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Canadian Physiotherapy Examination Oral Practice Case

CPTE Oral Knee Case Scenario Practice

Read the clinical case, complete the CPTE oral-style questions, then open the answer key dropdowns to compare your reasoning.

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Practice Instructions

Use this like a mini CPTE oral station

Start the timer

The 15-minute timer stays on screen while students scroll through the oral case.

Read the full case

The stem follows the exact clinical format: demographics, history, subjective, objective, and function.

Open answers later

Each answer key is hidden in a dropdown so students can attempt the questions first.

Demographic Data

Patient Profile

Name
Mr. Rahul S.
Age
34 years
Gender
Male
Occupation
Warehouse worker — frequent lifting, stair climbing, prolonged standing, and walking.

Psychosocial / Contextual Factors

Patient Context

  • Recently immigrated; sole financial provider for his household.
  • Experiences pressure from management to avoid taking sick leave.
  • Lives in a basement apartment with steep stairs, which he negotiates multiple times daily.
  • Has limited insurance coverage, restricting access to paid physiotherapy services.
  • High motivation to continue working despite pain due to financial responsibility.

History / Mechanism of Injury

History

Mr. Rahul presents with a 4-month history of gradual-onset anterior knee pain with no specific traumatic event. He denies any episodes of locking, catching, or giving way, and reports no acute injury.

His symptoms have progressively worsened over time and are associated with repetitive occupational demands.

Presenting Complaint

Subjective Presentation

  • Dull, aching pain localized around the patella.
  • Pain is aggravated by climbing stairs.
  • Pain is aggravated by prolonged sitting, also known as theatre sign.
  • Pain is aggravated by lifting and carrying heavy boxes at work.
  • Symptoms improve with rest but recur with activity.

Pain Characteristics

Pain Profile

Intensity — NPRS
  • At rest: 2–3/10
  • With aggravating activities: 6–7/10
Type of Pain

Diffuse, aching anterior knee pain.

Aggravating Factors
  • Stair ascent and descent
  • Prolonged sitting
  • Repetitive lifting and squatting
Relieving Factors
  • Rest
  • Activity modification

Objective Assessment

Findings

The objective findings are intentionally larger and more visible so students can quickly identify key exam clues.

Observation / Gait

  • Mild foot pronation noted during gait assessment.
  • No visible swelling or deformity.

Range of Motion — ROM

  • Full active and passive knee ROM.
  • No pain at end range.

Strength

  • Weakness noted in hip abductors and external rotators.

Special Tests

  • Positive patellar compression test, reproducing anterior knee pain.
  • No ligamentous laxity on varus/valgus, Lachman, or drawer tests.

Joint Assessment

  • No effusion.
  • No signs of instability.

Functional Limitations

  • Difficulty with stair negotiation at home and work.
  • Increased pain with prolonged sitting and repetitive occupational tasks.
  • Reduced tolerance for full work duties due to knee pain.

Clinical Impression

Student Task — Form Your Impression

Before moving to the questions, use the history, subjective report, and objective findings to form your clinical impression and justify the likely diagnosis.

Prompt

What is the most likely clinical impression, and which subjective and objective findings support it?

Mr. Rahul S. is a 34-year-old warehouse worker presenting with a 4-month history of insidious-onset anterior knee pain. This presentation is consistent with a chronic overuse condition rather than an acute traumatic injury.

His pain is dull and aching around the patella and is aggravated by activities that increase patellofemoral joint compressive forces, including stair negotiation, prolonged sitting, squatting, repetitive lifting, and carrying tasks required at work.

The absence of mechanical symptoms such as locking, catching, or giving way, along with the lack of joint effusion or ligamentous laxity on examination, makes intra-articular pathology such as meniscal tear or ligament injury less likely. Reproduction of symptoms with the patellar compression test supports involvement of the patellofemoral joint as the primary pain generator.

Case Scenario 2 — Oral Questions

Attempt all questions before opening the answer key

Answer in a structured CPTE oral format. Include the intervention, rationale, safety considerations, and patient-specific education where appropriate.

1

Exercise Prescription for PFPS

  1. 1.A List three exercises that would be appropriate to improve symptoms of Patellofemoral Pain Syndrome.
  2. 1.B Explain the primary purpose of each exercise in reducing patellofemoral joint stress.
  3. 1.C Describe how these exercises should be progressed safely to support functional recovery.
2

Workplace and Activity Modification

  1. 2.A Identify three workplace or activity modifications that could help reduce knee stress for this patient.
  2. 2.B Explain how each modification helps to minimize patellofemoral loading and prevent symptom aggravation.
  3. 2.C Describe how the physiotherapist would educate the patient to implement these modifications consistently.
3

Ethical Support Issue — Caregiving Responsibilities

Scenario: The patient is the sole financial provider and primary caregiver for a mother with dementia.
  1. 3.A Identify three ethical or psychosocial concerns present in this scenario related to caregiving, work demands, and the patient’s injury.
  2. 3.B Explain the physiotherapist’s role and responsibilities in supporting the patient while remaining within professional scope of practice.
  3. 3.C Identify three strategies or referrals the physiotherapist could recommend to reduce caregiver burden and risk of physical or emotional burnout.

Answer Keys

Click each dropdown to reveal the answer

Keep these closed until students have completed the case. Each answer expands separately for cleaner review.

1.A Three exercises to improve PFPS

  1. Hip abductor and external rotator strengthening — examples include side-lying hip abduction, clamshells, and banded monster walks.
  2. Quadriceps strengthening in a pain-free range — examples include quad sets, straight leg raises, short-arc knee extension, and sit-to-stand.
  3. Functional closed-chain control exercises — examples include step-downs, controlled mini-squats, and sit-to-stand drills with alignment cues.

1.B Purpose of each exercise

  1. Hip strengthening: Reduces excessive femoral internal rotation and dynamic knee valgus, decreasing lateral patellofemoral joint stress during stairs, squats, and lifting.
  2. Quadriceps strengthening: Improves patellar tracking, knee control, and load tolerance during daily and occupational activities.
  3. Functional control exercises: Train neuromuscular control during real-life movements so the patient can transfer strength gains into stair negotiation, lifting mechanics, and work tasks.

1.C Safe progression

  • Begin with low-load, pain-free exercises and prioritize movement quality.
  • Progress by increasing repetitions, resistance, and functional demand gradually.
  • Progress from isolated strengthening to closed-chain and work-specific tasks.
  • Monitor symptoms: pain should not exceed 2–3/10 and should resolve within 24 hours.
  • Avoid rapid increases in exercise volume, deep knee flexion, or excessive stair loading early in rehabilitation.

2.A Three modifications

  1. Reduce repetitive stair use and deep squatting.
  2. Use task rotation and temporary load modification at work.
  3. Schedule micro-breaks during prolonged standing, walking, or lifting duties.

2.B Rationale

  1. Stair and squat modification: Reduces high patellofemoral compressive forces during early rehabilitation and prevents repeated symptom provocation.
  2. Task rotation and load reduction: Prevents cumulative overload and gives irritated tissues time to recover while allowing the patient to remain active at work.
  3. Micro-breaks: Reduce fatigue-related poor mechanics, such as dynamic knee valgus, poor squat control, or altered gait, which may increase knee stress.

2.C Patient education strategies

  • Use clear, practical examples tied directly to his warehouse tasks.
  • Provide written activity guidelines, diagrams, or simple pacing rules.
  • Explain that modification is not avoidance; it is a way to maintain work safely while symptoms settle.
  • With patient consent, collaborate with the employer for realistic accommodations.
  • Teach self-monitoring using pain level, recovery time, and next-day symptom response.

3.A Ethical and red-flag concerns

  1. Risk of physical burnout and injury progression: The patient continues high physical load despite injury, which may worsen symptoms and prolong disability.
  2. Caregiver strain and psychosocial stress: Being both the sole caregiver and sole provider increases risk of emotional distress, fatigue, and reduced coping capacity.
  3. Potential unmet duty of care to dependent mother: Pain, fatigue, and reduced function may compromise the patient’s ability to safely care for his mother with dementia.

3.B Physiotherapist’s role and responsibilities

  • Acknowledge caregiver burden empathetically and validate the patient’s concerns.
  • Screen for red flags such as exhaustion, inability to cope, worsening pain, or safety risks at home or work.
  • Stay within scope and avoid giving social work, legal, or financial advice.
  • Advocate for patient safety while respecting patient autonomy and informed decision-making.
  • Explain that ignoring the injury may compromise both the patient’s recovery and his ability to support his dependent mother.

3.C Strategies and referrals

  1. Referral to social work or community resources: Explore caregiver support services, respite care, financial assistance, or community programs.
  2. Education on pacing and energy conservation: Helps reduce overuse injury risk and lowers the chance of physical or emotional burnout.
  3. Documentation and interprofessional communication: Document concerns clearly and communicate with the healthcare team when safety risks are identified.

Textbook & Professional References

References used for this case

Kisner, C., & Colby, L. A. (2017). Therapeutic Exercise: Foundations and Techniques (7th ed.). F.A. Davis. — PFPS rehabilitation, exercise progression, and biomechanics.

Dutton, M. (2017). Orthopaedic Examination, Evaluation, and Intervention (4th ed.). McGraw-Hill. — PFPS assessment, differential diagnosis, and functional loading.

O’Sullivan, S. B., & Schmitz, T. J. (2020). Physical Rehabilitation (7th ed.). F.A. Davis. — Activity modification, patient education, and chronic MSK care.

Canadian Physiotherapy Association (CPA). (2020). Code of Ethics and Professional Conduct. — Duty of care, advocacy, ethical decision-making, and patient safety.

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