FORTINBERRY CH1

Question 1

The sinoatrial node is located in what chamber of the heart?
A. Leftatrium
B. Right atrium
C. Leftventricle
D. Right ventricle

Answer 1

Right atrium

The sinoatrial node is located in the right atrium of the heart. It serves as the pacemaker for the heart. Impulses generated there are passed on from right to left and inferiorly to the atrioventricular node in the lower end of the interatrial septum.

Question 2

Where in the tissues does nutrient exchange take place?
A. Capillaries
B. Interstitial spaces
C. Arterioles
D. Venules

Answer 2

Interstitial spaces

The vessels of the various sizes provides transmission conduits for body fluids, but the exchange described takes place between cell surfaces and the interstitial fluid.

Question 3

During which phase of the cardiac cycle is ventricular volume the lowest?
A. Atrial systole
B. Isovolumetric ventricular contraction
C. At the onset of rapid ventricular ejection
D. Isovolumetric ventricular relaxation

Answer 3

Isovolumetric ventricular relaxation

During the isovolumetric ventricular relaxation phase, all of the ventricular volume has been ejected. The semilunar and AV valves are closed, and no volume is changing in the ventricles. This phase has the lowest volume.

Question 4

The heart contains a variety of different types of muscle fibers, each with a different frequency of spontaneous contraction. Which of the following has the shortest period (highest frequency) of spontaneous contraction?
A. Purkinje fibers
B. SA node
C. AV node
D. Myocardium

Answer 4

SA node

The SA node has a frequency of 70 to 80 depolarization per minute: the AV node frequency is 40 to 60; and the purkinje cell frequency is 15 to 40; the myocardium is even slower. This question refers to how often these fibers will have action potentials, not haw fast they travel.

Question 5

Stimulation of CN X will cause which of the following effects?
A. Atrial fibrillation
B. Sinus bradycardia
C. Cardiac rigor
D. Ventricular fibrillation

Answer 5

Sinus bradycardia

Cranial nerve X stimulation causes
bradycardia by inhibiting automaticity of the SA node. Tachycardia effects are caused by inhibiting, not stimulating, the vagus. Cardiac rigor is a consequence of hypercalcemia and causes the heartto stop in systolic

Question 6

The volume of air moved going from full forced expiration to full forced inspiration is known as
A. Inspiratory capacity
B. Vital capacity
C. Total lung capacity
D. Inspiratory reserve volume

Answer 6

Vital capacity

Inspiratory capacity is the volume of air moved going from normal expiration to full forced inspiration. Total lung capacity is the volume of air in the lung on full forced inspiration and cannot be measured on spirometiv. Inspiratorv reserve volume is the volume or air moved going from normal inspiration to full forced inspiration

Question 7

During periods of intense physical activity, many physiologic adaptations occur, especially in the circulatory system. Which of the following occurs during increased physical exertion?
A. Increased ventricular refilling, secondary to increased venomotor tone
B. Decreased cardiac output
C. Decreased stroke volume
D. Increased cardiac cycle time

Answer 7

Increased ventricular refilling, secondary to increased venomotor tone

Cardiac output and stroke volume both increase during exertion. Increase cardiac cycle time is just another way of saying the heart beating is slower, which is the opposite of what occurs with exertion.

Question 8

Which of the following is indicative of left heart failure?
A. Pitting pedal edema
B. Neck vein distention
C. Orthopnea
D. Ascites

Answer 8

Orthopnea

Orthopnea, which is dyspnea in the recumbent position, is a typical symptom of chronic left heart failure. All of the other symptoms and signs are due to right heart failure.

Question 9

A patient asks the therapist to explain the function of his medication verapamil (a calcium antagonist. Which of the following points should be conveyed in the therapist’s explanation?
A. Verapamil causes decreased contractility of the heart and vasodilation of the coronary arteries.
B. Verapamil causes decreased contractility of the heart and vasoconstriction of the coronary arteries.
C. Verapamil causes increased contractility of the heart and vasodilation of the coronary arteries.
D. Verapamil causes increased contractility of the heart and vasoconstriction of the coronary arteries.

Answer 9

Verapamil causes decreased contractility of the heart and vasodilation of the coronary arteries.

Verapamil reduces contractility of the heart and increases coronary artery dilation, resulting in decreased cardiac workload and increased blood flow to the heart muscle.

Question 10

The protocol for a cardiac patient states that the patient should not exceed 5 metabolic equivalents (METs) with any activity at this stage of recovery. Which of the following activities would be inappropriate for the patient?
A. Cycling 11 mph
B. Walking 4 mph
C. Driving a car
D. Weeding a garden

Answer 10

Cycling 11 mph

Cycling 11 mph is approximately 6 to 7
METs. Walking 4 mph is approximately 4.6
METs. Driving a car is approximately 2 METs.
Weeding a garden is approximately 3 to 5 METs.

Question 11

During the opening of a patient’s mouth, a palpable and audible click is discovered in the left temporomandibular joint. The physician informs the therapist that the patient has an anteriorly dislocated disk. This click most likely signifies that
A. The condyle is sliding anteriorly to obtain normal relationship with the disk
B. The condyle is sliding posteriorly to obtain normal relationship with the disk
C. The condyle is sliding anteriorly and losing normal relationship with the disk
D. The condyle is sliding posteriorly and losing normal relationship with the disk

Answer 11

The condyle is sliding anteriorly to obtain normal relationship with the disk

In the case of a reciprocal click, the initial click is created by the condyle slipping back into the correct position under the disk with opening of the mouth. In this disorder, the condyle is resting posterior to the disk before jaw opening. With closing, the click is caused by the condyle slipping away from the disk.

Question 12

In what position should the therapist place the upper extremity to palpate the supraspinatus tendon?
A. Full abduction, full flexion, and full external rotation
B. Full abduction, full flexion, and full internal rotation
C. Full adduction, full external rotation, and full extension
D. Full adduction, full internal rotation, and full extension

Answer 12

Full adduction, full internal rotation, and full extension

The supraspinatus tendon is best
palpated by placing the patient’s involved upper extremity behind the back in full internal rotation.

Question 13

A 13-year-old girl has fractured the left patella during a volleyball game. The physician determines that the superior pole is the location of the fracture. Which of the following should be avoided in earl rehabilitation?
A. Full knee extension
B. 45 degrees of knee flexion
C. 90 degrees of knee flexion
D. 15 degrees of knee flexion

Answer 13

90 degrees of knee flexion

The superior pole is in most contact at approximately 90 degrees of knee flexion.

Question 14

During conference with the physical therapist, a respiratory therapist indicates that the patient has a low expiratory reserve volume. What does this mean?
A. The volume of air remaining in the lungs after a full expiration is low.
B. The volume of air in a breath during normal breathing is low.
C. The volume of air forcefully expired after a forceful inspiration is low.
D. The amount of air expired after a resting expiration is low.

Answer 14

The amount of air expired after a resting expiration is low.

Choice D describes an expiratory
reserve volume. Choice A is residual volume, choice B is tidal volume, and choice C is vital capacity.

Question 15

During an evaluation a 74-year-old woman informs you that she is “taking a heart pill.” The patient does not have her medication with her but states that the medication “slows down my heart rate.” Which of the following is the most probable medication?
A. Epinephrine
B. Digitalis
C. Quinidine
D. Norepinephrine

Answer 15

Quinidine

Epinephrine, digitalis, and
norepinephrine increase heart rate. Quinidine is an antiarrhythmic drug.

Question 16

A patient is referred to physical therapy with a secondary diagnosis of hypertension. The physician has ordered relaxation training. The therapist first chooses to instruct the patient in the technique of diaphragmatic breathing.
Which of the choices is the correct set of instructions?
A. Slow the breathing rate to 8 to 12 breaths perminute, increase movement of the upper chest, and decrease movement in the abdominal region.
B. Slow the breathing rate to 12 to 16 breaths perminute, increase movement of the abdominal region, and decrease movement in the upper chest.
C. Slow the breathing rate to 8 to 12 breaths per minute, increase movement of the abdominal region, and decrease movement in the upper chest.
D. Slow the breathing rate to 12 to 16 breaths per minute, increase movement of the upper chest, and decrease movement in the abdominal region.

Answer 16

Slow the breathing rate to 8 to 12 breaths per minute, increase movement of the abdominal region, and decrease movement in the upper chest.

Choice C provides correct instructions.
The patient is often instructed to begin this technique in the supine position and progress to the sitting position. This technique should be practiced for approximately 5 minutes several times per day.

Question 17

Which of the following statements about cardiovascular response to exercise in trained and/or sedentary patients is false?
A. If exercise intensities are equal, the sedentary patient’s heart rate will increase faster than the trained patient’s heart rate.
B. Cardiovascular response to increased workload will increase at the same rate for sedentary patients as it will for trained patients.
C. Trained patients will have a larger stroke volume during exercise.
D. The sedentary patient will reach anaerobic threshold faster than the trained patient if workloads are equal.

Answer 17

Cardiovascular response to increased workload will increase at the same rate for sedentary patients as it will for trained patients.

The sedentary patient’s cardiovascular response increases faster than the trained patient’s if the workloads are equal.

Question 18

A therapist is asked to examine a patient in the intensive care unit. The patient is comatose but breathing independently. During the assessment of range of motion in the right upper extremity, the therapist notices that the patient is breathing unusually. The pattern is an increase in breathing rate and depth followed by brief pauses in breathing. The therapist should notify the appropriate personnel that the patient is exhibiting which of the following patterns?
A. Biot’s respiration
B. Cheyne-Stokes respiration
C. Kussmaul’s respiration
D. Paroxysmal nocturnal dyspnea

Answer 18

Cheyne-Stokes respiration

The pattern described in the question: a
gradual increase in the rate and depth of respirations followed by periods of absent breathings known as Cheyne-Stokes breathing,
Small breaths followed by inconsistent periods of absent breathing are known as a Biot’s breathing pattern. Deep gasping breaths are known as a Kussmaul’s breathing pattern.
Awakening during the night because of periods of absent breathing is known as paroxysmal nocturnal dyspnea.

Question 19

Which of the following statements is not a common physiologic change of aging?
A. Blood pressure taken at rest and during exercise increases.
B. Maximal oxygen uptake decreases.
C. Residual volume decreases.
D. Bone mass decreases.

Answer 19

Residual volume decreases.

Residual volume, the amount of air left in the lungs after a forceful expiration, increases with age.

Question 20

A patient with cardiac arrhythmia is referred to physical therapy services for cardiac rehabilitation. The therapist is aware that the heart receives nerve impulses that begin in the sinoatrial node of the heart and then proceed to the
A. Atrioventricular node, then to the Purkinie fibers, and then to the bundle branches
B. Purkinie fibers, then to the bundle branches, and then to the atrioventricular node
C. Atrioventricularnode, then to the bundle branches, and then to the Purkinie fibers
D. Bundle branches, then to the atrioventricular node, and then to the Purkinie fibers

Answer 20

Atrioventricularnode, then to the bundle branches, and then to the Purkinie fiber

The heart receives nerve impulses that travel through the sinoatrial node to the ventricles by way of the atrioventricular node, bundle branches, and Purkinie fibers.

Question 21

A 65-year-old man is scheduled to begin a wellness program. He has no cardiovascular disease, major svstemic illness, or musculoskeletal abnormality. However, he is deconditioned because of an extremely sedentary lifestyle. Resting heart rate is 90 beats minute, and resting blood pressure is 145/92 mm Hg. Which of the choices describes the most correct intensity, frequency, and duration at which the patient should begin exercise?
A. 75Vo2max: 30 min/day: 3 days/wk
B. 40Vo2 max; 30 min/ day; 5 days/wk
C. 40 Vo2 max: 10 minutes twice dailv: 5 davs /wk
D. 75 Vo 2max; 10 minutes twice daily: 3 days/wk

Answer 21

40 Vo2 max: 10 minutes twice dailv: 5 davs /wk

Deconditioned people benefit initially from low-intensity exercise with multiple sessions per day and perweek.

Question 22

A 17-year-old athlete has just received a posterior cruciate ligament reconstruction. The therapist is attempting to explain some of the characteristics of the posterior cruciate ligament. Which of the following is incorrect information?
A. The posterior cruciate ligament prevents posterior translation of the tibia on the femur.
B. Posterior bands of the posterior cruciate ligament are their tightest in full knee extension.
C. The posterior cruciate ligamentis attached to the lateral meniscus and not to the medial meniscus.
D. The posterior cruciate ligament helps with medial rotation of the tibia during full knee extension with open-chain activities.

Answer 22

The posterior cruciate ligament helps with medial rotation of the tibia during full knee extension with open-chain activities.

The posterior cruciate ligament becomes tight in full knee extension. This assists the tibia in external rotation, which is needed for the screw home mechanism with open-chain activities.

