CHT Clinical Reasoning 5 — Questions and Answers
Question 1: A CHT is using motivational interviewing with a patient who is non-compliant with home exercises. The therapist's BEST response to the patient's ambivalence is:
- Emphasize the consequences of non-compliance
- Explore the patient's own reasons for wanting to improve (Correct answer)
- Prescribe a written home program with detailed instructions
- Reduce the number of exercises to increase compliance
Correct answer: Explore the patient's own reasons for wanting to improve
Motivational interviewing focuses on eliciting the patient's intrinsic motivation by exploring their own values and goals for recovery.
Question 2: A patient with a mallet finger deformity treated conservatively for 6 weeks shows persistent extensor lag of 20 degrees. The MOST appropriate clinical reasoning is:
- Discontinue splinting and begin active DIP extension exercises
- Continue uninterrupted splinting for an additional 6 weeks and reassess (Correct answer)
- Refer immediately for surgical intervention
- Begin resistive extension immediately
Correct answer: Continue uninterrupted splinting for an additional 6 weeks and reassess
A residual extensor lag at 6 weeks may indicate inadequate healing; continuing splinting with reassessment is standard conservative management.
Question 3: A CHT identifies fear-avoidance behavior in a patient with chronic hand pain. Which assessment tool BEST quantifies this?
- Short Form-36 (SF-36)
- Tampa Scale of Kinesiophobia (TSK) (Correct answer)
- Patient-Rated Wrist and Hand Evaluation (PRWHE)
- Michigan Hand Outcomes Questionnaire (MHQ)
Correct answer: Tampa Scale of Kinesiophobia (TSK)
The Tampa Scale of Kinesiophobia specifically measures pain-related fear of movement and is the standard tool for assessing fear-avoidance.
Question 4: When reasoning about a patient's risk for developing chronic pain after hand surgery, which psychosocial factor has the STRONGEST evidence as a predictor?
- Patient age over 60
- Pre-surgical catastrophizing (Correct answer)
- Low grip strength prior to surgery
- History of smoking
Correct answer: Pre-surgical catastrophizing
Pain catastrophizing is one of the strongest psychological predictors of chronic post-surgical pain and poor functional outcomes.
Question 5: A CHT is treating a patient with partial thickness burns to the dorsal hand. Which clinical reasoning principle should guide early splinting?
- Splint in a position of comfort to reduce pain
- Splint in the intrinsic plus position to prevent contracture (Correct answer)
- Avoid all splinting until wounds are closed
- Splint in wrist extension only, leaving digits free
Correct answer: Splint in the intrinsic plus position to prevent contracture
The intrinsic plus position (wrist extension, MP flexion, IP extension) is the anti-deformity position that prevents dorsal hand burn contractures.
Question 6: A patient who sustained a high-pressure injection injury to the palm presents to outpatient therapy. The therapist's FIRST action should be:
- Begin edema management with retrograde massage
- Immediately refer to the emergency department if not yet evaluated (Correct answer)
- Evaluate grip strength and ROM
- Apply a compressive wrap and schedule follow-up
Correct answer: Immediately refer to the emergency department if not yet evaluated
High-pressure injection injuries are surgical emergencies requiring immediate debridement; if not yet evaluated by a surgeon, emergency referral is mandatory.
Question 7: A CHT uses the clinical reasoning strategy of 'hypothesis testing' during evaluation. This is BEST described as:
- Administering all available special tests to the patient
- Forming a probable diagnosis and selecting tests to confirm or refute it (Correct answer)
- Waiting for imaging results before forming a clinical impression
- Documenting multiple diagnoses and treating each separately
Correct answer: Forming a probable diagnosis and selecting tests to confirm or refute it
Hypothesis testing involves forming a working diagnosis based on initial findings and selectively choosing tests to confirm or rule out that hypothesis.
CHT Clinical Reasoning 5
A CHT is using motivational interviewing with a patient who is non-compliant with home exercises.
The therapist's BEST response to the patient's ambivalence is: