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PCE - Physiotherapy Competency Exam Study Guide
1. Describe the 3 stages of tissue healing. What are their general durations?: 1. Inflammatory: 1-7 days post-injury.
2. Proliferative / Repair: 5-28 days post-injury.
3. Remodelling / Maturation: 28+ days to months/years.
2. Describe 3 contraindications to resistance exercise.: 1. Acute inflammation.
2. Joint ettusion.
3. Fracture.
4. Joint/muscle pain during AROM.
5. Bony metastasis / cancer.
3. Describe 3 contraindications to stretching.: 1. Acute infection / inflammation.
2. Fracture.
3. Joint ettusion.
4. Recent corticosteroid injection.
5. Hypermobility / instability in the direction being stretched.
4. Describe 3 items in your treatment for a patient with spinal stenosis.: 1. Lumbar spine flexion exercises.
2. Lumbar traction.
3. Core stabilization to prevent lumbar flexion.
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4. Aerobic exercise in a position allowing lumbar spine flexion.
5. Education on posture and ergonomics.
5. 1. What is the most common type of lumbar disc herniation?
- What is the most common age category for lumbar disc herniation?: 1. Postero-lateral.
- 30-50 years old.
6. Describe 2 signs and symptoms of a lumbar disc herniation.: 1. Radiculopathy - neuropathic pain following a dermatomal
distribution.
2. Myotomal weakness.
3. Low back / leg pain with weightbearing activities.
- +ve SLR.
- +ve Slump.
7. Describe 2 items in your treatment plan for lumbar disc herniation.: 1. Graduated extension protocol.
2. Traction.
3. Lumbar stabilization exercises.
4. Education on duration of healing time, what healing process may look like.
5. Education to avoid prolonged flexion.
8. Describe 3 signs and symptoms of greater trochanteric pain syndrome.: 1. TOP greater trochanter.
2. Pain w/ abduction and/or external rotation of hip.
3. Pain with prolonged standing.
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13. Describe the "swipe test" of the quadriceps and its utility.: The test is used to confirm the presence of edema.
1. Swipe upwards x2-3 on the medial aspect of the knee.
2. Then, swipe downwards x2-3 laterally.
3. Watch for fluid returning medially.
14. What are the 3 ligaments of the sacroiliac joint?: 1. Anterior sacro-iliac ligament.
2. Interosseous.
3. Posterior (overlies the interosseous).
15. What are the ligaments of the lateral pelvic walls?: 1. Sacrospinous ligament.
- Sacrotuberous ligament. *Together, these structures create both the greater and lesser sciatic foramen.
16. What are the origin and insertion of the iliopsoas?: Origin: iliac fossa, vertebrae T12-L5. Insertion: lesser trochanter of femur.
Actions: hip flexion, external rotation.
17. What are the orign, insertion, innervation, and actions of the sartorius?: Ori-gin: ASIS.
Insertion: Pes anserinus. Innervation: Femoral n. (L2-4). Actions: Hip F, ABD, ER; Knee F.
18. What are the orign, insertion, innervation, and actions of the pectineus?: -
Origin: pubis; pectineal line.
5 / 83 Insertion: inferior to lesser trochanter; pectineal line. Innervation: femoral n. OR obturator n. Action: Hip F, ADD, IR
19. What are the orign, insertion, innervation, and actions of the rectus femoris?: Origin: AIIS
Insertion: quadriceps tendon Innervation: femoral n. Action: hip F, knee E
20. What artery supplies the anterior compartment of the knee?: Femoral artery.
21. Describe 3 signs and symptoms of arterial insufficiency due to peripheral vascular disease.: 1. Diminished
or absent pulse in attected area.
- Decreased capillary refill.
2. Shiny, thin, hairless skin.
3. Intermittent claudication: pain, aching, or cramping in attected area during activity.
4. Mild edema
22. Describe 3 signs and symptoms of venous insufficiency due to peripheral vascular disease.: 1. Significant
edema
2. Pruritis, "tightness"
3. Brown or eczema-presenting skin
4. Pain that is worse at the end of the day.
5. Pain improves with exercise.
7 / 83 Systolic: >20 mmHg Diastolic: >10 mmHg
29. What is the optimal positioning for a patient who is acutely experiencing orthostatic hypotension?:
Supine
30. For how long should patients avoid strenous activity following heart surgery?: 6-10 weeks
31. What blood pressure is considered hypertensive?: SBP >139 DBP >
32. What is considered uncontrolled hypertension and a contraindication to exercise?: SBP >
DBP >
33. What is considered dangerously hypotensive?: SBP <90 DBP <
34. What is heart rate reserve?: The ditterence between someone's maximum heart rate and their resting heart rate.
35. At what intensity (using heart rate reserve) do you want to prescribe aerobic exercise for cardiac patients?:
40-70% heart rate reserve (HR Reserve x % intensity) + resting HR = exercise HR
36. Describe 3 resistance training principles for cardiac patients.: 1. NO valsalva
2. NO isometric / static exercises
3. Lower resistance + higher reps
4. Slower rate of progression; don't increase more than one of FITT each week.
37. Describe 2 precautions when mobilizing a patient with a chest tube.: 1. Do NOT lift chest tube above the site of
insertion to avoid backflow.