Question 23

A patient starting to use antihypertensive medications must be observed when getting up or leaving a warm therapeutic pool in order to avoid an episode of
A. Bradycardia
B. Orthostatic hypotension
C. Dysrhythmias
D. Skeletal muscle weakness

Answer 23

Orthostatic hypotension

Antihypertensive medication may cause a sharp drop in blood pressure when getting up quickly or leaving a warm pool, which causes vasodilation. This is most evident at the beginning of therapy. Patients must be supervised and warned to get up slowly, to hold on to something firm, and to sit down when leaving the pool.

Question 24

A patient whose exercise-induced heart rate is less than the heart rate was before exercise is most likely starting therapy with
A. Anticholinergic drugs
B. Alphablockers
C. Betablockers
D. Antianginals

Answer 24

Betablockers

Beta blockers block the beta receptors on the heart; they also block sympathetic nerve impulses and reduce heart rate and contractility.
The other drugs have no effects, or they might increase heart rate.

Question 25

A patient inhales a beta agonist to relieve his asthma. After its use, you may notice A. An increase in heart rate B. A few moments of incoordination C. Flushing with red face D. A decrease in blood pressure

Answer 25

An increase in heart rate A beta agonist stimulates cardiac beta receptors, leading to an increase in heart rate and blood pressure.

Question 26

A patient is using a statin drug. Which of the following drug-induced signs or symptoms should be reported to the treating physician? A. Muscle pain B. Irregular heart beat C. Persistent diarrhea D. Intermittent confusion

Answer 26

Muscle pain In a small percentage of patients, statin drugs can cause liver damage (liver function tests are required) and muscle pain, which can leadto rhabdomyolisis (dark urine due to muscle breakdown), a potentially life-threatening condition. The other signs/symptoms are usually not drug related.

Question 27

Statin drugs lower cholesterol by A. Preventing cholesterol absorption B. Binding to cholesterol in the intestines C. Inhibiting HMG-CoA reductase D. Inhibiting lipoprotein lipase

Answer 27

Inhibiting HMG-CoA reductase Statin drugs inhibit HMG-CoA reductase and lower cholesterol levels most effectively (about 30% or more), while the other drugs interfere with absorption and lipase activity.

Question 28

A patient is being treated with an antiarrhythmic drug. The drug might cause all of the following adverse reactions except A. Dizziness and fainting B. Stevens Johnson svndrome C. Irregular heartbeats D. Joint and muscle pain

Answer 28

Joint and muscle pain All of the listed reactions can be observed, with joint and muscle pain being the exception.

Question 29

An asthmatic patient is to be exercised in a rather cool environment. It is recommended that the patient use the inhaler A. About 1 hr before exercise B. About 20 minutes before exercise C. Just at the beginning of exercise D. At the first onset of breathing problems during exercise

Answer 29

About 20 minutes before exercise While the use of an inhaler is user specific, it is generally recommended to have the patient inhale about 20 minutes before exercise, particularly in a cool environment, which seems to aggravate existing asthma.

Question 30

A patient using a beta blocker is exercised and might experience all of the following except A. Some breathing difficulties B. Muscle cramps and pain C. A smaller than expected increase in heart rate D. Some drowsiness

Answer 30

Muscle cramps and pain The reactions described in choices A and C can be expected because of blockade of beta receptors in the lungs and heart, and drowsiness is perhaps caused by a central action. No muscle cramps and pain should be expected.

Question 31

A beta blocker reduces blood pressure by all of the following actions except A. A reduction in cardiac output B. A reduction in central sympathetic outflow C. Inhibition of renin release D. A reduction in peripheral resistance

Answer 31

A reduction in peripheral resistance Beta receptor blockade, both peripherally and perhaps centrally, causes the blood pressure reducing effects, but peripheral resistance is not reduced but rather might be slightly increased (patient might complain about cold extremities).

Question 32

A patient on calcium channel blocker therapy might complain during therapy sessions about all of the following except A. Lightheadedness and dizziness B. Muscle pain and joint stiffness C. Tremors D. Edema

Answer 32

Tremors Calcium channel blockers will cause all of the listed reactions, except tremors, by interfering with calcium fluxes in blood vessels and cardiac muscle.

Question 33

A patient under the influence of local anesthetic therapy might experience all of the following except A. Some sensory impairment B. Increased blood pressure C. Tremors D. Motor deficits

Answer 33

Increased blood pressure A local anesthetic that might leak into the general blood circulation can affect the cardiac (bradvcardia, hvpotension) and central nervous systems (restlessness, tremors, seizures) and can interfere with the functions of sensory nerves and motor neurons.

Question 34

A patient with angina pectoris experiences some pain during exercise therapy and uses three tablets of sublingual nitroglycerin, but the pain does not subside. You should A. Ask the patient to stretch out quietly and breathe deeply B. Tell patient to continue the medication until the pain stops C. Call 911 since this could signal a true heart attack D. Administer two tablets of a non-narcotic analgesic to help reduce the pain

Answer 34

Call 911 since this could signal a true heart attack Nitroglycerin dilates coronary blood vessels and provides more blood and oxygen to the heart and also reduces peripheral resistance, making it easier for the heart to pump. Both actions eliminate the pain. If no relief is obtained, then this could be a true heart attack.

Question 35

Your patient is a 48-year-old male who reports to phvsical therapy with complaints of left shoulder and neck pain. Symptoms began insidiously 3 weeks ago and have been increasing in frequency and duration since that time. He notices the symptoms with lifting heavy objects and shoveling dirt for a garden that he is building. Walking fast elicits symptoms. Symptoms abate after several minutes of rest. He is in relatively good health with the exception of high blood pressure and shortness of breath. What system is most likely affected? A. Cardiovascular B. Pulmonary C. Musculoskeletal D. Hepatic

Answer 35

Cardiovascular All of the symptoms could potentially be related to musculoskeletal problems within the shoulder, but several factors make the cardiovascular svstem the best answer. The symptoms began insidiously, and many musculoskeletal shoulder issues can be traced back to a single incident or repetitive motions that aggravate and result in damage to musculoskeletal tissue. The patient cannot remember any incident that triggered the symptoms. Most of the symptoms that the patient is reporting can be attributed to the cardiovascular system. Lifting heavy objects, shoveling dirt, walking fast, high blood pressure, and shortness of breath are all symptoms indicative of cardiovascular system involvement.

Question 36

Your patient is a 38-year-old male who is a patient that you have been treating for left shoulder pain. He was in a motor vehicle accident since you last treated him 2 days ago. He was the driver and was rear-ended. He hit his left side on the door handle and has been having sharp pain in his ribs. X-rays the day of the accident revealed fractured ribs (ribs 6 and 7 on the left. He has been having difficulty breathing and has been very short of breath. Sharp pain is noted on the left with breathing and coughing. He has also noticed some blood in his sputum. What svstem is mostly likely the source of the patient's symptoms? A. Musculoskeletal B. Pulmonary C. Cardiovascular D. Hepatic

Answer 36

Pulmonary Although some of the svmptoms could be the result of musculoskeletal svstem involvement (i.e., rib fracture) or the cardiovascular system (left-sided pain), the best answeris the pulmonary system. The blood in the sputum is an indicator that the ribs may have punctured the lungs. This evidence, coupled with the breathing problems, should move the pulmonary system up as your top hypothesis.

Question 37

Aspirin and clopidogrel (Plavix) fall into which class of antithrombics? A. Thrombolvtics B. Platelet aggregator inhibitors C. Anticoagulants D. Fibrinolytics

Answer 37

Platelet aggregator inhibitors Aspirin and clopidogrel act as anticlotting/anticoagulant medications by preventing platelets from clumping together, thereby making it harder to form a clot.

Question 38

Which of the following drugs should angina patients always carry with/on them in case of an angina attack? A. Nitroglycerin patch B. An ACE inhibitor C. Digoxin D. Sublingual nitroglycerin

Answer 38

Sublingual nitroglycerin Sublingual nitroglycerin acts very quickly to relieve anginal pain by relaxing blood vessels to allow more blood to flow to the heart. Nitroglycerin patches are used to prevent an angina attack but sublingual nitroglycerin is most effective once an attack occurs.

Question 39

The part of the respiratory system that is most effected by asthma is/are the A. Bronchioles B. Trachea C. Nasal cavity D. Bronchi

Answer 39

Bronchioles The bronchioles are the smallest branches of the airways and are surrounded by smooth muscle. During an asthma attack. inflammation and muscle contraction occur, narrowing these airways and causing asthma symptoms.

Question 40

Some of the classes of drugs used to treat angina include A. Nitrates B. HMG-CoA reductase inhibitors C. Alpha-blockers D. Diuretics

Answer 40

Nitrates Angina is caused by decreased blood flow to the heart resulting in pain. Nitrates relax blood vessels, allowing more blood to flow to the heart and thereby decreasing pain.

Question 41

Beta-blockers that are useful in the treatment of hypertension A. Work by competitively inhibiting beta-receptors, thereby decreasing heart rate B.Are alwavs selective for betal-receptors C. Do not cause bronchoconstriction in patients with asthma D. Should not be combined with any other type of antihypertensive

Answer 41

Work by competitively inhibiting beta-receptors, thereby decreasing heart rate Beta-blockers block beta1-and beta2-receptors, resulting in decreased heart rate and dilation of blood vessels, which helps decrease hypertension. Unfortunately, they could also trigger an asthma attack in susceptible persons by blocking the beta2-receptors in the lungs.

Question 42

Which of the following medications should be used to treat an acute asthma attack? A. An oral steroid such as prednisone B. Along-acting beta-agonist such as salmeterol C. An inhaled steroid such as fluticasone D. A short-acting beta-agonist such as albuterol

Answer 42

A short-acting beta-agonist such as albuterol Short-acting beta-agonists, also known as "rescue" meds, act very quickly by binding to the beta2-receptors in the bronchioles, causing relaxation of the airways. They are indicated for asthma attacks and are not useful for long-term control of asthma symptoms.

Question 43

In children with osteogenesisimperfecta, fractures heal A. Within the normal healing time B. More quickly than normal C. More slowly than normal D. Only with assistance of medication

Answer 43

Within the normal healing time Healing time is unchanged with this patient population.

Question 44

Components of lower extremity alignment that contribute to toe-in include (1.44) A. Femoral retroversion B. Femoral anteversion C. Calcaneovalgus feet D. External tibial torsion

Answer 44

Femoral anteversion Femoral anteversion is the only one that would account for the internal rotation seen in toe in.

Question 45

Osteochondritis dissecans occurs most commonly in the (1.45) A. Capitellum B. Humeral condyle C. Medial femoral condyle D. Lateral femoral condyle

Answer 45

Medial femoral condyle The medial femoral condvle is the most common area for osteochondritisdissecans, although it can occur in the femoral capital epiphysis.

Question 46

The joint most frequently involved in pauciarticular juvenile rheumatoid arthritis is the (1.46) A. Cervical spine B. Lumbarspine C. Knee D. Wrist

Answer 46

Knee The knee is most common with this diagnosis followed by the ankles and elbows.

Question 47

The most common onset type of juvenile rheumatoid arthritis is (1.47) A. Svstemic B. Juvenile ankylosing spondylitis C. Polyarticular D. Pauciarticular

Answer 47

Pauciarticular Pauciarticular iuvenile rheumatoid arthritis (RA) occurs in 50%to 60% of the cases, followed by polyarticular RA and then svstemic RA.

Question 48

Considering an injury to the medial collateral ligament (MCL) of the knee, when does the inflammatory phase of healing begin? (1.48) A. First days after injury B. 2 to 3 weeks after injury C. 4 to 6 weeks after injurv D. 6 to 8 weeks after injury

Answer 48

First days after injury The healing phase of ligaments is divided into the following categories: inflammatory phase (first few days after injury, proliferative phase (1 to 6 weeks after injury), and remodeling phase (begins at 7 weeks postinjury).

Question 49

Which of the following types of exercise is most likely to intensify delayed onset muscle soreness (DOMS)? (1.49) A. Concentric exercise is most likely to intensify DOMS. B. Eccentric exercise is most likely to intensify DOMS. C. Isometric exercise is most likely to intensify DOMS. D. DOMS will remain constant no matter the type of exercise.

Answer 49

Eccentric exercise is most likely to intensify DOMS. Since eccentric exercise makes the muscle work the hardest, this type of exercise will exacerbate DOMS. DOMS symptoms are alleviated in 2 to 3 days with stretching and ice application.

