PCE Clinical Knowledge and Theory 3 — Questions and Answers
Question 1: A patient recovering from a tibial shaft fracture develops compartment syndrome. Which finding is the EARLIEST clinical indicator?
- Paralysis of toe extensors
- Pain out of proportion to the injury (Correct answer)
- Absent pedal pulses
- Tense, woody feel of the compartment
Correct answer: Pain out of proportion to the injury
Pain disproportionate to the injury—especially pain with passive stretch of muscles in the compartment—is the earliest and most sensitive sign of acute compartment syndrome.
Question 2: The Ottawa Ankle Rules help determine whether radiography is needed. An X-ray is required if there is bone tenderness at the:
- Midshaft of the fibula only
- Posterior edge or tip of the lateral or medial malleolus (Correct answer)
- Anterior talofibular ligament insertion
- Peroneal muscle belly
Correct answer: Posterior edge or tip of the lateral or medial malleolus
The Ottawa Ankle Rules specify tenderness at the posterior 6 cm or tip of either malleolus as an indication for ankle radiograph.
Question 3: Which cardiac condition is considered an absolute contraindication to aerobic exercise testing?
- Stable angina pectoris
- Controlled hypertension
- Recent myocardial infarction within 2 days (Correct answer)
- Mild aortic stenosis
Correct answer: Recent myocardial infarction within 2 days
Acute myocardial infarction within the preceding 2 days is an absolute contraindication to exercise testing per ACSM guidelines.
Question 4: In the context of nerve conduction studies, a reduced amplitude with normal conduction velocity most likely indicates:
- Demyelinating neuropathy
- Axonal loss (Correct answer)
- Neuromuscular junction dysfunction
- Central motor neuron lesion
Correct answer: Axonal loss
Axonal loss reduces the number of conducting axons, decreasing amplitude, while demyelination primarily slows conduction velocity.
Question 5: Which specific test assesses the integrity of the posterior cruciate ligament (PCL)?
- Lachman test
- Anterior drawer test
- Posterior drawer test (Correct answer)
- Pivot shift test
Correct answer: Posterior drawer test
The posterior drawer test applies a posterior force to the proximal tibia at 90° flexion; excessive posterior translation indicates PCL laxity.
Question 6: Complex Regional Pain Syndrome (CRPS) Type I differs from Type II in that Type I:
- Always involves a peripheral nerve injury
- Occurs without a definable nerve lesion (Correct answer)
- Is associated with causalgia
- Responds only to surgical intervention
Correct answer: Occurs without a definable nerve lesion
CRPS Type I (reflex sympathetic dystrophy) occurs without a confirmed peripheral nerve injury, whereas Type II (causalgia) follows a documented nerve lesion.
Question 7: The stretch reflex arc is mediated primarily by which afferent fiber type?
- Type Ia (Aα) (Correct answer)
- Type Ib (Aα)
- Type II (Aβ)
- Type IV (C)
Correct answer: Type Ia (Aα)
Type Ia afferents from muscle spindle primary endings detect muscle stretch velocity and initiate the monosynaptic stretch reflex.
PCE Clinical Knowledge and Theory 3
A patient recovering from a tibial shaft fracture develops compartment syndrome.
Which finding is the EARLIEST clinical indicator?