TherEx Exam 3 Post Op

1.

1 point

pp362
Your pt underwent a surgery which took a graft from his own patellar tendon in order to reconstruct his torn ACL. Which type of graft did he have?

synthetic graft

autograft

allograft

2.

1 point

pp370
Which of the following procedures would be used to correct a valgus deformity of the knee and shift WB loads away from the deteriorated cartilage in the lateral compartment of the knee?

high tibial osteotomy

intertrochanteric osteotomy of the proximal femur

Medial wedge osteotomy of the femur

periacetabular osteotomy

3.

1 point

pp362
Which of the following types of grafts have had a high rate of failure and have also been associated with chronic synovitis of the knee?

autografts

allografts

synthetic grafts

4.

7 points

Tests and measures are components of both the initial pre-op exam & eval and the subsequent post-op eval during rehab. Check all the ones that apply.
pp352 K&C

Gait analysis

Pain

ROM & Joint Integrity

Posture

Functional status

Integrity of the skin

Muscle performance

5.

1 point

You suspect your pt has acquired DVT and thrombophlebitis. According to box 12.8, your plan of care is to:
Prevent recurrence of the acute disorder.
Which of the following intervention sets will you use to do this?

use of a sequential pneumatic compression pump

passive or active motion or application of moist heat.

continuation of appropriate medical and pharmacological management and use of strategies to prevent DVT.

6.

1 point

pp363
Surgical stabilization or recon of a joint capsule is indicated for which of the following?
Check all that apply

traumatic dislocation with associated capsular or labral avulsion or fx

irreducible (fixed) dislocation

recurrent dislocation or symptomatic subluxation despite a course of non-op tx

7.

1 point

pp363
All of the following joints are the MC sites of ligamentous injury and surgical intervention EXCEPT:

ankle

elbow

knee

wrist

8.

1 point

pp362
Which one of the following types of grafts is used when an autograft in a previous surgery has failed or when an appropriate autograft is unavailable? This type of graft uses fresh or cryopreserved tissue that comes from a cadaver or some source other than the pt.

allograft

autograft

synthetic graft

9.

1 point

Table 12.1 pp361
Myotomy, tenotomy, fasciotomy, capsulotomy, tenolysis, muscle-tendon lengthening, retinacular release, and arthroscopic subacromial decompression are all examples of which MSK surgery?

realignment or stabilization

reconstruction or replacement

release or decompression

resection or removal

10.

1 point

pp363
For patients who have undergone ligamentous surgery that wish to return to high demand work or sport, it may take at least (?) to (?) of rehab?

1 to 6 years

3 to 6 months

6 months to 1 year

6 to 12 weeks

11.

1 point

Table 12.1 pp361
All of the following are MSK surgeries to reconstruct or replace a structure EXCEPT:

capsulolabral and ligamentous reconstruction

chondroplasty, tenoplasty, arthroplasty

synovectomy

12.

1 point

pp364
If the purpose of your patient's tendon transfer was to change the function of the muscle, which of the following post-op management procedures are used to help a pt learn to control the new action of the transferred muscle-tendon unit?

early muscle setting and protected motion

biofeedback and E-stim

gradually progressed resisted movement

13.

1 point

pp359
During the early stages of a DVT, only 25% to 50% of cases can be identified by clinical manifestations such as:
Check the ones that apply.

numbness and tingling

swelling

dull aching or severe pain

heat and redness of the skin

14.

1 point

Which of the following procedures is a surgical fusion of the surfaces of a joint?
pp368

interposition arthroplasty

arthrodesis

joint replacement arthroplasty

ORIF

15.

1 point

Box 12.5
Your patient is in the moderate protection / controlled motion phase of her post-op rehab. Your plan of care is to strengthen the involved muscles and improve joint stability. Which of the following is the appropriate intervention for your patient's phase?

multiple angle isometrics against increasing resistance

alternating isometrics and rhythmic stabilization procedures

dynamic exercise against light resistance in open and closed chain positions

all of the above

16.

1 point

Table 12.1 pp361
Tenorrhaphy, tendon repair, meniscus or ligament repair, articular cartilage repair are all examples of what type of MSK surgery?

release or decompression

repair

realignment or stabilization

resection or removal

17.

1 point

pp364
Using an arthroscopic approach, thermal energy (laser or radiofrequency) is delivered to the capsule to shrink selective portions.

capsulolabral recon

electrothermally assisted capsulorrhaphy

capsulorrhaphy

18.

1 point

Box 12.5
There are 9 plans of care for the maximum protection phase. Which of the following is NOT one of the max protection phase plans of care?

Acquire or relearn specific motor skills

Maintain motion and strength in areas above and below the operative site

Prevent pulmonary complications and joint stiffness / soft tissue contractures

Maintain functional mobility while protecting operative site

19.

1 point

pp369
What is the optimal position for the shoulder that has undergone an arthrodesis?

slight extension

15-30 degr. abduction and flexion, and 45 degr. IR

20 degr. flexion

neutral

20.

1 point

pp363
After a tendon repair, the muscle-tendon unit must be held in a shortened position for several weeks. Vigorous stretching and high intensity resistance exercise should not be initiated until _(how long)_, when healing of the tendon has occurred.

12 weeks

4 weeks

6 weeks

8 weeks

21.

1 point

All of the following are CONTRAINDICATED for patients with DVT and thrombophlebitis, EXCEPT:

passive or active motion

avoiding contact sports and high fall risk activities

use of a sequential pneumatic compression pump

application of moist heat

22.

1 point

pp365
When synovium proliferates in the synovial sheaths of tendons, it is referred to as ___. Removal of excess synovium from tendon sheaths, then, is known as ___.

synovitis, synovectomy

arthritis, arthroplasty

tendinitis, tenotomy

tenosynovitis, tenosynovectomy

23.

1 point

pp366
This procedure is designed to stimulated growth of hyaline cartilage for repair of defects of articular cartilage and prevention of progressive deterioration of joint cartilage leading to OA. It occurs in two stages: extraction and implantation

excision arthroplasty with implant

chondrocyte transplantation

osteochondral allografts and autografts

interposition arthroplasty

24.

1 point

pp365
Which of the following procedures involves arthroscopic removal of fibrillated cartilage, unstable chondral flaps, and loose bodies in a joint? Osteophytes may also be excised. This procedure is most often indicated to relieve joint pain and biomechanical "catching" during joint movement.

arthroscopic debridement and lavage

synovectomy

abrasion arthroplasty

capsulorrhaphy

25.

1 point

The integrity of an incision across a joint should be noted during and after exercise.
Box 12.4

True

False

26.

1 point

Box 12.5
Avoid vigorous / high intensity stretching or resistance exercises with soft tissues that have been repaired or reattached for at least _(how long)_ to ensure adequate healing and stability

6 months

6 weeks

6 days

6 years

27.

1 point

Muscle setting, deep breathing, coughing, and active ankle pumping exercises are examples of which of the following components of preoperative pt education?

bed mobility

initial postoperative exercises

transfers

gait training

28.

2 points

pp369
Choose the two main priorities of post-op management of ORIF (open reduction internal fixation) procedures.

CPM

maintaining stability of the fx site so that boney healing can occur

getting the pt OOB as early as possible

muscle setting

29.

1 point

Table 12.1 pp361
All of the following are examples of surgical realignment or stabilization procedures for the MSK system EXCEPT:

extensor mechanism realignment

arthrodesis

capsulorrhaphy

tenodesis

tendon transfer

30.

1 point

Deep breathing exercises initiated on the day of surgery and early standing and ambulation may reduce the risk of which of the following potential post-op complications? Choose the two that apply.
pp357

atelactasis

pneumonia

DVT

local or systemic infection

31.

1 point

You suspect your pt has acquired DVT and thrombophlebitis. According to box 12.8, your plan of care is to relieve pain during the acute inflammatory period. Which of the following intervention sets will you use to do this?

bed rest, pharm management, elevation of affected lower extremity, keeping the knee slightly flexed

passive or active motion or application of moist heat

continuation of appropriate medical and pharmacological management.

graded ambulation w/ legs wrapped in elastic or nonelastic bandages or when pressure gradient support stockings are worn

32.

1 point

pp365
Which of the following is NOT part of post-op management of a synovectomy?

after wrist or elbow synovectomy, lifting heavy objects is restricted permanently

if an arthroscopic approach is used, PROM or assisted ROM or CPM and muscle setting are begun within 24-48 hours after surgery

avoid excessive exercise or activity that increases joint pain or swelling

progress ADLs and exercises more slowly for open synovectomy pts

33.

1 point

Table 12.1 pp361
Arthrodesis and ORIFs (open reduction with internal fixation) are examples of which type of MSK surgery?

release or decompression

fusion or fixation for boney union

resection or removal

repair

34.

1 point

If a joint capsule has been incised during surgery, as is the case for total joint replacements or labrum repairs, there is an increased risk for which of the following potential post-op complications?
pp358

dislocation

nerve entrapment

delayed wound healing

DVT

35.

1 point

pp365
Which of the following procedures would be performed for RA pts who have chronic proliferative synovitis but minimal articular changes, and medical management has failed to alleviate joint inflammation for 4 - 6 months?

synovectomy

myotomy

tenotomy

fasciotomy

36.

