CAPR PCE Written cheat sheet

Ligament sprain grading: Grade I = mild stretch, no laxity, firm endpoint; Grade II = partial tear, increased laxity with firm endpoint; Grade III = complete tear, laxity with no endpoint.

Ottawa Ankle Rules (radiograph if any): bony tenderness at posterior edge or tip of lateral malleolus, posterior edge or tip of medial malleolus, base of 5th metatarsal or navicular, OR inability to bear weight for 4 steps both immediately and in the emergency department.

Ottawa Knee Rules (radiograph if any of): age 55 or older, isolated patellar tenderness, tenderness at fibular head, inability to flex knee to 90 degrees, inability to bear weight 4 steps immediately and in the ED.

Approximate normal AROM: shoulder flexion/abduction 180, external rotation 90, internal rotation 70; hip flexion 120, extension 30, abduction 45; knee flexion 135; ankle dorsiflexion 20, plantarflexion 50.

High-yield special tests: Lachman (most sensitive for ACL), McMurray (meniscus), Thompson (Achilles rupture), drop-arm (rotator cuff tear), apprehension (anterior shoulder instability), Spurling (cervical radiculopathy).

Tissue healing timeline: inflammation days 0-5, proliferation/repair roughly day 5 to week 6, remodelling from about week 6 up to 12 months; loading must be graded to phase.

Myotomes: C5 shoulder abduction, C6 elbow flexion/wrist extension, C7 elbow extension, C8 finger flexion, L2 hip flexion, L3 knee extension, L4 ankle dorsiflexion, L5 great toe extension, S1 plantarflexion.

Manual muscle testing grades: 0 no contraction, 1 trace, 2 active movement with gravity eliminated, 3 against gravity only, 4 against gravity plus moderate resistance, 5 normal.

Fracture/infection/malignancy red flags: night pain unrelieved by rest, unexplained weight loss, fever, history of cancer, major trauma, inability to weight bear, and progressive neurological deficit all warrant medical referral before treatment.

ASIA Impairment Scale: A = complete (no sacral sparing S4-S5), B = sensory incomplete, C = motor incomplete with more than half of key muscles below the level less than 3/5, D = motor incomplete with at least half at 3/5 or more, E = normal.

Upper motor neuron signs: hyperreflexia, spasticity, clonus, positive Babinski, minimal atrophy. Lower motor neuron signs: hyporeflexia/areflexia, hypotonia, fasciculations, marked atrophy.

Glasgow Coma Scale: eyes 1-4, verbal 1-5, motor 1-6; total ranges 3-15, with 8 or less conventionally indicating severe impairment.

Tendon reflex levels: biceps and brachioradialis C5-C6, triceps C7, knee jerk L3-L4, ankle jerk S1.

Modified Ashworth Scale grades resistance to passive movement 0 to 4, with an added 1+ grade; 0 = no increase in tone, 4 = rigid limb.

Berg Balance Scale scores 0-56; a score below 45 is associated with increased fall risk and is commonly used as a cutoff in stroke and older-adult rehabilitation.

Decorticate posturing (arms flexed, legs extended) suggests damage above the red nucleus; decerebrate posturing (arms and legs extended, internally rotated) suggests a lower brainstem lesion and is generally worse.

Cranial nerves: I olfactory, II optic, III oculomotor, IV trochlear, V trigeminal, VI abducens, VII facial, VIII vestibulocochlear, IX glossopharyngeal, X vagus, XI accessory, XII hypoglossal.

Rancho Los Amigos cognitive levels run I (no response) to VIII (purposeful, appropriate); agitation typically peaks around level IV, and structured, low-stimulation environments reduce escalation.

Normal arterial blood gases: pH 7.35-7.45, PaCO2 35-45 mmHg, PaO2 80-100 mmHg, HCO3 22-26 mmol/L. Respiratory acidosis = low pH with high PaCO2; metabolic acidosis = low pH with low HCO3.

