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Bahrain NHRA Physiotherapist study materials
Bahrain NHRA Physiotherapist study resources

Bahrain NHRA Physiotherapist practice questions

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Question 1Physiotherapy Practice

Which type of muscle contraction involves the muscle developing tension while its length remains constant?

  1. Isometric contraction Correct answer.
  2. Isotonic eccentric contraction
  3. Isotonic concentric contraction
  4. Isokinetic contraction

Explanation

An isometric contraction generates tension without any change in muscle length, so joint angle stays fixed, as when holding a weight steady. Concentric and eccentric actions are both isotonic because the muscle changes length while the load stays constant. Isokinetic work instead requires a constant angular velocity controlled by a dynamometer.

Question 2Physiotherapy Practice

A patient reports pain over the lateral elbow that worsens with resisted wrist extension. Which condition is most consistent with this presentation?

  1. Medial epicondylalgia
  2. Carpal tunnel syndrome
  3. Lateral epicondylalgia Correct answer.
  4. De Quervain tenosynovitis

Explanation

Lateral epicondylalgia involves the common extensor origin at the lateral epicondyle, so pain is provoked by resisted wrist extension and gripping. Medial epicondylalgia affects the common flexor origin on the medial side. Carpal tunnel syndrome and De Quervain tenosynovitis produce different patterns of distal wrist and thumb symptoms.

Question 3Physiotherapy Practice

Which outcome measure is designed specifically to assess balance and fall risk in older adults?

  1. Visual Analogue Scale
  2. Oswestry Disability Index
  3. Modified Ashworth Scale
  4. Berg Balance Scale Correct answer.

Explanation

The Berg Balance Scale rates performance of functional balance tasks and is widely used to quantify fall risk in older adults. The Visual Analogue Scale measures pain intensity, the Modified Ashworth Scale grades spasticity, and the Oswestry Disability Index measures low back disability.

Question 4Physiotherapy Practice

Which modality transfers energy to deep tissues using high-frequency sound waves?

  1. Intermittent pneumatic compression
  2. Transcutaneous electrical nerve stimulation
  3. Therapeutic ultrasound Correct answer.
  4. Shortwave diathermy

Explanation

Therapeutic ultrasound uses high-frequency sound waves in the megahertz range to deliver thermal and non-thermal effects to deeper tissues. Shortwave diathermy uses electromagnetic radiofrequency energy, TENS uses electrical current for sensory stimulation, and pneumatic compression applies mechanical pressure.

Question 5Physiotherapy Practice

Which structure is most commonly injured in an anterior cruciate ligament tear during a non-contact pivoting movement?

  1. Patellar tendon
  2. Medial collateral ligament
  3. Posterior cruciate ligament
  4. Anterior cruciate ligament Correct answer.

Explanation

Non-contact pivoting and deceleration injuries typically rupture the anterior cruciate ligament because it resists anterior tibial translation and rotational stress. The posterior cruciate ligament is usually injured by a direct blow to the proximal tibia, and the medial collateral ligament by valgus stress. Patellar tendon rupture follows a forceful eccentric load in an already degenerate tendon.

Question 6Physiotherapy Practice

Which exercise principle states that load must be progressively increased as the body adapts?

  1. Specificity
  2. Reversibility
  3. Progressive overload Correct answer.
  4. Individuality

Explanation

Progressive overload requires gradually increasing the training stimulus so adaptation continues as the tissues become stronger. Reversibility describes loss of gains after training stops, specificity means adaptation is directed at the trained task, and individuality acknowledges variation between people.

Question 7Physiotherapy Practice

In which position should a patient with a recent total hip replacement avoid lying to protect the surgical approach?

  1. Side-lying on the unoperated side with a pillow between the knees
  2. Side-lying on the operated side with the leg adducted across the midline Correct answer.
  3. Supine with a pillow between the knees
  4. Semi-recumbent with the hip in slight flexion

Explanation

After a lateral or posterior approach, adduction across the midline combined with internal rotation risks dislocation, so the operated leg should not be crossed over. Supine positioning with an abduction pillow and side-lying on the unoperated side with a pillow between the knees are accepted safe positions.

