DPT 624: Acute Care and Therapeutic Exercise Flashcards
1
Q
A patient who has a “slouched posture” would demonstrate all of the following except
a. Short TFL and IT band
b. Weak, stretched Iliosoas
c. Weak, poorly developed gluteus Maximus
d. Shortened rectus femoris and hamstrings
A
A
2
Q
All of the following exercises are primary exercises for the quads EXCEPT:
a. Sitting – LAQ
b. Lunge
c. Supine bridge on flat surface
d. Wall sit
A
C
3
Q
How many degrees of movement does the knee go through during gait?
A
60 degrees
4
Q
A PT student who spends countless hours sitting in class switching b/w looking up at the instructor and down at their computer screen may sometimes experience low back pain. This pain is most likely due to which of the following common faulty postures?
a. Slouched or swayback
b. Lordotic posture
c. Round back with forward head posture
d. Flat upper back and neck postured
A
C
5
Q
When providing CPR, the appropriate ratio of chest compressions to breaths is
a. 50:3
b. 10:1
c. 30:2
d. 20:2
A
C
6
Q
The patient you been seeing in sports rehab arrives one day for treatment of his chronic back pain. While assisting him with his therapy, he reveals to you that he just started a prescription of penicillin for a cold. You notice that his lips are swollen and he is wheezing. This could indicate which of the following?
a. Monitor patient, but continue with therapy as this is a mild allergic reaction
b. Call 911, as he is having a severe allergic reaction, monitor closely and administer CPR if necessary
c. Call 911, and leave the patient under the supervision of a tech so you can see your other patients
d. Stop therapy, reschedule for another time
A
B
7
Q
While volunteering at the Special Olympics track meet, you come upon a spectator that has collapsed in the stands. Upon examination, you note that they are profusely sweating their pulse is shallow and rapid. You have alterted the EMT on duty at the track, but while waiting for their arrival the best position for this patient to be placed in is
a. Supine
b. Prone
c. Supine with legs elevated
d. Sitting
A
C
8
Q
True or False
If your patient, who is a known diabetic, comes to clinic for PT and has fruity adored breath (not due to gum), flushed, dry skin, and deep, labored breathing, you would suspect the patient is hypoglycemic and offer them juice
A
False
9
Q
Noxious stimulu causes the body to have an unregulated sympathetic response resulting in uncontrolled sudden onset hypertension. This phenomenon is known as:
a. Orthostatic hypertension
b. Autonomic hyperreflexia
c. Sympathetic/parasympathetic dysfunction
d. Orthostatic hypotension
A
B
10
Q
True or False
Bone remodeling after surgery or an injury, such as a fracture, can occur up to one year after the injury or surgery
A
True
11
Q
Ligaments after an injury or repair are considered being at their _____ at around day 21, during the _______ phase of healing.
a. Weakest, proliferative
b. Strongest, proliferative
c. Strongest, remodeling
d. Weakest, inflammatory
A
A
12
Q
DVTs are an associated risk factor when venous pooling occurs. Which of the following are imperative to help prevent DVT’s in patients?
a. Ambulation ASAP after surgery
b. LE exercises
c. Anticoagulant therapy
d. Sequential compression devices (SCDs)
e. All of the above
A
E
13
Q
Your patient is preparing to d/c home after completing PT. he underwent a THR 3 days prior… you take a set of vital signs and notice his HR is elevated and his O2 saturation is 94%; both of which are new findings from the previous vital sign monitoring during therapy sessions. You alert the nurse immediately, as you suspect:
a. Pneumonia
b. Indigestion
c. DVT
d. Pulmonary embolism
A
D
14
Q
A patient of yours is being seen 2x weekly for rehab s/p ACL repair 12 weeks ago. Because you took a thorough health history and have a keen eye, you notice nicotine stains on her fingers and teeth, thus deduce she is a smoker (thought she denied it on her health history form). Will this impact when and how much resistance you add to her LE strengthening regimen on the surgically repaired side?
a. Yes – more resistance and sooner than a non-smoker
b. No- as her physician has her on a strict protocol that must be followed
c. No- her tissue will repair itself as normal
d. Yes- her tissue repair will take longer than a non-smoker, thus will need a modified treatment
A
D
15
Q
Look at picture questions!
A
MIDTERM: look at questions 1, 20, 24, 32, 48, 49, 53, 54
FINAL: look at questions 3, 4, 8, 18
16
Q
A 50 year old man is in the hospital for 2 days after he received a TKR. He is experiencing acute post-operative pain. What type of pain relief will he most likely be using initially while in the hospital?
a. epidural pump
b. intravaneous patient controlled anesthesia (IV-PCA)
c. oral pain medications
d. intrathecal pump
A
B
17
Q
Which of following is not a goal of physical therapy intervention in acute care settings?
a. provide the patient with social stimulus and activity
b. make recommendations for appropriate discharge planning for patients
c. prevent contractures and pressure ulcers
d. prevent/minimize adverse effects of immobility/inactivity
A
A
18
Q
You are physical therapies in an acute care setting and have just received new orders for a patient. you have reviewed the patients history in the medical chart and found she is a 23 year-old female with severe burns and open wounds to lower 2/3 of her body from a chemical explosion. what type of bed would you anticipate this patient to be using when you enter her room for treatment?
a. turning bed frame
b. standard adjustable bed
c. low air loss therapy bed
d. air fluidized support bed
A
D
19
Q
If a patient were to experience muscle aches after receiving medication, would this be considered an adverse or an allergic reaction?
A
Adverse
20
Q
If a patient were to experience dizziness or syncope after receiving medication, would this be considered an adverse or an allergic reaction?
A
Allergic
21
Q
If a patient were to experience sneezing after receiving medication, would this be considered an adverse or an allergic reaction?
