du++on 1 Flashcards
A patient is referred to physical therapy with a diagnosis of pes anserinus bursitis. The physical therapist selects ultrasound as part of the intervention. The ultrasound should be applied to the area:
A. proximal to the lateral femoral condyle
B. proximal to the medial femoral condyle
C. distal to the medial tibial condyle
D. distal to the lateral tibial condyle
Correct Answer: C
Rationale: This is the area where the tendons of the pes anserinus insert.
Which of the following is the best exercise to correct a Trendelenburg gait pattern?
A. Bridging with Straight Leg Raise
B. Bridging
C. Bridging with resisted abduction
D. Wall squats
Correct Answer: C
Rationale: This exercise is designed to strengthen the gluteus meduius, weakness of which causes the Trendelenberg gait pattern.
The physical therapy intervention for a patient with Parkinson’s disease includes therapeutic exercise. The desired response to exercise for this patient is:
A. Increased isotonic and isometric strength
B. Improved initiation of movement and reciprocal motion
C. improved range of motion and joint stability
D. increased proximal and distal stability
Correct Answer: B
Rationale: Dysfunctions related to Parkinson’s disease include problems with initiation of movement and reciprocal motion.
An elderly female patient with poor vision is being prepared for discharge after a 3 week hospitalization. The best intervention strategy for this patient to increase her ambulation level and safety is to:
A. instruct the patient to keep curtains and window shades closed to avoid glare.
B. Recommend that the patient change the color of her walls to bright yellow.
C. practice walking in areas of high illumination and strong color contrasts.
D. teach the patient to walk while not looking at her feet at all times.
Correct Answer: C
Rationale: It is important to prepare the patient for difficult situations.
Which of the following is a contraindication to a 1-MHz ultrasound at 1.5 watts/cm²?
A. Over an injured tendon
B. Over an injured muscle belly
C. Over a non-cemented metal implant
D. Over an inflamed bursa
Correct Answer: C
Rationale: The use of ultrasound over metal components is contraindicated.
You are instructed to provide electrical stimulation to a 58 year old patient with a venous stasis ulcer on the right lower extremity. What is the most suitable type of electrical stimulation to promote wound healing?
A. Transcutaneous electrical stimulation
B. Direct current
C. Iontophoresis
D. Biphasic pulsed current
Correct Answer: B
Rationale: The use of direct current is the preferred form of electrical stimulation for wound healing.
After an above knee amputation, a patient cannot accept the loss of her leg. She reports being constantly tired, weepy, and has no energy to do anything. She also reports dificulty with sleeping. The BEST action you can take is:
A. tell the patient’s husband to monitor her behavior
B. request her primary physician to refer her for a psychological evaluation.
C. tell the patient to stop over-reacting, and to get on with her therapy.
D. observe her closely for possible suicide
Correct Answer: B
Rationale: This patient is demonstrating obvious signs of depression and the physician should be notified.
A physical therapy plan of care for a newborn with Erb palsy would include all of the following, EXCEPT:
A. splinting the shoulder in abduction and external rotation, and forearm supination.
B. facilitate awareness of the involved upper extremity.
C. gentle ROM following the immobilization to prevent contractures
D. partial immobilization of limb across upper abdomen for 1-2 weeks
Correct Answer: A
Rationale: Erb palsyis associated with a lack of shoulder motion – the affected arm is held adducted, pronated, and internally rotated.
A patient is referred to physical therapy for stretching of the right sternocleidomastoid muscle. The MOST effective method to stretch the muscle is by positioning the head and neck into:
A. extension, left side-bending, and right rotation.
B. flexion, left side-bending, and left rotation.
C. extension, right side-bending, and left rotation.
D. flexion, right side-bending, and left rotation.
Correct Answer: A
Rationale: The right sternocleidomastoid muscleproducers flexion right side bending and left rotation – it should therefore be stretched in the opposite directions.
A patient with an above-knee amputation is having great difficulty wrapping his residual limb. Your BEST course of action is to:
A. use a shrinker.
B. Spend more time teaching the patient proper wrapping.
C. Apply a temporary prosthesis
D. Consider recommending the application of an Unna’s paste dressing.
Correct Answer: A
Rationale: Shrinkers provide a degree of independence with those individuals who are not able to properly wrap the residual limb.