Question 8Physiotherapy Practice

Which gait deviation is typically seen in a patient with weak hip abductors on the stance limb?

  1. Steppage gait
  2. Trendelenburg gait Correct answer.
  3. Waddling gait
  4. Scissor gait

Explanation

Weakness of the stance-limb hip abductors allows the pelvis to drop on the opposite swing side, producing a Trendelenburg pattern. Steppage gait reflects foot drop, scissor gait reflects adductor spasticity, and waddling gait is a bilateral pattern seen in proximal muscle weakness.

Question 9Physiotherapy Practice

A patient with chronic obstructive pulmonary disease becomes breathless during walking. Which technique should be taught to reduce breathlessness?

  1. Pursed-lip breathing during exertion Correct answer.
  2. Rapid shallow breathing through the mouth
  3. Breath-holding during activity
  4. Vigorous coughing after every step

Explanation

Pursed-lip breathing prolongs expiration and creates back pressure that helps prevent airway collapse, reducing dynamic hyperinflation and breathlessness. Rapid shallow breathing worsens hyperinflation, breath-holding increases air trapping, and repeated coughing is fatiguing rather than therapeutic.

Question 10Physiotherapy Practice

Which finding is most consistent with an upper motor neuron lesion?

  1. Fasciculations with muscle wasting
  2. Flaccid paralysis with absent reflexes
  3. Sensory loss in a single dermatome
  4. Hyperreflexia with increased muscle tone Correct answer.

Explanation

Upper motor neuron lesions produce increased tone, hyperreflexia, and often an extensor plantar response because descending inhibition is lost. Flaccid paralysis, absent reflexes, fasciculations, and marked wasting point to lower motor neuron involvement, while a single dermatomal sensory loss suggests a root lesion.

Question 11Physiotherapy Practice

Which intervention is the priority for a patient with a complete spinal cord injury at T4 who develops sudden severe headache, flushing, and bradycardia?

  1. Encourage the patient to lie flat and drink fluids
  2. Begin vigorous passive range of motion of the legs
  3. Apply ice to the forehead and continue therapy
  4. Sit the patient upright and check for bladder distension Correct answer.

Explanation

These features suggest autonomic dysreflexia, a hypertensive emergency triggered by noxious stimuli below the lesion, most often bladder distension. The immediate action is to sit the patient upright to lower blood pressure and identify and remove the trigger. Lying flat worsens the hypertension, and exercise should not continue until the episode resolves.

Question 12Physiotherapy Practice

Which test is used to assess the integrity of the anterior cruciate ligament?

  1. Valgus stress test
  2. Lachman test Correct answer.
  3. Thomas test
  4. McMurray test

Explanation

The Lachman test applies anterior tibial translation with the knee slightly flexed to assess the anterior cruciate ligament and is considered highly sensitive. McMurray tests meniscal integrity, valgus stress tests the medial collateral ligament, and the Thomas test assesses hip flexor tightness.

Question 13Physiotherapy Practice

Which posture is most likely to contribute to forward head posture in a desk worker?

  1. Sustained cervical retraction with a tucked chin
  2. Neutral cervical alignment with relaxed shoulders
  3. Sustained neck flexion with a protruded chin Correct answer.
  4. Sustained cervical extension during screen use

Explanation

Forward head posture develops from prolonged cervical flexion and chin protrusion, which increases the extensor moment and load on the cervical spine. Retraction and neutral alignment reduce this load, and sustained extension is not the typical desk posture.

Question 14Physiotherapy Practice

Which intervention is most appropriate for a patient with a healing stage II pressure ulcer over the sacrum?

  1. Applying heat packs directly over the ulcer
  2. Massaging the ulcer margins twice daily
  3. Encouraging prolonged sitting to build tolerance
  4. Repositioning schedule with pressure-relieving support surfaces Correct answer.

Explanation

Pressure ulcers heal when pressure and shear are removed, so regular repositioning combined with an appropriate support surface is the core intervention. Massage over or near the ulcer causes tissue damage, heat increases metabolic demand in compromised tissue, and prolonged sitting increases pressure over the sacrum.