Spirometry: FEV1/FVC below 0.70 after bronchodilator supports persistent airflow obstruction; a reduced FVC with preserved or increased ratio suggests a restrictive pattern.

1 MET = 3.5 mL O2/kg/min; approximately 2 METs = self-care, 3-5 METs = light housework/walking 4-6 km/h, more than 7 METs = vigorous activity or stair climbing.

Six-minute walk test: a change of about 30 m is the commonly cited minimal clinically important difference in chronic respiratory disease.

Post-median sternotomy precautions for roughly 6-8 weeks: no lifting more than about 5-10 kg (10-20 lb) is institution-specific, avoid pushing or pulling with the arms and avoid resisted arm exercises.

Oxygen targets: 88-92% SpO2 for people at risk of hypercapnia (e.g., COPD), 94-98% for most other acutely ill adults.

Exercise prescription: estimated maximal heart rate = 220 minus age; target heart rate by Karvonen = (HRmax - HRrest) x intensity% + HRrest, with 40-70% of heart rate reserve typical for moderate training.

Airway clearance techniques include postural drainage, percussion, vibration, active cycle of breathing, autogenic drainage, PEP and high-frequency oscillation; position the segment to be drained uppermost and monitor for desaturation.

Stop or modify exercise with: chest pain, SpO2 falling below prescribed target, a drop of more than 4% SpO2, severe dyspnoea, dizziness, new arrhythmia, or excessive blood pressure rise.

Pressure injury staging: Stage 1 = intact skin with non-blanchable erythema; Stage 2 = partial-thickness loss with dermis exposed; Stage 3 = full-thickness loss with subcutaneous fat visible; Stage 4 = full-thickness loss with fascia, muscle, tendon or bone exposed.

Unstageable pressure injury = full-thickness loss obscured by slough or eschar; deep tissue injury = intact or non-intact skin with persistent purple/maroon discolouration.

Braden Scale scores six subscales (sensory perception, moisture, activity, mobility, nutrition, friction/shear), maximum 23; lower scores mean higher risk, with 18 or below indicating risk and 9 or below very high risk.

Rule of Nines (adult): head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%; the palm of the patient's hand approximates 1% body surface area.

Venous ulcer: medial malleolus, moist granulating base, oedema, haemosiderin staining, compression indicated. Arterial ulcer: distal/lateral, dry, pale, punched-out, painful with elevation, compression contraindicated.

Burn depth: superficial (epidermis only, erythema, painful), superficial partial (blisters, moist, very painful), deep partial (mottled, less painful), full thickness (leathery, insensate, requires grafting).

Wound assessment documentation: location, size and depth, wound bed tissue percentages, exudate amount and type, odour, periwound skin, infection signs, and pain.

Diabetic foot ulcer Wagner grading 0-5: 0 = intact skin with deformity, 1 = superficial ulcer, 2 = deep to tendon/bone, 3 = abscess or osteomyelitis, 4 = localized gangrene, 5 = extensive gangrene.

Scar management: silicone gel or sheeting as first-line for hypertrophic scars, plus pressure garments (about 20-25 mmHg), positioning, massage and stretch as indicated.

Elements of valid informed consent: the patient has capacity, receives adequate and understandable disclosure of benefits, risks, alternatives and consequences, participates voluntarily, and comprehends the information; consent may be withdrawn at any time.

Capacity is decision-specific and presumed in adults; when a patient lacks capacity, obtain consent from the legal substitute decision-maker according to the applicable provincial health consent law.

Confidentiality may be breached only with consent, when required by law (e.g., mandatory reporting, court order, communicable disease reporting), or to prevent serious imminent harm.

Privacy legislation: federal PIPEDA covers commercial activity, while provinces such as Ontario (PHIPA), Alberta (HIA) and British Columbia (PIPA) have health-specific privacy statutes that govern collection, use and disclosure.