1 point

Box 12.5
During the maximum protection phase, which intervention is used to decreasing post-op pain, muscle guarding or spasm?

relaxation exercises, TENS, cold or heat, CPM

progressive balance and coordination training

apply principles of motor learning

AAROM w/in limits of pain, joint mobs

37.

1 point

pp370
Which procedure is used to correct a varus or valgus knee deformity by changing the mechanical axis of the knee, and shift the load on joint surfaces in a pt with unicompartmental degenerative arthritis of the knee?

periacetabular osteotomy

intertrochanteric osteotomy of the prox femur

High tibial, medial or lateral opening, wedge osteotomy

medial wedge osteotomy of the distal femur

38.

1 point

Table 12.1 pp361
Synovectomy, meniscectomy, capsulectomy, debridement and lavage, laminectomy, and excision of soft tissue or boney neoplasms are all examples of which type of MSK surgery?

reconstruction or replacement

resection or removal

fusion or fixation

realignment or stabilization

39.

1 point

pp364
Involves arthroscopic or open repair of a capsular lesion and labral tear (e.g. a Bankart lesion) by reattaching the labrum to the rim of the glenoid combined with stabilization of the capsule.

capsulolabral recon

capsulorrhaphy

electrothermally assisted capsulorrhaphy

40.

1 point

pp364
Using an arthroscopic or an open approach, a specific portion of the capsule is incised and tightened by imbrication / plication (overlapping and then suturing) of the redundant tissue.

capsulolabral recon

electrothermally assisted capsulorraphy

capsulorrhaphy

41.

1 point

Box 12.5
Your patient is in the moderate protection / controlled motion phase of his post-op rehab. Your plan of care is to establish a mobile scar. Which of the following will you use to do this?

use of modalities such as TENS, hot packs, and ice

gentle massage across and around the maturing scar

cleaning and dressing the incision

self stretching techniques

42.

1 point

pp370
Which of the following procedures:
is most often performed at the knee or hip
used to reduce pain and correct deformity in selected patients (such as a young adult with knee varus deformity as the result of OA, or a child with severe hip joint deterioration and pain secondary to congenital dysplasia)

osteotomy

arthrodesis

tenotomy

ORIF

43.

1 point

pp362
All of the following are components of post-op management for a muscle repair, except one, which is a CONTRAINDICATION. Select the contraindication.

when immob removed, active ROM in a controlled motion within protected range

vigorous stretching or return to a full level activity within 4 weeks post-op

low load, high repetition resistance exercises progressed very gradually to protect the healing muscle

WB partially restricted until strength and flexibility of the repaired muscle are returned to functional level

44.

1 point

Indications for surgery for MSK disorders of the extremities and spine include all of the following EXCEPT:
Box 12.1 K&C

acute joint swelling

Incapacitating pain at rest or with functional activities

marked limitation with active or passive motion

gross instability of a joint or bony segments

joint deformity or abnormal joint alignment

significant structural degeneration

failed conservative or previous surgical management

45.

1 point

pp358
Proper use of supportive devices, such as crutches or a walker, to control WB during ambulation can reduce the risk of which of the following post-op complications?

restricted motion from adhesions and scar tissue formation

pulmonary complication

subluxation or dislocation after joint surgery

Failure, displacement, or loosening of internal fixation device

46.

1 point

pp364
What is the difference between a realignment procedure and a tendon transfer?

there is no difference

usually the distal attachment of the muscle tendon unit is removed from its boney insertion and reattached to a different bone

Although a realignment slightly alters the line of pull, it does not change the action of the muscle-tendon unit; whereas a tendon transfer from one boney surface to another, the line of pull is altered AND the action of the muscle is also changed

healing times are different

47.

1 point

Sudden onset of SOB, rapid and shallow breathing, and chest pain located at the lateral aspect of the chest that intensifies with deep breathing and coughing are hallmark signs of which of the following post-op complications?
pp359

pulmonary embolism

congestive heart failure

DVT

active malignancy

48.

2 points

pp362
Common sites for of acute tendon tear or rupture are:
Check the two that apply

Achilles tendon

anterior tib

biceps femoris tendon

bicipital tendon at the shoulder

49.

1 point

Which of the following is a benefit of preoperative contact with a patient?
Box 12.2

exam & eval of a patient's pre-op impairments and functional status to establish a baseline for documenting post-op improvement

authorization for a pre-op visit is difficult to obtain in today's health care environment

pre-operative contact with a group of pts with similar conditions may be possible

50.

1 point

pp366
All of the following are disadvantages to excision arthroplasty EXCEPT:

possible joint instability

A space is left in which fibrotic scar tissue is laid down in the healing process

persistent muscular imbalance and weakness

in the hip, significant leg length discrepancy and poor cosmetic result bc of shortening of the operated extremity