Question 15Physiotherapy Practice

Which measure best quantifies a patient's functional independence in self-care and mobility?

  1. Goniometric measurement
  2. Functional Independence Measure Correct answer.
  3. Manual muscle testing
  4. Numeric Pain Rating Scale

Explanation

The Functional Independence Measure scores the amount of assistance needed for self-care, mobility, and cognition, giving an overall index of independence. Pain scales, goniometry, and manual muscle testing describe impairment rather than functional independence.

Question 16Physiotherapy Practice

A patient two days after an uncomplicated total knee replacement has a swollen, warm knee. Which approach is most appropriate?

  1. Aggressive passive flexion beyond 120 degrees
  2. Prolonged immobilisation in full extension
  3. Immediate high-resistance quadriceps strengthening
  4. Elevation, cryotherapy, and gentle active-assisted range of motion Correct answer.

Explanation

Early after knee replacement, swelling and inflammation are managed with elevation, cold application, and gentle active-assisted movement to preserve range and reduce oedema. Aggressive passive flexion and heavy resistance increase inflammation, and prolonged immobilisation promotes stiffness and weakness.

Question 17Physiotherapy Practice

Which finding suggests a positive Phalen test?

  1. Pain at the medial knee during valgus stress
  2. Reproduction of symptoms during hip flexion and internal rotation
  3. Reproduction of median nerve symptoms during sustained wrist flexion Correct answer.
  4. Pain at the lateral elbow during resisted wrist extension

Explanation

The Phalen test holds the wrists in maximal flexion for about a minute, which raises carpal tunnel pressure and reproduces median nerve symptoms in carpal tunnel syndrome. The other descriptions correspond to tests for lateral epicondylalgia, medial knee ligament stress, and hip pathology.

Question 18Physiotherapy Practice

Which type of study provides the strongest evidence for the effectiveness of a physiotherapy intervention?

  1. Systematic review of randomised controlled trials Correct answer.
  2. Uncontrolled before-and-after study
  3. Expert opinion article
  4. Single case report

Explanation

A systematic review of randomised controlled trials pools high-quality comparative evidence and sits at the top of the evidence hierarchy. Case reports and expert opinion are low-level evidence, and an uncontrolled study cannot separate treatment effects from natural recovery.

Question 19Physiotherapy Practice

A patient with a complete C6 spinal cord injury wants to transfer from bed to wheelchair. Which muscle group is most likely to be available to assist?

  1. Finger flexors
  2. Wrist extensors Correct answer.
  3. Ankle dorsiflexors
  4. Hip extensors

Explanation

A C6 lesion spares the C6 myotome, so wrist extensors are innervated and can be used for tenodesis grip and assisted transfers. Finger flexors, hip extensors, and ankle dorsiflexors are innervated below C6 and are therefore not voluntarily available.

Question 20Physiotherapy Practice

Which finding indicates that a patient is ready to progress from assisted to independent standing balance training?

  1. Maintaining standing for 30 seconds without upper limb support Correct answer.
  2. Achieving full passive knee extension in lying
  3. Demonstrating 4/5 quadriceps strength in sitting
  4. Requiring a walking frame for all standing tasks

Explanation

Independent standing for 30 seconds without upper limb support shows adequate postural control to progress to less supported balance training. Reliance on a frame indicates ongoing support needs, and passive range or non-weight-bearing strength does not confirm standing balance.

Question 21Physiotherapy Practice

Which mechanism most likely produced a posterior hip dislocation in a road traffic crash?

  1. Forced hip abduction with external rotation
  2. Hyperextension of the hip in standing
  3. Direct blow to the lateral greater trochanter
  4. Axial load through a flexed and adducted hip Correct answer.

Explanation

Posterior hip dislocation classically follows a dashboard impact that drives the flexed, adducted, and internally rotated hip posteriorly. Lateral blows and abduction with external rotation are associated with different injury patterns such as anterior dislocation or trochanteric fracture.

Question 22Physiotherapy Practice

A patient with multiple sclerosis experiences marked fatigue that limits therapy. Which strategy is most appropriate?