A
Allergic
22
Q
If a patient were to experience difficulty swallowing or speaking after receiving medication, would this be considered an adverse or an allergic reaction?
A
Allergic
23
Q
If a patient were to experience swelling of the mouth, face, or tongue after receiving medication, would this be considered an adverse or an allergic reaction?
A
Allergic
24
Q
If a patient were to experience drowsiness after receiving medication, would this be considered an adverse or an allergic reaction?
A
Adverse
25
After receiving a consult for teaching a patient “rotator cuff repair protocol” in same day surgery, you are unable to verify the ‘protocol’, as this is a new surgeon whose protocols are not in the EMR. before seeing the patient, you were able to read the operative report, which noted the procedure was a ‘repair of all rotator cuff tendons on the R shoulder, two of which were massive tear repairs. having this information, you now know to educate your patient in the following:
a. pendulum exercises and PROM in pain free range
b. AAROM/AROM in available planes
c. assisted shoulder elevation exercises with a wand or a cane
d. AROM with light resistance in pain free range
A
26
A tension graft, such as an ACL goes through a necrotizing process the first 2 to 3 weeks postoperatively before revascularization commences and before maturation gradually occurs. Thus, the graft is at its ___________ during the _____________ phase:
a. strongest, proliferative
b. strongest, inflammatory
c. weakest, proliferative
d. weakest, remodeling
C
27
Is the pronator quadratus a one joint muscle or two-joint muscle
one joint muscle
28
Is the long head of biceps brachii a one joint muscle or two-joint muscle
two-joint muscle
29
Is the soleus a one joint muscle or two-joint muscle
one joint muscle
30
Is the deltoida one joint muscle or two-joint muscle
one joint muscle
31
Which acute care equipment has the highest infection rate among patients in the ICU?
a. mechanical ventilators
b. feeding devices
c. chest tubes
d. urinary catheters
A
32
Please designate the expected time period for weight bearing, lifting, and stretching for a patient that has had an Achilles tendon repair? (assuming you have physician clearance)
a. 2 weeks post-op
b. 4 weeks post-op
c. 8 weeks post-op
d. 6 weeks post-op
C
33
All of the following are advantages of a turning bed frame EXCEPT
a. it allows one person to easily turn the patient
b. it allows patients to be positioned in any position necessary
c. it allows placement to the Trendelenburg position if necessary
d. allows patient to wheeled/transported without removal from the bed
B
34
52 year old patient was working in the garden when her lung collapsed. she was rushed to the hospital and chest tube was inserted into her chest to re-inflate the lung by draining out the pleural cavity. What would the best form of physical therapy be for the patient? (prior level of function was complete independence)
a. EOB sitting exercises only, to diminish the risk of dislodging the chest tube
b. the patient must remain supine, quad sets and UE exercises only
c. no exercise
d. exercise and activity per patients tolerance, being cautious of chest tube
D
35
When evaluating a patient to determine their readiness to advance to the moderate protective phase of rehab following a TSA, which criteria must be met?
a. time is the most critical/important element. after 6 weeks, patient can advance
b. no subscapularis pain with resisted, isometric internal rotation
c. 75 degrees passive elevation
d. weight bearing through surgical extremity without pain
B
36
A patient visiting you clinic underwent a reverse rTSA 12 weeks prior. per her report, she was not a candidate for a regular rTSA because of ‘rotary cup’ problems. Which muscle function would be pertinent to gain shoulder flexion?
a. subscapularis
b. teres minor
c. supraspinatus
d. deltoid
D
37
Which of the following values are of primary importance when treating patients who are using a mechanical ventilator?
a. body temperature
b. heart rate
c. oxygen saturation
d. blood pressure
C
38
What type of catheter would you expect to have post operatively for a total hip or knee surgery?
a. external
b. suprapubic
c. intermittent
d. Foley
D
39
The principles of aerobic conditioning in PT are of utmost importance when prescribing exercise for individuals following cardiac events such as a myocardial infarcation of a coronary artery bypass graft. During which phase of cardiac rehab would the FITT method be introduced?
a. Phase III
b. Phase II
c. After discharge from Phase III
d. Phase I
B
40
As discussed during class, a prevalent occurrence for a patient saying in the ICU is critical illness polyneuropathy. which signs an symptoms most appropriately describe the physical findings of this disorder?
a. diminished lung volume and cardiac output
b. hyperreflexia
c. distal extremity weakness, muscle wasting, sensory loss
d. weak quadriceps and abdominal muscles
C
41
A 50 y/o male patient s/p CABG (coronary artery bypass graft) x 1 has been referred to you for PT while still in inpatient. His telemetry and pulse oximeter allow you, the PT to:
a. obtain preliminary reading before exercise, and if WNL, allow you as the PT to progress the patients exercise
b. confirm the doctors protocol
c. watch for changes during exercise only
d. obtain a baseline reading, readings during exercise and post exercise readings, which alow the PT to assess changes and document results for further exercise protocol
D
42
You have been assigned to work with a patient who has had a recent TKA and the patient has been suffering from end stage renal disease for the past 5 years and must continue dialysis treatment while in the hospital. the most optimal time to work with this patient is during dialysis.
a. true
b. false
False
43
Your patient had a TKA yesterday. Today her Hgb is 10.1 gm/dL. which of the following would demonstrate the appropriate course of action for treating this patient?
