Red Flags of LE
Which of the following is NOT one of the 6 P's to watch out for with acute compartment syndrome?
a) pressure
b) protected posture
c) palor
d) pulselessness
B
(6 P's include: pain, pressure, palor, paresthesia, pulselessness, and paralysis)
A 33-year-old male is referred to physical therapy for a neurological evaluation. He reports that he has been experiencing difficulty walking and stiffness in his legs. On examination, you observe hypertonia and hyperreflexia in both legs. A Babinski sign is present. His deep tendon reflexes are exaggerated, and there is no muscle atrophy or weakness. Based on these findings, which of the following is the most likely diagnosis?
A) Multiple sclerosis
B) Amyotrophic lateral sclerosis
C) Spinal cord injury at the L2 level
D) Polio
A) Multiple sclerosis
Hypertonia, hyperreflexia, and a positive Babinski sign are indicative of UMN involvement. Multiple sclerosis often presents with these UMN signs, and it can cause spasticity and other neurological deficits due to demyelination in the central nervous system.
Which of the following is most important to document in a physical therapy progress note?
A) Detailed discussion of the patient’s personal history
B) A subjective report of the patient’s progress and functional status
C) A comprehensive list of all exercises the patient plans to do at home
D) The exact dates and times of all therapy sessions
B) A subjective report of the patient’s progress and functional status
During iontophoresis treatment, a physical therapist administers dexamethasone (a corticosteroid) through the skin. What is the mechanism by which iontophoresis delivers the medication?
A) Electromagnetic waves pass through the skin to deliver the medication directly to the tissues
B) The medication is absorbed via passive diffusion through the skin
C) A small electrical current drives the negatively charged medication into the tissues
D) The current increases the permeability of the skin, allowing larger molecules to pass through
C) Iontophoresis uses an electrical current to drive charged particles (ions) of a medication into the tissue, based on the principle that like charges repel. Since dexamethasone is negatively charged, it is delivered using a negative electrode.
A 40-year-old female presents with right shoulder pain and reports numbness and tingling in her fingers, particularly in the fourth and fifth digits. She also notes that the symptoms worsen when she raises her arms overhead or holds them in a fixed position for long periods, such as when driving or holding a phone. On physical examination, a positive Adson’s test is noted. What is the most likely diagnosis?
A) Rotator cuff tear
B) Carpal tunnel syndrome
C) Thoracic outlet syndrome
D) Ulnar nerve entrapment
Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures (typically the brachial plexus, subclavian artery, and/or subclavian vein) as they pass through the thoracic outlet.
Most likely diagnosis:
Painful knee that is worse with activity. Mild effusion and most special tests are negative. Often a result of acute trauma or repetitive stress.
a) stress fracture
b) Osteochondritis Dissecans
c) patellofemoral pain syndrome
d) gout
b) Osteochondritis Dissecans
A progressive UMN & LMN disease that affects nerve cells in the brain and SC. Patients will lose their ability to speak, eat, move and breathe.
A) MS
B) ALS
C) Post polio syndrome
D) GBS
A physical therapist is treating a patient who is pregnant and in her second trimester. The patient expresses concerns about certain physical therapy modalities during the treatment. Which of the following physical therapy modalities is considered contraindicated during pregnancy?
A) Cryotherapy for swelling management
B) Transcutaneous electrical nerve stimulation (TENS) for pain control
C) Iontophoresis with dexamethasone for inflammation
D) Ultrasound therapy to reduce muscle spasm
C)
Iontophoresis with corticosteroids (e.g., dexamethasone) is contraindicated during pregnancy due to the potential for harmful effects on the developing fetus
A physical therapist is applying cold packs to a patient’s ankle following an acute sprain. Which of the following physiological responses is expected as a result of cryotherapy?
A) Increased metabolic rate in the tissues to promote healing
B) Vasodilation and increased blood flow to the affected area
C) Decreased nerve conduction velocity, which helps to reduce pain
D) Increased tissue oxygenation and collagen synthesis
C)
Cryotherapy reduces pain by decreasing nerve conduction velocity and vasoconstriction, limiting the flow of blood and reducing the inflammatory response.
A 60-year-old male presents with pain in his left elbow after a fall. He reports feeling numbness and tingling in his fourth and fifth fingers. On examination, he has weakness in his hand grip and a positive Tinel’s sign at the elbow. Patient is starting to develop a "claw hand." What is the most likely condition?
A) Lateral epicondylitis
B) Cubital tunnel syndrome
C) Brachial plexopathy
D) Medial epicondylitis
Cubital tunnel syndrome
The combination of pain at the elbow, numbness and tingling in the fourth and fifth fingers, and positive Tinel’s sign at the elbow are indicative of cubital tunnel syndrome, which involves compression of the ulnar nerve at the elbow. The red flag = if the compression is severe and untreated, possibly leading to permanent damage (e.g., Claw hand).
Which of the following is not on the wells score for DVT?
A) active cancer
B) calf swelling greater than 3 cm
c) hemoptysis
d) recently bedridden
C- this would be a sign of pulmonary embolism instead
Patient presents with the following:
1) weakness of foot and lower leg
2) foot deformities, including a high arch and hammer toes
3) numbness, tingling, burning, and loss of temperature sensation in hands and feet (in stocking glove pattern)
4) Activity limitations include reduced walking and hand function
You suspect:
A) Neuropathy caused by DM
B) GBS
C) Charcot foot
D) Charcot-Marie-Tooth
D) Charcot-Marie-Tooth
An inherited disorder that causes nerve damage, usually in the arms and legs
A physical therapist is treating a patient who presents with chronic pain due to fibromyalgia. The therapist wants to improve the patient’s physical function and quality of life through exercise therapy. The patient expresses fear of engaging in exercise due to a perceived increase in pain. Which of the following should the therapist emphasize in their approach to treatment?
