Cardiopulmonary & Ethics

 

Vignette 1 - Sally is a frail +70-year-old female that has been admitted to the hospital with pneumonia. Her CXR showed some consolidation in bilateral lower lobes posterior segments. Her hemoglobin is at 70 g/L and WCB at 11 000. She is on 4L of oxygen via nasal prongs and SpO2 is at 94% at rest. She started with a dry cough but now has a productive cough. Sally has a past medical history of advanced dementia and has been on a puree diet for the past 6 months. This is your first time seeing Sally and the nurse reports that she is feeling dizzy and weak.

What is your initial treatment plan for Sally?

 

A) Mobilize with a 2 wheeled walker on 4.5L/min oxygen for a short distance and get a therapy assistant to follow behind closely with a chair

 

B) Get Sally to march at the edge of the bed holding onto a 2 wheeled walker

 

C) Teach autogenic drainage and how to huff/cough sitting at the edge of bed supported

 

D) Percussions and vibrations in the appropriate postural drainage position, encourage coughing after and suction if needed

 

 

After your treatment session with Sally, she points to her mouth and says "water". You ask if she is thirsty and she nods. What do you do?

 

A) Go get Sally a cup of water

 

B) Go get Sally a cup of water with a straw

 

C) Go get Sally a cup of ice cubes

 

D) Tell Sally to ask her nurse instead

 

E) Go speak with Sally's bedside nurse

 

 

What do you expect to hear during auscultation on Sally?

 

A) Decreased breath sounds in the lower lobes with some wheezing and crackles

 

B) Bronchial breath sounds and decreased breath sounds in the lower lobes

 

C) Normal breath sounds with scattered inspiratory crackles in the lower lobes

 

D) Bronchial breath sounds with wheezing and crackles

Which of the following may be a reason why it is not a good idea to perform postural drainage on Sally?

 

A) Sally has dementia

 

B) Sally may have an aspiration risk

 

C) Sally is frail

 

D) None of the above, it is perfectly fine to perform postural drainage on Sally

 

 

Vignette 2- Ricky is a 13-year-old boy with exercise induced asthma. He loves playing soccer but has found it increasingly difficult to do so. Ricky's mother is very concerned and believes Ricky should give up soccer.

Ricky and his mother appears to have different goals for treatment, what do you do?

 

A) Tell Ricky to limit soccer or try other less intense sports as parents know what is best for their children until Ricky is older

 

B) In order to uphold to patient centered care, you tell Ricky's mom that the goal of treatment is to enable Ricky to continue with soccer

 

C) Listen to both parties, encourage open communication between Ricky and his mother and try family-oriented goal setting

 

D) You tell Ricky and his mother that according to your professional training, it is best to temporary limit soccer until Ricky's exercise induced asthma is better controlled

 

Which of the following is true?

 

A) Exercise induced asthma is equally likely to occur with any level of exercise intensity

 

B) Exercise induced asthma typically kicks in immediately after exercise

 

C) Exercise induced asthma typically kicks in a few hours after exercise

 

D) Exercise induced asthma typically kicks in 6-8 minutes after exercise

 

What are the triad characteristics of asthma?

 

A) Inflammation, bronchoconstriction, lung obstruction, bronchial cast

 

B) Inflammation, bronchoconstriction, excessive mucus production

 

C) Inflammation, bronchoconstriction, hypersensitivity to allergen

 

D) Inflammation, bronchospasm, increased thickness of mucus production

 

What education can you give the Ricky if he decides to continue with soccer?

 

A) Avoid soccer in cold weather and only exercise indoors

 

B) Encourage Ricky's mother to perform percussions and vibrations on Ricky if he gets an exercise induced asthma attack

 

C) Encourage Ricky to take his bronchodilator after soccer

 

D) Proper warm-up and cool down techniques

Vignette 3- Maria is a 60-year-old female with a past medical history of hypertension and she has been told she has atherosclerosis in one of her coronary arteries. After 10 minutes of shovelling, Maria is experiencing chest pain and pressure that radiates into her jaw and left arm. She is feeling short of breath and is sweating. She also has a history of clinical anxiety.

After resting and taking her nitroglycerin, Maria has not noticed any improvements and went to the hospital. Maria was diagnosed with a MI and eventually treated with a CABG surgery. After the surgery, you go to educate her on post CABG precautions. What are they?

 

A) No heavy lifting > 10 lbs, no driving, and no prone sleeping for 6 weeks

 

B) No heavy lifting > 10 lbs, no driving, and no prone sleeping for 8 weeks

 

C) No heavy lifting > 5lbs, no driving, and no sitting at the front seat for 6 weeks

 

D) No heavy lifting >5 lbs, no driving and no sitting at the front seat for 8 weeks

 

After Maria's CABG surgery, Maria was also told that she has atrial fibrillation. What do you expect to see on her ECG if she has atrial fibrillation?

