“150”, Aptitude Test Questions and Answers for Physiotherapist II – MDA & LGA.
ABSTRACT
This preparation package contains 150
carefully developed multiple-choice questions and answers for candidates
preparing for the Physiotherapist II (Fiziotherapia Daraja la II) MDA and LGA
Public Service online aptitude test in Tanzania. The questions assess practical
understanding, clinical reasoning, patient safety, rehabilitation principles,
musculoskeletal and neurological physiotherapy, cardiopulmonary care,
therapeutic exercise, mobility and gait training, disability prevention,
community health education, patient records, equipment management, ethics, and
professional decision-making. Each question uses closely related and plausible
answer choices to strengthen critical thinking and reflects realistic
situations that a Physiotherapist II may encounter in Tanzanian public health
facilities. Detailed rationales are provided to explain the correct answers and
reinforce key concepts, making the package suitable for focused revision and
aptitude-test preparation.
Prepared by: Physiotherapist
II
Based in Dar-es-salaam.
0628729934.
Date: July 29, 2026
Dear applicants,
This collection of questions and answers
has been carefully prepared to help all of you to understand the key areas
tested during the interview. The goal is to provide a useful, and practical
study guide so you can all perform confidently and fairly in the selection
process. I wish you the best of luck, and may this resource support you in
achieving success!
Warm regards,
Physiotherapist II
For Personal Use by Applicants Preparing
for MDA and LGA Physiotherapist II interview at Public Service Recruitment Service.
ALL
QUESTIONS ARE COMPILED TOGETHER.
Question 1
A 58-year-old patient attending a
regional referral hospital develops sudden calf pain and swelling three days
after abdominal surgery. The physiotherapist had planned gait training that
morning. What is the MOST appropriate immediate action?
A. Continue gentle walking while
monitoring symptoms B. Apply local heat before beginning mobility C. Withhold
treatment and arrange urgent medical assessment D. Perform calf stretching
before reassessing swelling
Answer: C. Withhold treatment and arrange
urgent medical assessment
Rationale: Sudden unilateral calf pain and swelling
following recent surgery should raise suspicion of deep vein thrombosis (DVT),
particularly because surgery and reduced mobility increase venous
thromboembolism risk. The physiotherapist should stop the planned intervention
and ensure prompt medical assessment rather than performing exercises, massage,
heat treatment, or unnecessary mobility. Clinical reasoning requires
recognizing when a patient's presentation falls outside routine rehabilitation
and when continuing treatment could expose the patient to serious
complications.
Question 2
A patient with a recent stroke can sit
independently but consistently loses balance toward the affected side when
reaching outside the base of support. Which intervention BEST addresses this
functional problem?
A. Practise controlled reaching in
sitting with graded weight shifting B. Strengthen both upper limbs using
resisted exercises only C. Maintain supported sitting to prevent movement
toward that side D. Begin independent stair climbing to improve postural
reactions
Answer: A. Practise controlled reaching
in sitting with graded weight shifting
Rationale: The problem described is impaired
dynamic sitting balance, particularly during weight shifting toward the
affected side. Task-specific reaching exercises that progressively move the
centre of mass within and toward the limits of the base of support directly
train postural control, trunk activation, sensory integration, and confidence.
Simply strengthening the upper limbs does not specifically address dynamic
sitting balance, while excessive support reduces the opportunity to develop
postural control. Stair training is premature when the patient cannot yet
safely control balance during sitting tasks.
Question 3
During assessment of a patient with low
back pain, the physiotherapist identifies new urinary retention, altered
sensation in the saddle region, and progressive bilateral leg weakness. What is
the MOST appropriate management?
A. Begin lumbar stabilization and review
after one week B. Arrange immediate medical assessment for suspected serious
neurological compression C. Use lumbar traction before deciding whether
referral is necessary D. Prescribe bed rest until the neurological symptoms
improve
Answer: B. Arrange immediate medical
assessment for suspected serious neurological compression
Rationale: New urinary retention, saddle sensory
disturbance, and progressive bilateral lower-limb weakness are major
neurological red flags suggestive of cauda equina syndrome or another serious
compressive neurological condition. The patient requires immediate medical
assessment rather than routine conservative management. Exercise, traction, or
waiting for spontaneous improvement could delay time-sensitive investigation
and treatment, potentially resulting in significant neurological consequences.