You are applying mechanical cervical traction to patient diagnosed with cervical radiculitis using a cervical halter. During the traction, the patient complains of pain in the area of the TMJ. You should: A. discontinue the treatment
B. Replace the halter with a sliding device to take pressure off the TMJ
C. decrease the traction poundage
D. Increase the treatment time
Correct Answer: B
Rationale: The sliding device applies no pressure to the TMJ
A 12-year old girl has sustained full thickness burns to both arms and is now beginning to develop hypertrophic scars. The most appropriate intervention to manage these scars is:
A. ace wrapping the affected areas
B. surgical resection
C. excision followed by autografts.
D. custom made pressure garments.
Correct Answer: D
Rationale: Although expensive, these garments apply an even pressure and help prevent scarring
You have been consulted about a child in the elementary school system who has moderate extensor spasticity and limited head control. The MOST appropriate positioning device would be a:
A. Supine stander
B. wheelchair with a back wedge and head supports.
C. HKAFOs
D. Prone stander
Correct Answer: B
Rationale: All of the other alternatives do not address the child’s limited head control or the spasticity.
A patient has lumbar spinal stenosis encroaching on the spinal cord. Which of the following activities should you instruct the patient to avoid?
A. rowing.
B. bicycling.
C. Tai Chi.
D. All of these activities can be performed
Correct Answer: D
Rationale: All of these activities would be appropriate provided that the patient is able to avoid spinal extension
The best course of action for a patient with symptoms of an early stage of ankylosing spondylitis include:
A. Strengthening the anterior chest muscles, and stretching of scapular stabilizers.
B. spinal extension and rib expansion exercises, and education about the maintenance of proper posture to prevent deformity.
C. Pain management, abdominal strengthening, and referral to a psychologist.
D. Cardiovascular conditioning, and weight bearing exercises.
Correct Answer: B
Rationale: Ankylosing spondylitis results in a gradual loss of spinal extension, and rib expansion
You are about to perform an ice massage for an acutely sprained knee. This is the first time the patient has had an ice massage. In order to repare the patient, you should tell the patient he/she will experience:
A. Intense cold, then burning, and then aching, followed by numbness.
B. aching, then numbness, and then burning, followed by intense cold.
C. burning, then intense cold, and then aching, followed by numbness.
D. numbness, then aching, and then intense cold, followed by burning.
Correct Answer: A
Rationale: The typical sequence experienced by the patient when ice is applied is cold, then burning, then aching, and then numbness.
Which of the following is not a benefit of a post-operative rigid dressing?
A. limits the development of post-operative edema
B. allows for earlier ambulation
C. allows for earlier fitting of a prosthesis
D. allows for daily wound inspection and dressing changes
Correct Answer: D
Rationale: As their name suggests, rigid dressings do not allow for wound inspections or for dressing changes.
You are setting up a patient on electrical stimulation for the purposes of muscle re-education. The most appropriate on:off time ratio is: A. 5:1 B. 15:1 C. 1:5 D. 1:15
Correct Answer: C
Rationale: This is the correct on:off time ratio used with muscle reeducation.
A patient with suspected nerve root impingement has been referred to you for a trial of mechanical lumbar traction. The patient is a 170 pound male. The most appropriate amount of force to initiate the session is: A. 20 lbs. B. 35 lbs. C. 60 lbs. D. 85 lbs.
Correct Answer: B Rationale: 25-50lbs is the recommended initial weight for lumbar traction. 50% of the body weight is required for vertebral separation.
- You are preparing to perform joint mobilizations on a patient’s proximal radioulnar joint. How would you position the joint to place it in the loose packed position? A. 10 degrees flexion, 10 degrees pronation B. 20 degrees flexion, 45 degrees supination C. 45 degrees flexion, 20 degrees supination D. 70 degrees flexion, 35 degrees supination
Correct Answer: D
Rationale: This is the loose pack position for the proximal radioulnar joint.