Question 50

What is the correct order of the stages of bone healing after a fracture? (1.50) A. Inflammatory phase, hard callous phase, soft callous phase, remodeling phase B. Inflammatory phase, soft callous phase, hard callous phase, remodeling phase C. Remodeling phase, soft callous phase, hard callous phase, inflammatory phase D. Remodeling phase, hard callous phase, soft callous phase, inflammatory phase

Answer 50

Inflammatory phase, soft callous phase, hard callous phase, remodeling phase Healing phases of bone after fracture are divided into the following categories: Inflammatory phase (immediately after injury), soft callous phase (1 to 6 weeks postinjury), hard callous phase (4 to 6 weeks after injury), and remodeling phase (6 weeks to several months postinjury).

Question 51

Which type of connective tissue includes the superficial sheath of body tissue under the skin, muscle, and nerve sheaths, and the framework of internal organs? A. Dense regular connective tissue B. Dense irregular connective tissue C. Loose irregular connective tissue D. Loose regular connective tissue

Answer 51

Loose irregular connective tissue Dense regular connective tissue includesligaments and tendons, and dense irregular connective tissue includes joint capsules, periosteum, and aponeurosis. Choice D does not exist.

Question 52

Which patient population is most likely to have osteophyte formation that leads to rotator cuff damage? A. 16-year-old baseball player B. 34-year-old factory worker C. 45-year-oldtennis plaver D. 75-year-old sedentary individual

Answer 52

75-year-old sedentary individual The aged are more likely to have osteophyte formation. All other populations can have rotator cuff damage, but it will most likely come from another source.

Question 53

You are seeing a patient who has just received a steroid injection into a joint. You should A. Treat this joint vigorously B. Treat this joint gently C. Not touch this joint at all D. Postpone the session for at least 1 week

Answer 53

Treat this joint gently A steroid injection can weaken tendons andligaments; thus, the joint must be moved carefully.

Question 54

A patient with osteoporosis might be treated with all of the following drugs except A. Bisphosphonates B. Calcitonin C. Calcium with vitamin D D. Thyroid hormones

Answer 54

Thyroid hormones Thyroid hormone is not used but the parathyroid hormone is used in cases of certain calcium imbalances. All of the listed agents are used with bisphosphonates to be taken on an empty stomach and sitting or standing for at least 30 min.

Question 55

A patient has been told to use Advil for rheumatoid arthritis. You notice that the patient uses acetaminophen because a friend uses it, and it is cheaper. You can tell the patient that acetaminophen A. Can be used since it is the same as Advil B. Is different from Advil but has the same therapeutic action C. Is actually more effective than Advil D. Does not work in rheumatoid arthritis

Answer 55

Does not work in rheumatoid arthritis Acetaminophen has analgesic and antipyretic but no antiinflammatory properties. It is not indicated in rheumatoid arthritis, which is an inflammatory condition; however, it can be used in osteoarthritis, which is not an inflammatory problem.

Question 56

Skeletal muscle relaxants A. May interfere with walking in patients who use their spasticity to control balance B. Selectively paralyze certain muscle groups C. Should be stopped quickly after long-term use when problems have been resolved D. Have never been proven effective

Answer 56

May interfere with walking in patients who use their spasticity to control balance Some patients use certain aspects of spasticity to maintain balance; weakening of this spasticity could interfere with their balance. Skeletal muscle relaxants (except botulinus toxin) weaken but do not paralyze muscles, and some may cause physical dependence, which prohibits abrupt cessation of their long-term use. Numerous studies have confirmed the effectiveness of skeletal muscle relaxants.

Question 57

While doing a worksite assessment in the hospital business office, a physical therapist found several employees complaining of neck and shoulder pain. It was determined that making a simple change in the set-up of the computer stations could reduce symptoms. The change to the computer monitor that would MOST affect neck and shoulder discomfort is A. Lowering the monitor to the desk surface B. Moving the computer monitor closer to the employee's face C. Tilting the monitor forward D. Putting a nonglare screen on the monitor

Answer 57

Moving the computer monitor closer to the employee's face The line of vision dictates head and neck posture. If the screen is too low or too far away from the face, the user must flex the neck and trunk. If the head is held forward, cervical muscles become fatigued.

Question 58

The cuboid bone is located just posterior to the A. Base of the first metatarsal B. Head of the first metatarsal C. Medial cuneiform bone D. Tuberosity of the fifth metatarsal

Answer 58

Tuberosity of the fifth metatarsal The tuberosity of the fifth metatarsal is at the base of the metatarsal. The base of the metatarsal is proximal and the head is distal. The medial cuneiform is on the high medial side of the transverse arch of the foot. The cuboid bone is on the lower lateral side of the foot.

Question 59

59. The metacarpophalangeal joints are classified as what type of joint? A. Plane B. Hinge C. Condyloid D. Saddle

Answer 59

Condyloid Metacarpophalangealjoints are condyloid joints. These are biaxial joints that allow flexion /extension around one axis and abduction /adduction around another axis.

Question 60

Which muscle would move the abducted (90 degree) arm anteriorly? A. Sternocostal head of the pectoralis major B. Clavicular head of the pectoralis major C. Inferior fibers of the serratus anterior D. Pectoralis minor

Answer 60

Clavicular head of the pectoralis major These actions can be easily demonstrated and palpated. Resisting anterior movement of the arm abducted to 60 degrees tests the sternocostal head of the pectoralis major; the clavicular head is tested after the arm is abducted to 90 degrees.

Question 61

Which one of the following structures does NOT pass through the foramen magnum of the occipital bone? A. Spinal cord B. Meninges C. Cranial nerve XII D. Vertebral artery

Answer 61

Cranial nerve XII The structures that pass through the foramen magnum include the spinal cord, the meninges, the spinal components of cranial nerve Xl, and the vertebral arteries. Cranial nerve XII exits the skull through the hypoglossal canals.

Question 62

Contraction of which muscle produces extension of the head? A. Spinaliscervicis B. Longuscapitis C. Longuscolli D. Sternocleidomastoid

Answer 62

Spinaliscervicis The longuscapitis, longuscolli, and sternocleidomastoid muscles are all associated with the anterior aspect of the cervical vertebrae and thus produce flexion of the head.

Question 63

The nucleus pulposus is thickest in which region of the spine? A. Lumbar spine B. Inferior half of the thoracic spine C. Superior half of the thoracic spine D. Cervical spine

Answer 63

Lumbar spine The nucleus pulposus is thickest in the lumbar spine, followed by the cervical region; it is thinnest in the thoracic spine.

Question 64

The speed of muscle contraction is a function of which of the following factors? A. Resting length of the muscle fiber B. Cross-sectional diameter of the muscle C. Creatine phosphate of the muscle D. Glycolytic capacity of the muscle

Answer 64

Resting length of the muscle fiber The speed of contraction is directly related to the resting length of the muscle fiber, whereas the force of contraction depends upon the cross-sectional diameter. Creatine phosphate content ensures availability of ATP for the contraction-relaxation cvcles, and glycolytic capacity is important for endurance.

Question 65

Which of the following describes the proper normal anatomy of the proximal carpal row, from lateral to medial? A. Capitate, lunate, triquetrum, pisiform B. Lunate, trapezium, capitate, hamate C. Scaphoid, lunate, triquetrum, pisiform D. Scaphoid, hamate, lunate, capitate

Answer 65

Scaphoid, lunate, triquetrum, pisiform This is the normal anatomy, lateral to medial of the proximal row of the carpus. The distal row, lateral to medial, is the trapezium, trapezoid, capitate, and hamate.

Question 66

A therapist is testing key muscles on a patient who recently suffered a spinal cord injury. The current test assesses the strength of the long toe extensors. Which nerve segment primarily innervates this key muscle group? A. L2 B. L3 C. L4 D. L5

Answer 66

L5 The long toe extensors represent the spinal cord segment L5. The iliopsoas represents L2. The quadriceps are innervated by L3 and the tibialis anterior is innervated by L4.

Question 67

A physician notes a vertebral fracture in the x-ray of a patient involved in a car accident. The fractured vertebra has a bifid spinous process. Which of the following vertebrae is the most likely to be involved? A. Fourth lumbar vertebra B. Fifth cervical vertebra C. Twelfth thoracic vertebra D. First sacral vertebra

Answer 67

Fifth cervical vertebra Bifid spinous processes (spinous processes that are split) are found only in the cervical spine.

Question 68

If the line of gravity is posterior to the hip joint in standing, on what does the body first rely to keep the trunk from moving into excessive lumbar extension? A. Iliopsoas muscle activity B. Abdominal muscle activity C. Anterior pelvic ligaments and the hip joint capsule D. Posterior pelvic ligaments and the hip joint capsule

Answer 68

Anterior pelvic ligaments and the hip joint capsule In static standing, the line of gravity is posterior to the hip joint. The body relies on the anterior pelvic ligaments and the hip joint capsule. The iliopsoas may be recruited at times, but anterior ligaments are used first to keep the trunk from extending in static stance.

Question 69

What is the closed-packed position of the shoulder? A. Internal rotation and abduction B. External rotation and abduction C. Internal rotation and adduction D. External rotation and adduction

Answer 69

External rotation and abduction The area of contact between the humerus and the glenoid fossa is maximal in this position.

Question 70

A patient with a diagnosis of a rotator cuff tear has just begun active range of motion. The therapistis strengthening the rotator cuff muscles to increase joint stability and oppose the superior shear of the deltoid. Which of the rotator cuff muscles participate least in opposing the superior sheer force of the deltoid? A. Infraspinatus B. Subscapularis C. Teres minor D. Supraspinatus

Answer 70

Supraspinatus The subscapularis, teres minor, and infraspinatus muscles oppose the superior pull of the deltoid muscle. The supraspinatus does not oppose the pull of the deltoid but is important because (along with the other cuff muscles) it provides a compression force to the glenohumeral joint.

Question 71

What portion of the adult knee meniscus is vascularized? A. The outer edges are vascularized. B. The inner edges are vascularized. C. The entire meniscus is vascular. D. The entire meniscus is avascular.

Answer 71

The outer edges are vascularized. Only the edges of the adult meniscus are vascularized by the capillaries from the synovial membrane and joint capsule.

Question 72

At what age does a human have the greatest amount of fluid in the intervertebral disc? A. 1 year B. 4 years C. 7 years D. 10 years

Answer 72

1 year The intervertebral disc has the greatest amount of fluid at the time of birth. The fluid content decreases as a person ages.

Question 73

Which of the following is not an example of a synarthrodial joint in the body? A. Coronal suture B. The fibrous joint between the shaft of the tibia and fibula C. Symphysis pubis D. Metacarpophalangeal

Answer 73

Metacarpophalangeal The metacarpophalange al joint is enclosed in a joint capsule and therefore is considered a diarthrodial joint.

Question 74

A football player presents to an outpatient clinic with complaints of pain in the right knee after an injury suffered the night before. The phvsician determines that the anterior cruciate ligament (ACL) is torn. Which of the following is most commonly associated with an injury causing damage to the ACL only? A. Varus blow to the knee with the foot planted and an audible pop B. Foot planted, medial tibial rotation, and an audible pop C. Valgus blow to the knee with the foot planted and no audible pop D. Foot planted, lateral tibial rotation, and no audible pop

Answer 74

Foot planted, medial tibial rotation, and an audible pop Choice B best describes the position that causes injury only to the ACL. In most cases an audible pop indicates a tear of the ACL. Varus or valgus blows to the knee injure the collateral ligaments and possibly the ACL.

Question 75

A 27-year-old woman is referred to a physical therapy clinic with a diagnosis of torticollis. The right sternocleidomastoid is involved. What is the most likely position of the patient's cervical spine? A. Right lateral cervical flexion and left cervical rotation B. Right cervical rotation and right lateral cervical flexion C. Left cervical rotation and left lateral cervical flexion D. Leftlateral cervical flexion and right cervical rotation

Answer 75

Right lateral cervical flexion and left cervical rotation Torticollis involving the right sternocleidomastoid would cause right lateral cervical flexion and left cervical rotation.

Question 76

Observing a patient in a standing position, the therapist notes that an angulation deformity of the right knee causes it to be located medially in relation to the left hip and left foot. This condition is commonly referred to as A. Genu varum B. Genu valgum C. Pescavus D. None of the above

Answer 76

Genu valgum Genu valgum is a term used to describe a deformity of the knee causing an inward bowing of the legs. Genu varus is an outward bowing of the legs. Coxavalgum is a deformity at the hip in which the angle between the axis of the neck of the femur and the shaft of the femur is greater than 135 degrees. In coxavarus this angle is less than 135 degrees. Pescavus is an increase in the arch of the foot. Pesplanus is flat foot.