  1. Schedule sessions during cooler periods and include energy conservation and rest breaks Correct answer.
  2. Increase session intensity to build endurance quickly
  3. Perform all training in a hot hydrotherapy pool
  4. Discourage rest breaks to improve tolerance

Explanation

Heat sensitivity and fatigue are common in multiple sclerosis, so cooler conditions, pacing, and planned rest breaks preserve function during therapy. Heat exposure and high-intensity training can transiently worsen symptoms, and withholding rest increases fatigue.

Question 23Physiotherapy Practice

A patient with a recent stroke has shoulder pain and inferior subluxation on the hemiplegic side. Which approach is most appropriate?

  1. Support the arm in alignment and avoid overhead pulley exercises Correct answer.
  2. Perform vigorous overhead pulleys to strengthen the shoulder
  3. Encourage the patient to lift the arm overhead without support
  4. Apply traction to the arm during all transfers

Explanation

Glenohumeral subluxation after stroke is managed by supporting the limb in alignment and avoiding positions that stress the capsule, such as overhead pulleys. Vigorous overhead exercise and unsupported elevation increase pain and risk of traction injury, and pulling on the arm during transfers can further damage the shoulder.

Question 24Physiotherapy Practice

A runner has medial tibial stress pain that persists at rest despite two weeks of reduced training. Which action is most appropriate?

  1. Increase mileage rapidly to strengthen the bone
  2. Arrange medical review and imaging before resuming loading Correct answer.
  3. Apply heat before every run and continue training
  4. Resume full training with the same mileage

Explanation

Rest pain in a suspected bone stress injury raises concern for a high-grade stress fracture, which requires medical assessment and imaging before loading resumes. Continuing or escalating training risks progression to a complete fracture, and heat does not address the underlying bone injury.

Question 25Physiotherapy Practice

In a patient with a rotator cuff tear, which finding best supports a diagnosis of a full-thickness supraspinatus tear?

  1. Diffuse cervical pain reproduced by neck extension
  2. Pain reproduced by resisted wrist extension
  3. Marked weakness in resisted shoulder abduction with a positive drop arm sign Correct answer.
  4. Pain only at end range of passive elevation with full strength

Explanation

A full-thickness supraspinatus tear typically produces substantial weakness in resisted abduction and an inability to control the arm during lowering, known as a positive drop arm sign. Pain at end range with preserved strength suggests tendinopathy, and cervical or wrist findings point to different sources.

Question 26Physiotherapy Practice

Which muscle is the primary flexor of the hip and is commonly tested in the supine position?

  1. Biceps femoris
  2. Adductor magnus
  3. Iliopsoas Correct answer.
  4. Gluteus maximus

Explanation

The iliopsoas is the main hip flexor and is tested by asking the supine patient to lift the thigh against resistance. The other muscles listed are hip extensors or adductors, not primary flexors.

Question 27Physiotherapy Practice

Which modality uses high-frequency sound waves to produce deep tissue heating?

  1. Therapeutic ultrasound Correct answer.
  2. Shortwave diathermy
  3. Cryotherapy
  4. Transcutaneous electrical nerve stimulation

Explanation

Therapeutic ultrasound applies high-frequency acoustic waves that generate deep heating in soft tissue. Electrical stimulation and cryotherapy do not use sound waves, and shortwave diathermy uses electromagnetic energy.

Question 28Physiotherapy Practice

Which type of muscle contraction involves the muscle generating tension while lengthening?

  1. Concentric contraction
  2. Isokinetic contraction
  3. Eccentric contraction Correct answer.
  4. Isometric contraction

Explanation

In an eccentric contraction the muscle produces force while its fibres lengthen, as when lowering a weight slowly. Concentric work shortens the muscle, and isometric work holds length constant.

Question 29Physiotherapy Practice

Which structure is most commonly injured in an inversion ankle sprain?

  1. Anterior talofibular ligament Correct answer.
  2. Plantar fascia
  3. Deltoid ligament
  4. Posterior tibiofibular ligament

Explanation

Forced inversion stresses the lateral ligament complex, and the anterior talofibular ligament is the first and most frequently torn. The deltoid ligament is injured with eversion forces, and the plantar fascia is not an ankle ligament.