Question 4
A physiotherapist measures knee flexion
as 90° actively and 125° passively. Passive movement is painless, and no firm
mechanical restriction is detected before 125°. Which finding BEST explains the
marked active-passive discrepancy?
A. Joint stiffness preventing both active
and passive movement B. Pain inhibition occurring specifically during passive
movement C. A fixed contracture preventing the knee from moving beyond 90° D.
Reduced muscle performance or motor control limiting active movement
Answer: D. Reduced muscle performance or
motor control limiting active movement
Rationale: When passive movement is substantially
greater than active movement, the joint is capable of moving through a range
that the patient cannot produce voluntarily. This pattern directs assessment
toward factors affecting active movement, including muscle weakness, impaired
motor control, tendon dysfunction, or neurological impairment. A fixed
contracture or major joint restriction would also limit passive movement, while
the absence of pain during passive testing makes passive pain inhibition an
unsuitable explanation for the discrepancy.
Question 5
A patient recovering from prolonged
hospitalization can walk only 20 metres before becoming fatigued, although
manual muscle testing shows near-normal lower-limb strength. Which measure
would BEST provide additional information about functional exercise capacity?
A. Six-minute walk test B. Passive
straight-leg raise test C. Deep tendon reflex testing D. Limb circumference
measurement
Answer: A. Six-minute walk test
Rationale: The six-minute walk test evaluates
functional exercise capacity by measuring how far a patient can walk over a
defined period and is useful when endurance rather than isolated muscle force
is the principal limitation. Near-normal manual muscle testing does not rule
out poor cardiopulmonary endurance or generalized deconditioning. Straight-leg
raising assesses neural or musculoskeletal responses, reflex testing examines
neurological function, and limb circumference can help assess swelling or muscle
bulk, but none directly measures functional walking endurance.
Question 6
A patient with knee osteoarthritis
reports increased pain after the physiotherapist substantially progressed
strengthening exercises during the previous session. There is no new trauma,
marked swelling, or systemic illness. What is the BEST response?
A. Stop all exercise until the knee
becomes completely symptom-free B. Continue the same workload because
post-exercise pain is always expected C. Reassess symptoms and modify the
exercise dose while maintaining appropriate activity D. Replace strengthening
permanently with passive modalities alone
Answer: C. Reassess symptoms and modify
the exercise dose while maintaining appropriate activity
Rationale: Exercise dosage should be individualized
according to the patient's response. A symptom increase following a substantial
progression warrants reassessment of intensity, volume, technique, recovery,
and functional tolerance rather than abandoning exercise or blindly continuing
the same load. Appropriate strengthening remains an important component of
osteoarthritis management, but progression should be tolerable and clinically
justified. Passive modalities alone do not address strength and functional
capacity, while complete inactivity may unnecessarily contribute to
deconditioning.
Question 7
A patient with right-sided weakness uses
a single walking stick for additional stability. Assuming no special clinical
reason to do otherwise, on which side should the stick generally be held?
A. Right side to move simultaneously with
the weak limb B. Either side because hand placement has no biomechanical effect C.
Right side to increase loading through the affected limb D. Left side to assist
support when the weaker right limb advances
Answer: D. Left side to assist support
when the weaker right limb advances
Rationale: A single walking stick is generally held
on the side opposite the weaker or painful lower limb. For right-sided
weakness, holding the stick in the left hand allows the stick to advance with
the right leg, increasing the effective base of support and helping reduce
demand on the affected side while promoting a more efficient gait pattern. The
rule may be modified for individual circumstances, but contralateral use is the
standard principle when unilateral lower-limb weakness is the primary issue.
Question 8
During chest physiotherapy, a
hospitalized patient suddenly becomes markedly breathless, dizzy, and unable to
continue treatment. What should the physiotherapist do FIRST?
