DUTTON SET A (1-250) 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 condle
C. distal to the medial tibial condyle
D. distal to the lateral tibial condvle
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 medius, 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. Thebest 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 vellow.
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.
Coirect 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/cm??
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 curent
CoITect Answer: B
Rationale: The use of direct crent 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
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
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.
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.
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. Youshould:
A. discontinue the treatment
B. Replace the halter with a sliding device to take pressure off the IM
C. decrease the traction poundage
D. Increase the treatment time
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.
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 andlimited 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
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
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
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 anice 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 bynumbness.
B. aching, then numbness, and then burning, followed by intense cold.
C. burning, then intense cold, and then aching, followed bynumbness.
D. numbness, then aching, and then intense cold, followed by burning.
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
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 puposes of muscle re-education. The most appropriate on: off time ratio 1S:
A.5:1
B. 15:1
C. 1:5
D. 1:15
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 Ibs.
D. 85 Ibs.
Answer: B
Rationale: 25-50 lbs 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 positionthe 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
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 an modification
D. contact the referring physician
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
D. decrease in pain
Answer: B
Rationale: Because the CM 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
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
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%
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 mostappropriate for stretching maneuvers?
A. I. II
B. I. III
C. II. III
D. III. IV
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 occuring 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
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
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 ptergoid
B. Masseter
C. Medial ptervgoid
D. Temporalis
Answer: A
Rationale: The lateral ptergoid opens the mouth.
You are about to perform a postural drainage technique on a patient using percussions. Which of the following is notan 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
Answer: C
Rationale: Percussion techniques should not be performed over bony prommences 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 bevond neutral when hip is flexed
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 whichmuscle group would you apply the hold-relax?
A. Hamstrings
B. Quadriceps
C. Hip flexors
D. Anterior tibialis
Proposed Answer and Ratio: B
Quadriceps, since the hamstrings serve as the agonist muscle of knee flexion. The quads act as antagonist to the movement, therefore should be the one limiting knee flexion. Hold- relax targets the antagonist muscle through the principle of autogenic inhibition. Contract-relax works the same way as hold-relax by principle of autogenic inhibition, but involves isotonic contraction by rotation of the range-limiting antagonist muscle instead
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
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
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
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 services.
While playing soccer approximately two months ago, your patient had an inversion sprain of the calcaneo fibular 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
Answer: A
Rationale: Based on the symptoms, the 3 Mhz would be a better choice as it is less invasive/ more superficial.
You 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
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.
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 Tvpe 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
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
Answer: B
Rationale: Knowledge of results can contribute to the development of motor skills, while visual input is key for developing coordination skills
Your patient presents with left shoulder pain after painting her dining room ceiling two days before. You determine that she has acute subdeltoid bursitis and therefore decide that the best intervention initially is to:
A. Use modalities to reduce pain and inflammation and instruct the patient in pendulum exercises
B. Initiate rotator cuff strengthening exercises
C. Begin correction of muscle imbalances
D. Order a TENs unit for the patient
Answer: A
Rationale: The first priority with this patient is to control the pain and inflammation.
As a home health physicial therapist, you have been asked to treat a teenage girl with a diagnosis of cystic fibrosis.
Which of the following interventions would NOT be appropriate for this patient?
A. inspiratory muscle training
B. secretion removal techniques
C. exercises and activities designed to increase endurance
D. breathing techniques designed to decrease inspiratory volumes
Answer: D
Rationale: All would be appropriate except that the goal would be to increase inspiratory volumes.
You are treating a woman who was referred to your clinic with a diagnosis of stress incontinence and who reports loss of control with coughing or laughing. Which of the following interventions would be best for this patient?
A. functional electrical stimulation three times a week
B. behavioral modification techniques
C. Instruction on Kegel exercises to be performed several times a day
D. using a biofeedback unit one hour a week
Answer: C
Rationale: Stress incontinence involving loss of control during valsalva type activities responds well to a strengthening program to address weakness of the pelvic floor muscles
Youhave been consulted to treat a patient with a 4 cm stage III decubitus ulcer over the right heel You note a green/yellow, pungent exudate at the wound site and opt to use electrical stimulation. Your choice of polarity and electrode placement would be:
A. The cathode is placed in the wound
B. The anode is placed in the wound
C. The cathode is placed proximal to the wound
D. The cathode is placed proximal to the wound
Answer: A
Rationale: This is the correct choice of polarity–cathode (negative pole), which is used to stimulate production of granulation tissue or to promote antimicrobial or anti-inflammatory effects, and the correct placement.