a. AAROM and AROM exercises in supine and sitting and work on transfers
b. continue on total joint protocol, meaning BID treatment including gait trainin, AROM and AAROM
c. place patient on hold until Hgb is in and non-critical range for treatment
d. isometrics and PROM only
B
44
At your outpatient clinic, one of your clients was recently diagnosed with diabetes. she reports to you that she is having difficulty gaining control of her blood glucose levels. This was demonstrated at both PT sessions the following week. on Monday, she came in for her RTSA rehab and halfway through her forward flexion exercises, complained of hunger and developed paleness in her skin color. on Wednesday, she returned for continued therapy. this time, during scapular stabilization exercises, her skin became flushed and she reported feeling like she needed to vomit
the warning signs on Monday indicate _________________ and one Wednesday ______________
hypoglycemia; hyperglycemia
45
The best way to describe a chest tube would be:
a. A hollow tube that drains fluid directly out of the lungs
b. A hollow tube that drains fluid, blood and air out of the pleural cavity, and is inserted between the ribs
c. A tube that is inserted into the heart following open heart surgery
d. A hollow tube that drains fluid, air, and blood and is inserted into the alveoli of the lungs
B
46
A patient in acute care is in need of an exercise protocol that will help them begin recovery but is having trouble maintaining a high level of O2 at all times. which selection of monitor would be most appropriate to provide information about changes in O2 saturation levels?
a. telemetry
b. pulsed oximeter
c. ICP monitor
d. blood pressure cuff
B
47
During the max protection phase of activity after a patient has undergone a TSA, the following activities would be most appropriate (on surgical extremity)
a. passive ER to 45 degrees, horizontal abducgtion to 90 degrees, shoulder shrugs (trapezius contraction)
b. PROM in allowable range, pendulum exercises, scapular stabilization exercises in NWB position
c. AAROM in allowable range, gentile weight bearing through surgical UE, resistive exercises for biceps strengthening
d. wall push-ups, finer ladder for shoulder flexion, PROM of GH joint
B
48
A 23 y/o female is being seen in your clinic after undergoing a procedure to heal an articular cartilage lesion on her distal femoral condyle. she had the procedure 6 weeks prior. what is the most appropriate exercise instruction you can provide her at this time?
a. resistive exercises for strength training
b. PROM, synovial fluid is the primary source of nutrition to the joint surfaces since there is no blood supply
c. balance board training on the surgical extremity
d. repetitive AROM to optimize fluid movement and avoid contractures
B
49
When providing PT to a patient in acute care, it is imperative to the read the chart/EMR prior to every treatment. which of the following information is necessary to determine your treatment plan?
a. order for PT, weight bearing status, vital sign parameters, lab values
b. sleep patterns, dietary needs/nutrition, patients body temperature, patients cognitive status
c. weight bearing status, prior treatment with PT, vital sign parameters, lab values
d. presence of patients family, patietns cognitive status, vital signs, lab values
A
50
When providing rehab for a patient that just underwent a CABG, one aspect of rehab is educating the patient on sternal precautions. sternal precautions are: no overhead movment of UE’s, no pushing from the chair with UE’s, and no lifting greater than 5 lbs
a. true
b. false
True
51
Your patient (in acute care) has COPD and has historically been on supplemental O2. however, when you enter their room for a PT session, the patient is not wearing their O2 mask, Their SpO2 is 80%. you should:
a. Walk the patient without any oxygen supplementation
b. Give the patient oxygen and immediately walk them
c. Give the patient oxygen and come back later to walk them
d. Let a nurse or respiratory therapist know and then come back later
D
52
Your patient has been using a nasal cannula for two weeks. You notice redness has developed within the last two days around the patient’s ears and they are complaining of pain. What should you do in this case.
a. Suspect the patient has a latex allergy and order a non-latex cannula
b. Put padding around the ears
c. Don’t allow the patient to use the oxygen
d. Put Vaseline around the ears
B
53
When performing rehab with a patient who has undergone a total elbow arthroplasty TEA, teaching lifting limits is crucial part of the patients rehab success. which of the following is the correct progression of the weight?
a. 1 lb for 6 months, 2 lbs for the next 3 months, 5 lbs for long-term repetitive lifting, 10-15 lbs max for a single lift
b. 5 lbs for 3 months, 10 lbs for the next 3 months, 15 lbs for long-term repetitive lifting, 25 lbs for a single lift
c. 2 lbs for 3 months, 3 lbs for the next 3 months, 5 lbs for long-term repetitive lifting, 20 lbs for a single lift
d. 1 lb for 3 months, 2 lbs for the next 3 months, 5 lbs for long-term repetitive lifting, 10-15 lbs for a single lift
D
54
Dialysis is utilized for patients with end-stage renal disease. It helps to function as the kidneys by performing all of the following except:
a. Removing waste and toxic materials
b. Controlling the acid-base balance
c. Removing excess electrolytes
d. Removing excess creatine
C
55
Why is knowing the Hgb level in a patient important consideration when prescribing a physical therapy regimen?
a. if Hgb is low, a patients ROM and muscular contractivity may be limited
b. as long as the Hgb isnst lower than 8.0 gm/dL, a PT regimen will be the same as for a patient with a Hgb of 12.0 gm/dL
c. abnormal Hgb levels affect the bodies ability to carry oxygen, thus, potentially decreasing the amount of oxygen available in cardiac demands increase
C
56
A 20 y/o woman with a history of CP is demonstrating worsened spasticity while in the hospital. To decrease her pain and spasticity, her physicians prescribe a pain pump. as she is going through exercises and mobility training with her therapist and parents, she experiences an increase in pain. who is best suited to administer her pain medication though her IV?
a. The PT
b. The patient
c. her parents
d. The physician
B
57
Which of these is NOT a precaution for catheter use?
a. Urinary tract infection
b. Impaired cognition
c. Urinary retention
d. Overactive bladder syndrome
C
58
Acute care facilities were originally designed to treat the lower social status population. however, due to the development of ___________, acute care facilities began to increase in number and became treatment centers for all levels of socioeconomic status
a. malpractice/tort reform
b. medicare
c. Medicaid
d. health care reform in the 80s
B
59
When prescribing aerobic exercise program in a patient that is deconditioned or has a chronic illness, it is necessary to determine the exercise heart rate response that can be safely reached. which of the following provides for the most accurate exercise heart rate?
