PCE REE PCE Clinical Practice and Patient Management 3 — Questions and Answers
Question 1: A patient presents with acute ankle inversion sprain. According to best evidence, which intervention should be prioritized in the first 72 hours?
- Immobilization in a cast for 4 weeks
- Protected weight bearing with early functional rehabilitation (Correct answer)
- Complete non-weight bearing for 2 weeks
- Ultrasound therapy daily for 10 sessions
Correct answer: Protected weight bearing with early functional rehabilitation
Current evidence supports early protected weight bearing and functional rehabilitation over prolonged immobilization for acute lateral ankle sprains.
Question 2: Which sign differentiates a supraspinatus tear from subacromial impingement syndrome during a shoulder assessment?
- Positive Hawkins-Kennedy test
- Weakness and pain arc between 60°–120° of abduction
- Positive Empty Can test with weakness but no pain (Correct answer)
- Painful arc with full strength restored at 180°
Correct answer: Positive Empty Can test with weakness but no pain
A positive Empty Can test with significant weakness but minimal pain is more indicative of a rotator cuff tear than impingement, which typically presents with pain.
Question 3: A therapist uses the Oswestry Disability Index with a patient with chronic low back pain. A score of 41–60% indicates:
- Minimal disability requiring self-management advice
- Moderate disability where pain remains the main problem
- Severe disability affecting most life activities (Correct answer)
- Crippling back pain requiring comprehensive intervention
Correct answer: Severe disability affecting most life activities
A score of 41–60% on the Oswestry Disability Index represents severe disability, indicating that pain affects most aspects of daily life.
Question 4: When setting goals for a pediatric patient using the SMART framework, which element is MOST often missing in novice clinician goal-writing?
- Specific
- Measurable
- Time-bound (Correct answer)
- Attainable
Correct answer: Time-bound
Time-bound elements specifying when the goal will be achieved are most frequently omitted, reducing the goal's clinical utility for tracking progress.
Question 5: A patient with a C5-C6 complete spinal cord injury is likely to retain which functional ability?
- Independent ambulation with ankle-foot orthoses
- Independent manual wheelchair propulsion on flat surfaces (Correct answer)
- Independent transfers without assistive devices
- Independent dressing of upper and lower body
Correct answer: Independent manual wheelchair propulsion on flat surfaces
Individuals with C5-C6 complete SCI typically retain shoulder and elbow function, allowing independent wheelchair propulsion on flat surfaces with appropriate equipment.
Question 6: Which neurological test is MOST sensitive for detecting upper motor neuron lesions in the lower extremity?
- Babinski sign (Correct answer)
- Clonus test
- Romberg test
- Hoffman's sign
Correct answer: Babinski sign
The Babinski sign (extensor plantar response) is the most sensitive and widely accepted indicator of upper motor neuron pathology in the lower extremities.
Question 7: A physiotherapist is documenting a patient's gait deviation as 'Trendelenburg gait.' Which muscle weakness is the primary cause?
- Ipsilateral hip flexors
- Contralateral hip abductors
- Ipsilateral hip abductors (Correct answer)
- Contralateral hip extensors
Correct answer: Ipsilateral hip abductors
Trendelenburg gait results from weakness of the ipsilateral hip abductors (gluteus medius), causing the contralateral pelvis to drop during single-leg stance.
PCE REE PCE Clinical Practice and Patient Management 3
A patient presents with acute ankle inversion sprain.
According to best evidence, which intervention should be prioritized in the first 72 hours?