You are designing an exercise program for cardiac rehabilitation. All of the following activities would be considered to be within the 3-6 MET levels except:
A. Walking at a moderate or brisk pace of 3 to 4.5 mph on a level surface inside or outside
B. Roller skating or in-line skating at a leisurely pace
C. Water aerobics
D. Mountain climbing, rock climbing, rapelling
answer: D
mountain climbing, rock climbing, rapelling activities are vigorous activities that require more than 6 METS (more than 7 kcal/min)
You are monitoring a cardiac patient during an exercise session. All of the following would be expected to occur physiologically with this patient at a given workload, except:
A. both HR and svstolic/diastolic BP will increase
B. HR will be higher while systolic BP will be lower
C. Systolic and diastolic BP will both increase
D. The patient will tire the longer the exercise duration
Answer: A
Rationale: As with HR, a linear increase in systolic pressure is expected with increasing levels of work.
You are treating a patient who has a complete spinal cord injury at the level of C6. As part of your intervention you decide to instruct the family in exercises to maintain the patient’s passive range of motion. What should you instruct the family to do?
A. Focus on ranging only those muscles that assist with specific functional needs
B. Maintain the normal ROM of all of the patient’s muscles
C. Emphaize flexibilty of the low back extensors and hamstrings while maintaining normal ROM in the other areas
D. Avoid range of motion to certain areas to promote stability, e.g. shoulders
Answer: A
Rationale: It is important to only range those joints where flexibility is needed and to allow other joints to become more stable.
While performing an ultrasound treatment on a patient’s lateral epicondyle using an intensity of 1.5 Wem?, the patient reports an increase in symptoms in the treatment area. Based on this feedback, what be the most appropriate action?
A. Change the ultrasound frequency
B. Add more transmission gel and continue
C. Decrease the ultrasound intensity
D. Increase the size of the treatment area
Answer: C
Rationale: Of those listed, decreasing the ultrasound intensity is the only option that addresses the issue while not changing the purpose of the treatment.
You are monitoring the exercise of a patient with a diagnosis of myocardial ischemia and coronary artery disease. This patient’s ECG changes would be expected to include
A. bradycardia with ST segment depression
B. significant arrhythmias early on in exercise with a shortened QRS segment
C. tachcardia at a relatively low intensity of exercise and ST segment depression
D. tachycardia early on in exercise with ST segment elevation
Answer: C
Rationale: Tachycardia occurs as the diseased heart works harder to pump blood. The ST segment connects the QRS complex and the T wave and can be depressed in ischemia.
During your examination of an athlete, you noticed that the patient could not fully dorsiflex his right ankle while the right knee was positioned in full extension. When ankle dorsiflexion is tested with the knee flexed, the range of motion remains the same. Your evaluation and subsequent focus of treatment should be on which structure?
A. adaptive shortening of the right hamstrings
B. adaptive shortening of the right gastrocnemius
C. adaptive shortening of the right soleus
D. adaptive shortening of the right hip flexors
Answer: C
Rationale: Because the gastrocnemius is a two joint muscle, its effect on ankle dorsiflexion is altered with the introduction of knee flexion, whereas the length of the soles muscle is not altered.
You are treating a 16-year-old basketball player who sustained a Grade II inversion ankle sprain 16 days ago. Interventions for this phase of rehabilitation (early subacute) should include:
A. Rest, Ice, Compression, Elevation (RICE and crutch training
B. lower extremity functional strengthening specific to soccer
C. open-chain lower extremity exercises and contrast baths
D. the fitting of an orthosis, closed-chain lower extremity strengthening, cardiovascular, and proprioceptive exercises
Answer: D
Rationale: Given the stage of healing, the patient should be moving toward a functional progression while still protecting the injury site.
Youare instructing a patient diagnosed with lymphedema on how to self-administer intermittent compression to the right lower extremity at home. Your recommended treatment time for home administration would be:
A. Up to 8 hours/day
B. Up to 1 hour/day
C. Up to 3 hours/day
D. Up to 4 hours/day
Answer:A
Rationale: The recommended time for the application of intermittent compression is up to eight hours per day.
