PCE Practical Skills and Problem-Solving 2 — Questions and Answers
Question 1: A patient post-total knee replacement reports severe swelling and warmth at the surgical site on day 3. What is the physiotherapist's priority action?
- Proceed with passive ROM as scheduled
- Notify the referring physician immediately (Correct answer)
- Apply ice and elevate the limb
- Perform gentle active-assisted exercises
Correct answer: Notify the referring physician immediately
Sudden warmth and swelling post-TKR may indicate deep vein thrombosis or infection, both requiring urgent physician notification.
Question 2: During gait training, a patient with incomplete SCI demonstrates foot drop. Which assistive device most directly addresses this impairment?
- Lofstrand crutches
- Ankle-foot orthosis (AFO) (Correct answer)
- Knee-ankle-foot orthosis (KAFO)
- Rocker-bottom shoe
Correct answer: Ankle-foot orthosis (AFO)
An AFO holds the ankle in neutral dorsiflexion to prevent foot drop and improve toe clearance during the swing phase.
Question 3: When applying moist hot packs, the minimum number of towel layers between the pack and the patient's skin is:
- 2
- 4
- 6 (Correct answer)
- 8
Correct answer: 6
At least six layers of toweling are required to prevent burns while allowing therapeutic heat transfer.
Question 4: A therapist is performing PROM on a patient's shoulder following rotator cuff repair. The patient winces and guards at 90° abduction. The correct response is to:
- Push through to achieve full range
- Stop and reassess, staying within the pain-free range (Correct answer)
- Apply a Grade III joint mobilization
- Have the patient perform active motion instead
Correct answer: Stop and reassess, staying within the pain-free range
Pain and guarding are signals to halt PROM and reassess to avoid disrupting the surgical repair.
Question 5: Which outcome measure is most appropriate for quantifying functional balance in a community-dwelling older adult at risk for falls?
- Visual Analogue Scale (VAS)
- Berg Balance Scale (BBS) (Correct answer)
- Oswestry Disability Index (ODI)
- Modified Ashworth Scale (MAS)
Correct answer: Berg Balance Scale (BBS)
The Berg Balance Scale is a validated 14-item measure specifically designed to assess fall risk and functional balance in older adults.
Question 6: A patient with COPD desaturates to 88% SpO2 during a 6-minute walk test. The therapist should:
- Continue the test and document the desaturation
- Stop the test and administer supplemental oxygen if available (Correct answer)
- Increase walking speed to shorten test duration
- Encourage the patient to breathe faster
Correct answer: Stop the test and administer supplemental oxygen if available
SpO2 below 88% is a standard stop criterion for exercise testing; the patient requires rest and potentially supplemental oxygen.
Question 7: A physiotherapist palpates asymmetrical posterior superior iliac spine (PSIS) heights in standing. The most appropriate next step is to:
- Immediately perform a sacroiliac joint manipulation
- Perform additional screening tests to determine clinical significance (Correct answer)
- Prescribe a heel lift for the shorter leg
- Refer the patient for X-ray before any treatment
Correct answer: Perform additional screening tests to determine clinical significance
PSIS asymmetry alone is not diagnostic; additional tests are required to determine whether it reflects a true structural or functional finding.
PCE Practical Skills and Problem-Solving 2
A patient post-total knee replacement reports severe swelling and warmth at the surgical site on day 3.
What is the physiotherapist's priority action?