Deck 16

Question 1

supine SLR preferentially strengthens which muscles?

Answer 1

hip flexors

quadriceps

Question 2

A 69-year-old male with left lateral hip pain that sometimes radiates to the groin (rated 2/10) is referred to physical therapy. He is having some difficulty with basic ADLs like putting on his socks and shoes because of hip pain. The physical examination shows restrictions and pain with active hip flexion to 75 degrees, active hip extension to 8 degrees, active hip internal rotation to 12 degrees, and active hip external rotation to 30 degrees. He has strength of 4-/5 in bilateral hip abductors and extensors. A FABER test is positive on the left but negative on the right. Joint play is limited with inferior, anterior, and posterior glides of the femoroacetabular joint on the right.

The physical therapist has seen the patient for six visits, and the patient is improving, but the physical therapist would like to change the manual therapy and utilize thrust manipulation on the patient’s hip. What is the best course of action for the physical therapist?

A. It is not appropriate to use thrust manipulation with this patient because of her age and objective findings
B. Use long-axis distraction hip manipulation, starting in open-pack position and progressing to closed-pack position in the patient’s most restricted range
C. Use long-axis distraction hip manipulation only in open-pack position
D. Use thrust manipulation, but only at the lumbar spine, to address the hip

Answer 2

B. Use long-axis distraction hip manipulation, starting in open-pack position and progressing to closed-pack position in the patient’s most restricted range

Question 3

A 69-year-old male with left lateral hip pain that sometimes radiates to the groin (rated 2/10) is referred to physical therapy. He is having some difficulty with basic ADLs like putting on his socks and shoes because of hip pain. The physical examination shows restrictions and pain with active hip flexion to 75 degrees, active hip extension to 8 degrees, active hip internal rotation to 12 degrees, and active hip external rotation to 30 degrees. He has strength of 4-/5 in bilateral hip abductors and extensors. A FABER test is positive on the left but negative on the right. Joint play is limited with inferior, anterior, and posterior glides of the femoroacetabular joint on the right.

After four weeks in physical therapy, the patient indicates he will be going to Florida for the winter, where he lives in a retirement community with a pool. Based on current evidence, what should the physical therapist’s recommendation be regarding aquatic therapy?

A. Aquatic exercise is only appropriate for those who are obese, so because the patient has a normal body mass index, aquatic therapy will be of no benefit
B. Aquatic exercise will provide good long-term benefit, so it is best to discontinue land physical therapy and only utilize aquatic therapy in the future
C. Aquatic therapy will provide short-term benefit, so the patient should continue to perform some of his home exercises and go to a physical therapist in Florida if symptoms persist
D. There is no evidence available for hip osteoarthritis and aquatic therapy, only knee osteoarthritis, so the physical therapist cannot make a recommendation to the patient

Answer 3

C. Aquatic therapy will provide short-term benefit, so the patient should continue to perform some of his home exercises and go to a physical therapist in Florida if symptoms persist

Question 4

Per Hoeksma studies in 2004/2005, LAD thrust manipulation of the hip used starting in open packed and progressing to closed packed position where the pt was most restricted for a maximum of __ manipulation attempts

Answer 4

5

Question 5

Per Hoeksma et al. studies, LAD thrust technique for the hip should progress to ___ position for the best pt outcomes

Answer 5

close packed

Question 6

Aquatic therapy has only been shown to provide (short/long) term benefit

Answer 6

short

Question 7

An 82-year-old male is referred to physical therapy with right calf pain that radiates to the right ankle sporadically throughout the day and began six months ago. There is no injury or incident the patient can connect the symptoms to, and he is unable to provoke symptoms by changing position or activity. In the past year, the patient began taking blood pressure and cholesterol medications for the first time, but other than that, the patient’s health is remarkable for his age. Given the provided information, which diagnosis is most likely?

A. Achilles tendinosis
B. Femoral artery obstruction
C. GSC strain
D. Popliteal artery obstruction

Answer 7

D. Popliteal artery obstruction

Question 8

With popliteal artery obstruction, the pt will report pain or discomfort where?

Answer 8

calf and/or ankle

Question 9

With a femoral artery obstruction, the pt would be more likely to see pain where along with calf pain?

Answer 9

thigh

Question 10

A 54-year-old male reports substernal pain that will radiate to the posterior thoracic spine and also to his left shoulder. He attributes the pain to a recent tennis game, where he exerted himself more than normal. He plays tennis twice a week, but this recent match became much more competitive than his typical matches. He noticed that his pain gets worse when he lies down and that it also seems to increase when he coughs, takes a deep breath, or laughs hard. If he leans forward or holds his breath, the symptoms decrease. The patient has a history of high blood pressure, but he is currently not taking medication because his recent readings were within the normal range. What should the physical therapist’s next step be?