A. Stop treatment, ensure immediate
safety, and assess the patient's condition B. Encourage the patient to complete
the planned breathing exercise C. Place the patient in prone lying and continue
airway-clearance treatment D. Document the episode first before informing the
clinical team
Answer: A. Stop treatment, ensure
immediate safety, and assess the patient's condition
Rationale: An acute deterioration during treatment
requires immediate cessation of the intervention and rapid assessment of the
patient's safety and clinical status. The physiotherapist should then seek
appropriate medical or emergency assistance according to the findings and
facility procedures. Continuing treatment despite severe symptoms may worsen
the situation, while documentation is important only after immediate patient
needs have been addressed. This question tests prioritization: patient safety
precedes completion of the treatment plan or administrative tasks.
Question 9
A patient with an upper motor neuron
lesion has increased resistance to passive movement that becomes more
pronounced when the limb is moved faster. Which finding is MOST consistent with
this presentation?
A. Flaccidity B. Spasticity C. Rigidity D.
Contracture
Answer: B. Spasticity
Rationale: Spasticity is classically characterized
by a velocity-dependent increase in resistance to passive stretch and is
associated with upper motor neuron lesions. Faster passive movement therefore
produces greater resistance. Rigidity is generally not velocity-dependent,
flaccidity involves reduced muscle tone, and a contracture represents
structural shortening of soft tissues that mechanically restricts movement.
Recognizing these differences is important because treatment planning depends
on whether movement restriction is neural, structural, or related to reduced
tone.
Question 10
A physiotherapist wants to determine
whether an intervention has genuinely improved a patient's mobility rather than
relying on the patient's impression alone. Which approach is BEST?
A. Compare the patient's condition with
another patient of similar age B. Ask whether the patient feels better after
each treatment session C. Repeat an appropriate standardized outcome measure
under comparable conditions D. Use the therapist's observation without
repeating baseline measurements
Answer: C. Repeat an appropriate
standardized outcome measure under comparable conditions
Rationale: A standardized outcome measure provides
a structured and reproducible way to quantify change over time. Repeating the
same appropriate measure under reasonably comparable conditions allows the
physiotherapist to evaluate progress against the patient's own baseline and
supports evidence-informed decisions about continuing, modifying, or ending
treatment. Patient reports and clinical observation remain valuable, but using
them alone provides less objective evidence of change. Comparison with another
patient is inappropriate because baseline characteristics and recovery patterns
differ.
Question 11
Following a lower-limb injury, a patient
develops rapidly worsening pain disproportionate to the apparent injury, tense
swelling, and progressive distal sensory changes. What is the MOST appropriate
physiotherapy decision?
A. Apply firm compression to reduce the
swelling immediately B. Begin active exercise to improve circulation in the
limb C. Elevate the limb and reassess at the next scheduled appointment D. Stop
routine treatment and arrange urgent medical assessment
Answer: D. Stop routine treatment and
arrange urgent medical assessment
Rationale: Rapidly worsening pain disproportionate
to the injury, tense swelling, and progressive distal neurological changes are
serious warning features that may indicate acute compartment syndrome or
another neurovascular complication. Routine rehabilitation should not continue
while such a condition is suspected. Urgent medical assessment is required
because delay in appropriate management may result in significant muscle,
nerve, and vascular damage. Compression, exercise, or waiting for a later
appointment would be inappropriate in this presentation.
Question 12
A patient has reduced ankle dorsiflexion
during swing phase and repeatedly catches the toes while walking. Which
intervention MOST directly addresses the immediate gait-safety problem?
A. Assess dorsiflexor function and
consider an appropriate foot-clearance aid B. Strengthen hip adductors before
allowing further gait practice C. Restrict knee flexion during swing to
stabilize the lower limb D. Encourage slower walking without investigating the
cause of toe drag
Answer: A. Assess dorsiflexor function
and consider an appropriate foot-clearance aid
Rationale: Toe drag during swing commonly results
from inadequate dorsiflexion, although other factors such as reduced hip or
knee flexion may contribute. Assessment should identify the cause, and where
dorsiflexor weakness is significant, an appropriate orthotic or other
foot-clearance strategy may improve safety while rehabilitation addresses
underlying impairments. Strengthening hip adductors does not directly solve
inadequate foot clearance, restricting knee flexion can worsen toe clearance,
and simply slowing the gait fails to address the mechanism.
Question 13
A physiotherapist in an LGA health
facility discovers that an electrical therapy unit has a damaged power cable
with exposed wiring. Several patients are waiting for treatment. What is the
BEST action?
A. Use the unit at low intensity until
maintenance staff become available B. Remove it from clinical use and report it
through the appropriate procedure C. Cover the damaged section temporarily and
continue scheduled treatment D. Ask patients whether they consent to treatment
using the damaged equipment
Answer: B. Remove it from clinical use
and report it through the appropriate procedure
Rationale: Electrical equipment with exposed wiring
presents an unacceptable safety risk to patients and staff. It should be taken
out of service and reported according to the facility's equipment-management
and maintenance procedures. Neither patient consent nor reduced treatment
intensity makes electrically unsafe equipment acceptable. Physiotherapist II
duties include caring for departmental equipment, which involves identifying
faults, preventing unsafe use, and facilitating appropriate reporting or maintenance
rather than improvising repairs that may create additional hazards.
Question 14
A patient with a recent lateral ankle
sprain demonstrates normal strength and nearly full range of motion but
repeatedly loses balance when standing on the injured leg with the eyes closed.
Which impairment MOST likely contributes to this finding?
A. Reduced aerobic capacity limiting
single-leg endurance B. Shortening of the ankle plantar flexors during stance C.
Impaired proprioceptive input affecting postural control D. Weakness of the
contralateral upper-limb muscles
Answer: C. Impaired proprioceptive input
affecting postural control
Rationale: Following an ankle sprain, injury to
joint and ligamentous mechanoreceptors may impair proprioceptive information
used for postural control even after strength and range of motion have
substantially recovered. Closing the eyes removes visual information that might
otherwise compensate for reduced somatosensory input, making the balance
deficit more apparent. This finding supports assessment and rehabilitation of
proprioception and neuromuscular control rather than focusing only on strength
or joint mobility.
Question 15
A patient after stroke has enough
strength to stand but repeatedly requires assistance because balance
deteriorates during transfers. Which treatment goal should receive the HIGHEST
immediate priority?
A. Increase isolated grip strength to
normal levels B. Restore full passive shoulder range before mobility C. Improve
cardiovascular endurance through prolonged walking D. Develop safe postural
control during task-specific transfers
Answer: D. Develop safe postural control
during task-specific transfers
Rationale: The patient's immediate functional
limitation is unsafe transfer performance caused by inadequate balance and
postural control despite sufficient strength to stand. Rehabilitation should
therefore prioritize the impairment that is directly limiting the essential
activity. Task-specific transfer practice can integrate weight shifting,
postural control, sequencing, and safety. Grip strength, shoulder range, and
endurance may be relevant elsewhere in rehabilitation, but they do not address
the principal reason the patient currently requires assistance during
transfers.
Question 16
A patient referred for physiotherapy
because of neck pain reports that symptoms are accompanied by progressive
weakness in both hands and increasing difficulty walking. What is the BEST
course of action?
A. Recognize neurological red flags and
arrange prompt medical assessment B. Begin resisted neck exercises and reassess
after several sessions C. Treat the neck pain with heat before evaluating the
limb symptoms D. Advise the patient to avoid activity until the next routine
review
Answer: A. Recognize neurological red
flags and arrange prompt medical assessment
Rationale: Progressive bilateral hand weakness
together with gait difficulty suggests possible involvement of the spinal cord
or another significant neurological process rather than uncomplicated
mechanical neck pain. Such findings require prompt medical assessment and
appropriate investigation. A physiotherapist must screen for serious pathology
before proceeding with routine musculoskeletal treatment. Focusing only on pain
with heat or strengthening could overlook the more important neurological
presentation and delay necessary management.
Question 17
A physiotherapist is teaching a caregiver
how to assist a patient from bed to chair. Which approach BEST promotes both
patient function and caregiver safety?
A. Lift the patient completely to prevent
the patient from losing balance B. Use appropriate transfer technique while
encouraging the patient's safe participation C. Pull the patient by both arms
because this reduces caregiver effort D. Complete transfers quickly so the
patient has less time to become fatigued
Answer: B. Use appropriate transfer
technique while encouraging the patient's safe participation
Rationale: Safe transfer training should protect
both patient and caregiver while maximizing the patient's functional
participation according to their abilities. Appropriate positioning, movement
strategy, communication, environmental preparation, and use of suitable
assistance are preferable to manually lifting a patient who can contribute.
Pulling through the arms may cause injury, particularly in neurologically
impaired patients, while rushing compromises safety. Encouraging active
participation also supports rehabilitation rather than unnecessarily increasing
dependence.
Question 18
A patient with chronic respiratory
disease becomes short of breath when walking to the toilet but remains
clinically stable. Which physiotherapy strategy is MOST appropriate for
improving functional tolerance?
A. Avoid walking because breathlessness
indicates that exercise is contraindicated B. Use maximal resistance exercise
until breathlessness limits each session C. Introduce graded activity with
symptom monitoring, pacing, and appropriate rest D. Restrict rehabilitation to
breathing exercises performed only in bed
Answer: C. Introduce graded activity with
symptom monitoring, pacing, and appropriate rest
Rationale: Stable chronic respiratory disease does
not automatically contraindicate physical activity. Graded functional exercise,
combined with monitoring, pacing, breathing control where appropriate, and
planned recovery periods, can improve exercise tolerance and independence. The
intensity should match the patient's clinical condition and response rather
than repeatedly driving symptoms to their maximum. Restricting rehabilitation
to bed-based breathing exercises fails to address the functional limitation of
walking and may contribute to further deconditioning.
Question 19
A patient has remained in bed for several
weeks following severe illness. On first standing with the physiotherapist, the
patient becomes light-headed and unstable. What is the MOST appropriate initial
response?
A. Continue standing because adaptation
occurs only through prolonged exposure B. Ask the patient to walk immediately
to activate the calf muscle pump C. Perform maximal lower-limb strengthening
while the patient remains standing D. Return the patient to a safe position and
assess the physiological response
Answer: D. Return the patient to a safe
position and assess the physiological response
Rationale: Light-headedness and instability
following a change from prolonged recumbency to standing may indicate
orthostatic intolerance or another physiological problem. Immediate priorities
are preventing a fall, placing the patient safely, and assessing the response,
including relevant observations according to the clinical setting. Mobilization
can later be progressed gradually once the patient is stable. Forcing continued
standing or walking despite significant symptoms places the patient at
unnecessary risk and ignores the need to determine why the symptoms occurred.
Question 20
A physiotherapist performs manual muscle
testing of knee extension. The patient completes the full available range
against gravity but cannot tolerate additional resistance. Which grade BEST
describes the muscle performance on the commonly used 0–5 scale?
A. Grade 3 B. Grade 2 C. Grade 4 D. Grade
5
Answer: A. Grade 3
Rationale: On the commonly used manual muscle
testing scale, Grade 3 indicates that the patient can complete the available
range of motion against gravity but cannot maintain the movement against added
manual resistance. Grade 2 indicates movement through the available range with
gravity minimized, while Grades 4 and 5 require progressively greater ability
to resist external force. The distinction is important because the therapist
must separate the ability to overcome gravity from the ability to tolerate additional
resistance.
Question 21
During gait assessment, a patient drops
the pelvis on the unsupported side while standing on the affected limb.
Weakness of which muscle group is MOST strongly associated with this finding?
A. Ankle plantar flexors of the
unsupported limb B. Hip abductors of the stance limb C. Knee flexors of the
unsupported limb D. Hip adductors of the stance limb
Answer: B. Hip abductors of the stance
limb
Rationale: During single-limb support, the hip
abductors of the stance limb, particularly gluteus medius and associated
muscles, generate force to stabilize the pelvis in the frontal plane. Weakness
can allow the pelvis to drop toward the unsupported side, producing a positive
Trendelenburg-type finding. The important reasoning point is that the deficit
lies primarily in the abductors of the weight-bearing side, not in the limb
toward which the pelvis visibly drops.
Question 22
A patient with reduced sensation in the
feet is being considered for a superficial heating modality. What is the MOST
important concern before treatment?
A. Whether the patient prefers treatment
before or after exercise B. Whether the treatment room is warmer than the ward C.
Whether impaired sensation prevents reliable detection of excessive heat D.
Whether the patient has previously received strengthening exercises
Answer: C. Whether impaired sensation
prevents reliable detection of excessive heat
Rationale: Safe application of superficial heat
depends partly on the patient's ability to perceive and report excessive
temperature or discomfort. Reduced sensation can impair this protective
feedback and increase the risk of thermal injury, requiring careful assessment
and potentially selection of a safer alternative. Treatment preference and room
temperature may affect comfort but do not address the central safety issue.
Previous strengthening exercise does not establish whether the patient can
safely detect potentially harmful heat.
Question 23
A physiotherapist notices that several
patients with stroke are repeatedly returning with preventable shoulder
problems after discharge. Which response BEST reflects the duty of community
health education?
A. Provide targeted education on safe
positioning, handling, warning signs, and prevention B. Wait until each patient
develops pain before providing individual advice C. Advise families to avoid
moving the affected upper limb under all circumstances D. Focus education
exclusively on medication because rehabilitation is facility-based
Answer: A. Provide targeted education on
safe positioning, handling, warning signs, and prevention
Rationale: Community health education should
address preventable disability before complications become established. Stroke
survivors and caregivers benefit from practical information on safe
positioning, appropriate handling, protection of the affected limb, continued
rehabilitation, and signs requiring professional review. Advising complete
avoidance of movement may contribute to stiffness and functional loss, while
waiting for complications defeats the preventive purpose. This directly
reflects the Physiotherapist II responsibility to educate communities about
recognizing problems and preventing disability.
Question 24
A patient has completed several weeks of
rehabilitation after a lower-limb injury. Muscle strength has improved
considerably, but the patient still cannot safely return to work that requires
repeated stair climbing. What should MOST influence the next treatment
progression?
A. Whether passive range measurements are
identical on both limbs B. Whether the patient has attended every scheduled
treatment session C. Whether isolated muscle strength has reached the
therapist's target D. Whether functional training addresses the specific
demands of stair-based work
Answer: D. Whether functional training
addresses the specific demands of stair-based work
Rationale: Rehabilitation should ultimately
translate improvements in body functions such as strength into meaningful
activities and participation. Because the patient's remaining problem is
inability to manage repeated stair climbing required at work, treatment progression
should include graded, task-specific training that reflects those demands while
remaining safe. Normal isolated measurements do not automatically establish
functional readiness. Attendance is useful for understanding adherence, but it
cannot substitute for assessment and training of the activity the patient
actually needs to perform.
Question 25
At the end of a treatment session, a
physiotherapist realizes that an important functional finding was omitted from
the patient's record. What is the MOST appropriate action?
A. Leave the record unchanged because
treatment has already been completed B. Add an accurate entry according to
documentation procedures without falsifying timing or facts C. Ask another
staff member to record the finding as if they had assessed it D. Wait until the
next visit and document the previous finding as a new observation
Answer: B. Add an accurate entry
according to documentation procedures without falsifying timing or facts
Rationale: Clinical records should be accurate,
complete, traceable, and truthful. When an omission is recognized, it should be
corrected or supplemented according to the facility's documentation procedure
in a manner that preserves the integrity of the record rather than disguising
when the information was entered. Asking another person to document an
assessment they did not perform or presenting an earlier finding as a new
observation compromises professional accountability and may distort subsequent
clinical decisions. Proper documentation also supports continuity of care,
departmental statistics, communication, and evaluation of patient progress.
Question 26
A 42-year-old patient reports shoulder
pain during overhead activity. Active abduction is painful between
approximately 70° and 120°, but movement below and above this range is
considerably less painful. Which finding BEST describes this presentation?
