PCE Assessment and Evaluation 3 — Questions and Answers
Question 1: During a shoulder assessment, the Hawkins-Kennedy test elicits pain. What structure is most likely being impinged during this test?
- Supraspinatus tendon under the coracoacromial arch (Correct answer)
- Biceps tendon in the bicipital groove
- Subscapularis tendon under the coracoid
- Infraspinatus tendon at the posterior capsule
Correct answer: Supraspinatus tendon under the coracoacromial arch
Hawkins-Kennedy places the shoulder in 90° flexion with internal rotation, impinging the supraspinatus under the coracoacromial arch.
Question 2: A physiotherapist measuring ankle dorsiflexion with a goniometer obtains 8° in weight-bearing and 15° in non-weight-bearing. What does this discrepancy most likely suggest?
- Gastrocnemius tightness contributing more than soleus tightness (Correct answer)
- Soleus tightness without gastrocnemius involvement
- Ankle joint capsule restriction
- Tibialis anterior weakness
Correct answer: Gastrocnemius tightness contributing more than soleus tightness
The gastrocnemius crosses the knee; weight-bearing (knee extended) reduces dorsiflexion more than non-weight-bearing (knee flexed), suggesting gastrocnemius restriction.
Question 3: A patient presents with saddle anesthesia, bilateral leg weakness, and recent urinary retention. Which finding on assessment would make this a physiotherapy emergency?
- Loss of perianal sensation and absent anal wink reflex (Correct answer)
- Reduced lumbar flexion range of motion
- Positive straight leg raise at 60°
- Grade 4/5 hip flexor weakness bilaterally
Correct answer: Loss of perianal sensation and absent anal wink reflex
Loss of perianal sensation and absent anal reflexes indicate cauda equina syndrome, which requires immediate emergency referral.
Question 4: Which of the following best describes the concept of 'minimal detectable change' (MDC) in outcome measure interpretation?
- The smallest change that exceeds measurement error and represents true change (Correct answer)
- The smallest change that is meaningful to the patient
- The difference between two groups needed to achieve statistical significance
- The change score associated with a clinically important outcome
Correct answer: The smallest change that exceeds measurement error and represents true change
MDC is the minimum change in score that exceeds the inherent measurement error of a tool, confirming real change occurred.
Question 5: A therapist applies a tuning fork (128 Hz) to the medial malleolus and the patient cannot feel vibration. This finding suggests impairment in which pathway?
- Dorsal column–medial lemniscal pathway (Correct answer)
- Anterolateral spinothalamic tract
- Corticospinal tract
- Spinocerebellar tract
Correct answer: Dorsal column–medial lemniscal pathway
Vibration sense is transmitted via large-diameter Aβ fibers through the dorsal columns (posterior funiculus) to the medial lemniscus.
Question 6: When measuring grip strength with a dynamometer, which arm position is standardized according to the American Society of Hand Therapists (ASHT) protocol?
- Shoulder adducted, elbow at 90°, forearm neutral, wrist 0–30° extension (Correct answer)
- Shoulder at 90° abduction, elbow extended, forearm supinated
- Shoulder at 45° abduction, elbow at 120°, forearm pronated
- Shoulder neutral, elbow fully extended, forearm neutral
Correct answer: Shoulder adducted, elbow at 90°, forearm neutral, wrist 0–30° extension
The ASHT recommends seated with the shoulder adducted, elbow flexed to 90°, forearm neutral, and wrist in 0–30° extension for standardized grip strength testing.
Question 7: A patient with a T6 complete spinal cord injury is assessed for autonomic dysreflexia during a bladder assessment. Which blood pressure change would prompt immediate intervention?
- Systolic rise of ≥20 mmHg above baseline (Correct answer)
- Systolic rise of ≥10 mmHg above baseline
- Diastolic rise of ≥10 mmHg above baseline
- Any reading above 120/80 mmHg
Correct answer: Systolic rise of ≥20 mmHg above baseline
Autonomic dysreflexia is defined by a systolic BP rise ≥20 mmHg above the individual's baseline and requires immediate management.
PCE Assessment and Evaluation 3
During a shoulder assessment, the Hawkins-Kennedy test elicits pain.
What structure is most likely being impinged during this test?