2. Do NOT lay or roll onto chest tube.
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3. If connected to wall suction, check with medical team if the patient is able to be disconnected.
38. What are some unique considerations for femoral ART lines compared to brachial or radial?: 1. NO hip
flexion >80 degrees
- When removed, no coughing for 2 hours. Patient must lie flat for 4-6 hours.
39. What is normal intracranial pressure? Dangerously elevated?: Normal ICP = 0-10 mmHg
Dangerous ICP = >20 mmHg
40. In what position are patients with elevated intracranial pressure treated?
What is one treatment consideration for those with elevated ICP?: Head of bed elevated 15-30 degrees. Further, these patients require procedures such as suctioning or manual techniques to be limited.
41. What is the difference between a step and a stride?: Step: one leg moving forward; right heel strike to left heel strike.
Stride: when one step of each the left and right leg occur in succession; one gait cycle
42. During gait, what percentage is spent in the stance phase? In swing phase?-
: Stance: 60% Swing: 40%
43. What are the sub-categories of the stance phase of gait? How much of a total gait cycle do we spend
in each?: Initial Contact: 0% (double support) Loading Response: 0-10% (double support) Midstance: 10-30% Terminal Stance: 30-50% Pre-Swing: 50-60% (double support)
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54. What gait aid(s) are most appropriate for non-weightbearing and feath-er-weightbearing?
What type of gait pattern is used?: 1. Standard Walker
- Crutches Gait Pattern: 3-point
55. What gait pattern would a patient who is partial-weightbearing use?: 1. 3-point
- 4-point
56. What type of gait pattern(s) are used for patients who are WBAT or full-weightbearing?:
- 2-point
- 4-point
57. What does an order of "supervision" mean?: Patient does not require physical help, but might require cues or someone nearby for
potential assistance.
58. What does an order of "minimal assistance" mean?: Patient performes at least 75% of the activity
59. What does an order of "moderate assistance" mean?: Patient performs at least 50% of the activity
60. What does an order of "maximal assistance" mean?: Patient performs less than 25% of an activity
61. After a hip or knee replacement, which leg should lead during gait?: Operated lower extremity.
62. What are the typical hip precautions?: 1. No hip flexion >90 degrees
2. No internal rotation of the hip
3. No adduction past midline
*WBAT
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63. What is the hierarchy for inherent balance strategies - small to large per-turbations in balance?: 1.
Ankle
2. Hip
3. Step
64. If you suspect that your patient is experiencing a transient ischemic attack or a stroke, what should you
do?: 1. Stop treatment
2. Ensure patient safety (lying with head slightly elevated)
3. Call emergency services
4. Monitor the patient
5. Avoid giving food or drink
65. Relating to strokes, what does the acronym "FAST" stand for?: Face drooping Arm weakness
Speech diflculty Time to call emergency services
66. What are some factors supporting a positive prognosis post-stroke?: 1. Younger age
2. Ischemic type stroke
3. Absence of severe deficits (e.g. aphasia, visospatial deficits, incontinence)
4. Early mobility
67. In what timeframe do we expect the majority of neurological recovery to occur post-stroke?
Functional recovery?: Neuro: 12 weeks Functional: 14-15 weeks
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2. Visual/spatial problems
3. Neglect
4. Visual agnosia
*Non-verbal / artistic brain
76. What are common characteristics of LEFT CVA strokes?: 1. Right-sided weakness
2. Aphasias (Broca's, Wernicke's, etc.)
3. Apraxia (diflculty planning and executing motor tasks)
77. What is Broca's aphasia?: Lesion to left frontal lobe resulting in impaired production of speech.
Auditory comprehension is intact.
78. What is Wernicke's aphasia?: Lesion to left temporal lobe resulting in impaired auditory compre-hension of speech.
Spontaneous speech is preserved, intentional speech will not make sense.
79. In a patient with an acute stroke with a clearly affected side, which side would you transfer towards?
Would this change as the patient progresses through rehab?: Acute: transfer towards strong side for increased safety. Sub-Acute: transfer towards attected side for therapeutic benefit.
80. What are some considerations for constraint-induced movement therapy?-
: 1. Must be completed for 90% of waking hours
2. Patient must be CMSA III or higher
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3. Practice should be task-oriented.