 

A) No P waves

 

B) P waves look identical (saw tooth pattern)

 

C) Extra beats

 

D) Spaghetti line shape

 

E) Large QRS complex

 

Which of the scenarios below would have been inappropriate for Maria to engage in active physiotherapy?

 

A) ST Elevation & troponin <0.15ug/L

 

B) Atrial flutter & troponin >0.15ug/L

 

C) Ventricular tachycardia & troponin <0.15ug/L

 

D) Premature ventricular contraction & troponin > 0.15 ug/L

 

Several months after Maria's CABG surgery, she is interested in integrating exercise into her daily life. She was previously sedentary before her myocardial infarction. What is the most appropriate exercise program recommendation for her?

 

A) Aquatic exercise (given all scarring is healed) and using heart rate max as intensity marker

 

B) Strength training focusing on large muscle groups and educating to avoid valsalva

 

C) Moderate intensity exercise in at least 10-minute bouts, 45-60 minutes a day

 

D) Moderate to vigorous intensity exercise 20-40 minutes a day

 

E) Low intensity seated biking, 45-60 minutes a day

 

 

Neurology

 

Vignette 1 - A 26 year old C6 ASIA B spinal cord injury patient is struggling to learn an independent pivot transfer. The most difficult portion of the task is learning to use his head-hips relationship to swing. The therapist should.

 

A) Provide whole task training focusing on knowledge of results

 

B) Provide part task training and focus on proprioceptive demonstrations

 

C) Provide a delayed feedback of how the patient performed

 

D) Focus on part task training and knowledge of results

 

What type of functional tasks would you expect this patient to be able to perform after tertiary rehab

 

A) Modified independent with bed mobility, independent with transfers, and independent with wheelchair skills on uneven surfaces

 

B) Modified independent with bed mobility, partially independent with transfers, and independent with wheelchair skills

 

C) Modified independence with bed mobility, and independence with transfers, dependent on power wheelchair

 

D) Modified independence with bed mobility, modified independent with transfers, but may require some wheelchair assistance with uneven surfaces

 

Six months later the patient sensation has changed. He still lacks motor function below C6 but can feel general light touch and proprioceptive sensation. He lacks any pain or temperature sensation below level of injury. The patient most likely has

 

A) Central Cord Syndrome

 

B) Brown Sequard Syndrome

 

C) Cauda Equina

 

D) Conus Medullaris

 

E) Anterior Cord syndrome

 

A homecare physiotherapist finds the patient in his room complaining of dizziness, headache and profuse sweating in his legs

 

A) The therapist calls the code team as this is a medical emergency

 

B) Monitors vitals and lies the patient down into recovery position

 

C) Scans the patient for a noxious stimulus and lies the patient down

 

D) Scans the patient for a noxious stimulus and sits the patient up

 

 

Vignette 2 - A 76 year old male with 40 year history of MS comes into clinic on a power wheelchair.  He reports shoulder pain that is radiating into the anterior deltoid area.  His goals are to perform a standing pivot transfer into his vehicle. On assessment, you find

ROM 90 deg flexion 80 deg abduction, and poor postural awareness
+ hawkin kennedy
Hyper-reflexia on c5-c6 tendon
Mmt 4 triceps, 4 biceps, internal rotation 3-

What exercise or educational advice would be most suitable for this patient?

 

A) External rotation with theraband

 

B) Sit to stands holding onto a table for balance support

 

C) Fatigue management tips

 

D) Dips using the wheelchair handles

 

During history taking, this reports they have numbness and tingling along the medial aspect of the forearm. What pattern of numbness and tingling would you expect to find with this client?

 

A) Ulnar nerve upper limb tension test positive

 

B) Medial antebrachial nerve impingement

 

C) Ulnar Claw deformity

 

D) Sock and glove pattern of numbness

 

What other objective assessments test would be most helpful?

 

A) Upper limb tension testing

 

B) Flexor carpi Ulnaris mmt

 

C) Sharp Purser Testing

 

D) Cervical ROM

 

On assessment, you find

ROM 90 deg flexion 80 deg abduction, and poor postural awareness
+ hawkin kennedy
Hyper-reflexia on c5-c6 tendon
Mmt 4 triceps, 4 biceps, internal rotation 3-
What exercise advice could you provide this client?

 

A) Dosage of strengthening should be reduced to 2 x a week and 20 reps

 

B) Fatigue management

 

C) Postural awareness and scapular retraction

 

D) Avoid exercising in warmer areas to avoid Uhthoff's phenomena

 

 

Vignette 3 - An ENT referred you a patient with dizziness for treatment. This patient reports that he has some hearing loss on the left side.

Which cranial nerve is involved in this patient?

 

A) 4

 

B) 8

 

C) 10

 

D) 12

 

What instrument will you use to test hearing in this patient?