Question 77

Which of the following is the most vulnerable position for dislocation of the hip? A. 30 degrees hip extension, 30 degrees hip adduction, and minimal internal rotation B. 30 degrees hip flexion, 30 degrees hip adduction, and minimal external rotation C. 30 degrees hip flexion, 30 degrees hip abduction, and minimal external rotation D. 30 degrees hip extension, 30 degrees hip abduction, and minimal external rotation

Answer 77

30 degrees hip flexion, 30 degrees hip abduction, and minimal external rotation This is the loose-packed position of the hip. code: FABER 3030slight

Question 78

Which of the following articulate with the second cuneiform? A. Navicular B. Talus C. First metatarsal D. Cuboid

Answer 78

Navicular The second cuneiform of the foot articulates with the first cuneiform, second metatarsal, third cuneiform, and navicular.

Question 79

The terms below refer to properties of water that make hydrotherapy valuable to a variety of patient populations. Match the following terms with the statement that best relates to each term. 1. Viscosity 2. Buoyancy 3. Relative density 4. Hydrostatic pressure I.This property can assist in the prevention of blood pooling in the lower extremities of a patient in the pool above waist level II. This property makes it harder to walk faster through water III. A person with a higher amount of body fat can float more easilvthan a lean person because of this property IV. This property makes it easier to move a body part to the surface of the water and harder to move a part away from the surface. A. 1-II, 2-III, 3-IV, 4-I B. 1-II, 2-IV, 3-III, 4-I C. 1-111, 2-II, 3-1, 4-IV D. 1-1. 2-II, 3-I, 4-IV

Answer 79

1-II, 2-IV, 3-III, 4-I Viscosity is the friction of fluids. Buoyancy is the property that pushes up on the part immersed with a pressure that is equal to the weight of the amount of water displaced by that part. Relative density states that if the specific gravity of an object is less than one, it will float, and if it is greater than one, it will sink. Hydrostatic pressure is the property of water that places pressure equally on the immersed part.

Question 80

A physician ordered a splint for a patient who should keep the thumb of the involved hand in abduction. A new graduate is treating the patient and is confused about the difference between thumb flexion, extension, abduction, and adduction. Which of the following lists is correct? A. Extension is performed in a plane parallel to the palm of the hand, and abduction is performed in a plane perpendicular to the palm of the hand. B. Flexion is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. C. Extension is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. D. In referring to positions of the thumb, flexion and adduction are used synonymously, and extension and abduction are used synonymously.

Answer 80

Extension is performed in a plane parallel to the palm of the hand, and abduction is performed in a plane perpendicular to the palm of the hand Flexion and extension of the thumb are performed in a plane parallel to the palm of the hand. Abduction and adduction are performed in a plane perpendicular to the palm of the hand.

Question 81

A physical therapist receives an order from the physician to treat a patient using iontophoresis. The order indicates that the purpose of the treatments to attempt to dissolve a calcium deposit in the area of the Achilles' tendon. When preparing the patient for treatment, the therapist connects the medicated electrode to the negative pole. Which of the following medications is the therapist most likelv preparing to administer? A. Dexamethasone B. Magnesium sulfate C. Hydrocortisone D. Acetic acid

Answer 81

Acetic acid Acetic acid is sometimes used in attempts to dissolve a calcium deposit and is driven by the negative pole. Dexamethasone is an anti-inflammatory driven by the negative pole. Magnesium sulfate is used to decrease muscle spasms andis driven by the positive pole. Hydrocortisone is also used to treat inflammation and is driven by the positive pole.

Question 82

A therapist is assisting a patient in gaining lateral stability of the knee joint. The therapist is using strengthening exercises to strengthen muscle groups that will increase active restraint on the lateral side of the joint. Which of the following offers the least amount of active lateral restraint? A. Gastrocnemius B. Popliteus C. Bicepsfemoris D. Iliotibial band

Answer 82

Gastrocnemius The popliteus, biceps femoris, and iliotibial band offer active restraint for the lateral side of the knee joint. The gastrocnemius assists in active restraint of the posterior side of the knee joint.

Question 83

A patient is in an outpatient facility because of an injury sustained to the right knee joint. Only the structures within the synovial cavity were compromised during the injury. Knowing this information only, the therapist is not concerned with injury to which of the following structures? A. Patellofemoral ioint B. Anterior cruciate ligament C. Medial meniscus D. Femoral condyles

Answer 83

Anterior cruciate ligament The anterior cruciate ligament is located within the articular cavity but outside the synovial lining. The anterior and posterior cruciate ligaments have their own synovial lining. Code: ICES

Question 84

A patient is being examined by a physical therapist because of bilateral knee pain. The therapist is attempting to rule out ankle or foot dysfunction as the source of the pain. Which of the following observations is not true in examining a patient without foot or ankle problems in the standing position? A. The talus is situated somewhat medially to the midline of the foot. B. In quiet standing, the muscles surrounding the ankle joint remain silent. C. The first and second metatarsal heads bear more weight than the fourth and fifth metatarsal heads. D. The talus transmits weight to the rest of the bones of the foot.

Answer 84

In quiet standing, the muscles surrounding the ankle joint remain silent. Plantar flexors have to contract in quiet standing. Other muscles are recruited with movement of the center of gravity.

Question 85

A physical therapist is examining a female distance runner who complains of intermittent medial ankle pain. In static standing, the therapist palpates excessive lateral deviation of the head of the talus. From this information, in what position is the subtalar joint during palpation? A. supination B. Pronation C. Neutral D. Unable to determine from the information given

Answer 85

supination The talus is palpated just anterior and lateral to the medial malleolus. Supination is excessive lateral deviation of the talus, and pronation is excessive medial deviation.

Question 86

Which of the following is not part of the triangular fibrocartilage complex of the wrist? A. Dorsal radioulnar ligament B. Ulnar collateral ligament C. Radial collateral ligament D. Ulnar articular cartilage

Answer 86

Radial collateral ligament The triangular fibrocartilage complex is made up of the dorsal radioulnar ligament, ulnar collateral ligament, ulnar articular cartilage, volar radioulnar ligament, ulnocarpal meniscus, and sheath of the extensor carpi ulnaris.

Question 87

A physical therapist is attempting to explain the importance of slow stretching to an athlete training to compete in a marathon. The therapist explains that quick stretching often causes the muscle to________ , which is a response initiated by the _______ which are located in the muscle fibers. A. Relax, Golgi tendon organs B. Contract, Golgi tendon organs C. Relax muscle spindles D. Contract, muscle spindles

Answer 87

Contract, muscle spindles The muscle spindles are responsible for the stretch reflex. When a muscle is stretched too quickly, the muscle spindles cause the muscle to contract and shorten (which is called the stretch reflex). The Golgi tendon organs are responsible for the inverse stretch reflex. They are located in the junction between the muscle andtendon and detect changes in tension. When a tendon is stretched too quickly, the Golgi tendon organs cause the muscle to relax.

Question 88

What is the normal low-end range for interincisal opening with a TMD patient? A. 50 mm B. 30 mm C. 40 mm D. 60 mm

Answer 88

40 mm Forty millimeters is the normal end range of opening.

Question 89

What is dental trismus? A. Capsulitis of the TMJ B. Osteoarthritis of the TMJ C. Muscle spasm of the TMJ D. The triggerpoint of the TMJ

Answer 89

Muscle spasm of the TMJ Dental trismus mav be due to spasm or to abnormally short law muscles. There is an inability to open the jaw fully.

Question 90

Temporomandibular anterior disc displacement without reduction occurs between the A. Disc and the lower joint compartment B. Disc and the ementia articularis C. Disc and the lateral pterygoid muscle D. Disc and the upper joint compartment

Answer 90

Disc and the upper joint compartment The condyle glides anterior translatory down the eminence (26 mm to 50 mm of opening) with the disc in the upper joint compartment. Occasionally the disc is displaced anteriorly, and adhesions may occur that produce an anterior displaced disc without reduction (locked joint).

Question 91

What are the signs and symptoms of a temporomandibular anterior displaced disc with reduction? A. Crepitation with loss of opening B. Clicking with opening C. No clicking with loss of opening D. Temporomandibular joint tenderness and loss of opening

Answer 91

Clicking with opening Reduction indicates that the condvle is able to slide under the disc (reduce), causing a clicking noise.

Question 92

What is the normal TMJ arthrokinematics for lateral movements? A. Bilateral translation B. Bilateral rotation C. Contralateral rotation and ipsilateral translation D. Ipsilateral rotation and contralateral translation

Answer 92

Ipsilateral rotation and contralateral translation Ipsilateral rotation and contralateral translation describe lateral jaw movement.

Question 93

What is the normal TMJ arthrokinematics for protrusion? A. Bilateral anterior translation B. Bilateral posterior translation C. Ipsilateral rotation with contralateral translation D. Bilateral rotation

Answer 93

Bilateral anterior translation Bilateral anterior translation describes jaw protrusion.

Question 94

What is the normal TMJ arthrokinematics for wide opening? A. Bilateral translation B. Combination of rotation occurs first 26 mm then anterior translation C. Combination of anterior translation occurs first 26 mm then anterior rotation D. Bilateral rotation

Answer 94

Combination of rotation occurs first 26 mm then anterior translation A combination of rotation occurs during the first 26 mm. then anterior translation describes wide jaw opening.

Question 95

Positioning of a patient in right side-lying can create pressure on the A. Right ischial tuberosity B. Left greater trochanter C. Right lateral malleolus D. Occiput

Answer 95

Right lateral malleolus Pressure in right side-lying would create pressure on the right greater trochanter and right lateral mallelous. No pressure is put on the occiput or ischial tuberosity in side-lying.

Question 96

Ideal postural alignment is influenced by appropriate muscle balance. What combinations of muscle imbalance would likely contribute to increased anterior pelvic tilt? A. Short hamstrings and elongated hip flexors B. Strong anterior abdominals and strong hip flexors C. Short hip flexors and lengthened anterior abdominals D. Strong anterior abdominals and strong hip extensors

Answer 96

Short hip flexors and lengthened anterior abdominals Shortened hip flexors and lengthened anterior abdominals will contribute to an anterior tilt. Choices A and D would create a posterior pelvic tilt, and choice B will likely present with a more neutral position of the pelvis.

Question 97

A patient presents with anterior knee pain, which of the following cannot be the source of that pain? A. SYnovium B. Capsule C. Patella cartilage D. Patella bone

Answer 97

Patella cartilage Patella cartilage cannot be the source of the pain. Every structure in the knee has pain nerve fibers except the articular cartilage.

Question 98

Anterior cruciate ligament tears do not heal as well as medial collateral ligament tears because A. The ACL is under greater tension B. Synovial fluid inhibits ACL healing C. The MCL is broad and flat allowing better healing D. There is more motion in the ACL

Answer 98

Synovial fluid inhibits ACL healing Synovial fluid has been shown to inhibit healing of ligament tissues.

Question 99

Patellofemoral joint reactive forces are highest with A. Running B. Straight leg raises C. Prolonged sitting D. Plyometrics

Answer 99

Plyometrics Jumping (plyometrics) can generate up to 7 times body weight at the patella. Running is next most stressful at 3.5 times body weight.

Question 100

Rotator cuff tear A. Is rare under the age of 40 B. Is usually painful C. Progresses from the bursal side toward the articular side D. Requires surgical repair

Answer 100

Is rare under the age of 40 Rotator cuff tear is rare under the age of 40. It can occur from either side and is very common. Cadaver studies confirm that cuff tear is not usually svmptomatic.

Question 101

Foot drop following total hip arthroplasty most likely indicates A. Stroke B. Disc herniation C. Sciatic laceration D. Traction neurapraxia

Answer 101

Traction neurapraxia Traction from operative positioning, retractor placement, or lengthening of the leg leads to most cases of sciatic traction neurapraxia and foot drop.

Question 102

Sever's apophysitis A. Frequently occurs with Achilles tendinitis B. Is a result of leg length inequality C. Is not an inflammatory condition D. Responds to ultrasound treatment

Answer 102

Frequently occurs with Achilles tendinitis Sever's apophysitis is a physeal stress injury. Tight Achilles tendons are uniformly seen and frequently there is tendinitis.

Question 103

Pesplanus A. Is a painful condition B. Is common in patients with hyperlaxity C. Requires orthotics treatment D. Results in anterior knee pain if not corrected

Answer 103

Is common in patients with hyperlaxity Pesplanus is common and usually painless. Hyperlaxity is a powerful risk factor for development of pesplanus. In most cases, no treatment is necessary.

Question 104

A patient was referred for physical therapy after removal of a long arm cast extending to the forearm. She lacks full passive elbow extension. What may be causing this problem? A. Active insufficiency of the biceps B. Tightness in posterior humeroulnar joint capsule C. Passive insufficiency of the pronator teres D. Passive insufficiency of the triceps

Answer 104

Passive insufficiency of the pronator teres Passive insufficiency of the pronator teres. The question asks specifically about passive limitations to elbow extension. The pronator teres is a polyarticular muscle crossing anterior to the elbow joint.