81. What are some treatment principles for a flaccid, subluxed shoulder in a stroke patient?: 1. Avoid positioning
the shoulder in internal rotation
2. Ensure that the GH joint remains supported
3. Encourage weight-bearing as tolerated through the arm for joint loading
4. Proper shoulder positioning (slight abduction + ER)
5. Use of NMES
6. Education to family
7. Safe PROM
82. What are some facilitation strategies to use when treating stroke patients with little voluntary muscle
activation?: 1. Tactile cues (e.g. tapping, vibration, joint compression)
2. Stimulation (e.g. electrical)
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89. What innervates the muscles of mastication?
What are the main muscles of mastication?: Cranial nerve V (trigeminal) Masseter, temporalis, medial + lateral pterygoid
90. What are the 4 joints of the shoulder complex?: sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic
91. What clinical features would indicate plantar fasciopathy?: 1. Pain over plantar fascia and calcaneal tuberosity
2. Most pain with first few steps in the morning / after a period of rest
3. Decreased dorsiflexion
4. Recent increase in activity
92. What clinical features would indicate medial tibial stress syndrome?: 1. Pain over medial aspect of tibia (TOP)
2. Pain with resisted plantarflexion
3. Pain can improve or worsen with exercise, but is usually worst at the beginning of an exercise bout
4. One leg hop test to rule out stress # (unable to hop with #)
5. Pes Planus
93. Lateral ankle sprain: what is the typical MOI and what are the typical affected ligaments?: MOI:
inversion and plantarflexion Ligaments: ATFL, CFL
94. Syndesmosis / High Ankle Sprain: what is the typical MOI: MOI: excessive DF and ER of the leg when it's planted
95. What tests would you use to assist in the diagnosis of a high ankle sprain / syndesmosis?: 1. Squeeze test
- Kleiger test
96. What is the Royal London Hospital test?: Used to assist in the diagnosis of achilles tendinopa-thy.
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97. What is the ARC sign for achilles tendinopathy?: Palpation of achilles tendon during plantarflexion / dorsiflexion - can
tendon be felt moving? Any thickening?
98. What are some common techniques used to assist in determining the presence of a knee meniscal
pathology?: 1. McMurray's Test
2. Thessaly's Test
3. Apley's test
4. Joint line tenderness
99. What is the most common MOI for the "unhappy triad" of the ACL, medial meniscus, and medial
collateral ligament?: Plant + twist / dynamic valgus Forceful rotation of the knee combined with flexion
100. What is the origin and insertion of the ACL?: Origin: posterio-medial aspect of lateral femoral condyle
Insertion: antero-medial tibial head
101. What is the most common test done to assess the integrity of the ACL?
What is the most important ROM to restore after an ACL injury?: Test: Lachman's test ROM: Knee extension
102. What test would you use to assist in the diagnosis of an MCL sprain?
How do MCL injuries tend to heal?: Test: valgus stress test at 0 + 30 degrees
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3. Motor response to pain Score:
108. Describe decorticate and decerebrate posturing following a brain injury.-
: Decorticate: lower extremities extended, upper extremities "hugging" self (wrist F) Decerebrate: lower extremities extended, upper extremity extended (wrist F) *involuntary posturing indicating a severe brain injury
109. Summarize what a subarachnoid hemmorage is.: Type: high pressure arterial bleed Symptoms: rapid onset headache,
vomiting, confusion, decreased LOC, CN III signs Treatment: surgical intervention (clip)
110. Summarize what a subdural hematoma is.: Type: low pressure venous bleed Symptoms: onset occurs over hours,
fluctuating symptoms, appears drunk Treatment: surgical intervention (holes to relieve pressure)
111. Summarize what a epidural hematoma is.: Type: rapid arterial bleed associated with skull fracture
Symptoms: initially pt feels normal, then decline in mental status until LOC Treatment: medical emergency, ABCs
112. What are the 3 qualifications of a mild traumatic brain injury?: 1. loss of consciousness <30 minutes
2. After 30 mins, GCS >=
3. Post-traumatic amnesia <24 hours
113. What are some of the sideline evaluations on the SCAT-6 concussion as-sessment tool?: 1. Positive
observable signs
2. Glasgow coma scale <
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3. Neck pain, tenderness, loss of ROM (if YES, then cervical collar)
4. Coordination / ocular motor screen
5. Memory assessment
*If any positive, remove from play for immediate medical assessment
114. What are SCAT-6 RED FLAGS for immediate removal from play?: 1. Neck pain or tenderness
2. Seizure or convulsion
3. Double vision
4. LOC
5. Neuro signs in more than 1 extremity
6. Deteriorating LOC
7. Vomiting
8. Sudden or increasing headache
9. GCS >
10. Visible deformity of skull
11. Increasingly restless, agitated, or combative
115. What ligament does the anterior drawer test for the ankle primarily stress?: ATFL
116. What ligament does the talar tilt test for the ankle primarily stress?: CFL