You begin treating a patient status post total shoulder reconstruction is examined in physical therapy. The referring physician insists on a very specific post-operative protocol. If you decide to deviate from the established protocol, the most appropriate action is for you to:
A. read the patient’s operating report
B. complete a thorough examination
C. carefully document any modification
D. contact the referring physician
Correct Answer: D
Rationale: Whenever an intervention deviates from a physician’s order, the physician must be first consulted
You are examining a patient following a total knee replacement. The patient asks you about the benefits of a continuous passive motion (CPM) machine. All of the following are reported benefits from a CPM, except:
A. increase in vascular dynamics
B. prevention of muscle atrophy
C. increases in range of motion
Correct Answer: B
Rationale: Because the CPM only provides passive range of motion, there are no strengthening benefits.
Which of the following cryotherapeutic agents provides the greatest magnitude of tissue cooling?
A. frozen gel packs
B. ice massage
C. fluori-methane spray
D. cold water bath
Correct Answer: B
Rationale: Of the modalities listed, ice massage provides the greatest magnitude of tissue cooling.
A patient has been referred to your department for paraffin treatments for a chonic hand injury. When using the dip and wrap method, the most appropriate number of times to dip the hand would be: A. 1-3 B. 2-4 C. 4-6 D. 6-10
Correct Answer: D
Rationale: 6-10 dips are recommended using the dip and wrap method.
A 35-year-old wheelchair bound patient is being discharged home from your hospital. In preparation for discharge, you visit the home and find he will require a ramp that will allow entry into the patient’s house. What is the maximum recommended grade for the ramp? A. 6.2 % B. 8.3 % C. 9.5 % D. 10.4 %
Correct Answer: B
Rationale: According to ADA, the grade of a ramp should be no greater than 8.3%.
You are preparing to stretch the glenohumeral capsule of a patient. Which grades of oscillation are the most appropriate for stretching maneuvers? A. I, II B. I, III C. II, III D. III, IV
Correct Answer: D
Rationale: Under the Maitland system, grades III and IV impart a stretch.
You are mobilizing a patient’s left shoulder using a large-amplitude movement occurring from near the beginning of available range to near the end of available range. What grade mobilization, according to Maitland, is being performed? A. Grade I B. Grade II C. Grade III D. Grade IV
Correct Answer: B
Rationale: Under the Maitland system, a grades II mobilization occurs from near the beginning of available range to near the end of available range.
A local primary care physician is looking to refer patients with incontinence to your department. Knowing that this is an area of specialty, the physician asks if you know which muscles need to be the focus of the strengthening program to maintain a strong pelvic floor. Which of the following muscles would be included in your reply?
A. Gemellus inferior, obturator internus, and pubococcygeus
B. Obturator internus, pubococcygeus, and coccygeus
C. Rectus abdominis, iliococcygeus, and internal oblique
D. Iliococcygeus, pubococcygeus, and coccygeus
Correct Answer: D
Rationale: Of those lited the Iliococcygeus, pubococcygeus, and coccygeus are all pelvic floor muscles.
A patient is referred to physical therapy with a history of temporomandibular joint pain and difficulty closing her mouth against minimal resistance. Which of the following muscles would not be a target for strengthening to help close the mouth?
A. Lateral pterygoid
B. Masseter
C. Medial pterygoid
D. Temporalis
Correct Answer: A
Rationale: The lateral pterygoid opens the mouth.
You are about to perform a postural drainage technique on a patient using percussions. Which of the following is not an indication for postural drainage with percussion?
A. To loosen and mobilize secretions
B. To utilize the shape and direction of the lung segments in order to help with drainage
C. To safely apply forces over bony prominences such as the scapula, spinous processes, and clavicles
D. To help clear airways in conditions such as cystic fibrosis
Correct Answer: C
Rationale: Percussion techniques should not be performed over bony prominences such as the scapula, spinous processes, and clavicles.
You are providing patient education to a 78-year-old man who received a cemented right total hip arthroplasty (THA) 24 hours ago. You noted from the operating report that the surgeon used a posterolateral incision. Which precaution would you not stress to the patient?
A. Avoid hip flexion beyond 90 degrees
B. Avoid hip adduction past midline
C. Avoid any hip abduction
D. Avoid hip internal rotation beyond neutral when hip is flexed
Correct Answer: C
Rationale: Hip abduction should not be avoided completely.
