The patient reveals a right Trendelenburg gait due to a left total

hip replacement

• D. The patient reveals a left Trendelenburg gait due to a left total hip replacement

A
a. The patient reveals a right Trendelenburg gait due to a right total hip replacement - CORRECT

o If the left pelvis drops during left swing, then the left pelvis is

dropping during right stance = a Right Trendelenburg. A right

Trendelenburg means that there is weakness to the right hip

stabilizers (gluteus medius/minimus). Lateral hip stabilizer

weakness occurs after a THR with a posterolateral approach

due to the nature of the surgical incision and injury to muscles

tissue. We can conclude that this patient has right hip

weakness resulting in a right Trendelenburg due to a right

THR.

b. The patient reveals a left Trendelenburg gait due to a right total hip replacement

c. The patient reveals a right Trendelenburg gait due to a left total hip replacement

d. The patient reveals a left Trendelenburg gait due to a left total hip

replacement

A physiotherapist took a course on gait analysis over the weekend and is now utilizing his skills to assess the gait pattern of three of his patients.

Q93. If this patient were to compensate for their Trendelenburg gait, which direction would they lean their trunk during stance?

• A. Left side flexion during right stance

• B. Left side flexion during left stance

• C. Right side flexion during right stance

• D. Right side flexion during left stance

C
a. Left side flexion during right stance

b. Left side flexion during left stance

c. Right side flexion during right stance - CORRECT

o In the question above it was concluded that this patient has

right hip weakness leading to a right Trendelenburg.

o Therefore, to compensate for right hip weakness, the patient

will lean ipsilaterally (towards the weak hip) during stance.

o The reason for the ipsilateral lateral trunk lean is to decrease

the moment arm of gravitational forces pulling on the swing

side thus decreasing load on the weak stance side abductors.

d. Right side flexion during left stance

A physiotherapist took a course on gait analysis over the weekend and is now utilizing his skills to assess the gait pattern of three of his patients.

Q94. The second patient being assessed is demonstrating a right foot drop. What compensatory movement would be present in someone with right foot drop?

• A. Increased left hip and knee flexion during right swing

• B. Right leg circumduction during right stance

• C. Hiking of right hip during left swing

• D. Vaulting on the left leg during right swing

D
a. Increased left hip and knee flexion during right swing

o Compensation for a right foot drop would result in right hip

and knee flexion during right swing to ensure foot clearance.

b. Right leg circumduction during right stance

o Right leg circumduction during right swing would aid in foot

clearance.

c. Hiking of right hip during left swing

o Hiking of right hip during right swing would aid in foot

clearance.

d. Vaulting on the left leg during right swing - CORRECT

o This compensation could be present if a patient had a right

foot drop.

o Vaulting involves rising up onto the toes of the unaffected

(left) leg during stance to allow increased clearance of affected

(right) leg while it swings through.

A physiotherapist took a course on gait analysis over the weekend and is now utilizing his skills to assess the gait pattern of three of his patients.

Q95. Which of the following conditions would not result in a foot drop?

• A. Diabetes

• B. Superficial peroneal nerve injury

• C. Multiple Sclerosis

• D. L4 nerve root impingement

B
a. Diabetes

o Nerve damage due to diabetes can lead to foot drop.

b. Superficial peroneal nerve injury - CORRECT

o Superficial peroneal nerve innervates peroneus longus and

brevis which are involved in eversion of the ankle, NOT

dorsiflexion.

c. Multiple Sclerosis

o Brain and spinal cord disorders can affect motor activation of

ankle dorsiflexion and result in foot drop.

d. L4 nerve root impingement

o Compression of L4 nerve root can result in foot drop.

A physiotherapist took a course on gait analysis over the weekend and is now utilizing his skills to assess the gait pattern of three of his patients.

Q96. The third patient is demonstrating an antalgic gait due to severe left knee osteoarthritis. Which of the following statements is false regarding

this patient’s antalgic gait?

• A. Left stance time is decreased

• B. Right step length is decreased

• C. Cadence is decreased

• D. Right stride length is increased

D
a. Left stance time is decreased - TRUE

o This is a true statement - The patient will spend less stance

time on the painful left leg.

b. Right step length is decreased - TRUE

o This is a true statement - By decreasing right step length

(swing), the patient spends less time in stance on the left leg.

c. Cadence is decreased - TRUE

o This is a true statement - Pain will ultimately lead to a slower

gait speed/cadence.

o Cadence is the rate at which a person walks, expressed in

steps per minute.

d. Right stride length is increased - FALSE

o Stride length is the distance between successive points of heel

contact of the same foot (double step length).

o Therefore, if right step length is decreased, right stride length

will also be decreased in someone with an antalgic gait

pattern due to left leg pain.