a. intermittent HR assessment during aerobic conditioning, such as treadmill walking
b. 220-age
c. exercise tolerance based on patients RPE (rate of perceived exertion), taking HR when maximum RPE is reached
d. karvonen formula
D
60
Prior to evaluating a patient for PT, you’ve done a thorough medical chart review, including checking lab values. of note, the patients PaCO2 level is 56 mmHg. Assumming the patient is otherwise stable medically and bale to undergo a PT evaluation, what technique might you use during evaluation and treatment to help normalize this lab value?
a. relaxation techniques to slow down hyperventilation, as the patient has respiratory alkalosis
b. pursed lip and shallow breathing, to compensate for the decreased CO2 level to help slow the patients breathing as needed.
c. upright sitting/positioning and deep breathing activities, as the patient has respiratory acidosis and is retaining CO2
d. remove the supplemental oxygen, as the patents O2 levels are stable at 97% while on nasal canula O2
C
61
While volunteering at the health fair held by you DPT school, you come upon a person near the restroom that has collapsed. After determining that they are breathing and do not beed CPR, you still call 911 for assistance, but proceed with assessing and treating the patient for suspected _________
a. heat exhaustion, as the person is not sweating and is excessively pale
b. heat stroke, as the person is sweaty and has labored breathing
c. shock, as the person has a slow pulse and constricted pupils
d. shock, as the person is sweating and has dilated pupils
D
62
After seeing your patient for TKR for 2 days in the hospital, he develops a DVT in his left calf. the physician places him on anticoagulation therapy to prevent further clot formation. what is the appropriate choice concerning when you will resume therapy with this patient?
a. immediately, as there is no risk of DVT or PE formation now that the patient is on Coumadin
b. immediately, as there is not an increased risk of bleeding if the patients INR level supratherapeutic
c. when the INR is at a therapeutic range of (2.0-3.0)
d. when the INR is at a therapeutic range of (4.0-5.0)
C
63
Your pt. is displaying signs of nasogastric tube complications (sinusitis, nasal wing lesion). What is the best way to avoid these complications?
a. Remove the tube after each feeding
b. Use a smaller diameter and more flexible tube
c. Disinfect/clean the area
d. All of the above
B
64
A gastric feeding tube is indicated when a pt needs a feeding tube for more than ___ weeks.
a. 2
b. 3
c. 4
d. 5
C
65
All of the following are advantages to a Posttrauma Mobility bed EXCEPT
a. it may provide some environmental stimulation for neurolically impaired patients
b. it improves upper respiratory tract function
c. it allows placement in the Trendelenburg position if necessary
d. it eliminates friction and shear forces associated with turning a patient
C
66
You are a PT working in a hospital and your patient has recently been placed in an external fixation device on his lower leg. he is FWB on his unaffected LE and has full strength and function of both UEs. pt is going to begin ambulation and gait traning with axillary crutches. your main concern with this patient as a PT is to:
a. teach the patient proper gait training with the device since it extends from the body and can contact the crutches
b. understand how to remove the device once the fracture has fully healed
c. instruct the patient to begin WBAT on the affected LE
A
67
You're seeing a patient in the hospital who just had an ostomy device put in. In general, which of the following may accumulate in the bag?
a. Fecal matter only
b. Urine and fecal matter
c. Urine, fecal matter, and gas
d. None of the above
C
68
Which of the following about the physiological response to aerobic exercise is false?
a. respiratory response to exercise includes increases in gas exchange, increase in body temperature, and an increase in epinephrine
b. cardiac response to exercise in includes increased HR, increased SNS stimulation, and increased cardiac myofibril force
c. peripheral response to exercise includes generalized vasoconstriction to kidney, liver, and spleen
d. cardiovascular response includes no redistribution of cardiac output
D
69
One of your patients in acute care recently had to have a colostomy due to colon cancer, their device cases some limitations to activity. which should be avoided?
a. running
b. aquatic therapy
c. bathing
d. weight-lifting to degree causing abdominal strain/Valsalva
D
70
Patients in the ICU often experience issues that impact the level of activity they can participate in with physical therapy. which of the following is also known as ICU psychosis. which can impair a patients cognitive abilities?
a. anesthesia
b. acute pain
c. substance abuse withdrawal
d. sleep pattern disturbances
D
71
Beds in the acute care setting have all of the following purposes EXCEPT:
a. to allow the ability to alter a patients position
b. to allow access to care
c. to provide support
d. to provide comfort to the patient
D
72
You are a SPT working with a patient that has a newly placed Halo Device to increase traction and stabilization of their cervical spine. Which is (are) true regarding working with this patient?
a. Make sure the patient doesn't lose their balance while walking due to the fact that this device weighs 8-12 lbs and may throw off their vestibular system.
b. To help with balance, you may grab the patient by the front two bars of the device.
c. Make sure the patient is able to get from supine to sit safely, with and/or without assistance
d. All of the above
e. A and C only
D
73
You have received a referral in your outpatient clinic for a patient with shoulder pain. The patient has had an old rotator cuff tear repair but is now experiencing stiffening and a slight loss of ROM. After taking a thorough health history and examining the patients record, you have discovered that this patient has just finished a round of chemotherapy for leukemia. his WBC count is 9,000 mm3 and his platelet count is 22,000 u/L. Which of the following activities would be most appropriate during your treatment?