In an effort to help control pain during a debriding procedure on a patient, you decide to apply TENS during the procedure using the brief intense mode. What on the parameters you should set in terms of frequency and pulse width?
A. Frequency: 1-4 Hz; pulse width: 250+ us
B. Frequency: 80 Hz; pulse width: 150 us
C. Frequency: 10 Hz; pulse width: 150 lIs
D. Frequency: 10 Hz; pulse width: 200-500 us
Answer: A
Rationale: These are the correct parameters for the brief intense mode.
You have been treating a 16-year-old soccer player following an ACL repair. After 4 weeks of treatment the patient still complains of pain and instability even though he reports he reports being compliant with his home exercise program and wearing his brace. The original referral was for 7 to 8 weeks of physical therapy. Your next step should beto:
A. discuss your findings and refer the patient back to his referring physician
B. complete the full 8 weeks of treatment and document the patient’s lack of improvement
C. Discharge the patient
D. Continue treating the patient and give him more time to improve
Answer: A
Rationale: The patient is making no progress despite indicating being compliant with the program. It would therefore be prudent to contact the physician and discuss your findings.
During your examination of a patient with chronic shoulder pain, you observe excessive winging of the scapuladuring overhead motion. The overall focus of your intervention should be:
A. strengthening the rotator cuff muscles
B. strengthening of the rhomboids and middle trapezius
C. strengthening of middle and lower trapezius and the serratus anterior
D. Stretching the middle and upper trapezius muscles
Answer: C
Rationale: Winging of the scapula is indicative of a weak serratus anterior, and the middle and lower trapezius.
While examining a patient you notice color changes in the skin during position changes of the foot. Specifically, pallor develops during elevation of the leg and hyperemia develops when the limb is then positioned in the dependent position.
Based on your findings, you decide to treat this patient for:
A. chronic venous insufficiency
B. arterial insufficiency
C. Ravnaud’s phenomena
D. Buerger’s disease
Answer: B
Rationale: Pallor developing with leg elevation which is then replaced with hyperemia when the leg is placed in the dependent position (rubor of dependency) is diagnostic for arterial insufficiency.
One of your findings during the gait assessment of a patient is that he ambulates with a Trendelenburg gait. The best intervention to correct this problem is:
A. Strengthening the quadratus lumborum
B. Core strengthening program
C. Strengthening the gluteus maximus
D. Strengthening the gluteus medius
Answer: D
Rationale: The Trendelenburg sign is associated with weakness of the gluteus medius.
You are treating a patient who has limited right trunk rotation in sitting, which you have determined to be caused by left thoracic facet joint capsular tightness. Following a specific joint mobilization to the affected thoracic facet joint, you educate the patient in the following exercise to reinforce your mobilization and improve right rotation in sitting
A. Lumbar extension combined with right trunk rotation
B. Lumbar flexion combined with right trunk rotation
C. Lumbar flexion combined with left trunk rotation
D. Lumbar extension combined with left trunk rotation
Answer: B
Rationale: The combined motion of lumber flexion and right trunk rotation stretches the left thoracic facet joints more than any of the other movements.
You are treating a patient with a closing restriction at the right joint of C5 on C6. Which of the following describes the most specific technique vou could use?
A. Position the patient’s head and neck in neutral, apply central P/A pressure on the spinous process ofC5
B. Position the patient’s head and neck in flexion, and left rotation and apply central P/A pressure on the spinous process of C5
C. Position the patient’s head and neck in extension and right rotation, and apply P/A pressure on the facet joint of C6 in the direction of the plane of the C5-6 joint
D. Position the patient’s head and neck in extension and left rotation, and apply P/A pressure on the facet joint of C6 in the direction of the plane of the C5-6 joint
Answer: C
Rationale: Position the patient’s head and neck in the combined position of extension and right rotation places the closing restriction on the right side at its end range, thereby facilitating the mobilization technique.
You are treating a patient for generalized weakness following a prolonged period on bedrest. The patient is able to ambulate well on the level, but is having difficulty with ascending stairs. Although he is able to position his foot on the step, he is unable to climb the stairs without pulling hard on the railing. Which of the following muscles will need to be strengthened to help this patient climb the stairs?
A. Hip and knee extensors
B. Biceps and triceps of both upper extremities
C. Hip extensors and core muscles
D. Hip and knee flexors
Answer: A
Rationale: Hip and knee extension strength is necessary for ascending stairs, which involves the patient’s ability to straighten the knee and then extend the hip.
