PCE Practical Skills and Problem-Solving 3 — Questions and Answers
Question 1: A patient with a recent L4-L5 disc herniation reports increased low back and leg pain during the straight leg raise (SLR) at 40°. This finding is most consistent with:
- Piriformis syndrome
- Lumbar facet joint irritation
- Nerve root tension or compression (Correct answer)
- Hip labral tear
Correct answer: Nerve root tension or compression
A positive SLR below 60° that reproduces radiating leg pain is a sensitive indicator of lumbar nerve root compression.
Question 2: When using electrical stimulation for muscle re-education, which waveform parameter primarily determines patient comfort?
- Pulse frequency
- Pulse duration
- Amplitude
- Ramp time (Correct answer)
Correct answer: Ramp time
Ramp time gradually increases current intensity, reducing the startle response and improving patient comfort during stimulation onset.
Question 3: A therapist is treating a patient with right-sided hemiplegia and notices the patient pushes strongly toward the affected side during sitting. This phenomenon is called:
- Pusher syndrome (Correct answer)
- Hemineglect
- Anosognosia
- Spastic diplegia
Correct answer: Pusher syndrome
Pusher syndrome is characterized by active pushing toward the hemiplegic side and resistance to passive correction to vertical.
Question 4: Which manual therapy technique is classified as a Grade IV joint mobilization?
- Large amplitude movement at the beginning of range
- Small amplitude movement at end range (Correct answer)
- High-velocity thrust at end range
- Sustained traction throughout range
Correct answer: Small amplitude movement at end range
Grade IV is defined as a small-amplitude oscillation performed at the end of the available range of motion, per the Maitland grading system.
Question 5: During treadmill training with a patient post-stroke, the therapist notices the patient's affected knee hyperextends during stance. The best intervention to address this is:
- Increase treadmill speed to encourage faster stepping
- Strengthen the quadriceps with resisted extension exercises
- Strengthen and re-educate the hamstrings and gastrocnemius for eccentric control (Correct answer)
- Apply a rigid knee brace to block extension
Correct answer: Strengthen and re-educate the hamstrings and gastrocnemius for eccentric control
Genu recurvatum during stance is often due to poor eccentric control of the hamstrings and calf; strengthening these muscles addresses the root cause.
Question 6: A physiotherapist is treating a 10-year-old with Osgood-Schlatter disease. The most appropriate initial management is:
- Surgical debridement of the tibial tuberosity
- Activity modification, ice, and quadriceps flexibility exercises (Correct answer)
- Full immobilization in a cast for 6 weeks
- Corticosteroid injection into the patellar tendon
Correct answer: Activity modification, ice, and quadriceps flexibility exercises
Conservative management with relative rest, ice, and quadriceps/hamstring stretching resolves most cases of Osgood-Schlatter disease in adolescents.
Question 7: When screening for cauda equina syndrome, which cluster of findings warrants immediate emergency referral?
- Bilateral calf tightness with lumbar flexion pain
- Saddle anesthesia, bilateral leg weakness, and bladder/bowel dysfunction (Correct answer)
- Positive SLR at 70° with dermatomal paresthesia
- Central low back pain worse with prolonged sitting
Correct answer: Saddle anesthesia, bilateral leg weakness, and bladder/bowel dysfunction
Saddle anesthesia combined with bilateral weakness and loss of bowel/bladder control are hallmark red flags for cauda equina syndrome requiring emergency surgery.
PCE Practical Skills and Problem-Solving 3
A patient with a recent L4-L5 disc herniation reports increased low back and leg pain during the straight leg raise (SLR) at 40°.
This finding is most consistent with: