Practical Examination Questions: Year 2

Below are some practical exam questions for two year exams. All universities will be different and should offer their own exemplar questions. Remember read the question and do what the question asks. If it asks you to show how you would test strength and you look at ROM it is difficult for them to give you marks! Exams are always stressful but remember they want you to pass (it looks bad on the uni if you fail). So deep breath, do the preparation and you’ll be fine!!

 

Cervicothoracic 1

An 80 year old woman has been referred to physiotherapy complaining of moderately severe neck pain and stiffness of 2 weeks duration. She has a history of similar episodes but this time the symptoms are more severe and not settling with medication. an X-Ray taken two years ago shows marked cervical spondylosis.

  • Test the active range of the cervical spine movement with gentle passive overpressure.
  • Provide self management advice for the patient including postural and ergonomic advice and home exercises.

 

Hints and tips Hints and tips

  • Consider age (Expected ROM.)
  • Known spondylosis – consider presence of osteophytes and caution with treatment and over pressure.
  • Identify pain mechanism.
  • Self management may include heat, gentle ROM, postural re-education.
  • Consider what position exercises may be best achieved? Do you want to be getting an 80 year old lady off the bed hourly to do prone DNF strengthening? Probably not.

 

Cervicothoracic 2

A 30 year old medical secretary attends physiotherapy complaining a six week history of intermittent right sided neck and arm pain which is aggravated by computer work. on occasions the symptoms extend to the thumb on her right hand.

  • Demonstrate how you would assess this patient using repeated active movement assessment according to the McKenzie system.
  • Teach the model a home exercise regime of repeated neck retraction.

 

Hints and tips Hints and tips

  • Consider aggravating factor? Remove cause of issue. has the patient had an ergonomic assessment or received advice on this?
  • Mckenzie- Aiming to centralise pain.
  • Symptoms in right thumb (Radial Nerve)
  • “Teach” model  (clear/ concise). Demonstrate, explain, ask patient to repeat.
Cervicothoracic 2

A 45 year old male executive attends physiotherapy complaining of  a to week history of right sided neck pain and restricted left rotation and lateral flexion following a game of squash.

  • Palpate the spinous processes of the C2-T5 vertebrae stating which level you are palpating and how this has been determined.
  • Demonstrate how you would test one PAVIM (passive accessory vertebral movements) at a cervical intervertebral segment of your choice.

 

Hints and tips Hints and tips

  • Do a little research on cervical assessments
  • With the patient in supine if you palpate the occiput and gently allow your fingers to drop off it towards the thoracic spine the first spinous process should be C2. You can then palpate along each (peak and trough: Peaks = Spinous processes)
Cervicothoracic 4

A 29 year old receptionist, attends physiotherapy complaining of  3/12 history of episodic left-side cervical pain and occipital headaches which is most noticeable with computer keyboard work for extended periods.

  • Demonstrate the cranio-cervical flexion test for assessing function of the deep neck flexors, using a pressure biofeedback unit.
  • Teach exercises to improve deep neck flexor (DNF) function showing how the exercises can be progressed.

 

Hints and tips Hints and tips

  • Cervical tests
  • DNF ( What % of contraction do you want? Excessive contraction will encourage activation of the sternocleidomastoid which we want to avoid).
  • Progressions – Supine: Sitting: Prone ( Maintaining contraction against gravity will increase difficulty).

 

Cervicothoracic 5

A 32 year old rugby player attends physiotehrapy complaining of a persistent neck ache with restricted movement and intermittent paraesthesia into the forearm and radial side of the right side of the right hand following a tackle 3 months ago.

  • Test the integrity of C2, C5 and C6 nerve roots.
  • demonstrate the ULTT1 (median nerve). with additional sensitising movements to assist differential diagnosis.

 

Hints and tips Hints and tips

Cervicothoracic 6

A 35 old unemployed man with a eight month history of chronic neck and bilateral arm painfollowing a lifting injury. He is wearing a soft collar and futuro wrist splints on both hands and also complains of diffused upper limb muscle soreness and hypersensitivity.

  • Assess the active range of cervical movements including passive end range overpressure.
  • assess one passive physiological intervertebral joint movement (PPIVM) at a cervical segment of your choice.

 

Hints and tips Hints and tips

  • Cervical tests
  • Supine (Passive SF,ROT,FLEX,EXT)
  • Good explanation to patient.

 

Cervicothoracic 7

A 35 year old martial arts instructor attends physiotherapy complaining of a recent onset interscapular pain with intermittent pain around the left chest wall to the sternum exacerbated by activity.

  • Palpate the spinous processes of the T1-T4 vertebrae and the corresponding angles of the right ribs 1st to 4th, stating which level you are palpating and how this has been determined.
  • Demonstrate how you could test one PAVIM of the costoverterbral/costotransverse joints at an intervertebral segment of your choice.

 

Hints and tips Hints and tips

  • Cervical tests
  • Supine (Passive SF,ROT,FLEX,EXT)
  • Good explanation to patient.

Cervicothoracic 8

A 19 year old foreign stiudent self-refers for physiotherapy with a  two month history of increasing neck pain and stiffness, and has recently notied bilateral paresthesia in his legs. The history and examination suggests the nature of the condition is not of mechanical origin.

  • Test the active movements of the cervical spine in sitting.
  • Demonstrate tests you would carry out to assess the integrity of the central nervous system.

 

Hints and tips Hints and tips

  • Red Flags
  • Myotomes
  • Dermatomes
  • reflexes
  • Balbinski (Assessing for upper motor neuron lesion)
  • Clonus (Assessing for upper motor neuron lesion)

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