Antalgic gait is a gait pattern seen when a patient has pain in one of their

lower extremities. In order to reduce weight bearing on the affected limb,

there will be decreased step length of the unaffected limb resulting in

decreased stance time on the affected limb.

A 35-year-old patient is attending physiotherapy because of right shoulder pain and stiffness. He reports that his shoulder pain has been present for several weeks and is progressively becoming stiffer. On inspection, there is pain and limitation in both active and passive shoulder range of motion. Resisted isometrics with the arm at his side are pain free in all directions.

Q97. What diagnosis does the physiotherapist suspect?

• A. Rotator cuff tendinopathy

• B. Glenohumeral joint osteoarthritis

• C. Biceps tendinitis

• D. Adhesive capsulitis

D
a. Rotator cuff tendinopathy

b. Glenohumeral joint osteoarthritis

c. Biceps tendinitis

d. Adhesive capsulitis - CORRECT

o Pain with progressive increase in stiffness is indicative of

adhesive capsulitis (frozen shoulder)

o Pain free resisted isometrics would also be present given that

there is no contractile tissue dysfunction, the capsule is

stiffening which does not cause pain on resisted isometric

testing.

A 35-year-old patient is attending physiotherapy because of right shoulder pain and stiffness. He reports that his shoulder pain has been present for several weeks and is progressively becoming stiffer. On inspection, there is pain and limitation in both active and passive shoulder range of motion. Resisted isometrics with the arm at his side are pain free in all directions.

Q98. Given the suspected diagnosis, which presentation of active movements at the glenohumeral joint will most likely be demonstrated by the patient?

• A. External rotation to 25°; Abduction to 40°; Internal rotation to 20°

• B. Abduction to 90°; Internal rotation to 40°; External rotation to 5°

• C. Flexion to 100°; External rotation to 10°; Abduction to 90°

• D. External rotation to 15°; Flexion to 90°; Internal rotation to 55°

A
a. External rotation to 25°; Abduction to 40°; Internal rotation to 20° -

CORRECT

o Based on a suspected diagnosis of adhesive capsulitis, a

capsular pattern would be noted at the GH joint.

o Capsular pattern of the GH joint is: ER limitation > Abd

limitation > IR limitation

o Normal ROM for each of these movements is: ER 90°; Abd

180°; IR 70°

o Thus, answer A reflects a capsular pattern with the greatest

loss of ROM in ER followed by Abd and then IR

b. Abduction to 90°; Internal rotation to 40°; External rotation to 5°

c. Flexion to 100°; External rotation to 10°; Abduction to 90°

d. External rotation to 15°; Flexion to 90°; Internal rotation to 55°

A 35-year-old patient is attending physiotherapy because of right shoulder pain and stiffness. He reports that his shoulder pain has been present for several weeks and is progressively becoming stiffer. On inspection, there is pain and limitation in both active and passive shoulder range of motion. Resisted isometrics with the arm at his side are pain free in all directions.

Q99. The physiotherapist would like to perform a joint glide to assist in increasing shoulder abduction. What position should the physiotherapist position the arm in?

• A. 30 degrees of abduction, 55 degrees of horizontal adduction

• B. 20 degrees of abduction, 70 degrees of horizontal adduction

• C. 55 degrees abduction, 30 degrees horizontal adduction

• D. 70 degrees of abduction, 20 degrees of horizontal adduction

C
a. 30 degrees of abduction, 55 degrees of horizontal adduction

b. 20 degrees of abduction, 70 degrees of horizontal adduction

c. 55 degrees abduction, 30 degrees horizontal adduction - CORRECT

o This is the resting position (AKA open pack position) of the

glenohumeral joint. The resting position is the position used

for joint glides because:

§ It is the position with the least amount of joint surface

congruency

§ Capsule and support ligaments are lax

§ Accessory motion/joint play is maximized

d. 70 degrees of abduction, 20 degrees of horizontal adduction

A 35-year-old patient is attending physiotherapy because of right shoulder pain and stiffness. He reports that his shoulder pain has been present for several weeks and is progressively becoming stiffer. On inspection, there is pain and limitation in both active and passive shoulder range of motion. Resisted isometrics with the arm at his side are pain free in all directions.

Q100. Which direction of glide should the physiotherapist chose when mobilizing the humerus into abduction?

• A. Posterior glide

• B. Anterior glide

• C. Caudal glide

• D. Rostral glide

C
a. Posterior glide

b. Anterior glide

c. Caudal glide - CORRECT

o Based on the concave-convex rule, a caudal (inferior) glide is

chosen to increase abduction at the GH joint when moving the

convex humerus.

d. Rostral glide