A) Encourage a high-intensity exercise program immediately to challenge the patient’s endurance
B) Explain the role of graded exposure and begin with low-intensity exercises, gradually increasing difficulty as tolerated
C) Reassure the patient that the pain is due to muscle tightness and provide passive range-of-motion exercises only
D) Recommend a complete rest period for the first 4 weeks to allow for recovery
B-- For patients with fibromyalgia, a graded exercise approach is essential. This involves starting with low-intensity exercises and gradually increasing intensity to allow the body to adjust. It is important to avoid exacerbating pain and to provide psychological reassurance, especially since patients with fibromyalgia often experience fear avoidance behaviors.
A physical therapist is treating a patient with acute inflammation following a knee sprain. Which of the following modalities is most appropriate for reducing inflammation in the acute phase?
A) Thermotherapy
B) Ultrasound therapy with a pulsed mode
C) Heat packs applied to the affected area
D) Interferential current for deep tissue stimulation
B) In the acute phase of injury, pulsed ultrasound can help reduce inflammation by providing thermal effects without causing additional tissue damage. Ultrasound in pulsed mode promotes tissue healing, reduces swelling, and increases circulation.
A 50-year-old male presents with neck pain after a recent motor vehicle accident. He reports numbness and tingling in both hands and difficulty with balance. He also describes severe, constant neck pain that worsens with movement. On examination, you find weakness in his upper extremities, decreased reflexes, and difficulty performing coordination tests. Which of the following is the most concerning red flag that warrants immediate referral to a physician?
A) Numbness and tingling in both hands
B) Difficulty with balance and coordination
C) Severe neck pain worsening with movement
D) Decreased reflexes in the upper extremities
B) Difficulty with balance and coordination, along with neck pain and sensory changes, could indicate cervical myelopathy, which is caused by compression of the spinal cord in the cervical spine. This is a red flag that requires immediate referral to a physician, as cervical myelopathy can lead to permanent spinal cord damage if not treated promptly.
A 50-year-old male presents with sudden onset of severe anterior hip pain and tightness in the groin. The pain is exacerbated with weight-bearing activities, especially walking. He has a history of alcohol use and has been taking corticosteroids for a previous medical condition. What is the most likely diagnosis?
A) Femoral neck stress fracture
B) Avascular necrosis of the femoral head
C) Hip labral tear
D) Osteoarthritis of the hip
B)
AVN often presents with groin or anterior hip pain, exacerbated by weight-bearing. Risk factors include alcohol use and corticosteroid use.
A 55-year-old male presents to physical therapy with complaints of weight gain, particularly around his abdomen and face. He also has a round, “moon-shaped” face, a buffalo hump at the back of his neck, and thinning skin. He reports increased appetite, irritability, and difficulty sleeping. His recent blood tests show elevated cortisol levels. Which of the following is the most likely diagnosis for this patient?
A) Addison's disease
B) Cushing's syndrome
C) Type 1 DM
D) Hypothyroidism
B) Cushing's syndrome- characterized by excess cortisol levels, leading to symptoms such as central obesity, "moon face," buffalo hump, skin thinning, and increased appetite.
Addison's disease (is characterized by insufficient cortisol and presents with weight loss, fatigue, and hyperpigmentation).
A 40-year-old male presents to physical therapy following a lumbar disc herniation. During the evaluation, the physical therapist performs a slump test, which reproduces the patient’s symptoms of pain and tingling down the posterior leg. Which of the following is the most appropriate intervention to manage the patient’s symptoms in the acute phase of rehabilitation?
A) Initiate a strengthening program for the trunk and lower extremities
B) Implement lumbar traction to alleviate pressure on the affected disc
C) Encourage the patient to perform flexion-based exercises to increase disc space
D) Use a brace to immobilize the spine and limit movement
B) Lumbar traction can help relieve pressure on the affected disc, reduce nerve compression, and alleviate pain during the acute phase of rehabilitation.
To target muscle strengthening, on a larger quad muscle, through E-Stim, a PT should set the following parameters:
a) pulse of 35-80pps, ratio of 1:5, pulse duration of 150-200
b) pulse of 35-50 pps, 2-5 seconds on, pulse duration of 200-350
c) pulse of 35-80 pps, ratio of 1:5, pulse duration 200-350
d) pulse of 35-80 pps, ratio of 1:3, pulse duration 150-200
C=correct response
A=for starting out strengthening small muscles
B=edema reduction
D=ratio indicates progression of strengthening small muscles
A 32-year-old male presents to physical therapy following a motor vehicle accident. He reports a headache, dizziness, and nausea that have persisted since the accident. The therapist notices that the patient has difficulty with balance and has slurred speech. On examination, the patient's Glasgow Coma Scale (GCS) score is 13, and there is noticeable confusion during the interview. Which of the following is the most appropriate action for the therapist to take at this time?
A) Continue with physical therapy exercises to improve balance and coordination
B) Refer the patient immediately to a physician for further evaluation of a possible traumatic brain injury
C) Instruct the patient to rest and monitor symptoms at home
D) Proceed with vestibular rehabilitation to address balance deficits
B) The combination of a decreased GCS score (15 is normal), confusion, slurred speech, and persistent symptoms such as headache, dizziness, and nausea after a motor vehicle accident raises concern for a traumatic brain injury (TBI). Immediate referral to a physician is warranted for further evaluation and potential imaging to rule out more serious brain injury.