INSTITUT UNVIVERSITAIRE DE LA COTE

First Semester RESIT Examinations

2022/2023 Academic year

Department: Applied Option : PHYSIOTHERAPY Level: 200

Sciences Time : 8 :00—11 :00am
Course code/ Title: BPT401/ PHYSIOTHERAPY IN GENERAL Credit value : 4
MEDICINE AND GENERAL SURGERY
Duration : 3 hours Date : /2023 Venue : Examination Hall
Course Instructor Dr ASOBO – KHAN N.

SECTION 1 ; MCQs (20MARKS)

1. A physical therapist is working with a patient who had a total knee arthroplasty 2
days ago. The patient’s resting electrocardiogram is shown in strip A. While gait
training, the patient’s electrocardiogram changes, as shown in strip B. Based on this
finding, what is the BEST action for the therapist to take at this time?
A. Stop gait training and notify the nurse.
B. Continue gait training as the heart rate is less than 100 bpm.
C. Stop gait training and allow the patient to sit down and rest.
D. Continue gait training, but allow the patient standing rest breaks

2. As a patient progresses with physical therapy, which of the following changes in a

home exercise program is MOST likely to increase the patient’s adherence to the
program?
A. Add additional exercises to the home program.
B. Increase the intensity of the home exercises.
C. Increase the frequency of home exercise program execution.
D. Choose exercises that can be incorporated into daily activities.

3. For adequate documentation of physical therapy services for neurological patients,

changes in which of the following factors are MOST important to record?
A. Muscle tone
B. Functional abilities
C. Cognitive status
D. Quality of movement

4. A physical therapist is designing a rehabilitation program for a patient with a recent

diagnosis of ankylosing spondylitis. The therapist should anticipate that as the disease
progresses, the patient is MOST likely to require:
A. special precautions for osteoporosis.
B. a wheelchair for community mobility.
C. assisted ventilation.
D. bilateral ankle-foot orthoses
5. A physical therapist is educating a patient on the use of a moist hot pack for home
treatment. For the patient to prevent burns and still receive the benefits of superficial
heat, which of the following heat application time frames is MOST appropriate?
A. 5 to 10 minutes
B. 20 to 30 minutes
C. 45 to 60 minutes
D. 61 to 90 minutes

6. An important change in gastrointestinal function that occurs with aging is a(n):

A. increase in gastric motility.
B. increase in salivary secretion.
C. decrease in tooth decay.
D. decrease in nutrient absorption

7. Instruction in energy conservation and joint protection should be provided to a patient

with rheumatoid arthritis, because:
A. the joints may be predisposed to damage by overuse.
B. fatigue often masks joint pain.
C. phagocytes remove more pannus in a resting joint.
D. activity of the antigen-antibody complex is diminished with rest.

8. A physical therapist is taking the history of a patient with low back pain. If the
therapist suspects the pain is caused by an inflammatory reaction, which of the
following questions is BEST for the therapist to ask?
A. Is your pain constant or intermittent?
B. What activity bothers you the most?
C. Is it difficult to stand up straight after you’ve been sitting?
D. Does your pain radiate down into the leg?

9. When evaluating wheelchair positioning of a child with cerebral palsy, a physical

therapist should FIRST examine the position of the child’s:
A. pelvis.
B. lower extremities.
C. head.
D. spine.

10. A physical therapist is interviewing a female patient who reports mid-thoracic pain
that is limiting her ability to work. Which of the following additional symptoms
should prompt the therapist to refer the patient to a physician?
A. Increased pain with prolonged computer work
B. Nausea, excessive fatigue, and sleep disturbance
 C. Intermittent numbness and tingling in the right hand
D. Decreased pain with exercise and increased pain in the mid-morning

11. Which of the following clinical features is assessed by pressing into the patient’s skin
and observing for persistent indentation?
A. Turgor
B. Pitting edema
C. Dependent edema
D. Deep vein thrombosis

12. A patient with type 2 diabetes is evaluated by a physical therapist and found to be alert
and oriented to person, place, and time. When continuing the evaluation, the therapist
should give the HIGHEST priority to which of the following systems?
A. Cognitive
B. Sensory
C. Genitourinary
D. Musculoskeletal

13. In the early management of a patient with a partial peripheral nerve injury, the goal of
the physical therapy intervention will MOST likely be to prevent:
A. nerve degeneration.
B. spasticity and increased muscle tone.
C. muscle atrophy.
D. contractures and adhesions.

14. A nursing mother with functional urinary incontinence should MOST benefit from
which of the following exercise interventions?
A. Core stabilization
B. Cardiovascular training
C. Fine motor skill development
D. Pelvic floor muscle strengthening

15. A physical therapist is assigned the planning and implementation of physical therapy
services for all members of a community. The therapist’s FIRST step should be to:
A. develop a brochure for distribution to the community.
B. organize a health fair to provide screening for the community.
C. evaluate existing services and community resources.
D. Initiate contacts in the medical community to establish prescriptive
relationships.