You are treating a patient with a transtibial amputation fitted with a PTB prosthesis who is leaming to walk. During your gait analysis you notice that this patient is having difficulty maintaining prosthetic stability during the phase from heel-strike to footflat. Based on these findings which muscle group will you decide to strengthen?
A. Trunk extensors
B. Knee extensors
C. Knee flexors
D. Hip flexors
Answer: B
Rationale: The knee extensors are involved during the phrase from heel strike to foot flat.
You are treating a patient diagnosed with adhesive capsulitis of the shoulder. You decide to use joint mobilizations as part of your intervention plan. Which of the following mobilization techniques would be the most effective to use to help restore shoulder abduction?
A. Posterior glide at 90 degrees of abduction
B. Inferior glide at 30 degrees of abduction
C. General distraction technique
D. Inferior glide at 55 degrees of abduction
Answer: D
Rationale: Shoulder abduction involves an inferior glide of the humerus on the glenoid and the joint is placed in its loose packed position.
Your examination of a patient reporting right buttock and right posterior thigh pain reveals muscle spasms of theright piriformis muscle. You decide to use ultrasound to the right piriformis to help reduce the spasm. Which would be the most effective ultrasound setting in this case?
A. 3 MHz continuous at 1.5 W/cm2
B. 1 MHz continuous at 1.0 W/cm2
C. 1 MHz pulsed at 1.0 W/cm2
D. 3 MHz pulsed at 1.0 W/cm2
Answer: B
Rationale: Greater penetration is achieved with 1 MHz versus 3 MHz and with continuous versus pulsed.
You are treating a patient who has been diagnosed with acute synovitis of the right temporomandibular (TMJ joint. You early intervention should focus on:
A. gentle mobilizations to the right TMJ and patient education on posture, a soft food diet, and the application of ice athome
B. ROM exercises and grade Ill joint mobilizations to the TMJ
C. the issuing of a TENS unit to help control pain
D. application of an intraoral appliance
Answer: A
Rationale: The patient is in the acute stage of healing, therefore the focus should be on controlling the pain and inflammation.
You are treating a patient with complex regional pain syndrome (CRPS) of the right upper extremity. Which of the following interventions should be avoided with this patient?
A. Passive range of motion of the right upper extremity
B. Gradual exercising of the right upper extremity
C. Ice or heat applications
D. Jomt protection techniques
Answer: C
Rationale: Ice or heat applications should be avoided in most cases because they can cause over stimulation of nerve endings resulting in increased discomfort.
You are trying to teach a 15-year-old patient to use crutches and non-weightbearing on the right, but the patient ishaving difficulty due to weakness of the upper quadrant muscles. Which of the following muscles would be the most important to strengthen?
A. deltoid, biceps, and brachialis
B. lower trapezius, latissimus dorsi, and triceps
C. upper trapezius, rhomboids and serratus anterior
D. deltoid, upper trapezius and levator scapulae
Answer: B
Rationale: All of these muscles are involved when using crutches.
Your patient has atrophy of the quadriceps of his right lower extremity due to a long-standing knee injuy. You decide to use electrical stimulation to increase the patient’s quadriceps strength. Which of the following electrode placement and stimulation protocol should vou use?
A. Small electrodes, widely spaced; 10 secs on 10 secs off.
B. Small electrodes, closely spaced; 10 secs on, 30 secs off.
C. Large electrodes, closely spaced; 10 secs on, 30 secs off.
D. Large electrodes, widely spaced: 10 secs on, 30 secs off.
Answer: D
Rationale: Larger electrodes widely spaced allow for deeper penetration. The 10 seconds on, 30 seconds off ratio is appropriate for muscle strengthening.
A patient is referred to you for a course of iontophoresis for Achilles tendonitis. The patient arrives with the pain medication to be applied, which has a positive charge. The correct current type, polarity and active electrode placement IS:
A. Low volt continuous current with the anode placed distal on the tendon.
B. Monophasic current with the cathode placed on the tendon.
C. Low level current with the anode placed on the tendon.
D. Biphasic current with the cathode placed proximal on the tendon.
Answer: C
Rationale: Like poles repel, therefore the positive pole (anode) should be used for any medication with a positive charge.