A. Initiate a trial of manual therapy and therapeutic exercise to address the thoracic and shoulder pain per current evidence and address a rib dysfunction that is likely causing the substernal pain
B. Refer the patient for immediate medical attention due to what the physical therapist believes to be pericarditis
C. Refer the patient to a cardiologist for symptoms of angina
D. Treat the patient with modalities for pain and educate on activity modification until symptoms subside

Answer 10

B. Refer the patient for immediate medical attention due to what the physical therapist believes to be pericarditis

Question 11

Pericarditis aggs

Answer 11

• lying down
• coughing
• deep breath
• laughing hard

Question 12

Pericarditis eases

Answer 12

• forward flexion

- holding the breath

Question 13

A physical therapist asks a patient about pharmacological management for her recent diagnosis of ankylosing spondylitis. The patient states that she has not been taking any medication although she was advised to take a particular medication by her physician. She cannot remember the name of the medication. What recommendation is most appropriate for those with ankylosing spondylitis?

A. Acetaminophen
B. Naproxen
C. Paracetamol
D. Tylenol

Answer 13

B. Naproxen

Question 14

A physical therapist is treating a patient with rheumatoid arthritis, and the patient has developed a swan-neck deformity. The patient noticed an onset of this deformity six months prior to referral from her physician to physical therapy. It has become rather painful and has started to limit hand mobility in the past six weeks. Which of the following interventions will be most effective for this patient’s condition, based on the progression of the deformity?

A. Joint mobilization
B. Strengthening
C. Stretching
D. Surgical intervention

Answer 14

D. Surgical intervention

Question 15

Typically pts with a boutonniere deformity from RA will respond to what if treated early?

Answer 15

splinting and therapeutic exercise

Question 16

A physical therapist is working on narrowing down what she thinks is a particular type of arthritis. The patient has arthritic symptoms only in the distal interphalangeal joints of the fingers and toes. He has also reported a recent diagnosis of iritis, which has affected his ability to see. Which arthritic condition does this patient likely have?

A. Ankylosing spondylitis
B. Psoriatic arthritis
C. Reactive arthritis
D. RA

Answer 16

B. Psoriatic arthritis

Question 17

Presentation of symptoms only in the DIP joints of the fingers and toes is one of the 5 possible clinical presentations of

Answer 17

psoriatic arthritis

Question 18

Reactive arthritis commonly seen in which joints?

Answer 18

larger joints in the LEs

Question 19

RA (is/is not) commonly seen in just the DIP jts of the fingers/toes

Answer 19

is not (in fact, rarely seen in the DIP joints at all - primarily in PIP joints)

Question 20

Which of the following is a precaution to thrust joint manipulation?

A. Active spondyloarthropathies
B. Hypermobility
C. UMN lesion
D. Vertebral bone disease

Answer 20

B. Hypermobility

Question 21

Why is hypermobility the only precaution to thrust manipulation?

A. Active spondyloarthropathies
B. Hypermobility
C. UMN lesion
D. Vertebral bone disease

Answer 21

All the others are contraindications

Question 22

A physical therapy resident is looking at implementing a clinical prediction rule for a specific intervention he wants to use with his patient. Which of the following clinical prediction rule study types, if followed, could lead to inappropriate treatment of the patient?

A. Derivation study
B. Level 2 validation study
C. Level 3 validation study
D. Level 4 validation study

Answer 22

A. Derivation study

Question 23

A physical therapy resident is looking at implementing a clinical prediction rule for a specific intervention he wants to use with his patient. Why would a derivation study, if followed, lead to inappropriate treatment of the patient?

Answer 23

limitation of only being studied in a small group of pts with a small group of clinicians

Question 24

A level 2 validation study is one step below what type of study

Answer 24

impact study of utility analysis

Question 25

Which is better, a level 2 validation study or a level 3?

Answer 25

level 2

Question 26

A 52-year-old female presents to physical therapy with low back pain and right leg pain extending to the posterior Achilles tendon region that started approximately two weeks prior. The patient does not exhibit a lateral shift. There is a loss of AROM in both flexion and extension, and the symptoms increase into the posterior Achilles tendon region with both flexion and extension. Other findings include a positive prone instability test and positive straight-leg raise, slump, and crossed straight-leg raise tests. Lastly, there is diminished sensation in the posterior heel region on the right. The FABQ work subscale score is 16, and the physical activity subscale score is 8. Which of the following subgroups should this individual be placed into from the treatment-based classification?

