DPT Patient Evaluation & Diagnosis 5 — Questions and Answers
Question 1: A PT reviews a plain radiograph and notes a 'fish-tail' vertebral deformity in the thoracic spine of a 14-year-old female. This finding is MOST associated with:
- Scheuermann's disease (Correct answer)
- Spondylolisthesis
- Idiopathic scoliosis
- Ankylosing spondylitis
Correct answer: Scheuermann's disease
Scheuermann's disease produces anterior vertebral wedging and irregular endplates (Schmorl's nodes), creating a 'fish-tail' or kyphotic appearance on imaging.
Question 2: Which auscultation finding over the femoral artery would prompt a PT to withhold exercise and refer a patient for vascular evaluation?
- S1 heart sound referred to the groin
- Femoral bruit (Correct answer)
- Venous hum
- Absent bowel sounds
Correct answer: Femoral bruit
A femoral bruit indicates turbulent blood flow consistent with arterial stenosis, warranting referral prior to exercise.
Question 3: According to the Guide to Physical Therapist Practice, which of the following is considered a PT diagnosis rather than a medical diagnosis?
- Lumbar disc herniation at L4–L5
- Impaired joint mobility and pain due to connective tissue dysfunction (Correct answer)
- Osteoarthritis of the knee
- Type 2 diabetes mellitus
Correct answer: Impaired joint mobility and pain due to connective tissue dysfunction
PT diagnoses describe movement dysfunction and impairments (e.g., impaired mobility) rather than pathoanatomical tissue disease.
Question 4: When interpreting a diagnostic test's utility, a specificity of 97% means:
- 97% of people with the condition will test positive
- 97% of people without the condition will test negative (Correct answer)
- 97% of positive tests correctly identify disease
- 97% of all tests will be accurate
Correct answer: 97% of people without the condition will test negative
Specificity is the proportion of true negatives — the test correctly identifies 97% of individuals who do NOT have the condition.
Question 5: A patient with suspected deep vein thrombosis scores 3 on the Wells Clinical Prediction Rule. This score indicates:
- Low probability of DVT — no further testing needed
- Moderate probability — ultrasound recommended
- High probability — immediate anticoagulation without imaging
- High probability — imaging required before treatment decision (Correct answer)
Correct answer: High probability — imaging required before treatment decision
A Wells score ≥3 indicates high DVT probability, requiring confirmatory duplex ultrasound before treatment initiation.
Question 6: During posterior-anterior (PA) mobilization of the lumbar spine, the patient reports a concordant increase in left-leg radicular symptoms. The MOST appropriate clinical response is to:
- Increase the grade of mobilization to desensitize the nerve
- Continue the technique and reassess after the session
- Discontinue the technique and modify the examination approach (Correct answer)
- Immediately refer to emergency services
Correct answer: Discontinue the technique and modify the examination approach
Reproduction of concordant radicular symptoms during spinal loading suggests neural compromise; the technique should be stopped and the approach modified.
Question 7: In a patient with a C6 nerve root lesion, which reflex would MOST likely be diminished?
- Biceps reflex
- Brachioradialis reflex (Correct answer)
- Triceps reflex
- Hoffman reflex
Correct answer: Brachioradialis reflex
The brachioradialis reflex is primarily mediated by C6; diminishment localizes the lesion to the C6 nerve root.
DPT Patient Evaluation & Diagnosis 5
A PT reviews a plain radiograph and notes a 'fish-tail' vertebral deformity in the thoracic spine of a 14-year-old female.
This finding is MOST associated with: