CVR Physiotherapy › Technique cards › Exam skills
Practical exam pack: long case, short case, spots and journal
The CVR practical is 80 marks: a long case (45), a short case with two skills (20), five spots (10) and the journal (5), marked on knowledge, hands-on skill and attitude. This pack follows that scheme exactly and links each skill to the card that explains it.
- Syllabus
- Practical syllabus: positioning and breathing control, airway clearance and devices, handling techniques, PNF for breathing, exercise equipment and prescription, ICU equipment, physical and electrical agents, basic life support
- Priority
- Essential. 80 practical marks plus 20 internal assessment.
- Asked as
- Long case 45 Short case 20 Spots 10Journal 5
- Usual split
- Long case 10 + 10 + 10 + 15; short case 2 × 10; spots 5 × 2; journal 5
- Checked against
- MUHS BPTh syllabus (2012), CVR practical examination scheme; the cards on this site for each skill. Full list under Sources.
- Content checked
- 19 October 2026. Next review due October 2027.
- My revision
-
1The marking scheme
| Part | What is marked | Marks |
|---|---|---|
| Long case | (a) Subjective and physical examination 10; (b) evaluation and physiotherapy diagnosis (ICF) 10; (c) plan of care and goal setting 10; (d) demonstration of one important test and one treatment on the patient 15. Marked in cognitive, psychomotor and affective domains | 45 |
| Short case | Demonstration of two physiotherapy skills for effective patient management | 2 × 10 = 20 |
| Spots | Chest or cardiac X-ray, ABG, PFT, ECG, adjuncts and devices | 5 × 2 = 10 |
| Journal | Documentation: assessment, evaluation, diagnosis, prognosis and intervention of cases, with ICF | 5 |
| Total | Plus internal assessment 20 (terminal and preliminary exams) | 80 |
In the college terminal and preliminary practicals, spots carry 15 marks (5 × 3) and the journal carries no marks.
2Long case: assessment proforma
Subjective
- Demographics: name, age, sex, occupation (what the job demands), hand dominance, address (stairs, distance).
- Chief complaints in the patient's words, with duration.
- History of present illness: breathlessness (onset, triggers, mMRC or NYHA grade, orthopnoea, waking at night), cough and sputum (amount, colour, smell, blood), chest pain (character, radiation, relief), palpitations, fainting, swelling of the feet, calf pain on walking (claudication distance), fever, weight loss.
- Past history: TB, diabetes, hypertension, heart disease, surgery, admissions, ventilation.
- Personal history: smoking in pack-years (cigarettes a day ÷ 20 × years smoked), bidis and chewing tobacco, alcohol, diet, sleep, bladder and bowel.
- Drug history: inhalers and technique, cardiac drugs (beta-blockers change your exercise plan), oxygen at home.
- Family and social history: who lives at home, support, finances, home layout, work.
- The patient's goals ("I want to go back to driving").
Objective
- Vital signs: HR (rate and rhythm), BP, respiratory rate, SpO₂ (on air or oxygen), temperature, pain score.
- General observation: build and BMI, posture, cyanosis, clubbing, pallor, oedema, lines, drains, oxygen device, scars.
- Chest: shape, breathing pattern and rate, accessory muscle use, chest movement; palpation (trachea, expansion: tape measurements at the axilla, nipple line and xiphisternum, compared side to side); percussion; auscultation (breath sounds, added sounds); cough strength; sputum.
- Cardiovascular: pulses (including foot pulses), capillary refill, oedema (pitting grade), postural BP, ABI if vascular.
- Musculoskeletal and function: shoulder and thoracic range, posture, muscle strength (MRC grade), bed mobility, transfers, gait, balance.
- Exercise tolerance: 6MWT or shuttle test with SpO₂ and Borg, or a sit-to-stand test.
- Scales: mMRC, modified Borg, NYHA, CCS, pain scale, quality of life (CAT, SGRQ, MLHFQ).
- Investigations: X-ray, ABG, PFT, ECG, echo (EF), blood tests.
Then
- ICF table and one-line functional diagnosis (see the answer-writing card).
- Problem list; short- and long-term goals with time frames.
- Plan of care with doses and precautions.
- Demonstrate one test (for example chest expansion, 6MWT set-up, ABI, auscultation, postural BP) and one treatment (for example ACBT, drainage position, incentive spirometry, Phase I walking with monitoring).
3Presenting the long case (3–5 minutes)
Template
"Mr X, 55, a bank manager from Pune, is on day 3 after CABG for triple vessel disease. His main complaints are wound pain and breathlessness on walking. He is a smoker of 20 pack-years with hypertension. On examination: HR 92 regular, BP 130/84, SpO₂ 95% on air, reduced breath sounds at the left base, weak cough, walks 40 m with RPE 12. My functional diagnosis is ... . My short-term goals are ... ; long-term goals ... . My plan is ... . I will now demonstrate a 6-minute walk set-up and ACBT."
Likely viva questions: why this goal; what you would do if SpO₂ falls; stop criteria; how you would progress; what the X-ray or ECG shows; why this dose; what the drugs mean for exercise; outcome measures; home programme.
4Short case: demonstrating skills (2 × 10 marks)
Steps for any skill demonstration
- Introduce yourself, check the patient's identity, explain and take consent.
- Hand hygiene; privacy and draping; mask in suspected TB.
- Check vital signs and contraindications for this skill.
- Position the patient (and yourself) correctly.
- Explain each step in simple words; demonstrate; let the patient do it; correct.
- Watch the response (breathing, SpO₂, pain, colour) and stop if needed.
- State the dose (repetitions, sets, frequency) and the home programme.
- Reassess, thank the patient, and document.
| Skill | Card |
|---|---|
| ACBT, huffing, supported cough, autogenic drainage | ACBT |
| Postural drainage positions, percussion, vibration, shaking | Postural drainage |
| PEP mask, Flutter, Acapella; MDI with spacer; nebuliser set-up | PEP devices; nebulisers and inhalers |
| Diaphragmatic and pursed-lip breathing, thoracic expansion, SMI with incentive spirometer, thoracic mobility | Breathing exercises |
| NPF and PNF for breathing | NPF and PNF |
| Positions of ease, energy conservation, pacing, relaxation | Dyspnoea; yoga and relaxation |
| Inspiratory muscle training set-up | Respiratory muscle training |
| 6MWT, shuttle walk, Harvard step test; exercise prescription with heart-rate monitor and oximeter | Exercise testing; exercise physiology |
| ABI, pulses, postural BP, claudication distance; Buerger–Allen exercises | Investigations; therapeutic exercise |
| Stump bandaging; compression bandaging and fitting stockings; burns splints and positioning; taping; exercise and monitoring equipment | Handling skills; amputation; burns |
| Sternal precautions, log-roll, early mobilisation after surgery | IHD and CABG; bed rest |
| Suctioning, manual hyperinflation, ICU positioning (on a manikin) | Suctioning; positioning |
| TENS for wound pain; wound-healing modalities | Electrotherapy |
| Basic life support on a manikin | BLS |
5Spots (5 × 2 marks, a few minutes each)
| Spot | What to write |
|---|---|
| Chest X-ray | PA or AP; the main finding (for example "left lower lobe collapse": sail sign, raised left hemidiaphragm); two features; physiotherapy meaning. Order: investigations card |
| ABG | pH → respiratory or metabolic → compensation → oxygenation; name it (for example "acute type 2 respiratory failure"). ABG card |
| PFT | FEV1, FVC, ratio → obstructive, restrictive or mixed; severity; reversibility; a likely condition. Investigations card |
| ECG | Rate, rhythm, P waves, QRS width, ST changes → name; safe to exercise or not. Investigations card |
| Device | Name; parts; principle; one indication; one contraindication or precaution (table below) |
| Device | Principle or use | One precaution |
|---|---|---|