16. Which of the following outcomes would NOT be appropriate for a prenatal exercise
program?
A. Improved body mechanics
B. Application of relaxation techniques
 C. Improved ligamentous flexibility
D. Strengthened pelvic-floor musculature

17. A patient who had surgery yesterday has the initial dressing covering the surgical site.
What is the physiotherapist’s responsibility in assessing this patient’s wound?
A. Remove the dressing, inspect the wound, and reapply a new dressing.
B. Inspect the wound and reapply the surgical dressing every 2 hours.
C. Inspect the wound, and keep the dressing off until the health care provider
arrives.
D. Wait until the health care provider orders the removal of the surgical dressing.

18. A 66-year-old woman presents to her family doctor complaining of a pain in her left
groin that has appeared intermittently over the past several months. On physical exam,
a soft mass is palpated in her left groin, below the inguinal ligament, and near her
femoral pulse. On palpation, the mass is soft and slightly tender and disappears with
gentle compression. Which of the following is true regarding these types of hernias?
A. They are the most common hernia type in women
B. The risk of strangulation is relatively low
C. The hernia sac travels lateral to the femoral vein
D. If discovered incidentally and the patient is asymptomatic, repair is not
indicated
E. It is associated with multigravida

19. A 55-year-old man presents with a mass in the left groin that is intermittently painful.
The mass protrudes upon straining and reduces when he is in the supine position. With
the patient standing, there is an obvious mass in his left scrotum that protrudes from
the internal ring and becomes more prominent when the patient coughs. Elective
surgery is recommended. At surgery, the posterior wall of the hernia sac feels very
thickened and is consistent with a possible sliding hernia. Which of the following is
true regarding this type of hernia?
A. Every attempt should be made to excise the entire sac.
B. It poses a higher risk of colon injury during repair
C. It is more common on the right side
D. It is most often associated with direct inguinal hernias
E. The hernia sac should be divided at the internal ring

20. One week after open repair of a large right scrotal hernia, a 45-year-old male returns
complaining of severe pain in his right testicle. On physical exam, the testicle appears
to be slightly swollen and very tender to palpation. Doppler study demonstrates no
flow within the right testicle with normal flow in the left. Which of the following is
true about this condition?
A. It is most commonly due to thrombosis
B. Urgent exploration of the right testicle is recommended
C. It is most likely due to transection of the testicular artery
 D. It most likely represents testicular torsion
E. The testicle will likely remain permanently enlarged

SECTION 2: STRUCTURAL QUESTIONS (20marks)

1. Define Geriatrics and Gerontology. (2marks)

2. Classify cerebral palsy according to neuroanatomy and type of movement disorder.

(2marks)

3. Enumerate 3 benefits of assessment in physiotherapy. (3marks)

4. Rodney’s wife is 31 weeks pregnant; and you notice her frequently subjecting herself
to physical strain while executing daily chores; state 4 key points with which you will
counsel her regarding posture and ergonomics. (4marks)

5. State 4 types scars. (2marks)

6. State 4 factors which will influence wound healing. (4 marks)

7. Name the types of burns you know and state the type which is most likely to impair
functional autonomy? (4marks)

SECTION 3: SHORT ESSAY QUESTIONS (20marks)

Question 1 (20marks)
A 13-month-old male is being followed in the Pediatric outpatient clinic for Spastic Cerebral
Palsy. He was born at term by normal vaginal delivery without complications and his birth
weight was 3300g. His mother did not have any problems during the pregnancy. At 6 months
of age, the practitioner noticed his head control was poor. Currently, he calls everyone
"mama" and follows one-step commands. He is able to drink from a cup but drools a lot. He is
able to roll over from his stomach to his back but he is not able to sit or stand. Some primitive
reflexes such as the Asymmetric Tonic Neck Reflex (ATNR) persist and he has increased
muscle tone, especially in his legs. His deep tendon reflexes are exaggerated
1. Why is CP considered non-progressive? Explain what happens.(3marks)

2. Cerebral palsy is characterized by abnormal motor pattern and postures caused by

nonprogressive brain function brain during prenatal, perinatal, or postnatal period.
When do the majority of causes occur? List 5 causes.(5marks)
 3. What are some 6 signs and symptoms that would suggest a diagnosis of CP for the
child in the case study?(extrapolate accurately from the case study) (6marks)

4. True or false. Because of the neuromotor dysfunction and associated condition,

children with cerebral palsy rarely live into adulthood. (2marks)

5. What is the overall focus of therapeutic management for CP? (3marks)

SECTION 4: LONG ESSAY QUESTIONS (10marks)

QUESTION 1 (10marks)
Bivondo Paul presents with ulna sided first MCP pain after falling at a building site with a
hammer in his hand. The subjective examination indicates that pathology of the ulna
collateral ligament is a likely hypothesis.
List the stages of healing the ligament will undergo in the following 12 months.
 Marking guide
SECTION 1; MCQ = 20MARKS
SECTION 2: STRUCTURAL QUESTIONS (20marks)
1. Gerontology is the scientific approach to all aspects of aging (health,
sociological, economic, behavioral and environmental)

Geriatrics is a branch of gerontology and medicine which deals with the

clinical, rehabilitative (remedial), psycho-social and preventive aspects of
illness in elderly people.