Question 105

A 10 degrees hip flexion contracture produces torque at the hip that increases muscle demand on the A. Extension, quadriceps B. Flexion, biceps femoris C. Abduction, adductor magnus D. Flexion, iliopsoas

Answer 105

Flexion, biceps femoris Choice B, flexion, biceps femoris, is the correct answer. A hip flexion contracture increases flexor torque across the anterior hip. This increases muscle demand on the hip extensors. The biceps femoris is an extensor of the hip.

Question 106

The physical therapist is analyzing a patient's gait with descending stairs. During left single limb stance, the patient demonstrates a right pelvic drop with left trunk lean. The physical therapy hypothesis is A. Weak right gluteus medius with left trunklean to move center of mass towards stronger side B. Weak left gluteus medius with left trunk lean to move center of mass towards weaker side C. Weakleft quadratuslumborum producing left trunk lean D. Weak right gluteus medius with left trunklean to move center of mass towards stronger side

Answer 106

Weak left gluteus medius with left trunk lean to move center of mass towards weaker side Weak left gluteus medius with left trunk lean to move center of mass towards weaker side is the correct hypothesis. A pelvic drop in single limb midstance is a classic positive Trendelenberg sign of gluteus medius weakness. The compensatory trunk laterallean is to bringthe center of mass closer to the weaker side to decrease the external moment arm on the weak muscle.

Question 107

Left lateral trunk flexion is limited primarily by A. The thoracic spine because of sagittal facet alignment B. The rib cage because of multiple attachments C. The lumbar spine because of horizontal plane facet orientation D. The left quadratuslumborum

Answer 107

The rib cage because of multiple attachments Left lateral trunk flexion is limited primarily by the rib cage because of multiple attachments. The thoracic spine has frontal plane facet alignment. The lumbar spine facets are oriented in the sagittal plane. The left quadratuslumborum is on slack during left lateral flexion.

Question 108

Which is true about the hip joint? A. The hip joint's closed pack position is extension with full external rotation. B. The hip joint's loose pack position is 30 degrees of abduction, 70 degrees of flexion with lateral rotation. C. With its capsular pattern of restriction, medial rotation is most restricted in the hip joint. D. With its capsular pattern of restriction, flexion is most restricted in the hip joint.

Answer 108

With its capsular pattern of restriction, flexion is most restricted in the hip joint. According to Cyriax's classical description, flexion in the hip is limited to the greatest in its capsular pattern.

Question 109

A physical therapist is conducting a screen for visual field deficits by having the client look straight ahead and presenting a stimulus at the outer margins of the person's visual fields. The examination technique checks cranial nerves) function. A. II B. III, IV, VI C. V D. VIII

Answer 109

II Of the choices listed, cranial nerve Il or the optic nerve functions to constrict the pupil and vision. Ischemia, resulting from stroke or head injury, or pressure from tumors can adversely affect the function of the nerve. Visual field loss depends on the location of the lesion. A lesion occurring before the optic chiasm results in loss of vision in the fields on the same side. After the optic chiasm, a lesion will cause loss of vision in both fields. The visual field affected will be opposite to the side of the lesion and is also known as homonymous hemianopsia.

Question 110

The next patient on your schedule is a 69-year-old Asian woman with a diagnosis of "T8 fracture." What condition are you most concerned with for this patient? A. Neckpain B. Myopathy C. Dizziness D. Osteoporosis

Answer 110

Osteoporosis Risk factors for osteoporosis include advanced age, being thin, positive family history, exposure to certain medications, and ancestry (Caucasian or Asian).

Question 111

Which of the following are not appropriate interventions for a patient with osteoporosis and a T8 compressions fracture? A. Balance exercises B. Postural exercises C. Proprioceptive training D. Ultrasound

Answer 111

Ultrasound Physical therapy intervention for individuals with osteoporosis has several goals: optimization of bone formation, fall prevention, fracture prevention, postfracture rehabilitation, and treatment of musculoskeletal conditions that place the individual at risk for falls in the future. Ultrasound is contraindicated over a fracture site.

Question 112

A patient is suffering from chronic back pain as a result of a recent automobile accident. He is currently taking an opioid medication for reliefof this pain. Which of the following medications is an opioid? A. Ibuprofen B. Aspirin C. Codeine D. Acetaminophen

Answer 112

Codeine Opioids belong to a class of drugs that provide pain relief by binding to opioid receptors. Ibuprofen and aspirin are nonsteroidal anti-inflammatory (NSAID) medications, while acetaminophen is in a class of its own; however, none of these three medications bind to opioid receptors.

Question 113

An athlete has been complaining of muscle spasms. Her physician decided to treat herwith a medication called cyclobenzaprine, which is a muscle relaxant. She is unfamiliar with this medication and asks if you can tellher anything about it. Which of the following is a correct statement? A. There are no such medications as muscle relaxants. B. Muscle relaxants are the same thing as anti-inflammatory medications. C. Drowsiness, blurred vision, and dry mouth are some of the side effects of muscle relaxants. D. You cannot overdose on muscle relaxants.

Answer 113

Drowsiness, blurred vision, and dry mouth are some of the side effects of muscle relaxants. Drowsiness, blurred vision, and dry mouth are side effects of the anticholinergic properties that muscle relaxants possess. These side effects are also the ones patients complain about most often.

Question 114

All NSAIDs inhibit manner or another. A. Bradykinin B. Cyclooxygenase (COX) C. Prostaglandins D. Lipoxygenase

Answer 114

Cyclooxygenase (COX) All NSAIDs inhibit the enzyme cyclooxygenase (COX), thereby decreasing the inflammatory reaction.

Question 115

Which NSAID has been used because of its lower incidence of GI complications? A. Naproxen B. Aspirin C. Ketoprofen D. Celecoxib

Answer 115

Celecoxib Celecoxib is unique from the other NSAIDs in that it specifically inhibits COX- 2. One of the most worrisome side effects of NSAIDs is the potential for ulcers since nonselective COX inhibitor NSAIDs block the production of prostaglandins that provide a protective effect against acids in the stomach. COX-2 specific NSAIDs do not inhibit the production of these protective prostaglandins.

Question 116

Your patient had a laceration anterior to the medial malleolus that required stitches. He is now in your office complaining of pain along the medial border of the foot. Which nerve is most likely involved? A. Sural nerve B. Deep fibular C. Tibial nerve D. Saphenous nerve

Answer 116

Saphenous nerve The saphenous nerve lies just anterior to the medial malleolus alongside the great saphenous vein. This nerve is most likely to be injured by the sutures.

Question 117

Which named peripheral nerve is responsible for pain sensation from the pericardium, mediastinal pleura, diaphragmatic pleura, and diaphragmatic peritoneum? A. Vagus nerve B. Phrenic nerve C. Greater thoracic splanchnic nerve D. Tenth intercostal nerve

Answer 117

Phrenic nerve The phrenic nerve arises from ventral rami of C3, C4, and C5 spinal nerves. The sensory neurons of the dorsal root ganglia of C3, C4, and C5 supply axons for somatic pain from the named area of parietal serous membranes. C3, C4, and C5 also supply the shoulder with the cutaneous innervation by the supraclavicular nerves. This is why pericardial or diaphragmatic pain will refer to the shoulder.

Question 118

The neural canal is smallest and circular in shape in the region of the vertebral canal. A. Cervical B. Thoracic C. Lumbar D. Sacral

Answer 118

Thoracic The neural canal (vertebral canal) is largest and most triangular in the cervical region and smallest and most circular in the thoracic region.

Question 119

Ascending tracts in the white matter of the spinal cord carry information. A. Sensory B. Motor C. Both sensory and motor D. Autonomic

Answer 119

Sensory The white matter of the spinal cord carries ascending (sensory) tracts and descending (motor) tracts.

Question 120

Which of the following cranial nerves does NOT contain parasympathetic fibers? A. Oculomotor B. Facial C. Trigeminal D. Vagus

Answer 120

Trigeminal The four cranial nerves that contain parasympathetic fibers are oculomotor, facial, glossopharyngeal, and vagus nerves. Parasympathetic nerves: 1973

Question 121

A number of significant clinical conditions involve abnormalities of neurotransmitter release or reception at the myoneural junction. The neurotransmitter associated with the motor endplate is A. Norepinephrine B. Dopamine C. Acetylcholine D. Myasthenia gravis

Answer 121

Acetylcholine Norepinephrine can be a motor neurotransmitter at mvoneural junctions of postganglionic sympathetic neurons, but the term "motor endplate" is reserved for only skeletal muscles. Dopamine is a neurotransmitter in the basal ganglia, which is part of the motor system but nowhere near the myoneural junction. Myasthenia gravis is a condition of impaired neurotransmitter reception at the motor endplate, which is not what the question asked about.

Question 122

Which is an inhibitory neurotransmitter in the central nervous system? A. GABA B. Epinephrine C. Glutamate D. Norepinephrine

Answer 122

GABA Generally, GABA (gamma- aminobutvric acid) is an inhibitory neurotransmitter in the CNS, whereas epinephrine, glutamate, and norepinephrine are excitatory.

Question 123

On examination of a cross-section of the spinal cord of a cadaver, the examiner notes plaques. This finding is most characteristic of A. Parkinson's disease B. Myasthenia gravis C. Multiple sclerosis D. Dementia

Answer 123

Multiple sclerosis Parkinson's disease and dementia are disorders involving the brain. Myasthenia gravis is a problem with acetylcholine receptors at the neuromuscular junction.

Question 124

The therapist is ordered to evaluate a patient in the intensive care unit. The patient appears to be in a coma andis totally unresponsive to noxious, visual, and auditory stimuli. What rating on the Rancho Los Amigos Cognitive Functioning Scale is most appropriate? A. I B. III C. IV D. VIV

Answer 124

I I; No response. Il: Generalized response. III: Localized responses. IV; Confused agitated. V; Confused inappropriate. VI; Confused appropriate. VII; Automatic appropriate. VIII; Purposeful and appropriate.

Question 125

Which of the following is not an acceptable long-term goal for a patient with a complete C7 spinal cord injury? A. Independence with dressing B. Driving an automobile C. Balance a wheelchair for 30 seconds using a "wheelie" D. Independence with performing a manual cough

Answer 125

Balance a wheelchair for 30 seconds using a "wheelie" Choice A is incorrect because the patient should be able to learn how to be independent with activities of daily living. Choice B is incorrect because the patient can learn to drive an automobile independently with the assistance of hand controls. Choice C is correct because total balance of wheelchair using a wheelie is an unrealistic goal. After proper rehabilitation, this patient should be independent with a manual cough.

Question 126

Which of the following neural fibers are the largest and fastest? A. C fibers B. A beta fibers C. A delta fibers D. B fibers

Answer 126

A beta fibers A beta fibers are the largest in diameter and conduct faster than Cfibers and A delta fibers.

Question 127

A posterior lateral herniation of the lumbar disc between vertebrae L4 and L5 most likely results in damage to which nerve root? A. L4 B. L5 C. L4 and 15 D. L5 and S1

Answer 127

L5 The fifth lumbar nerve root is impinged because it arises from the spinal column superior to the L4-L5 lumbar disc.

Question 128

A therapists examining a patient in the intensive care unit. The therapist notes no eve opening, no verbal response, and no motor response. On the Glasgow coma scale, what is the patient's score? A. 0 B. 3 C. 5 D. 9

Answer 128

3 The responses of the patient represent the lowest possible score on the Glasgow Coma Scale. One point is given for each of the listed responses (or lack thereof).

Question 129

During the examination of an infant, the therapist observes that with passive flexion of the head the infant activelv flexes the arms and actively extends the legs. Which of the following reflexes is being observed? A. Protective extension B. Optical righting C. Symmetrical tonic neck D. Labyrinthine head righting

Answer 129

Symmetrical tonic neck Choice C describes the symmetric tonic neck reflex. With passive cervical extension, an infant displays upper extremity extension and lower extremity flexion.

Question 130

A patient asks the therapist whether she should be concerned that her 4-month-old infant cannot roll from his back to his stomach. The most appropriate response to the parent is: A."This is probably nothing to be concerned about because, although it varies, infants can usually perform this task by 10 months of age." B."This is probably nothingto be concerned about because, although it varies, infants can usually perform this task by 5 months of age." C."Your infant probably needs further examination b a specialist because, although it varies, infants can usually perform this task at 2 months of age." D."Your infant probably needs further examination by a specialist because, although it varies, infants can usually perform this task at birth."

Answer 130

"This is probably nothing to be concerned about because, although it varies, infants can usually perform this task by 10 months of age." Infants accomplish this task between approximately 5 and 10 months of age. The response in Choice A would prevent the parent from excessive unnecessary worry. Sources vary widely about the exact month when developmental milestones are reached, but A is the correct choice in this scenario.