| Incentive spirometer (volume or flow type) | Visual feedback for slow deep breaths with a hold (SMI); post-operative lung expansion | Add-on to deep breathing and walking; not for patients who cannot take a deep breath |
| PEP mask; Flutter; Acapella | Expiratory resistance 10–20 cmH₂O (plus oscillation) for airway clearance | Not with an undrained pneumothorax |
| Metered-dose inhaler, spacer, dry powder inhaler | Deliver bronchodilators and steroids to the airways | Rinse the mouth after steroids; DPI needs a fast, strong breath in |
| Jet nebuliser | Gas through a narrow opening makes droplets; baffle removes large ones | Air-driven in patients at risk of high CO₂ |
| Nasal cannula, simple mask, Venturi mask, reservoir mask | Oxygen at about 24–40%, 35–60%, fixed 24–60%, and 60–90% | Simple mask never below 5 L/min; target SpO₂ prescribed |
| Heat and moisture exchanger | Passive humidification for intubated patients | Not with thick or bloody secretions or during nebulisation |
| Suction catheter, Yankauer sucker | Remove secretions from the airway | Under 15 s, no stronger than −200 mmHg in adults |
| Self-inflating bag (Ambu) and manual hyperinflation circuit | Manual ventilation; bagging with a slow breath, hold and quick release | Not with an undrained pneumothorax; pressure about 40 cmH₂O or less |
| Endotracheal tube, tracheostomy tube (cuffed) | Artificial airway; the cuff seals and limits aspiration | Secure the tube during every turn |
| Intercostal drain with underwater seal | Drains air or fluid; the water acts as a one-way valve | Keep the bottle below the chest; never clamp a bubbling drain |
| Peak flow meter; spirometer | Peak expiratory flow; FEV1 and FVC | Best of three blows |
| Pulse oximeter | Measures SpO₂ and pulse by light absorption | Wrong with cold fingers, movement, nail polish and carbon monoxide |
| Hand-held Doppler and sphygmomanometer | ABI measurement | ABI above 1.40 is unreliable (calcified arteries) |
| Threshold inspiratory muscle trainer | Spring valve opens at a set pressure (start about 30% of MIP) | Not after recent pneumothorax or with a perforated eardrum |
| Compression stockings, bandages, pressure garments, thermoplastic splints | Venous disease, lymphoedema, DVT prevention; burns scar and contracture control | Check ABPI before compression; check splints for pressure areas |
6The journal (5 marks)
Each case written up under the same headings: assessment (subjective, objective), evaluation (investigations, scales), ICF and functional diagnosis, prognosis, goals, intervention with doses and progression, outcome measures, and a SOAP follow-up note. Keep it neat and complete; examiners read the ICF and the doses first. Template on the answer-writing card.
7The affective domain: what examiners watch
- Greeting, introduction, consent, respectful language, privacy and draping.
- Hand hygiene; infection control (mask for TB, cleaning shared devices).
- Safety: checking vital signs, oxygen, lines and drains before moving the patient; stopping when the patient is unwell.
- Explaining in the patient's language (Marathi or Hindi where needed) and checking understanding.
- Calm, honest answers in the viva: if you do not know, say so and say how you would find out.
- Thanking the patient and leaving them comfortable.
Last two weeks
- Present three practice long cases aloud (a cardiac, a respiratory and a vascular or surgical case), timed.
- Practise each short-case skill on a friend with the 8-step sequence.
- Do spot drills: one X-ray, ABG, PFT, ECG and device in 10 minutes, then check.
- Finish the journal.
Sources
- MUHS BPTh syllabus (2012), CVR physiotherapy: practical examination scheme and practical skills list.
- The technique cards and condition pages on this site, with their sources.
Educational notes for exam preparation. Check your college's exact practical format with your teachers.
Version 1. Content checked 19 October 2026. Next review October 2027.