a. no treatment as patients WBC and platelet count is within a ‘dangerously’ low level
b. AROM in available planes without resistance
c. AROM in available planes with resistance
d. AROM in available planes and PROM in areas of limited range
D
74
The sequence for single rescuer CPR is to call 911 first, apply chest compressions and give 2 breaths. the sequence for rescuer CPR is for one rescuer to call 911 while the other begins CPR. How many chest compressions are to be given and how many cycles of compressions/breathing are given before applying an AED (if available)?
a. 30; 2
b. 15; 2
c. 15; 5
d. 30; 5
D
75
Postoperative management of a patient that has had a total hip replacement includes PT intervention. which of the following factors influence a patients weight bearing status?
a. stability of joint/method of fixation
b. surgical approach
c. muscular strength
d. Hgb levels
B
76
After completing your treatment with a patient, you help the patient back into bed. which of the following statements is correct concerning the bed railings?
a. ensure at least 1-2 are down to prevent entrapment of the patient
b. only raise the bed rails on the opposite side of the bed from where the bathroom is located
c. ask the patient how many bed rails he/she would like up
d. ensure only 1 is up to prevent entrapment of the patient
A
77
Your patient has had a THA done yesterday. after reading the chart and finding the physicians orders and precautions, establishing lab values and getting the ‘OK’ by the nurse to proceed with treatment, you begin evaluating and treating your patient. the optimal inclusions in this treatment would be:
a. DVT prevention exercises, total hip protocol exercises, transfer and gait training
b. DVT prevention exercises, total hip protocol exercises, transfer and gait training, discharge planning
c. DVT prevention exercises, bed level exercises since it is the patients first therapy session, UE exercises
d. transfer and gait training, DVT prevention exercises, total hip protocol exercises,
B
78
Your uncle called you last night after playing three games in a softball tournament yesterday. He indicated that late in the third game when trying to stretch a double into a triple, he felt a sudden sharp pain in his calf, which significantly interfered with his ability to continue running. He is able to move his foot “up and down”, but both motions are painful. He is also able to walk if he “takes it slow”. From the information your uncle gave you and the fact that he is a 42 year old weekend warrior, you advise your uncle to perform which of the following exercises as it is the most appropriate exercise for this injury and stage of healing?
Picture - ankle alphabet
answer: no exercise today was also accepted...
79
Your test results indicate that your patient has 2/5 MMT strength of the hip abductors. Which of the following positions would be the BEST position for this patient to begin exercise to strengthen the hip abductors?
a. Standing
b. Supine
c. Left side-lying
d. Right side-lying
B
80
When determining the exercise heart rate, using a percentage of the max heart rate is as accurate as using the heart rate reserve (Karovean’s formula).
a. True
b. False
B
81
A PT initiating a resistive exercise program with a healthy 45 y/o male incorporates a program that includes slow, controlled lifting velocity with 8-12 repetitions of a moderate to high load amount is training which of the following characteristics?
a. Power
b. Endurance
c. Strength and hypertrophy
C
82
You are working in an out-patient setting as a CI for a student PT. one of the goals of the student physical therapist is to become confident and proficient with performing ROM on various patient types. The two of you are discussing which types of patients would be appropriate for ROM. You decide which of the following patients is MOST appropriate for ROM?
a. A patient that has a fracture
b. A patient whose condition is life-threatening
c. A patient that is on complete bed rest
d. A patient where ROM would disrupt the healing process of the injury
C
83
Your patient, a 19 y/o college student, sustained a nondisplaced fracture of the distal humerus, which was managed by closed reduction and 6 weeks of immobilization in a case. Yesterday the case was removed and the patient is to begin exercises to improve ROM and strength of the elbow. Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow. The patient describes her elbow as feeling “very stiff”, but pain occurs only when overpressure is applied at the end of the available ranges. One of the goals in this patient’s treatment plan is to increase elbow ROM. Which of the following techniques should you begin with to specifically increase elbow flexion ROM?
Picture - patient sitting with arm on table - using own arm to push affected arm into elbow flexion
84
Would Shoulder IR/ER against TB at 90/90 be considered a discrete, serial, or continuous motor task?
Discrete
85
Would Full throwing motion against be considered a discrete, serial, or continuous motor task?
Serial
86
Would Shoulder D2 pattern with weighted ball be considered a discrete, serial, or continuous motor task?
Discrete
87
Would A physical Upper body ergometer (arm bike) be considered a discrete, serial, or continuous motor task?
Continuous
88
For the following conditions/characteristics indicate “use extra caution” if extra caution should be used when stretching this patient population or indicate “stretch patient normally” if you can stretch this patient population normally without needing extra caution.
Osteoporosis
Following prolonged bed rest
Elderly patients
Following prolonged use of corticosteriods
Use extra caution for all of the conditions/characteristics listed
89
A physical therapist initiating a resistive exercise program with a trained 32 year old male incorporates a progression using low to moderate loads with multiple sets of 15-20 repetitions with short 30 second or less breaks is most likely training which of the following characteristics.
a. Strength and hypertrophy
b. Power
c. Endurance
C
90
You are initiating postoperative treatment of a 78 y/o woman who sustained an intertrochanteric fracture of the proximal femur 3 days ago and immediately underwent open reduction with internal fixation (screw-plate fixation). She has been referred to PT for post-op exercise and gait/functional training (initially with minimal weight bearing on the operated side)/ a decision has not yet been made as to whether this patient will be discharged directly to home where she lives with her husband or to a subacute skilled nursing facility. Prior to discharge from the hospital during the next few days, which of the following is the lowest priority intervention?
a. Assisted, progressing to active, ROM of the operated hip
b. Open-chain, resistance exercises for the operated lower extremity
c. Closed-chain, resisted exercises for the UE’s and non-operative LE
d. Gait training with a walker and transfer/bed mobility training
B
91
Avoidance of the Valsalva maneuver is especially important with patients who have a history of cardiovascular problems including CVA, myocardial infarction, and hypertension.