Question 30Physiotherapy Practice

A patient reports burning pain and tingling in the thumb, index, and middle fingers that wakes them at night. Which condition is most likely?

  1. Carpal tunnel syndrome Correct answer.
  2. De Quervain tenosynovitis
  3. Dupuytren contracture
  4. Lateral epicondylitis

Explanation

The median nerve supplies sensation to the thumb, index, and middle fingers, and compression at the carpal tunnel produces nocturnal burning and tingling in this distribution. The other conditions affect the radial wrist tendons, palmar fascia, or lateral elbow.

Question 31Physiotherapy Practice

Which instruction best promotes airway clearance in a patient with copious sputum who can cooperate?

  1. Lie flat in supine for prolonged periods
  2. Practise pursed-lip breathing at rest
  3. Use incentive spirometry every hour
  4. Perform the active cycle of breathing technique Correct answer.

Explanation

The active cycle of breathing combines breathing control, thoracic expansion, and huffing to mobilise and clear secretions. Pursed-lip breathing and incentive spirometry address breathlessness or lung expansion rather than secretion clearance.

Question 32Physiotherapy Practice

Which principle guides the safe use of a gait belt during patient mobilisation?

  1. The therapist holds the belt loosely to allow free movement
  2. The belt is placed around the patient's chest for better control
  3. The belt replaces the need to assess the patient's standing ability
  4. The belt is applied snugly around the waist and grasped from underneath Correct answer.

Explanation

A gait belt is secured snugly at the waist and grasped with an underhand grip so the therapist can control a loss of balance without pulling on the arms or clothing. It supports but does not replace assessment of standing tolerance.

Question 33Physiotherapy Practice

A patient with a complete T10 spinal cord injury is being taught bed mobility. Which movement pattern is most appropriate to encourage?

  1. Transferring by pulling on the bed rails with the legs
  2. Using the upper limbs to push up and swing the legs to roll Correct answer.
  3. Rolling by initiating movement from the trunk alone
  4. Sitting up by performing a straight sit-up using abdominal muscles

Explanation

With intact upper limb and abdominal innervation above T10, the patient can use the arms to push and swing the legs to generate momentum for rolling and sitting up. Trunk-only initiation and straight sit-ups rely on innervation that is lost below the lesion.

Question 34Physiotherapy Practice

A patient recovering from a stroke has increased tone in the elbow flexors. Which handling approach best supports active elbow extension during reach training?

  1. Passive flexion of the elbow held for several minutes
  2. Slow sustained stretch of the flexors before and during the reaching task Correct answer.
  3. Encouraging the patient to lift a heavy weight with the flexed arm
  4. Rapid bouncing of the elbow into flexion to fatigue the muscle

Explanation

Slow sustained stretch reduces flexor tone temporarily and allows the patient to practise active extension during a functional reach. Rapid movement and loaded flexion tend to increase spasticity rather than reduce it.

Question 35Physiotherapy Practice

A patient with knee osteoarthritis reports pain that increases with walking and improves with rest. Which exercise prescription is most appropriate initially?

  1. Deep squatting against heavy resistance every session
  2. Complete bed rest until pain resolves
  3. Daily high-impact jumping to build tolerance
  4. Low-impact strengthening of the quadriceps with gradual progression Correct answer.

Explanation

Low-impact quadriceps strengthening improves joint support and function without excessive loading in painful osteoarthritis. High-impact and heavy loaded squatting may aggravate symptoms, and complete rest leads to deconditioning.

Question 36Physiotherapy Practice

A patient with a below-knee amputation is being fitted with a prosthesis. Which measure is most useful for monitoring stump volume changes?

  1. Manual muscle testing of the sound hip
  2. Serial circumferential measurement of the residual limb Correct answer.
  3. Goniometric measurement of the sound knee
  4. Measurement of the patient's standing height

Explanation

Residual limb volume fluctuates with oedema and atrophy, and serial circumferential measurement guides socket fit and prosthetic adjustment. The other measures assess the intact limb or overall stature and do not reflect stump volume.