Question 131

A patient has traumatically dislocated the tibia directly posteriorly during an automobile accident. Which of the following structures is the least likely to be injured? A. Tibial nerve B. Popliteal artery C. Common peroneal nerve D. Anterior cruciate ligament

Answer 131

Common peroneal nerve The common peroneal nerve travels over the lateral knee. It is the least likely to be injured. The other structures are either within the knee or directly posterior.

Question 132

A patient is referred to physical therapy with complaints of sensation loss over the area of the radius of the right upper extremity, extending from the elbow joint distally to the wrist. Therapy sessions are focused on assisting the patient in regaining normal sensation. Which of the following nerves is responsible for sensation in this region? A. Medial antebrachial cutaneous B. Lateral antebrachial cutaneous C. Musculocutaneous D. Both B and C

Answer 132

Both B and C The radial side is the lateral side of the forearm, which is innervated by the musculocutaneous nerve. The lateral antebrachial cutaneous nerve is a continuation of the musculocutaneous nerve.

Question 133

While examining a patient who suffered a complete spinal cord lesion, the therapist notes the following strength grades with manual muscle testing: wrist extensors = 3+/5, elbow extensors = 2+/5, and intrinsic muscles of the hand = 0/5. What is the highest possible level of this lesion? A. C3 B. C4 C. C5 D. C7

Answer 133

C7 This patient has a lesion at the level of C7.

Question 134

A physical therapist must have a clear understanding of the normal development of the human bod to treat effectivelv and efficiently. Which of the following principles of treatment is incorrect? A. Earlv motor activitv is influenced primarily by reflexes. B. Motor control develops from proximal to distal and from head to toe. C. Increasing motor ability is independent of motor learning. D. Early motor activity is influenced by spontaneous activity.

Answer 134

Increasing motor ability is independent of motor learning Increasing motor ability is not independent of motor learning. A therapist must facilitate motor learning with proper sensory cues and by promoting appropriate motor activity. Choice D is true because infants begin spontaneous movement, which later develops into more deliberate movement. Choice A is true because reflex movement can be used to develop more deliberate movement.

Question 135

Which of the following statements about developmental motor control is incorrect? A. Isotonic control develops before isometric control. B. Gross motor control develops before fine motor control. C. Eccentric movement develops before concentric movement. D. Trunk control develops before distal extremity control.

Answer 135

Isotonic control develops before isometric control. Isometric control develops before isotonic control.

Question 136

Which of the following statements is true in comparing infants with Down's syndrome to infants with no known abnormalities? A. Motor milestones are reached at the same time with both groups. B. Postural reactions are developed in the same time frame with both groups. C. Postural reactions and motor milestones are developed slower in patients who have Down's syndrome, but with the same association as with normal infants. D. Postural reactions and motor milestones are not developed with the same association with patients who have Down's syndrome as with normal infants.

Answer 136

Postural reactions and motor milestones are developed slower in patients who have Down's syndrome, but with the same association as with normal infants. Postural reactions and motor milestone development occur in the same sequence as with normal infants, but the progression of an infant with Down's syndrome is slower.

Question 137

The spastictype of cerebral palsy usually results from involvement of the A. Corpus callosum B. Basal ganglia C. Motor cortex D. Cerebellum

Answer 137

Motor cortex Involvement of the basal ganglia results in dyskinesia or athetosis. Cerebellar lesions produce ataxia, or unstable movement. The corpus callosum is not involved.

Question 138

A complete rupture of a cord of the brachial plexus is best described using the term A. Neurotmesis B. Neuropraxia C. Axonomesis D. Axonoraxia

Answer 138

Neurotmesis Axonotmesis involves disruption of axons while the neural sheath remains intact. Neuropraxia is a temporary nerve conduction block with intact axons. The term axonopraxia does not exist.

Question 139

Which of the following statements is true regarding myelodysplasia? A. Myelodysplasia is defined as defective development limited to the anterior horn cells of the spinal cord. B. Embryologically, myelodysplastic lesions can be related to either abnormal nervous system neurolation or canalization. C. Myelodysplasia is often associated with genetic abnormalities; however, there is no association with teratogens. D. Myelodysplasia refers to defects in the lower spinal cord only.

Answer 139

Embryologically, myelodysplastic lesions can be related to either abnormal nervous system neurolation or canalization. Melodysplasia can involve the entire spinal cord, not just the anterior cord. Teratogens are any agents that cause a structural abnormality during pregnancy. Excessive alcohol and drug intake have been shown to cause myelodysplasia. Although the lower spinal region is more likely to be effected in myelodysplasia, it can refer to defects in any part of the spinal column.

Question 140

Which of the following statements is true regarding progressive neurologic dysfunction? A. Progressive neurologic dysfunction is common during periods of rapid growth but does not occur once skeletal maturitvis reached. B. Deterioration of the gait pattern is one of the last symptoms to be detected. C. Symptoms include loss of sensation and /or strength, pain along a dermatome or incision, spasticity onset or worsens, and changes in bowel or bladder sphincter control. D. Development of scoliosis will always be rapid.

Answer 140

Symptoms include loss of sensation and /or strength, pain along a dermatome or incision, spasticity onset or worsens, and changes in bowel or bladder sphincter control. Exteriorization of neuralgic function can occur throughout life, and gait abnormalities are often the first complaint. Scoliosis can be slow in developing and should be monitored by the physical therapist.

Question 141

Fine synergistic control of neck flexors and extensors in the upright position typically appears in the A. Second month B. Third month C. Fourth month D. Fifth month

Answer 141

Second month This result is typical in normal development.

Question 142

Ballistic movements of arms andlegs are characterized by A. Reciprocal activation of antagonist muscles. B. Coactivation of antagonist muscles. C. Need for proprioceptive feedback during movement. D. Visual guidance during movement.

Answer 142

Reciprocal activation of antagonist muscles. Ballistic movements are high velocity movements requiring antagonist muscle groups to contract. Coactivation would not produce movement, and visual guidance is not needed for random, ballistic movements. Propriception is not an issue.

Question 143

In typically developing children, successful head turning in a prone position with an erect head is characterized by A. Hip extension, medial rotation, and abduction B. Cervical spine extension and rotation with weight bearing on the upper abdomen C. Shoulderflexion and abduction with weight bearing on elbows D. Caudal weight shift with load bearing on lateral thighs and lower abdomen

Answer 143

Caudal weight shift with load bearing on lateral thighs and lower abdomen Since the head is large (compared to the body) at this stage of development, weight must be shifted to the thighs and lower abdomen to raise the head in a prone position.

Question 144

Development in children with cerebral palsy is characterized by A. Failure to develop reciprocal patterns of muscle activation B. The appearance of fidgety movements as defined by Prechtl and colleagues at about 9 weeks of age C. The appearance of chorea at about 6 months of age D. Failure to develop binocularity of vision

Answer 144

Failure to develop reciprocal patterns of muscle activation Contractions of antagonistic muscle groups produce reciprocal patterns. This is not seen in children with cerebral palsy.

Question 145

Circling arm movements, finger spreading, and a poor repertoire of general movements are characteristic of A. Down syndrome B. Muscular dystrophy C. Spastic cerebral palsy D. Dyskinetic cerebral palsy

Answer 145

Dyskinetic cerebral palsy These movements remain unti 5 months when they become associated with a lack of movement of the extremities to midline.

Question 146

The movement repertoire of the human newborn includes A. Projection of the arm toward stationary objects, kicking, and mouth-to-hand behaviors B. Projection of the arm toward stationary objects, reaching with grasping, and neonatal stepping behaviors C. Projection of the arm toward moving objects, reaching and grasping, and light-avoidance behaviors D. Projection of the arm toward moving objects, mouth-to-hand, and kicking behaviors

Answer 146

Projection of the arm toward moving objects, mouth-to-hand, and kicking behaviors Newborns do not move to stationary objects as in Choice A, nor can they grasp as in choice B. Light avoidance also occurs later in the development process.

Question 147

Once a new motor skill is obtained. further development entails A. Performance with more use of sensory feedback B. Constricting the degrees of freedom used when performing the skill C. Perfecting postural control and transitions between postures D. Developing a single way of performing the skill

Answer 147

Perfecting postural control and transitions between postures In normal development, gaining the ability of postural control allows for more rapid change of positions. This change will allow more normal movement patterns. An infant may not be able to understand feedback, and a single way of performing the skill is not advisable.

Question 148

Which is the strongest predictor of skill in walking for children with typical development? A. Age B. Duration of time since walking began C. Weight D. Extent of walking practice

Answer 148

Extent of walking practice Often children learn by trial and error. Age and weight are not strong predictors of walking skill.

Question 149

It is typical of a 3-year-old child to A. Manage buttoning well B. Alternate feet when ascending stairs C. Beunafraid of falling D. Show no dysmetria during block stacking

Answer 149

Alternate feet when ascending stairs Four year olds typically can manage buttons, and 3 year olds still show dysmetria with block stacking. Infants that are just beginning the skill of walking are unafraid of falling,

Question 150

A patient with Parkinson's disease on levodopa/carbidopa therapy might experience during therapy all of the following except A. The "off" phase B. Dizziness C. Involuntary movements D. Marked bradycardia

Answer 150

Marked bradycardia Levodopa/carbidopa can cause all of the listed effects except bradycardia. Due to the off-effect, the patient might have to be scheduled attimes when he or she is in the on-phase.

Question 151

A patient whose seizures are controlled with an anticonvulsant should be treated in a room or an area that A. Is devoid of bright flickering lights and repetitive, loud noises B. Has no electronic equipment near the patient C. Is warm and somewhat humid D. Is not frequented by many people

Answer 151

Is devoid of bright flickering lights and repetitive, loud noises It is known that flickering lights or repetitive noises can trigger epileptic episodes. Although anticonvulsants are quite effective, it is recommended to avoid such aversive stimuli in these patients.

Question 152

You might want to inform a patient on lithium therapy to contact the physician or call the physician directly if this patient shows A. Ataxia and a fine tremor B. Increased blood pressure and dyspnea C. Excessive salivation and tearing D. Constipation and trouble voiding

Answer 152

Ataxia and a fine tremor Lithium has a very small margin of safety and can be quickly under- or overdosed requiring frequent drug blood level determinations. Ataxia, tremors, increased deep tendon reflexes, confusion and later seizures are indications of lithium overdose.

Question 153

Your patient is on antipsychotic drug therapy. During your therapy sessions you might notice a number of movement abnormalities. The most severe one is A. Tardive dyskinesia B. Tremor C. Akathisia D. Dystonia

Answer 153

Tardive dyskinesia All of these movement disorders can occur but tardive dyskinesia is irreversible and might possibly require an immediate change in the drug prescribed.

Question 154

Which of the following adverse reactions experienced during antiviral drug treatment might be encountered most frequently during therapy? A. Elevated blood pressure B. Aggressive and inappropriate behavior C. Neuralgia and myopathies D. Sedation and incoordination

Answer 154

Neuralgia and myopathies Neuralgia and myopathies are encountered during antiviral treatments while all of the other reactions are rare. For some drugs, it is important to ask the patient to drink a lot of water during strenuous exercise to prevent dehydration and drug precipitations in the kidney.

Question 155

Which of the following adverse reactions might be encountered during therapy sessions by a patient receiving anxiolytic drugs? A. Psychomotor impairment B. Erraticheart rates C. Frequent interruptions due to diarrhea D. Excessive sweating

Answer 155

Psychomotor impairment The most common adverse reactions are sedation, confusion, and psychomotor impairment while erratic heartbeat might be of other origins.

Question 156

A patient starting cholinergic agonist therapy for myasthenia gravis might have to interrupt the therapy session repeatedly because of A. Abdominal cramps and diarrhea B. Intermittent tachycardia C. Joint stiffness and muscle cramps D. Extremely dry mouth

Answer 156

Abdominal cramps and diarrhea Cholinergic agonists stimulate muscarinic receptors and cause diarrhea, sweating, salivation, bradycardia, some decreased blood pressure, and miosis.

Question 157

Among other reasons, mental activity and motor control is the result of excitator and inhibitory neurotransmitter actions in the CNS. The most important inhibitory neurotransmitteris A. Glutamate B. GABA C. Norepinephrine D. Acetylcholine

Answer 157

GABA GABA is one of the main inhibitory neurotransmitters in the CNS. Some sedatives, anxiolytics, skeletal muscle relaxants, and anticonvulsants cause their therapeutic effects by increasing its actions.

Question 158

A patient has a tumor in the parietal lobe. The physical therapist anticipates problems with A. Muscle strength B. Perception of spatial relationships C. Sensation and motor function D. Vision

Answer 158

Perception of spatial relationships Choice B, perception of spatial relationships, is the correct answer. The parietal lobes function to integrate sensory information for perception of spatial relations.