a. True
b. False
True
92
What type of patient would you NOT indicate stretching with?
a. A patient with functional ability is limited by contractures
b. A patient with muscle weakness results from opposing muscle tightness
c. A patient when ROM is limited due to adhesions or scar tissue
d. A patient when a hematoma is present to help flush the area
D
93
Match the following phases of cardiac rehab with its purpose.
a. Supervised exercise conditioning program to maintain general health
b. Enhance cardiac functions and reduce cardiac cost of work using low level exercises
c. Initiate risk factor education, self-care activities, orthostatic control, educate caregivers
Phase III
Phase II
Phase I
94
What characteristic is the biceps brachii demonstrating when the body is positioned in full elbow flexion and full shoulder flexion?
a. Functional excursion
b. Functional mobility
c. Active insufficiency
d. Passive insufficiency
C
95
Your patient has regained normal strength and ROM during rehabilitation following a traumatic injury that severely stressed several ligament and joints of the ankle. He continues to have problems when walking, including stumbling and poor control while walking on gravel or other uneven surfaces. To remedy this problem, your exercise program should focus on:
a. Strengthening exercises for the invertor and evertor muscles of the ankle using elastic resistance
b. Stretching the invertor and evertor muscles of the ankle
c. Performing balance training with closed-chain disturbed balance activities on a rocker/balance board
d. Practicing walking on uneven surfaces while wearing a custom-made ankle/foot orthosis that control inversion and eversion
C
96
Selection of a TSA versus a reverse TSA (rTSA) versus a hemiarthoplasty depends on the etiology and severity of the joint dorientiation and the condition of the periarticular soft tissues. A patient will typically have a ____ if there is significant damage to the rotator cuff musculature and with this type of procedure the ____ musculature typically becomes the primary mover of the arm postoperatively and therapists will be much of the focus of rehab.
a. TSA; deltoid
b. rTSA; deltoid
c. TSA; rotator cuff
d. rTSA; bicep
B
97
When treating a patient with interventions for spinal rehabilitation there are exercises of skills thata all patients with spinal impairments should learn. While working with a patient with low back pain, you recognize that he has difficulty maintaining a neutral spinal position with the exercises and activites you instruct him to do. Upon further assessment of the patient, you identify that he has fair to good core muscle strength a d he adheres to your instructions of log rolling with transfers, but you observe that he is unable to recognize if he is maintaining a neutral spine or not. What type of training does this patient need to address his identified deficit?
a. Functional Training
b. Stabilization Training
c. Kinesthetic Training
C
98
You are working in an outpatient clinic and you just received a referral for a new patient who is 3 days s/p rotator cuff repair (RCR). In preparation for this patient initial evaluation and to assist you in developing the plan of care for this patient, you decide to review RCR recovery phases. Anticipating that you patient had a non-complicated RCR that follows typical recovery expectations, match each exercise with the appropriate post-surgical time frame
a. Pendulums
b. Bosu ball push-ups
c. Flexed arm stretch on table
d. Arm raises in scapular plane
e. Moving push-ups
f. Finger ladder
a. 1 week post op
b. 12 weeks post op
c. 1 week post op
d. 6 weeks post op
e. 12 weeks post op
f. 6 weeks post op
99
If a patient, who is in a prone-lying position with a cuff weight around his ankle, flexes his knee from a fully extended (0°) position to a fully flexed (150°) position, what type(s) of contraction will occur in which muscle group(s)?
a. The knee flexors contract eccentrically from 0°to 90°, and the knee extensors contract concentrically from 90° to 150° of flexion
b. The knee flexors contract eccentrically throughout the full ROM
c. The knee flexors contract concentrically throughout the full ROM
d. The knee flexors contract concentrically from 0° to 90°, and the knee extensors contract eccentrically from 90° to 150° of flexion
D
100
A patient demonstrates quadriceps (4-/5) and has difficulty descending stairs. The BEST intervention to regain functional strength in the quadriceps is:
a. Eccentric heel dips
b. Concentric partial squats progressing to lunges
c. Maximum isometric exercise at 45 and 90 degrees of knee extension
d. Isokinetic exercise at 30 degrees/second
A
101
Which of the following patients is NOT appropriate for ROM?
a. A patient with an acute, inflamed shoulder
b. A patient you are examining as a new eval
c. A patient who is comatose or paralyzed
d. A patient with a hypermobile shoulder
D
102
A patient with RA of the hands and wrists is experiencing an acute flare of the disease. To protect the inflamed joints and minimize deforming forces on the hands and wrists, you should teach the patient to:
a. Avoid strong gripping motions that require wrist extension, radial deviation of the wrist, and ulnar deviation of the fingers
b. Stretch the extrinsic finger tendons across all the joints simultaneously to gain mobility and counter contracture
c. Avoid all activities with the hands until there is no pain
d. Exercise the hands in functional ways such as wringing out a dishrag under warm water
A
103
You are seeing a 29 year old male for his initial evaluation of a right ankle injury. During the history portion of your initial evaluation the patient reports he was playing basketball and when he landed from a jump shot his ankle twisted and he heard a “pop”. He came out of the game and the ATC assessed his injury, taped him up and he attempted to go back in the game. The first trip up and down the court was too much for your patient to bear so he subbed out of the game. During your objective assessment of your patient’s ankle you notice increased joint mobility and tenderness to palpation. You suspect your patient has what grade of an ankle sprain?
a. Grade 1
b. Grade 2
c. Grade 3
B
104
You are working with a patient to increase his knee strength. During you objective assessment you identified a significant strength deficit in his quads. You have decided to add a closed-chain quad strengthening exercise to improve the overall strength and stability of his knee. Which of the following exercises is an example of a closed-chain quad strengthening exercise and therefore an exercise you could add to his treatment plan?