Question 37Physiotherapy Practice

A patient with Parkinson disease shows a festinating gait with small steps and forward trunk lean. Which cue is most likely to improve step length?

  1. Asking the patient to lean further forward
  2. Encouraging the patient to look down at the feet
  3. Instruction to walk as quickly as possible
  4. Auditory cueing with a regular rhythmic beat Correct answer.

Explanation

Rhythmic auditory cueing provides an external temporal reference that helps patients with Parkinson disease overcome freezing and increase step length. Walking quickly or leaning forward tends to worsen festination, and looking down disrupts postural alignment.

Question 38Physiotherapy Practice

A patient with chronic low back pain has been advised to remain active. Which approach best reflects current evidence for managing this condition?

  1. Strict bed rest for six weeks
  2. Avoiding all movement that causes any discomfort
  3. Repeated passive treatment without an active component
  4. Graded activity with reassurance and gradual return to function Correct answer.

Explanation

Evidence supports staying active with graded progression and reassurance to reduce fear avoidance and disability in chronic low back pain. Prolonged rest and passive-only care are associated with poorer outcomes.

Question 39Physiotherapy Practice

A patient in the intensive care unit is sedated and ventilated. Which intervention is appropriate for preventing ventilator-associated complications while maintaining safety?

  1. High-intensity resistance training during sedation
  2. Positioning and passive range of motion within haemodynamic limits Correct answer.
  3. Suctioning every fifteen minutes regardless of need
  4. Aggressive early ambulation while still sedated

Explanation

Positioning and passive range of motion are safe early interventions for a sedated ventilated patient and help prevent contracture and secretion stasis. Ambulation and high-intensity training require an awake, cooperative, and haemodynamically stable patient.

Question 40Physiotherapy Practice

A patient with a Colles fracture has been immobilised in a cast. Which activity should be avoided during the early immobilisation period?

  1. Gentle shoulder and elbow range of motion
  2. Heavy gripping and lifting with the affected wrist Correct answer.
  3. Elevation of the limb to control oedema
  4. Active finger flexion and extension

Explanation

Heavy gripping and lifting generate forces across the healing distal radius and may displace the fracture within the cast. Finger motion, proximal joint exercises, and elevation are safe and help maintain function and reduce swelling.

Question 41Physiotherapy Practice

A patient reports a sudden pop in the calf while sprinting, followed by pain and difficulty pushing off. Which muscle is most commonly involved?

  1. Peroneus longus
  2. Tibialis anterior
  3. Extensor digitorum longus
  4. Medial head of gastrocnemius Correct answer.

Explanation

The medial head of gastrocnemius is the most frequently strained calf muscle during push-off in sprinting. The other muscles are anterior or lateral compartment muscles that are less commonly injured in this mechanism.

Question 42Physiotherapy Practice

A patient who has had a recent myocardial infarction is beginning cardiac rehabilitation. Which parameter should be monitored continuously during exercise to ensure safety?

  1. Lung auscultation before each session only
  2. Knee joint range of motion
  3. Grip strength only
  4. Heart rate and perceived exertion Correct answer.

Explanation

Heart rate and ratings of perceived exertion guide exercise intensity and help detect an unsafe response during cardiac rehabilitation. Grip strength and knee range are unrelated to cardiovascular safety, and auscultation alone does not monitor exercise response.

Question 43Physiotherapy Practice

A patient with a complete spinal cord injury at C5 has intact diaphragm function but no hand function. Which activity of daily living is most likely to require adaptive equipment?

  1. Independent bed-to-chair transfer without assistance
  2. Feeding with a universal cuff Correct answer.
  3. Independent lower limb dressing
  4. Independent wheelchair propulsion on uneven ground

Explanation

At C5 the patient has shoulder and elbow control but no active finger grasp, so a universal cuff allows feeding. Independent transfers, lower limb dressing, and propulsion on uneven ground require more distal or lower limb function.

Question 44Physiotherapy Practice

A patient with a total hip replacement is being taught to use a walking aid. Which aid is most appropriate for partial weight bearing on the operated side?