Ethical principles commonly applied: autonomy, beneficence, nonmaleficence, justice, veracity, fidelity and confidentiality; a conflict between principles must be reasoned and documented.

Mandatory reporting duties vary by province but commonly include suspected child abuse or neglect, and reporting an impaired or incompetent colleague to the regulator.

Delegation to a physiotherapist assistant or rehab assistant requires that the task be within the physiotherapist's scope, the assistant be competent, the patient be stable and predictable, and the physiotherapist retain accountability with appropriate supervision.

Professional boundaries: any sexual relationship or sexualized behaviour with a current patient is prohibited regardless of consent; former patients raise a rebuttable presumption of misconduct in most Canadian jurisdictions.

Fees and business conduct: fee-splitting, paying referral incentives, and billing for services not delivered are prohibited; actual or potential conflicts of interest must be disclosed and managed.

SBAR handover structure: Situation, Background, Assessment, Recommendation; it is used when transferring care or escalating a deteriorating patient.

SOAP note structure: Subjective (patient report), Objective (measurable findings), Assessment (clinical interpretation and progress), Plan (interventions, goals, referrals, review dates).

Teach-back: ask the patient to restate or demonstrate the instruction in their own words; re-teach gaps rather than repeating the same wording louder.

Motivational interviewing core skills (OARS): Open questions, Affirmations, Reflections, Summaries; the goal is to evoke the patient's own arguments for change, not to persuade.

Transtheoretical stages of change: precontemplation, contemplation, preparation, action, maintenance (and relapse); match the intervention to the stage rather than assuming readiness.

Health literacy: use plain language at roughly a grade 6 reading level, limit to 3-5 key points, use pictures or demonstration, and avoid jargon; confirm understanding with teach-back.

Use a trained medical interpreter rather than a family member for consent discussions or complex education; document the interpreter's involvement.

Interprofessional role clarity: physiotherapy addresses mobility, strength and cardiorespiratory function; occupational therapy addresses ADL performance and equipment; speech-language pathology addresses swallowing and communication; nursing addresses skin, medications and medical monitoring.

Collaborative conflict resolution: address the issue directly and privately, focus on patient goals and shared evidence, escalate through the care team lead or an established chain of authority if unresolved, and document the outcome.

PICO framework: Population, Intervention, Comparator, Outcome; it converts a clinical uncertainty into an answerable, searchable question.

Levels of evidence (typical hierarchy): I = systematic reviews/meta-analyses of RCTs; II = individual RCT; III = quasi-experimental or non-randomized controlled studies; IV = cohort or case-control; V = case series, case reports, expert opinion.

Sensitivity = true positives / (true positives + false negatives); high sensitivity is useful for ruling out disease (SnNout). Specificity = true negatives / (true negatives + false positives); high specificity is useful for ruling in disease (SpPin).

Likelihood ratios: LR+ = sensitivity / (1 - specificity), with values above 10 indicating a large increase in post-test probability; LR- = (1 - sensitivity) / specificity, with values below 0.1 indicating a large decrease.

Number needed to treat = 1 / absolute risk reduction; NNT is the number of patients who must be treated for one additional patient to benefit.

Statistical error: alpha (conventionally 0.05) is the probability of a Type I error (false positive); beta is the probability of a Type II error (false negative), and power = 1 - beta, conventionally 0.80.

A 95% confidence interval that excludes the null value corresponds to p less than 0.05; wider intervals indicate less precision, and intervals crossing the null indicate a non-significant result.

Reliability benchmarks: kappa and ICC above 0.75 are generally considered good to excellent, 0.50-0.75 moderate, and below 0.50 poor.

MDC (minimal detectable change) is the smallest change beyond measurement error in an individual; MCID is the smallest change patients perceive as important. A change must exceed MDC before it can credibly represent MCID.

Intention-to-treat analysis includes all randomized participants in their assigned groups; it preserves randomization and better reflects real-world effectiveness, while per-protocol analysis risks attrition bias.