a. Standing hamstring curls
b. Squat
c. TKE
d. SAQ
B
105
You are working with a patient to increase her shoulder strength and stability. During your objective assessment you identify weakness in her pec muscles. You have decided to add an open-chain pec strengthening exercise to improve the overall strength and stability of her shoulder. Which of the following exercises is an open-chain pec strengthening exercise and therefore an exercise you could add to her treatment plan?
a. Bicep curl
b. Pushup
c. Dumbbell bench press
d. Tricep kickbacks
C
106
Which stage of learning do we hope our patients are able to achieve with each exercises we teach them to increase their compliance with their HEP and their oerall outcome with physical therapy?
a. Autonomous Stage
b. Associative Stage
c. Cognitive Stage
A
107
A patient easily completes ten anterior lunges. The PT would like to modify the exercise to maximally challenge the patient in the sagittal plane. Which of the following modifications would be MOST appropriate?
a. Anterior lunge with concurrent unilateral shoulder flexion to 90° degrees with a five pound weight
b. Anterior lunge with concurrent bilateral elbow flexion to 45° with 5 pound weights
c. Anterior lunge with concurrent bilateral shoulder flexion to 90° with 5 pound weights
d. Anterior lunge with concurrent bilateral abduction to 45° with 5 pound weights
C
108
Which of the following patients is MOST appropriate for stretching?
a. A patient with inflammation present
b. A patient with a recent fracture
c. A patient with a bony block limiting joint mobility
d. A patient who reports sharp, acute pain with joint movement
A
109
Your patient has a positive Trendelenburg sign. Which of the following exercises would be the MOST appropriate exercise for this patient to perform?
a. Position the patient in side-lying with the lower leg (weak side) straight and the top leg flexed forward with the foot on the surface. Have this patient alternately lift and lower the lower leg
b. Position the patient in supine with knees bent and feet flat on the surface (hook-lying). Have the patient alternately extend and flex the knee of the weak side
c. Position the patient standing with one leg (the weak side) on a 4 inch block/step and have them alternately lower and elevate the pelvis on the side of the unsupported leg.
C
110
A 44 year old male was playing basketball and ruptured his Achilles tendon. He underwent surgical repair 6 weeks ago and you are seeing him for the first time for evaluation and treatment. Which of the following is MOST appropriate for a first time treatment?
a. Seated stretching of ankle including towel stretches into DF, seated use of rocker board for PF/DF, sub-maximal contractions of inversion/eversion with resistance provided manually.
b. Heel/toe raises in standing, single leg stance on incline of operative extremity without UE support in standing, stationary bike with moderate intensity
c. Diathermy followed by massage over repair site, ankle joint mobilizations, no AROM or PROM secondary to patient exhibiting discomfort
d. Aggressive stretching in DF (manually by PT), slow treadmill jogging on flat surface, resisted walking
A
111
During lecture we discussed that safety is a fundamental consideration when creating an exercise program for a patient. What two classifications of people did we identify as important t to ensure safety of with exercises?
a. Patient and PT
b. Patient and other patients in the gym
c. Patient and family members
d. PT ad therapy staff
A
112
Your patient is lying supine and you are strengthening the iliopsoas on the (R) using manual resistance. The main reason you would want to place the patients (L) hip and knee in flexion (foot planted on the table) it to:
a. Stretch the erector spinae muscles in lumbar region of the back
b. Stabilize the pelvis in a neutral to posteriorly rotated position to lessen the possibility of an anterior pelvic tilt
c. Improve the mechanical efficiency of the iliopsoas on the (R)
d. Place the pelvis in a slight anterior tilt so the trunk is more stable and the iliopsoas can generate greater tension
B
113
Using a handheld weight as the source of resistance, which of the following positions to strengthen the elbow extensors begins with the long head of the triceps brachii fully lengthened?
a. While the patient is in a standing position and the hips are flexed to 90 degrees, begin with the shoulder in hyperextension
b. Have the patient assume a prone-lying position with the shoulder in 90 degrees abduction, the upper arm supported on the table, and the elbow flexed to 90 degrees
c. With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain shoulder in as much flexion as possible
d. Have the patient assume the supine position with the shoulder flexed to 90 degrees and the elbow flexed so the handheld weight touches the opposite shoulder
C
114
While administering a treadmill stress test on a 57 y/o female with a 20 year history of smoking, you are closely monitoring her with an ECG and taking vital signs. Which of the following scenarios would indicate the need to terminate the stress test?
a. Systolic BP drops > 20 mmHg after increasing the elevation of the treadmill
b. Patient reports feeling overheated
c. Shortness of breath
d. Abnormal ECG responses including ST segment depression less than 1mm
A
115
Upon assessment of a patient who reports symptoms of low back pain, you identify what common faulty posture of the pelvic and lumbar regions?
a. Round back posture
b. Flat low back posture
c. Lordotic posture
d. Sway back posture
C
116
Your patient as DJD of the knees. Although currently her left knee is asymptomatic, she has been experiencing pain and periodic “giving way” of her R knee for the past week. Her physician prescribed anti-inflammatory medication to reduce joint swelling and pain and has referred the patient to you for evaluation and treatment. The patient is experiencing significant stiffness of the knee, especially in the morning and after sitting for an extended period of time. Although she indicates that pain and swelling have decreased during the past few days since she began taking the prescribed medication, pain is still notable during walking with end ROM (more so in flexion than extension). The knee ROM is limited (active and passive knee flexion 100°, passive knee extension lacks 10°; active knee extension lacks 20°). Strength of knee musculature is 4/5. She exhibits an antalgic gait pattern. Which of the following interventions in MOST appropriate for this patient at this time?
