PAM Patient Assessment & Clinical Evaluation 3 — Questions and Answers
Question 1: A clinician is assessing a patient's response to a hot pack applied to the lumbar spine. Which finding indicates a normal physiological response to superficial heat?
- Blanching of the skin
- Mild erythema and patient-reported warmth (Correct answer)
- Vesicle formation
- Immediate pain increase
Correct answer: Mild erythema and patient-reported warmth
Mild erythema (redness) with a sensation of warmth is a normal vasodilatory response to superficial heat application.
Question 2: When screening a patient for contraindications to ultrasound therapy, which implant is an absolute contraindication over the treatment area?
- Stainless steel surgical screws
- Cemented joint replacement
- Cardiac pacemaker (Correct answer)
- Titanium dental implants
Correct answer: Cardiac pacemaker
A cardiac pacemaker is an absolute contraindication to therapeutic ultrasound when treating over or near the thorax, as mechanical vibration can interfere with pacemaker function.
Question 3: During goniometric assessment before PAM treatment, the clinician finds a patient's shoulder has 90° of active abduction but 150° of passive abduction. This difference indicates:
- Ligamentous laxity
- Contractile tissue dysfunction (Correct answer)
- Bony end-feel pathology
- Normal variation within reference ranges
Correct answer: Contractile tissue dysfunction
A significant discrepancy between active and passive ROM where passive exceeds active suggests a contractile tissue (muscle or tendon) problem rather than a joint capsule or bony restriction.
Question 4: Which pain characteristic, identified during the subjective exam, suggests central sensitization rather than peripheral nociception?
- Pain localized precisely to a surgical incision site
- Pain that is diffuse, widespread, and disproportionate to tissue injury (Correct answer)
- Pain reproduced with specific mechanical loading
- Pain relieved by rest and NSAIDs
Correct answer: Pain that is diffuse, widespread, and disproportionate to tissue injury
Central sensitization presents with diffuse, widespread pain disproportionate to tissue damage, often including allodynia and hyperalgesia beyond the injury site.
Question 5: A patient's monofilament sensory testing reveals inability to detect the 4.56 (2g) Semmes-Weinstein monofilament. What does this finding indicate?
- Normal protective sensation
- Diminished light touch sensation (Correct answer)
- Loss of protective sensation
- Deep pressure sensation only
Correct answer: Diminished light touch sensation
Inability to detect the 2g (4.56) monofilament indicates diminished light touch, while inability to detect the 10g (5.07) monofilament signals loss of protective sensation.
Question 6: When establishing baselines for PAM outcome measurement, which timing of reassessment is generally recommended to detect meaningful treatment change?
- After every single session
- After 4–6 treatment sessions or 2 weeks (Correct answer)
- Only at discharge
- After the first session only
Correct answer: After 4–6 treatment sessions or 2 weeks
Reassessment after 4–6 sessions or approximately 2 weeks allows sufficient time to detect clinically meaningful changes in impairment measures.
Question 7: Which finding during palpation assessment most specifically indicates active myofascial trigger point involvement?
- Generalized muscle tenderness to deep pressure
- Local twitch response with referred pain pattern on palpation (Correct answer)
- Diffuse swelling around the muscle belly
- Crepitus during muscle contraction
Correct answer: Local twitch response with referred pain pattern on palpation
A local twitch response accompanied by a predictable referred pain pattern upon palpation is the hallmark of an active myofascial trigger point.
PAM Patient Assessment & Clinical Evaluation 3
A clinician is assessing a patient's response to a hot pack applied to the lumbar spine.
Which finding indicates a normal physiological response to superficial heat?