  1. No aid until pain resolves
  2. A single stick held on the operated side
  3. Two crutches with a three-point gait Correct answer.
  4. A walking frame used with a hopping pattern

Explanation

Two crutches with a three-point gait allow the patient to keep weight off or partially load the operated limb while maintaining balance. A stick on the operated side offers inadequate support, and hopping with a frame is unsafe.

Question 45Physiotherapy Practice

A patient with a chronic wound over the ischium is being taught pressure relief. Which instruction is most appropriate?

  1. Use a ring cushion to concentrate pressure
  2. Remain seated for long uninterrupted periods
  3. Avoid inspecting the skin to prevent irritation
  4. Perform regular pressure-relieving lifts from the seat Correct answer.

Explanation

Regular pressure-relieving lifts redistribute load away from the ischium and allow reperfusion of the skin. Prolonged sitting and ring cushions increase local pressure, and skin inspection is essential for early detection of deterioration.

Question 46Physiotherapy Practice

A patient with a suspected deep vein thrombosis in the calf is referred for physiotherapy. Which action is the priority before starting treatment?

  1. Withhold treatment and refer urgently for medical assessment Correct answer.
  2. Begin vigorous calf massage to disperse the clot
  3. Proceed with mobilisation as planned
  4. Apply heat and commence strong ankle exercises

Explanation

A suspected deep vein thrombosis carries a risk of pulmonary embolism, so treatment must be withheld until medical assessment and diagnosis are complete. Massage, heat, and mobilisation could dislodge the thrombus.

Question 47Physiotherapy Practice

A patient with rheumatoid arthritis reports morning stiffness lasting more than an hour and active synovitis in the hands. Which exercise approach is most appropriate?

  1. Complete immobilisation of the hands for several weeks
  2. Endurance training of the small hand muscles to fatigue during the flare
  3. High-intensity resisted gripping during the acute flare
  4. Gentle range of motion during flare with isometric work, progressing when inflammation settles Correct answer.

Explanation

During an inflammatory flare, gentle motion and isometric exercise preserve function without aggravating synovitis, and resistance is progressed as inflammation subsides. Intense loading and prolonged immobilisation worsen outcomes.

Question 48Physiotherapy Practice

A patient with a traumatic brain injury shows agitation and poor attention during therapy. Which strategy best supports participation?

  1. Short structured sessions in a quiet environment with consistent routine Correct answer.
  2. Increasing task complexity rapidly to build tolerance
  3. Long sessions with multiple changing tasks in a busy gym
  4. Waiting until agitation resolves completely before any therapy

Explanation

Patients with reduced attention and agitation tolerate brief, structured sessions with minimal distraction and predictable routine. Busy environments and rapid progression increase overload, and delaying all therapy prolongs functional loss.

Question 49Physiotherapy Practice

A patient with a complete spinal cord injury at T6 develops a severe headache, profuse sweating, and a rising blood pressure during bladder catheterisation. Which action should be taken first?

  1. Begin vigorous trunk exercises to reduce the pressure
  2. Sit the patient upright and relieve the bladder stimulus Correct answer.
  3. Give a hot drink and continue monitoring
  4. Lay the patient flat and continue the procedure

Explanation

This is autonomic dysreflexia, triggered by a noxious stimulus below the lesion such as bladder distension. The immediate priorities are to sit the patient up to reduce blood pressure and remove the triggering stimulus, then seek medical help if it persists.

Question 50Physiotherapy Practice

A patient with a suspected cervical spine fracture after a fall has midline neck tenderness and neurological symptoms. Which action is most appropriate before any movement?

  1. Immobilise the neck and arrange urgent medical imaging Correct answer.
  2. Begin strengthening exercises for the neck muscles
  3. Perform cervical range of motion to assess stiffness
  4. Apply traction to the neck to relieve pain

Explanation

Midline tenderness with neurological signs after trauma raises concern for an unstable cervical fracture, so the neck must be immobilised and urgent imaging arranged. Movement, traction, and exercise could cause catastrophic spinal cord injury.