You are treating a patient who has a diagnosis of lumbar spinal stenosis. As part of the patient’s education, you should recommend the following sleeping position
A. Sleep on your stomach
B. Sleep on your back
C. Sleep on your side with a pillow between your bent knees
D. The sleeping position shouldn’t be an issue
Answer: C
Rationale: Sleeping on the side with the knees bent places the lumbar spine in flexion which helps widen the intervertebral foramen.
You are about to discharge a patient with a C7 spinal cord injwy. Which of the following would be challenging but obtainable goals for this patient?
A. Independent w/ all ADLs; may need adaptive aids for bowel care
B. Independent pressure relief
C. May have limited walking with bracing
D. Independent slide board transfer
Answer: A
Rationale: A patient with a C7 spinal cord injury should be able to achieve independence with all activities of daily living, but may need adaptive aids for bowel care.
To design an intervention for a patient with poor motor control of the lower extremities you must consider the correct sequence for the 4 stages of control, which are:
A. Mobility, controlled mobility, stability, skill
B. Mobility, stability, controlled mobility, skill
C. Stability, controlled stability, mobility, skill
D. Skill, controlled stability, controlled mobility
Answer: B
Rationale: This sequence is based on Rood’s concept of levels of control throughout activities.
When considering to use high-voltage or direct crent, all of the following are true statements abouthigh-voltage, except
A. It can be used to stimulate peripheral nerves
B. It is in effective in stimulating the denervated tissues
C. It is an effective current for iontophoresis
D. It effects superficial and deep tissues
Answer: C
Rationale: High voltage current is not effective for use with iontophoresis.
You are setting up a patient for a specific type of electrical stimulation where the intensity is produced in a burst mode that has a 50 percent duty cycle, with a pulse width range of 50-200 us, and an interburst interval of 10 ms. What type of electrical stimulation are vou planning to use?
A. TENS
B. Russian
C. Hi-volt
D. FES
Answer: B
Rationale: These are the parameters for Russian stimulation.
You are planning to use the acupuncture mode of a transcutaneous electrical nerve stimulation unit to help controla patient’s low back pain. Which of the following parameters on the unit produce this type ofstimulation?
A. Low intensity, duration of 50 sec, and a frequency of 60 Hz
B. High intensity, duration of 150 sec, and a frequency of 2Hz
C. Low intensity, duration of 120 sec, and a frequency of 80 Hz
D. High intensity, duration of 120 sec, and a frequency of 100Hz
Answer: B
Rationale: These are the parameters for the acupuncture mode of a TENS unit.
A patient has been referred to your facility for aquatic therapy. Which of the following information derived from the patient would be considered a contraindication to aquatic therapy?
A. chronic pain
B. cerebral palsy
C. multiple sclerosis
D. urinary tract infection
Answer: D
Rationale: A urinary tract infection would be a contraindication for aquatic therapy due to the likelihood of contamination
A patient you are treating requires an ambulation device to help with gait. Which of the following assistive devices provides the least stability?
A. Lofstrand crutches
B. walker
C. wheel walker
D. axillary crutches
Answer: A
Rationale: Of the assistive devices listed, Lofstrand crutches offer the least amount of stability.
While treating a patient with a T4 spinal cord injw, the patient begins to exhibit signs and symptoms of autonomic dysreflexia while exercising in the supine position. What would be the best course of immediate action?
A. Check the patient’s catheter for blockage
B. Sit the patient up
C. elevate the patient’s legs
D. Monitor the patient’s blood pressure
Answer: B
Rationale: Autonomic dysreflexia produces a sympathetic response resulting in a rise in blood pressure. Sitting may cause a pooling of blood in the lower extremities thereby lowering blood pressure.
Which of the following initial goals would be the least important for a patient who is being treated for extensive full thickness burns
A. A reduction in the risk of infection and complications
B. A reduction in the risk of secondarv impairments
C. Enhancement of wound and soft tissue healing
D. Achievement of good to normal strength
Answer: D
Rationale: Compared to the other goals, the achievement of good to normal strength is not a priority.
You are designing an ulcer prevention program for a patient who spends a lot of time in the seated position. Which ofthe following bony prominences would not be the major focus of vour intervention?
A. Vertebral spinous processes
B. Ischial tuberosities
C. Spines of the scapulae
D. Sacrum
Answer: D
Rationale: The sacrum is the most vulnerable bony prominence for skin breakdown while in a supine position.
You are assiting a patient with bed to chair transfers. In order to complete the task you have to provide the patient with 50% assist. How would you document this level of assist?