Question 159

What are the components of upper motor neuron svndrome? A. Fasciculations, spasticitv, hyperreflexia B. Spasticity, rigidity, hyporeflexia C. Spasticity, positive Babinski sign, rigidity D. Spasticity, hyperreflexia, positive Babinski sign

Answer 159

Spasticity, hyperreflexia, positive Babinski sign Choice D, spasticity, hyperreflexia, positive Babinski sign, is the correct answer. Fasciculations are also a sign of lower motor neuron disorders as they represent enervation hypersensitivity of the lower motor neuron. UMN svndrome does not produce rigidity. Rigidity is a sign of basal ganglia disease. Hyporeflexia is a sign of lower motor neuron lesions.

Question 160

After completing a developmental assessment on a seven month old, which of the following reflexes wound not be integrated? A. Galant Reflex B. Moro Reflex C. Landau reflex D. Symmetrical tonic neck reflex

Answer 160

Landau reflex The Landau reflex is not fully integrated until the child's second year.

Question 161

Nerve regeneration occurs at a pace of _______ per month A. 5 mm B. 1 inch C. 1 cm D. 2.5 inches

Answer 161

1 inch A nerve regenerates at an approximate rate of 1 inch per month.

Question 162

A physical therapist working in an early intervention program is providing intervention to an infant diagnosed with Erb's palsy. This condition most often involves what nerve roots? A. C2-C3 B. C3-C4 C. C5-C6 D. C8-T1

Answer 162

C5-C6 The most common injury of the brachial plexus is to the upper roots, C5-C6, resulting in an Erb's palsy.

Question 163

A patient with an Erb's palsy will have paralysis of all of the following muscles except A. Flexor carpi ulnaris B. Rhomboids C. Brachialis D. Teres minor

Answer 163

Flexor carpi ulnaris An injury to the C5-C6 nerve roots results in an Erb's palsy. The flexor carpi ulnaris is innervated by C8-T1.

Question 164

The physical therapist is beginning the examination of a patient in an outpatient cardiac rehabilitation facility. A chart review shows that this patient has active atrial fibrillation with a controlled ventricularrate. What is the most appropriate intervention for this patient? A. Low intensity aerobic exercise B. Highintensity aerobic exercise C. High intensity lower extremity exercise only D. Low intensity lower extremity exercise only

Answer 164

Low intensity aerobic exercise Atrial fibrillation is a relative contraindication for therapy. Exercise should start at a lower intensity and be progressed slowly if the ventricular ate remains controlled. There is no contraindication against upper extremity exercise.

Question 165

Which of the following is incorrect advice to give to a patient with a diagnosis of congestive heart failure who complains of shortness of breath and "smothering" while attempting to sleep? A. Sleep with the head on 2 to 3 pillows B. Sleep without any pillows C. Sleep in a recliner during exacerbations D. During exacerbations come to a standing position for short-term relief

Answer 165

Sleep without any pillows In a complete supine position, patients with this diagnosis will have excess fluid move from the lower body to the chest cavity. This causes a decrease in heart and lung function and efficiencv.

Question 166

A physical therapist is treating a patient with significant burns over the limbs and upper trunk. Which of the following statements is false about some of the changes initially experienced after the burn? A. This patient initially experienced an increase in the number of white blood cells. B. This patient initially experienced an increase in the number of red blood cells. C. This patient initially experienced an increase in the number of free fatty acids. D. This patient initially experienced a decrease in fibrinogen.

Answer 166

This patient initially experienced an increase in the number of red blood cells. This patient is likely to experience a decrease in the number of red blood cells. All of the other statements are correct. Fibrinogen drops initially but then rises throughout recovery.

Question 167

The most common cause of burn injury in infants is A. Accidental flame burn from a smoking adult B. Car accidents with immolation C. Scald injury, either intentional or accidental by neglect D. House fires, in which all family members are inured

Answer 167

Scald injury, either intentional or accidental by neglect Choice C is more common than the other choices.

Question 168

What are the four stages, in time order, of wound healing after surgery? A. Coagulation, inflammatory phase, granulation phase, and scar formation and maturation B. Inflammatory phase, coagulation, scar formation and maturation, and granulation phase C. Scar formation and maturation, granulation phase, coagulation phase, and inflammatory phase D. Inflammatory phase, granulation phase, coagulation, and scar formation and maturation

Answer 168

Coagulation, inflammatory phase, granulation phase, and scar formation and maturation This is the correct order of incision or wound healing after surgery.

Question 169

A patient is taking tetracyclines for an infection. You have to be most careful to A. Not expose the patient to excessive light or UV therapy B. Only exercise this patient moderately C. Avoid using the warm therapeutic pool D. Have the patient get up very slowly from a lying position

Answer 169

Not expose the patient to excessive light or UV therapy Tetracyclines cause mostlv a toxic photosensitization and sun light or UV light should be avoided. They should also not be given to children because of bone and teeth problems, and they should not be taken with antacids, which prevent their absorption.

Question 170

A patient with lymphedema following breast CA and reconstruction requires examination. She is presenting with heaviness, itching, aching and redness in herleft upper extremity. Your next course of action is to A. Take girth measurements of the arm B. Begin lymph drainage massage C. Take her temperature D. Send her back to physician

Answer 170

Send her back to physician Signs and symptoms of lymphangitis (infection) mav include some or all of the following: rash; red, blotchy skin; itching of the affected area; discoloration; increase of swelling and or temperature of the skin; heavy sensation in the limb (more so than usual); pain: and, in many cases, a sudden onset of high fever and chills. Treatment for infections is to immediately discontinue ALL current lymphedema treatment modalities (including manual lymphatic drainage, bandaging, pumps, and wearing of compression garments), and contact your physician as soon as possible.

Question 171

Which of the following layers of the epidermis is responsible for the constant renewal of epidermal cells? A. Stratum germinativum B. Stratum granulosum C. Stratum lucidum D. Stratum corneum

Answer 171

Stratum germinativum The stratum germinativum (basale) contains stem cells characterized by intense mitotic activity indicative of cellular division since the main function of this layer is the continual renewal of epidermal cells.

Question 172

The right adrenal gland is in contact with the A. Spleen B. Inferiorvena cava C. Pancreas D. Stomach

Answer 172

Inferior vena cava The right adrenal gland is in contact with the inferior vena cava anteromedially. It is separated from the pancreas by the duodenum. The left adrenal is in contact with the posterior wall and the stomach and the body-tail of the pancreas.

Question 173

Releasing hormones that regulate the anterior lobe of the pituitary gland are synthesized in the A. Hypothalamus B. Cerebral cortex C. Thalamus D. Basal ganglia

Answer 173

Hypothalamus The anterior lobe of the pituitary gland is regulated by releasing hormones produced by the hypothalamus. These hormones are sent to the anterior lobe via the hypophyseal-portal vascular system. The other three components of the central nervous system do not affect or connect to the anterior lobe.

Question 174

Erythropoietin is a hormone required for the production of red blood cells. It is produced primarily in the A. Kidney B. Lung C. Marrow D. Pancreas

Answer 174

Kidney Eighty percent to ninety percent of erythropoietin is formed in the kidney, with the remainder coming from the liver. Marrow responds to this hormone.

Question 175

Which abdominal organs does the thoracic cage protect? A. Spleen, liver, adrenal gland, and upper portion of kidneys and stomach B. Pancreas, liver, and vermiform appendix C. Gallbladder, urinary bladder, liver, and uterus D. Spleen, pancreas, adrenal gland, and ovaries

Answer 175

Spleen, liver, adrenal gland, and upper portion of kidneys and stomach The abdominal cavity extends superiorly into the thoracic cage. Subsequently, the ribs protect several abdominal organs. These are the spleen, liver, adrenal gland, and upper portions of the kidneys and stomach.

Question 176

Which of the following muscles of the pharynx is supplied by the glossopharyngeal nerve (CN IX)? A. Palatopharyngeus B. Stylopharyngeus C. Superior constrictor D. Middle constrictor

Answer 176

Stylopharyngeus All the pharyngeal muscles are supplied by the vagus nerve (CNX) exceptthe stylopharyngeus muscle, which is supplied by the glossopharyngeal nerve (CN IX).

Question 177

In abdominal examination, the spleen lies in which of the following quadrants? A. Upper left quadrant B. Upper right quadrant C. Lower left quadrant D. Lower right quadrant

Answer 177

Upper left quadrant The spleen lies in the upper left quadrant or left hypochondrium of the abdomen under the diaphragm, adjacent to the ninth, tenth, and eleventh ribs.

Question 178

The majority of disaccharide hydrolysis occurs due to the action of which enzymes? A. Enzymes from the pancreatic juice B. Enzymes in the brush border of the small intestine C. Enzymes found in the saliva D. Enzymes in the gastric mucosa

Answer 178

Enzymes in the brush border of the small intestine Enzvmes responsible for the breakdown of disaccharides are located in the brush border.

Question 179

The therapist in an outpatient physical therapy clinic receives an order to obtain a shoe orthotic for a patient. After examining the patient, the therapist finds a stage I pressure ulcer on the first metatarsal head. Weight-bearing surfaces need to be transferred posteriorly. Which orthotic is the most appropriate for this patient? A. Scaphoid pad B. Thomas heel C. Metatarsal pad D. Cushion heel

Answer 179

Metatarsal pad Metatarsal pads successfully transferweight onto the metatarsal shafts of this patient. A Thomas heel and a scaphoid pad are for patients with excessive pronation. A cushion heel absorbs shock at contact.

Question 180

While obtaining the history, the therapist learns that the patient was recently hospitalized for malfunction of the anterior pituitary gland. Based on this information alone, the therapist knows that there may be problems with the patient's ability to produce which of the following hormones? A. Adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone B. Insulin and glucagon C. Epinephrine and norepinephrine D. Cortisol, androgens, and aldosterone

Answer 180

Adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone Adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone, follicle-stimulating hormone, and luteinizing hormone are all produced by the anterior pituitary gland. Insulin and glucagon are produced in the pancreas. Epinephrine and norepinephrine are produced in the adrenal medulla. Cortisol, androgens, and aldosterone are produced by the adrenal cortex.

Question 181

A patient is using a medication for a thyroid condition. Which of the following could be the result of overdosing with the drug and should be mentioned to the physician? A. Tachycardia and restlessness when using propylthiouracil B. Tachycardia when using a T4 medication C. Weightloss when using propylthiouracil D. Bradycardiawhen using a T4 medication

Answer 181

Tachycardia when using a T4 medication Tachycardia could be the result of taking too much thyroid hormone, and a dose adjustment may be needed. Overdosing with propylthiouracil might cause lethargy and weight gain.

Question 182

A patient using insulin injections before a therapy session must receive special care like A. Not massaging the injection site B. Recommending the use of glucosamine to increase insulin's effects C. Having insulin injected into leg muscles before exercise D. All of the above

Answer 182

Not massaging the injection site Massaging the injection site can increase insulin absorption and cause hypoglycemia. Glucosamine can interfere with insulin effects, and injections into the abdomen are recommended when exercising,

Question 183

A patient with type 2 diabetes using metformin asks about the use of herbal medications and OTC drugs to be used with his medication. You answer that A. Some herbal preparations have been shown to be beneficial B. OTC cimetidine can be taken freely without concern C. Minerals and chromium might help drug actions D. The antacid Tums can be taken but not in excess

Answer 183

The antacid Tums can be taken but not in excess OTC cimetidine and chromium have been shown to interfere with the action of metformin, while herbal medications have not been found to be of significant benefit.

Question 184

Which of the following symptoms are most likelv to raise suspicion of liver disease? A. Fever, melena, urinary frequency B. Left shoulder pain, pallor, coffee ground emesis C. Jaundice, ascites, asterixis D. Leftupper quadrant pain, nausea, diaphoresis

Answer 184

Jaundice, ascites, asterixis The liveris located in the right upperquadrant making pain referral more common to the right shoulder. Coffee ground emesis or melena are generally associated with GI disorders, as liver disease tends to create gray-colored stools and dark urine.

Question 185

Which of the following statements about immune disorders is true? A. The progression of the disease will not change the clinical presentation of signs and symptoms. B. Early diagnosis is not likely to alter the course of the disease. C. Direct access will increase the likelihood that a physical therapist might be the first provider to identify potential autoimmune disorders. D.The risk factors for immune disorders are cleariv understood and will assist in differential diagnosis.

Answer 185

Direct access will increase the likelihood that a physical therapist might be the first provider to identify potential autoimmune disorders Direct access will increase the likelihood of therapists being the first provider for many conditions. Risk factor assessment is helpful in identifying immune problems, but the cause and risk for many conditions is still unknown. Disease progression is common with different signs and symptoms, and early recognition of immune dysfunction can improve the course of the disease.

