MSK/Pharmacology Quiz

During examination of the shoulder, a patient demonstrated painful shoulder flexion range of motion. Which of the following joint mobilization techniques is MOST appropriate?

• Large amplitude oscillations performed at the beginning of the the ROM in an anterior direction.

• Small amplitude oscillations into tissue resistance up to the limit of available motion in an anterior direction.

• Large amplitude oscillations within the available ROM in a posterior direction.

• Small amplitude oscillations into tissue resistance at the limit of available joint motion in a posterior direction.

Answer explanation

To improve shoulder flexion, a posterior glide should be used. The patient is experiencing painful shoulder flexion so this would indicate Grade 1 or 2 joint mobilizations would be helpful, which can be described as:

1: small amplitude performed at beginning of ROM

2: Large amplitude performed within available ROM, but not reaching limit

Flexion at the GHJ occurs with the convex humeral head moving on a concave glenoid fossa. Arthrokinematics here would be Anterior roll and Posterior Slide.

Slide and glide are used interchangeably. So this would indicate the need for a Posterior glide to address this limitation/

A patient is seen s/p 3 months right ankle fracture and has an active range of motion of 0-20d plantarflexion and 0 - 5d dorsiflexion. Which of the following joint mobilization techniques should the PT perform?

• Anterior glide of the talus on the tibia

• Lateral glide of the calcaneus on the talus

• Medial glide of the calcaneus on the talus

• Posterior glide of the talus on the tibia

Answer explanation

Dorsiflexion is most limited in this case, so therefore we would want to address our intervention to aide in limited DF ROM.

Dorsiflexion occurs with the talus moving on the tibia (convex on concave).

ie. Anterior roll, Posterior Slide

Therefore, a posterior glide would help this patient.

Which of the following medications to reduce HR and BP is contraindicated when patient has a history of COPD?

• Verapamil

• Diltiazem

• Atenolol

• Amlodipine

Answer explanation

All medications in list are Antihypertensives/Antiarrythmics. However, Beta Blockers cannot be prescribed to patients with Asthma or COPD because betablockers cause bronchoconstriction and these conditions already cause bronchoconstriction. A calcium channel blocker (CCB) may be prescribed instead such as amlodipine, diltiazem and verapamil.

After reviewing a patient's medication list you realize they are currently taking an antihypertensive, Amlodipine. Given what you know about this medication which of the following exercise recommendations should be followed in regard to intensity and safety of the patient?

• Continuing exercise when patient reports an RPE of 5

• Stopping exercise when patient reports an RPE of 5

• Continuing exercise when patient's HR surpases 100 bpm

• Allowing rest breaks when patient reports RPE of 3.

Answer explanation

Amlodipine is a calcium channel blocker. Calcium channel blockers and Beta Blockers reduce HR and BP in patients diagnosed with CAD, HTN or arrythmias. Due to the action of this medication it is best to follow the BORG scale or RPE to gage exercise tolerance and safety. An RPE of 5 indicates moderate exercise intensity and should not cause alarm to discontinue exercise.

All of the following are common side effects of loop diuretic use, except?

• Dizziness

• Reflex Tachychardia

• Venous Pooling

• Hyponatremia

Answer explanation

Side effects for diuretics are as follows:

Hypokalemia, Hyponatremia, Hypocalcemia, dehydration, orthostaic hypotension, reflex tachycardia, lethargy and dizziness.

The purpose of diuretics are to prevent reabsorption of water from loop of henle. A diuretic will not cause venous insufficiency but may help to reduce likelihood of venous insufficiency.

Which of the following medications would be classified as a potassium sparing diuretic?

• Spironolactone

• Hydrochlorothiazide

• Amlodipine

• Atenolol

Answer explanation

Spironolactone is a potassium sparing diuretic.

Hydrochlorothiazide (HCTZ) is a diuretic that spares CLUG (calcium, lipids, uria and glucose)

HCTZ should not be given to patients with DM or renal dysfunction.

The other medications are BB and CCB.

Following reattachment of the flexor tendons of the fingers, the patient is in a splint. One PT goal is to minimize adhesion formation, what should the physical therapist teach the patient to perform after 72 hours post surgery?

• Passive extension and active flexion of the IP joints

• Active extension and flexion of the IP joints

• Active extension and passive flexion of the IP joints

• Gentle passive extension and flexion of the IP joints

Answer explanation

severe edema increases tendon drag and likelihood of rupture. Therefore wait until 48-72 hours postop prior to initiating ROM therapy. It is best to begin passive finger flexion with caution as to not disrupt repair. Generally for weeks 1-3 there should be NO active flexion of the involved digitsas this could damage the repair.

A 13-year-old girl has been diagnosed with structural idiopathic scoliosis. The physical therapist notices a left thoracic, right lumbar structural scoliosis. Which postural deviation would be expected in this patient:

• The body of the thoracic vertebrae rotated to the right

• High right shoulder

• Spinous processes of thoracic spine rotated to the left

• Posteriorly protruding left scapulae

Answer explanation

The patient has a left thoracic scoliosis indicating left convex curve. The body of the vertebrae will rotate to the convex side (left) and the spinous processes will rotate to the concave side (right side). The shoulder will be elevated on the convex side and scapula will also become prominent on the convex side (leftside) making D the correct option.