A. Minimal assist
B. Moderate assist
C. Contact guard
D. Maximal assist
Answer: B
Rationale: This is the definition of a moderate assist.
All of the following are considerations when treating a patient with a transfemoral amputation, except.
A. Balance and stability
B. Difficulty rising from a seated position
C. Prosthetic comfort while sitting
D. prevent hip flexion, adduction and internal rotation contractures
Answer: D
Rationale: It is important to prevent hip flexion, abduction and external rotation contractures.
You have been asked to help design a newlocal business so that it meets ADA requirements. According to the ADA what are the requirments for doorway dimensions?
A. Minimum width of 32 inches, maximum depth of 24 inches
B. Minimum width of 20 inches, maximum depth of 36 inches
C. Minimum width of 36 inches, maximum depth of 28 inches
D. Minimum width of 34 inches, maximum depth of 30 inches
Answer: A
Rationale: These are the ADA requirements for doorway dimensions.
You have just finished treating a patient with a small, purulent wound located on her right malleolus using whirlpool irrigation. Disinfection of the whirlpool can best be achieved with:
A. Sterile water
B. Povidone-iodine
C. Epsom salts
D. Bleach
Answer: B
Rationale: Povidone-iodineis a water-soluble chemical that works through disruption of the pathogen cell walls.
A patient, who has a family history of coronary artery disease, is referred to you to begin an exercise program to improve her cardiac health. Which of the following would be the most accurate measure of exercise intensity to monitor during the first exercise session?
A. MET levels
B. Blood pressure
C. Heart rate
D. Rating of perceived exertion (RPE)
Answer: C
Rationale: Of the measures listed, the monitoring of heart rate would be the most important in this patient.
A concerned mother brings her 2 month-old infant to be examined at Early Intervention because she has noticed that, although the infant had been taking steps in supported standing at two weeks, the infant appears unable to do the same now. You should:
A. Refer the mother and her infant to a pediatric neurologist.
B. Express your concerns and perform a full developmental exam
C. explain that this is normal and that she should not be concerned
D. Recommend a CT scan of the infant’s brain
Answer: C
Rationale: This is a normal developmental finding so the parent should be reassured.
You are progressing a patient through an exercise program to restore normal function of the shoulder. The best PNE diagonal pattern to improve function of the shoulder is:
A. D1 flexion
B. D2 flexion
C. D1 extension
D. D2 extension
Answer: B
Rationale: D2 flexion involves shoulder flexion-abduction-external rotation – all key movements of the shoulder.
You are instructing a patient on how to use a reciprocating gait orthosis (RGO) with a walker. What is the correct sequence?
A. She should shift her weight onto her walker and one leg, extend the upper trunk, and swing her other leg through
B. She should shift her weight onto her walker, extend the upper trunk, and swing both legs forward together to approach the walker
C. She should shift her weight onto one leg, and swing her other leg through while leaning on the walker
D. You should not be teaching a patient to use a reciprocating gait orthosis with awalker
Answer: A
Rationale: As its name suggests, the RGO is designed to permit a reciprocal gait when accompanied with a weight shift.
You are treating a patient with a diagnosis of TMI dysfunction The patient is unaware when she is clenching her jaw during periods of stress. You decide to use biofeedback to help teach the patient when she is clenching her teeth. Initially, the biofeedback protocol should consist of:
A. low detection sensitivity with recording electrodes placed closelytogether.
B. high detection sensitivity with recording electrodes placed closely together.
C. low detection sensitivity with recording electrodes placed far apart.
D. high detection sensitivity with recording electrodes placed far apart.
Answer: A
Rationale: The electrodes are placed closely together and the sensitivity of the biofeedback unit is set at a low sensitivity setting and adjusted so that the patient can perform the repetitions at a ratio of two thirds of the maximal muscle contraction.
You are treating a 25-year-old female athlete with a diagnosis of patellofemoral syndrome. As part of the patient’s intervention you decide to use both open and closed kinetic chain exercises. Which of the following exercises places the most stress on the patellofemoral joint?
A. Closed kinetic chain exercises involving 90 degrees of knee flexion
B. Open kinetic chain exercises performed between 25 and 90 degrees of knee flexion
C. Open kinetic chain exercises performed between 120 and 90 degrees of knee flexion
D. Closed kinetic chain exercises involving greater than 120 degrees of knee flexion
Answer: D
Rationale: Closed kinetic chain exercises involving greater than 120° of knee flexion place a very significant amount of force through the patellofemoral joint.