a. Activity modification and use for an AD during ambulation, vigorous resistance exercsies of the asymptomatic knee to improve strength, isomentric resistance exercise, eccentric but no concentric resisted exercises of the involved knee, low-intensity stretching
b. Quads setting exercises, AROM within pain-free ranges, isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation
c. Low-intensity stretching to increase knee flexion, static and dynamic strengthening with unilateral closed-chain exercises, stationary cycling
d. Ice, rest, AROM through the pain-free range, quads and hamstring setting exercises, ambulation with crutches until pain and swelling subside
B
117
You have a patient referred to your clinic who describes pain whenever he reaches overhead. He likes to play hockey in a weekend league. Other than playing hockey, he leads a very active lifestyle working out 3-5days/week and works as a fireman. On examination, you observe moderate atrophy in the infraspinous fossa, substitution with upper trap shrug during shoulder elevation, and thoracic kyphosis with forward head. You place him in the quadruped position and have him perform a push-up and note neutral position of the scapula throughout all. Based on this information and the knowledge you have learned so far, your critical thinking skills lead you to the decision that which of the following exercises would be the MOST important to address at this time with this patient?
a. Rotator cuff strengthening
b. Thoracic mobility
c. Scapular stabilization
d. Cervical stretching
A
118
A PT initiating a resistive exercise program with a healthy 25 y/o female incorporates a program that includes fast lifting velocity with 6-8 repitions of a moderate to high load amount is training which of the following characteristics?
a. Power
b. Endurance
c. Strength and hypertrophy
A
119
A patient referred to you in your home health practice needs to spend the next 8 weeks on bed rest due to complications of pregnancy. You design an exercise program to reduce the adverse effects of prolonged bed rest. Which of the following is LEAST likely to occur as the result of deconditioning from prolonged bed rest?
a. Orthostatic hypotension
b. Decreased bone mineral density
c. Laxity of ligaments
d. Loss of muscle mass
C
120
When using Karovean’s formula, the exercise heart rate is higher than when using the maximum heart rate alone.
a. True
b. False
A
121
You are a PT working in an acute care setting. You have just received orders to evaluate and treat a new patient 1 day s/p TKR. You evaluate the patient and determine he is appropriate for PT and is significantly lacking in knee ROM and strength. The BEST plan for treatment for this patient would be:
a. All TKR exercises included in the standard departmental TKR rehab manual
b. Specific exercises to address his lack of ROM and strength
c. Only gait activities
d. Only transfer activities
B
122
You are a PT working in an outpatient setting with a UPS delivery man who is having LBP with work tasks. The patient is just starting therapy and today you have decided to work on body mechanics with this patient. The whole concept of body mechanic is too difficult for the patient. What type of discrete motor task would you instruct your patient?
a. Maintaining his pelvic tilt while lifting a box
b. Maintaining his pelvic tilt while climbing up stairs to simulate climbing into his truck
c. Walking on a treadmill at a slow speed while maintaining his pelvic tilt
d. Setting his pelvic tilt and maintaining contraction
D
123
As a therapist, one way you can be relatively confident that motor learning has taken place is when your patient demonstrates which of the following?
a. Consecutive repetitions of a task without error during the treatment session
b. Decreased need for manual guidance during the treatment sessions
c. The ability to perform a slight variation of the task in a new context during the treatment session
C
124
Which of the following neurophysiologic sensory organs in series with the muscle fibers and transmit information about tension of a passive stretch or active muscle contraction via type 2B fibers?
a. Muscle spindle
b. Monsynaptic stretch reflex
c. GTO
C
125
During the initial phase of ACL rehab after surgical repair (0-4 weeks), a patient should AVOID the following activities:
a. Bilateral LE mini squats from 0°-30° with UE support
b. SLR from 0°-60° as long as there is no extensor lag
c. Repetitive squats in the 60°-90° range
d. Quad sets with knee in full extension, as this is a closed pack position of the knee
C
126
If you are applying an agonist contraction active inhibition stretch for tight elbow flexion, what muscle would you instruct the patients to contract?
a. Triceps
b. Deltoid
c. Biceps brachii
A
127
Although interventions used to manage patellofemoral pain syndrome are based on an examination of each patient on an individual basis, each of the following interventions is commonly employed except:
a. Stretching the IT band and TFL
b. Lateral gliding of the patella
c. Strengthening of the knee and hip extensors in weight-bearing and non-weight bearing positions
d. Exercises or use of an insert (orthotic device) in a patients shoe to correct excessive foot pronation
B
128
To strengthen to elbow extensors you have the patient perform push-ups, using bodyweight as the source of resistance. Which of the following variations of push-ups provides the greatest amount of resistance to the elbow extensors?
a. Bilateral push-ups in a prone position with weight on the hands and knees
b. Bilateral wall push-ups while in a standing position and leaning into and pushing away from the wall
c. Bilateral push-ups while standing and leaning on the hands on a kitchen countertop
d. Bilateral push-ups while in fully prone position on the floor with weight on the hands and toes
D
129
You are modifying a HEP for a patient recovering from an episode of medial epicondylits. Although pain has subsided, there is evidence of mild limitation of motion and pain when the involved muscle tendon unit is placed on a stretch and overpressure is applied at the end of the available ROM. To fully lengthen the muscle-tendon unit typically involved in medial epicondylitis, have the patient perform a stretch by using the opposite hand to :
a. Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated.
b. Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated
c. Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated
d. Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated
D
130
If you are applying a contract-relax contraction active inhibition stretch for tight elbow flexion, what muscle would you instruct the patients to contract?
a. Triceps
b. Deltoid
c. Biceps brachii
C
131
51) Which type of stretch usually results in optimal rates of improved ROM?
a. Low load, low intensity
b. High load, low intensity
c. Low load, high intensity
d. High load, high intensity
A