2. Neuromuscular deficits and corresponding site of lesion:

• Spastic - Cortex
• Dyskinetic - Basal ganglia – extrapyramidal system
• Hypotonic / Ataxic - Cerebellum
• Mixed – Diffuse

3. -Better recognize common geriatric disorder.

-Plan an effective treatment program.
-Improve overall health and functional outcomes.
-Reduce vulnerability to subsequent illness.
-Provide better quality of life.

4. -Lying.
-Rolling :Effective, safe and efficient (ESE) roll.
-Sitting.
-Standing and walking.

5. – Fine-line scars
-keloid scars
- hypertrophic scars
-sunken scars
-scar contractures

6. -Age of Patient is inversely proportional to wound healing.

- Type of Wound; Larger wounds take longer to heal. Linear wounds heal
faster than rectangular wounds, and circular wounds are the slowest to heal.
- Infection; they decrease the rate of wound healing.
- Chronic Diseases; diabetes or circulatory system diseases may inhibit
wound healing due to poor blood flow.
-Poor Nutrition; It leads to insufficient resources to heal the wound as the
body may break down protein for energy.
-Lack of Hydration; it can halt cellular migration, decrease blood
oxygenation, and delay wound healing.

7. Thermal, Chemical, Electrical and Radiation burns.

Electrtical burns
SECTION 2: STRUCTURAL QUESTION = 20MARKS
1.
- Better recognize common geriatric disorder.
- Plan an effective treatment program.
- Improve overall health and functional outcomes.
- Reduce vulnerability to subsequent illness.
- Provide better quality of life.

Hemorragic complications
Infectious complications
Thrombotic complications
 Pressure ulcers
Aspiration pneumonitis

2. To achieve functional independence

To relieve pain
To improve/maintain range of motion
To improve/ maintain strength of movement
To improve cardiovascular endurance
To improve or maintain ambulatory status

3. Emergent phase
Acute phase
Rehabilitative phase

4. To determine the size and depth of burn injury for better management and
ample timely identification of potential sites of difficult, poor scarring.
5. The main goal is to optimise functional autonomy and overall level of
independence.
Ameliorate quality of life to the best possible degree.

SECTION 3 : SHORT ESSAY QUESTIONS = 20MARKS

QUESTION 1
1. It’s considered non-progressive because disease does not get worse
throughout the ages. It’s a loss or impairment of motor function, attacking
mostly the cerebral cortex. Some may improve while others either plateau
or have a worsening of motor abilities because of the difficulty to
maintain the ability over time.

2.
- Environmental toxins (lead and asbestos are some)
- Chorioamnionitis
- Hyperbilirubinemia and kernicterus
- Viral/bacterial infection of CNS (Meningitis and Encephalitis)
- Nutritional deficit

3.
- Drooling.
- Calling everyone “mama”
 - Poor head control at 6 months.
- Not being able to sit or stand
- Muscle weakness
- Hyperactive reflexes

4. Prophylactic, symptomatic, and supportive treatment.

SECTION 4 : LONG ESSAY QUESTIONS = 10MARKS

QUESTION 1
 Acute inflammatory phase- Phase begins within in minutes of injury &
continues over the next 48-72 hours
- During this phase, blood collects at the site of injury & platelet cells
interact with certain matrix components to change their shape and initiate
clot formation. The platelet-rich fibrin clot releases growth factors that are
necessary for healing
- When stimulated by growth factors, neutrophils, monocytes, & other
immune cells migrate to the injured tissue to initiate matrix turnover by
ingesting and removing debris and damaged cells during the inflammatory
phase.

 Proliferation - Defined as the production of "scar tissue" (dense, cellular,

collagenous connective tissue matrix) by hypertrophic fibroblastic cells.
This scar tissue is initially quite disorganized with more defects.

- After a few weeks of healing, the collagen becomes quite well aligned
with the long axis of the ligament despite the fact that the types of
collagen are abnormal and the collagen fibrils have smaller diameters in
the proliferating tissue.

 Regenerative phase - Can continue for months to years, during which time
collagen and ligament matrix are continually overturned by processes of
tissue synthesis and degradation. This provides ongoing opportunities for
the ligament to adapt with functional improvement, or degrade and fail
with applied loads.