A. Lumbopelvic joint manipulation
B. Specific exercise
C. Stabilization
D. Traction

Answer 26

D. Traction

Question 27

Based on evidence to support of the use of mechanical traction for those who fit into the traction subgroup from the treatment-based classification, which parameters should be used for mechanical traction?

A. Prone for a maximum of 12 minutes with 40% to 60% of body weight
B. Prone for a maximum of 24 minutes with 30% to 50% of body weight
C. Supine for a maximum of 12 minutes with 40% to 60% of body weight
D. Supine for a maximum of 24 minutes with 30% to 50% of body weight

Answer 27

A. Prone for a maximum of 12 minutes with 40% to 60% of body weight

Question 28

A 52-year-old female presents to physical therapy with low back pain and right leg pain extending to the posterior Achilles tendon region that started approximately two weeks prior. The patient does not exhibit a lateral shift. There is a loss of AROM in both flexion and extension, and the symptoms increase into the posterior Achilles tendon region with both flexion and extension. Other findings include a positive prone instability test and positive straight-leg raise, slump, and crossed straight-leg raise tests. Lastly, there is diminished sensation in the posterior heel region on the right. The FABQ work subscale score is 16, and the physical activity subscale score is 8. Which of the following subgroups should this individual be placed into from the treatment-based classification?

The patient is seen for three visits the first week and returns to physical therapy the following Tuesday. She states that the posterior Achilles tendon pain has fully resolved and that she only has symptoms in her low back and posterior gluteal region on the right. She indicates that she has the same feeling on the right posterior heel region as she does on the left, so she feels that her sensation is returning. The straight-leg raise, prone instability, slump, and crossed straight-leg raise tests are all now negative. AROM is 75% of normal for flexion and extension, with no change in symptoms during either motion. Using this new information, the physical therapist determines that the treatment-based classification subgroup for this patient has changed. What is the most likely subgroup this patient fits into now?

A. Lumbopelvic joint manipulation
B. Specific exercise
C. Stabilization
D. Traction

Answer 28

A. Lumbopelvic joint manipulation

Question 29

Based on current evidence, what are the two variables that help clinicians determine which patients with low back pain will benefit the most from mechanical traction?

A. Centralization with extension and a positive crossed straight-leg raise test
B. Centralization with extension and a positive straight-leg raise test
C. Peripheralization with extension and a positive crossed straight-leg raise test
D. Peripheralization with extension and a positive straight-leg raise test

Answer 29

C. Peripheralization with extension and a positive crossed straight-leg raise test

Question 30

After completing a round of mechanical traction for a patient who fits into the traction subgroup, which of the following is the most appropriate therapeutic exercise intervention?

A. Abdominal curl
B. Abdominal draw-in
C. Prone press-ups
D. SKTC stretch

Answer 30

C. Prone press-ups

Question 31

In differentiating between radiculopathy and facet joint dysfunction, which of the following referral patterns is most common if L5–S1 facet dysfunction is present?

A. Lumbar spine to gluteal region
B. Lumbar spine to groin region
C. Lumbar spine to lateral knee region
D. Lumbar spine to trochanteric region

Answer 31

A. Lumbar spine to gluteal region

Question 32

Of the following, which may be seen in migraine and cervicogenic headaches, but not in tension headaches?

A. Female predominant
B. Intense pain
C. Radiating pain back to front
D. Unilateral HA

Answer 32

D. Unilateral HA

Question 33

A physical therapist observes that a patient has severe spasms of the posterior upper cervical musculature. When the spinous process of C2 is palpated and the head turned, C2 remains stationary for approximately 25 degrees of cervical rotation. Which of the following is true regarding this observation?

A. This is a normal finding
B. This is an abnormal finding. The spinous process of C2 should move immediately in the contralateral direction of head rotation.
C. This is an abnormal finding. The spinous process of C2 should move immediately in the ipsilateral direction of head rotation.
D. This is an abnormal finding. The spinous process of C2 should move within 15 degrees of head rotation.

Answer 33

B. This is an abnormal finding. The spinous process of C2 should move immediately in the contralateral direction of head rotation.

Question 34

A physical therapist intends to utilize manual therapy in a patient with neck pain and decides to perform a premanipulative hold in passive rotation. For what length of time should the physical therapist hold the patient in passive rotation?

A. 10 sec
B. 30 sec
C. 60 sec
D. 90 sec

Answer 34

A. 10 sec

Question 35

Which person has the highest risk of cervical radiculopathy?

A. 36 yo
B. 43 yo
C. 62 yo
D. 80 yo

Answer 35

B. 43 yo