All of the following are complications that the physical therapist must take into consideration when designingan intervention plan for a patient with a diagnosis of spina bifida, except:
A. Neurogenic bowel and bladder
B. Myelodysplasia
C. Arnold-Chiari deformitv
D. All are associated complications of spina bifida
Answer: D
Rationale: All are associated complications.
All of the following would be appropriate goals when treating a patient diagnosed with Down syndrome, except:
A. Mininizing gross motor delay
B. Encouraging oral motor function
C. Management of obesity through exercise
D. Management of hypertonia
Answer: D
Rationale: Patients diagnosed with Down syndrome have difficulties with hypotonia, not hypertonia.
All of the following would be appropriate interventions for a patient diagnosed with muscular dystrophy, except:
A. Customized wheelchair to help maintain alignment of the spine and pelvis
B. Adaptive devices, such as a wheelchair table to maximize upper extremity mobility
C. Strengthening of the shoulder depressors and biceps to help with transfers
D. Brace prescription, such as ankle-foot orthoses and knee-ankle-foot orthoses, to prolong the period of ambulation and delav wheelchair dependency
Answer: C
Rationale: Should include strengthening of triceps, not biceps, to help with transfers.
All of the following are appropriate goals when prescribing strengthening exercises for a patient diagnosed with juvenile rheumatoid arthritis, except:
A. avoiding muscle substitutions
B. Minimizing atrophy
C. Minimizing deformity
D. Minimizing stability
Answer: D
Rationale: Strengthening exercises in this patient population are designed to decrease instability.
All of the following are appropriate goals when prescribing exercises for a patient diagnosed with spinal muscular atrophy (SMA), except.
A. Prevent contractures
B. Prevent deformity
C. Decrease spasticity
D. Prevent secondary complications such as scoliosis
Answer: C
Rationale: SMA is a disease involving degeneration of the anterior horn cells of the spinal cord, and will therefore not manifest with spasticity.
All of the following are absolute contraindications for exercise in the adult population, except.
A. Severe coronary artery disease with unstable angina pectoris
B. Uncontrolled hypertension
C. Acute thrombophlebitis
D. Patients older than 85 years old
Answer: D
Rationale: Increasing age is not a contraindication for exercise.
All of the following would be considered good advice to give to a patient diagnosed with hypertension, except
A. Lose weight if overweight
B. Maintain adequate intake of dietary potassium
C. Stop smoking
D. Reduce sodium intake to no more than 200 mmol/d
Answer: D
Rationale: Recommendation is no more than 100 mmol/d for sodium.
When designing an intervention plan for a patient diagnosed with a CVA, all of the following are primary impairments associated with stroke, except:
A. Visual changes, including neglect and visual field deficits
B. Changes in emotional status
C. Pain
D. All are primary impairments associated with stroke
Answer: D
Rationale: These are all primary impaiments associated with the stroke.
You are teaching a 20-year-old patient diagnosed with L3 paraplegia how to ambulate using an adaptive device. What type of equipment would be the most appropriate for this patient?
A. bilateral hip-knee-ankle-foot orthoses and crutches
B. bilateral knee-ankle-foot orthoses and crutches
C. bilateral ankle-foot orthoses and crutches
D. You should not be teaching a patient with L3 paraplegia to ambulate
Answer: B
Rationale: Bilateral knee and ankle foot orthoses and crutches would be appropriate for this level of spinal cord injury.
You are treating a patient who is recovering from a fracture of the surgical neck of the humerus, resulting in atrophy of the deltoid muscle. Which nerve was likely damaged by the fracture?
A. Axillary nerve
B. Musculocutaneous nerve
C. Dorsal scapular nerve
D. Long thoracic nerve
Answer: A
Rationale: The accessor nerve is commonly injured with a fracture of the surgical neck of the humerus.
You are treating a patient who sustained an injury to the area of the wrist known as the anatomical snuff-box. Whichof the following structures do not pass through the snuff-box?
A. Extensor pollicis longus
B. Abductor pollicis brevis
C. Extensor pollicis brevis
D. Abductor pollicis longus
Answer: B
Rationale: The abductor pollicis brevis does not pass through the anatomical snuff-box.