One of your goals of treatment is to increase the knee flexion range of motion of a patient. You decide to use the proprioceptive neuromuscular facilitation (PNF) technique of hold-relax to help reach your goals. To which muscle group would you apply the hold-relax?
A. Hamstrings
B. Quadriceps
C. Hip flexors
D. Anterior tibialis
Correct Answer: A
Rationale: The hamstrings serve to flex the knee (and extend the hip). The quadriceps would be used if a contract-relax technique was employed.
You are teaching a patient how to use a cane to assist with ambulation. The cane is usually used: A. Opposite the involved side B. On the involved side C. Only during the stance phase D. As needed
Correct Answer: A
Rationale: Placing the cane on the opposite side to the involved allows the forces to be better dissipated and allows the user to shift their weight off the involved side during the stance.
A 70 year-old patient has a pressue ulcer on the medial malleolus of his ankle. Upon inspection, you notice that the ankle is swollen, red, and painful with a moderate to high amount of exudate. Of the following dressings, which would be the BEST for this wound? A. Gauze
B. Hydrogel
C. Semi-permeable
D. calcium alginate dressing
Correct Answer: D
Rationale: Calcium alginate dressings are better suited to wounds with a moderate to high amount of exudate.
You are treating a patient admitted to the intensive care burn unit 48 hours ago with an acute deep partial-thickness burn covering 25% of the total body. As the treating physical therapist, what should be your major concern for this patient? A. Fluid balance B. Comforting the family C. Initiating range of motion D. Nutritional status
Correct Answer: C
Rationale: All of the other alternatives, while being of some concern to the PT, are not a major concern as they are the responsibility of other service
While playing soccer approximately two months ago, your patient had an inversion sprain of the calcaneofibular and anterior talofibular ligaments of the right ankle. The ankle is still painful, and very limited in motion. You decide to use ultrasound. The ultrasound treatment parameters should consist of: A. continuous US at 3 MHz. B. continuous US at 1 MHz. C. pulsed US at 1 MHz D. pulsed US at 3 MHz
Correct Answer: A
Rationale: Based on the symptoms, the 3 Mhz would be a better choice as it is less invasive/more superficial.
Your patient is recovering from a right CVA. During gait analysis you observe lateral trunk bending toward the left during midstance on the left leg. Of the following, what would you do to help correct this deviation?
A. strengthen the hip abductors on the right side
B. strengthen the hip abductors on the left side
C. Strengthen the hip extensors on the right side
D. Strengthen the hip extensors on the left side
Correct Answer: B
Rationale: The lateral trunk bending to the left is a compensatory motion for a weak gluteus muscle on the same side.
You are treating a patient whose chief complaint is difficultly with ballistic movements and who fatigues easily. The optimal exercise prescription for this patient is:
A. low intensity workloads for short durations to help develop slow twitch fibers.
B. high intensity workloads for long durations to help develop fast and slow twitch fibers.
C. high intensity workloads for short durations to help develop fast twitch fibers.
D. low intensity workloads for long durations to help develop slow twitch fibers.
Correct Answer: C
Rationale: Ballistic movements involve fast-twitch fibers, which in turn are strengthened using high intensity exercises.
Your patient is recovering from an Achilles tendon strain and is planning to train for a marathon. Her history indicates that she has Type I (IDDM) diabetes, controlled with twice daily insulin injections. In order to minimize the risk of a hypoglycemic event during exercise, you should advise the patient to:
A. avoid exercise if her blood glucose is above 300 or below 100
B. decrease her carbohydrate intake for 8 hours before her training sessions
C. exercise daily for 40-50 minutes to achieve proper glucose control
D. Carry on as normal
Correct Answer: A
Rationale: While exercises has many benefits for patients with diabetes, it is important to avoid exercising when the levels are indicating hypoglycemia (100) or hyperglycemia (300).
A patient is having difficulty learning how to coordinate herself for a transfer from bed to chair. Which of the following types of feedback would provide the best help?
A. Emphasize guided movements
B. Emphasize knowledge of results and visual inputs
C. Emphasize knowledge of performance and proprioceptive inputs
D. Encourage her by telling her that practice makes perfect
Correct Answer: B
Rationale: Knowledge of results can contribute to the development of motor skills, while visual input is key for developing coordination skills .