 

A) Tuning fork

 

B) Auditory speakers

 

C) Hearing aide

 

D) EMG

 

Dix Hallpike test is not used for which semicircular canal?

 

A) Posterior

 

B) Anterior

 

C) Horizontal

 

D) None of the above

 

 

 

 

Roll test is used to asses which semicircular canal?

 

A) Anterior

 

B) Posterior

 

C) Horizontal

 

D) Anterior +Posterior

 

 

Musculoskeletal

 

Vignette 1 - John was referred to you from obesity management clinic to design a exercise plan. Joh is very excited to start the program

Risk factors that you shoulder not consider before starting exercises are

 

A) Medications

 

B) Environmental factors

 

C) John is not very accustomed to exercises

 

D) John's emotional state

 

John was referred to you from obesity management clinic to design a exercise plan. John is very excited to start the program

What are the main issues affecting exercise adherence?

 

A) Boredom with exercises

 

B) Inconvenient Time

 

C) Poor Leadership

 

D) All the above

 

John was referred to you from obesity management clinic to design a exercise plan. John is very excited to start the program

When would you stop John from doing exercises

 

A) Systolic BP at 201 and Diastolic at 100

 

B) Systolic at 221 and Diastolic at 90

 

C) Systolic at 241 and Diastolic at 100

 

D) Systolic at 180 and Diastolic at 110

 

General guidelines for exercises adults aged between 18 to 35 are

 

A) 30 minutes of moderate intensity exercises 3 days per week

 

B) 30 minutes of vigorous exercises 3 days per week

 

C) 20 minutes of moderate intensity exercises 5 days per week

 

D) 20 minutes of vigorous exercises 3 days per week

 

 

Vignette 2 - Patient reported that he was playing soccer and twisted his knee. He saw a physician and was referred to you. On assessment, you find that the knee has limited arom. His knee does not extend one time and does not flex the next time

Patient also told you that he heard a pop in his knee which was very distinct. Most common cause op pop in the knee is due to

 

A) ACL Tear

 

B) Osteochondral Fracture

 

C) Popliteus Tendon

 

D) All the above

 

Patient reported that he was playing soccer and twisted his knee. He saw a physician and was referred to you. On assessment, you find that the knee has limited arom. His knee does not extend one time and does not flex the next time

What is the closed pack position of the Knee

 

A) Full Extension, lateral rotation of tibia

 

B) Full extension, medial rotation of Tibia

 

C) Full flexion Lateral Rotation of Tibia

 

D) Full Extension, Lateral rotation of Tibia

 

Patient reported that he was playing soccer and twisted his knee. He saw a physician and was referred to you. On assessment, you find that the knee has limited arom. His knee does not extend one time and does not flex the next time

Which Facet in the knee is affected the most in Chondromalacia Patella

 

A) Odd

 

B) Even

 

C) Medial

 

D) Lateral

 

In which of the following positions can a Physiotherapist palpate the lateral collateral ligament at best.

 

A) Knee at 60° of flexion and the hip externally rotated

 

B) Knee at 20° of flexion and the hip at neutral

 

C) Knee at 90° of flexion and the hip externally rotated

 

D) Knee at 0° and the hip at neutral

 

 

 

 

Vignette 3 - Betty is in gymnastics. While doing a jump, she landed on her elbow which caused a lot of pain. You are the team physio and you take her to the locker room to evaluate. Betty normal has hyperextended elbows

Most common injury gymnastic players with hyperextended injury is

 

A) Anterior dislocation

 

B) Posterior dislocation

 

C) Rupture of the capsule

 

D) Fracture of head of radius

 

Which is the first movement to be lost by injury to elbow and the first movement to be regained after rehab?

 

A) Flexion

 

B) Extension

 

C) Flexion - lost, Extension regained

 

D) Extension - lost, Flexion regained

 

If brachialis muscles is injured in this patient, stretching is contraindicated due to

 

A) Pull on the radial head

 

B) Ossification of brachialis

 

C) Dislocation of the radial head if fractures

 

D) All the above

 

Betty is in gymnastics. While doing a jump, she landed on her elbow which caused a lot of pain. You are the team physio and you take her to the locker room to evaluate. Betty normal has hyperextended elbows

Normal end feel during passive Elbow Flexion is

 

A) Bone to bone

 

B) Tissue stretch

 

C) Tissue approximation

 

D) Empty end feel

 

 

 

 

ANSWERS

Cardio and Ethics

Vignette 1 – D, E, A, B

Vignette 2 – C, D, B, D

Vignette 3 – C, A, B, C

 

Neurology

Vignette 1 – A, D, E, D

Vignette 2 – A, D, D, C

Vignette 3 – B, A, C, C

 

Musculoskeletal

Vignette 1 – D, D, C, B

Vignette 2 – A, D, A, C

Vignette 3 – B, B, B, C

MOCK EXAM QUESTIONS

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