A. Capsular restriction B. Painful arc C.
Fixed contracture D. Neurological weakness
Answer: B. Painful arc
Rationale: Pain occurring predominantly through the
middle range of shoulder abduction, commonly around 60°–120°, is described
clinically as a painful arc and may be associated with subacromial pain
involving structures such as the rotator cuff or subacromial bursa. The finding
does not by itself establish a specific tissue diagnosis, but it provides
useful information for further assessment. A capsular restriction primarily
produces a characteristic limitation of passive movement, while contracture
represents structural shortening and neurological weakness primarily affects
force production or motor control.
Question 27
A patient is referred after removal of a
below-knee cast for a healed ankle fracture. The ankle is stiff, the calf is
weak, and walking is limited, but weight bearing is now permitted. Which
initial rehabilitation plan is MOST appropriate?
A. Progressive mobility, strengthening,
gait retraining, and functional exercise B. High-impact jumping followed by
unrestricted running practice C. Prolonged immobilization until full strength
returns spontaneously D. Passive treatment alone until normal walking ability
is restored
Answer: A. Progressive mobility,
strengthening, gait retraining, and functional exercise
Rationale: Following immobilization, common
rehabilitation problems include joint stiffness, muscle weakness, reduced
proprioception, altered gait, and loss of functional capacity. Once healing and
weight-bearing status permit rehabilitation, a graded programme addressing
mobility, strength, gait, and function is appropriate. High-impact activity is
generally premature at the beginning of rehabilitation, while further
unnecessary immobilization can worsen stiffness and weakness. Passive
interventions may sometimes supplement treatment but cannot independently
restore the strength, motor control, and functional tolerance required for
normal mobility.
Question 28
A patient with hemiparesis after stroke
demonstrates knee hyperextension during stance. Before selecting treatment,
what should the physiotherapist do FIRST?
A. Prescribe a knee brace solely because
hyperextension is visible B. Strengthen the quadriceps maximally without
further examination C. Prevent all weight bearing through the affected lower
limb D. Determine the impairments and gait mechanisms producing the
hyperextension
Answer: D. Determine the impairments and
gait mechanisms producing the hyperextension
Rationale: Knee hyperextension during stance can
arise from different mechanisms, including quadriceps weakness or altered
control, plantar-flexor overactivity, restricted ankle dorsiflexion, impaired
proprioception, or compensatory movement strategies. Treatment should therefore
follow assessment rather than the visible gait abnormality automatically
determining the intervention. An orthosis, strengthening programme,
motor-control intervention, or other strategy may eventually be appropriate,
but only after the contributing mechanism has been identified. This is a
central principle of clinical reasoning: treat the cause of dysfunctional
movement rather than simply its appearance.
Question 29
A patient reports pain radiating from the
lower back into the leg. During repeated movement testing, the distal leg pain
decreases and becomes confined closer to the lumbar region. How should this
response BEST be interpreted?
A. Symptoms are worsening because pain
remains in the lumbar region B. Treatment must stop because symptom location
has changed C. Centralization has occurred and may help guide mechanical
management D. Peripheral nerve damage has been confirmed by repeated movement
Answer: C. Centralization has occurred
and may help guide mechanical management
Rationale: Centralization describes a response in
which symptoms that were experienced farther distally retreat toward the spine
during particular repeated movements or sustained positions. In an appropriate
mechanical assessment, this can be a clinically useful response and may help
guide exercise selection and management. It should not be interpreted as proof
of nerve damage or as deterioration merely because some pain remains centrally.
The entire clinical picture still matters, especially neurological findings and
red flags, but movement-related symptom behavior can provide valuable treatment
direction.
Question 30
A patient recovering from a peripheral
nerve injury can contract the ankle dorsiflexors only when gravity is minimized
and can complete the available range in that position. What manual muscle
testing grade is MOST appropriate?
A. Grade 2 B. Grade 3 C. Grade 4 D. Grade
1
Answer: A. Grade 2
Rationale: Grade 2 on the commonly used 0–5 manual
muscle testing scale indicates that the muscle can complete the available range
of motion when the effect of gravity is minimized. Grade 3 requires full
movement against gravity, while Grade 1 represents only a palpable or visible
contraction without meaningful joint movement. Grade 4 requires movement
against gravity plus moderate resistance. The distinction helps the
physiotherapist select an exercise starting position and appropriate resistance
according to the patient's current muscle performance.
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