Question 186

An 8-vear-old female is admitted to the hospital with hepatosplenomegaly; low grade fever; and swollen and stiff ankle, knee, hip, elbow, and wrist joints. What is the most likelv diagnosis? A. Systemiconset juvenile rheumatoid arthritis (IRA) B. Polyarticular JRA C. Pauciarticular JRA D. Oligoarticular JRA

Answer 186

Polyarticular JRA A patient with polvarticular JRA presents with acute or insidious svmmetrical arthritis of the large and small joints of the upper and lower extremities, with more than four joints involved. The joints are swollen and warm, but rarely red. The systemic symptoms are usually mild and include low grade fever, mild to moderate hepatosplenomegaly, and lymphadenopathy.

Question 187

Lvmphedema is A. pathologic accumulation of white-blood-cell-filled fluid B. accumulation of lymphocytes in the blood and tissues C. pathologic accumulation of protein-rich fluid in the tissue D. leakage of RBCs into the surrounding tissue

Answer 187

pathologic accumulation of protein-rich fluid in the tissue Lymphedema is swelling that occurs when protein-rich lvmph fluid accumulates in the interstitial tissue. This lymph fluid may contain plasma proteins, extravascular blood cells, excess water, and parenchymal products.

Question 188

The hormones FSH, progesterone, and estrogen do what during the onset of menopause? A. Increase B. Decrease C. Stay the same D. Cause VAs

Answer 188

Decrease The most dramatic bone loss in women occurs in the years immediately after menopause and its associated abrupt decline in estrogen production. Menopause begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation.

Question 189

According to the literature, development of bone mass peaks in and begins to decrease in A. Early thirties, late forties B. Midteens, late thirties C. Mid twenties, midforties D. Late twenties, late thirties

Answer 189

Late twenties, late thirties Peak bone mass is usually attained by age 30, and then begins a slow decline that will continue throughout life. Women lose 1; to 2; of bone mass per year (compared to 0.3; to 1; in men), ultimately losing 30; to 50; of their initial bone mass (compared to 20; to 30; in men).

Question 190

Primarv lymphedema occurs in patients who _ had surgery. A. Older, have B. Younger, have C. Younger, have not D. Older, have not

Answer 190

Younger, have not Primary lymphedemais an inherited disorder resulting from abnormal formation of lymphaticvessels before birth. These malformations most commonlv cause swelling that affects the feet and legs.

Question 191

A 14-year-old baseball player has type 1 diabetes and uses an insulin pump. His teammates want to know more about this condition. You inform them that all the following statements concerning insulin are true except A. It facilitates glucose transport out of the cell and into the blood B. It is secreted from b cells in pancreas C. It decreases blood glucose levels D. It may be present in decreasedlevels in those with type 2 diabetes mellitus

Answer 191

It facilitates glucose transport out of the cell and into the blood Insulin works to decrease blood glucose levels by transporting glucose out of the bloodstream and into cells.

Question 192

A patient who uses a magnesium-containing antacid at high doses for long periods might experience A. Constipation B. Diarrhea C. Headaches D. Muscle cramps

Answer 192

Diarrhea Although a patient should not self-medicate with large dose of antacids over long periods of time, such a use of magnesium-containing antacids can lead to diarrhea and use of aluminum-containing antacids can lead to constipation. Patients have experienced muscle weakness with magnesium-containing antacids perhaps because of interference with the neurotransmitter-releasing action of calcium at the neuromuscular junction.

Question 193

A patient on opioid pain medications might experience all of the following except A. Seeing poorly in the dark B. Some respiratory depression C. Motor incoordination D. Severe diarrhea

Answer 193

Severe diarrhea Opioid analgesics stimulate opioid receptors leading to analgesia, sedation, miosis (vision problems in the dark since pupils cannot dilate), respiratory depression, sometimes nausea (less in supine position), and constipation.

Question 194

Your patient is a 35-vear-old female who has been having severe low back pain for the past day. She has no mechanism of injury, but the pain that is located on the left side is greater than that on the right. Her only position of ease is in left fetal position. Her pain has increased in the last dav and now is at a constant level that waxes and wanes. She has a mild temperature and has been feeling weak andlethargic since the pain began. She has been experiencing nausea, vomiting, and diarrhea for the past day. What system is mostly likely the source of the patient's symptoms? A. Gastrointestinal B. Urogenital C. Musculoskeletal D. Cardiovascular

Answer 194

Gastrointestinal The best answer is the gastrointestinal system. Musculoskeletal and urogenital both can cause similar symptoms, but the musculoskeletal system usual is painful in response to mechanical changes in the body. This pain is relatively constant. The urogenital system is potentially the source, but symptoms are often central, and urogenital pathology does not usually result in nausea and diarrhea. The gastrointestinal system is the best answer because all of the patient's symptoms can be attributed to gastrointestinal dysfunction.

Question 195

Your patient is a 63-year-old male who presents to you in physical therapy with complaints of right shoulder and abdominal pain. He is having difficulty sleeping and has noticed bilateral tingling in his lateral three fingers. He has been feeling nauseated and has been vomiting lately. He is having muscle tremors and has noticed a dark color in his urine. He has noticed a yellowing of his eyes. What is svstem is mostly likely the source of the patient's symptoms? A. Endocrine B. Urogenitial C. Hepatic D. Gastrointestinal

Answer 195

Hepatic All of these symptoms could produce pain in the right low back. The symptoms that increase the likelihood that the hepatic system is the source of the symptoms are the patient's complaints of muscle tremors, dark urine, nausea, vomiting, and yellowing of the eyes. All of these symptoms are indicative of liver or gallbladder pathology. Both of these are a part of the hepatic system.

Question 196

A patient recently informed you that he was diagnosed with a duodenal ulcer and prescribed a proton pump inhibitor. Which of the following is a type of proton pump inhibitor? A. Ranitidine B. Metoclopramide C. Omeprazole D. Famotidine

Answer 196

Omeprazole Omeprazole is a proton pump inhibitor that inhibits the enzyme in the gastric parietal cells. When this enzyme (proton pump) is stopped, acid secretion decreases.

Question 197

Adrenergic receptors A. Are subdivided into four major categories B. Include the muscarinic and nicotinic receptors C. Include the alpha and beta receptors D. When blocked, can cause dry mouth. decreased salivation, blurry vision, and constipation

Answer 197

Include the alpha and beta receptors All of the other characteristics are those of cholinergic receptors, with the exception of A, which is not a characteristic of any receptor group.

Question 198

Which of the following is an absolute contraindication to initiation of an outpatient cardiac rehabilitation program? A. Obesity B. Patient currently on dialysis 3 days a week because of renal failure C. Asthma D. Third-degree heart block

Answer 198

Third-degree heart block A third-degree heart block can appear as dizziness and fatigue and may require a pacemaker. Patients with asthma and obesity should be monitored closely but should be permitted to exercise. Dialysis should be scheduled on nondialvsis davs.

Question 199

Fourteen weeks after surgical repair of the rotator cuff, a patient presents with significant deltoid weakness. Range of motion is within normal limits and equal bilaterally. Internal and external rotation strength is equal bilaterally; flexion and abduction strength is significantly reduced. What is the most likely cause ofthis dysfunction? A. Poor compliance with a home exercise program B. Tightness of the inferior shoulder capsule C. Surgical damage to the musculocutaneous nerve D. Surgical damage to the axillary nerve

Answer 199

Surgical damage to the axillary nerve The axillary nerve is in close proximity to the surgical field in this patient. ROM is normal so choice B is incorrect; poor compliance would lead to a multitude of problems rather than just deltoid weakness. The musculocutaneous nerve is not involved with this procedure, and it innervates muscles involved in elbow flexion.

Question 200

A patient has recently undergone an acromioplasty. What is the most important goal in early rehabilitation? A. Regaining muscle strength B. Return to activities of daily living (ADLs) C. Endurance and functional progression D. Return of normal range of motion (ROM)

Answer 200

Return of normal range of motion (ROM) The other choices will be important later in the rehabilitation of this diagnosis. ROM is important early to reduce abnormal scar tissue formation.

Question 201

Inhibition of the internal urethral sphincter allows the body to A. Micturate B. Defecate C. Hold the urine until later D. Ejaculate

Answer 201

Micturate Parasympathetic fibers inhibit the smooth muscles of the internal urethral sphincter, which allows urine to flow into the urethra.

Question 202

Which of the following hormones stimulates ovulation in the female? A. Follicle-stimulating hormone B. Growth hormone C. Prolactin D. Luteinizing hormone

Answer 202

Luteinizing hormone During the preovulatory phase of the menstrual cycle, follicle-stimulating hormone is the dominant hormone. The feedback mechanism of high levels of estradiol cause a midcycle surge in luteinizing hormone (LH). About 24 hours after the surge in LH, the follicle ruptures and ovulation occurs. LH also maintains the function of the corpus luteum in the postovulatory phase.

Question 203

Whiplash injury from a rear-end collision would tear the A. Posterior longitudinal ligament (PLL) B. Anterior longitudinal ligament (ALL) C. Ligamentum nuchae D. Ligamentum flavum

Answer 203

Anterior longitudinal ligament (ALL) Whiplash injury includes hyperextension of cervical vertebrae that may tear the anterior longitudinal ligament that limits extension of the cervical spine. All of the other ligaments limit flexion of the cervical spine; accordingly, they may be torn in hyperflexion injuries.

Question 204

A physical therapist should place the knee in which of the following positions to palpate the lateral collateral ligament (LCL)? A. Knee at 60 degrees of flexion and the hip externally rotated B. Knee at 20 degrees of flexion and the hip at neutral C. Knee at 90 degrees of flexion and the hip externally rotated D. Knee at 0 degrees and the hip at neutral

Answer 204

Knee at 90 degrees of flexion and the hip externally rotated The lateral collateral ligament of the knee is best palpated with the patient in the sitting position. The patient then places the foot of the involved lower extremity on the knee of the uninvolved lower extremity. This maneuver places the involved knee in 90 degrees of flexion and the hip in external rotation.

Question 205

A patient on combination contraceptive medication and smoking must be warned that smoking increases the risk of A. Thromboembolism B. Liver cancer C. Internal hemorrhaging D. Ovarian cancer

Answer 205

Thromboembolism Contraceptive combination medications increase the risk of thromboembolism, which is markedly enhanced by smoking. All the others should not occur or should not be affected.

Question 206

A patient on combination contraceptive medication might experience all of the following except A. Depressive episodes B. Weight gain C. Swelling of feet D. Joint or muscle pain

Answer 206

Joint or muscle pain All of the listed reactions can occur except joint or muscle pain.

Question 207

You notice that a patient looks anemic and when you ask, she tells you that she is self-medicating with iron since she always looses a lot of blood during menstruation. You should respond that she should see a physician since A. OTC iron is not effective for anemia B. The dose recommended on OTC preparations is much too low C. There are different anemias some of which do not respond to iron D. Iron alone is not effective but needs additional prescription drugs

Answer 207

There are different anemias some of which do not respond to iron Iron deficiency anemia responds to iron supplementation, but there are other anemias, including folic acid or B12 deficiency anemias, which only respond to folic acid or B12 administration.

Question 208

Your patient is a 33-year-old female who reports to physical therapy with complaints of left low back pain. She has been feeling cramping and has had sweats on and off for the past 3 days. Her symptoms are severe at times, but appear to be coming in waves. She is unable to find a position of comfort. No motion seemsto increase the symptoms. She seems to feel an increase in symptoms shortly after drinking water. What system is mostly likely the source of the patient's symptoms? A. Urogenital B. Gastrointestinal C. Hepatic D. Musculoskeletal

Answer 208

Urogenital The patient's symptoms do not appearto be provoked by movement or activities; therefore, the musculoskeletal system is probably not the top hypothesis. Hepatic symptoms usually appear on the right side and this patient has left-sided low back pain. Gastrointestinal and urogenital systems can both produce pain in the left low back. The fact that the symptoms appear to increase with the intake of fluid makes the urogenital system the best answer.

Question 209

Your patient is a 65-year-old male who reports to you with pain in his right big toe. Symptoms have been off and on for 3 years. He is having difficulty walking, and his great toe is hot and swollen. He has been having right midback pain. He has previously been diagnosed with kidney stones and irritable bowel syndrome. What svstem is mostly likely the source of the patient's symptoms? A. Renal B. Musculoskeletal C. Gastrointestinal D. Cancer

Answer 209

Renal Gastrointestinal pathology rarely results in great toe pain. The musculoskeletal system and cancer can both impact the great toe, but with the patient's 3-year history of waxing and waning symptoms, as well as his history of kidney disease places gout at the top of the hypothesis list. Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately.

Question 210

A patient requires examination 1 year after a hysterectomy. There is no hormone replacement therapy at this time. She complains of having pain with intercourse and some vaginal burning, What condition does she most likely have? A. Atrophicvaginitis B. Vulvodynia C. Asexually transmitted disease D. Complications from the surgery

Answer 210

Atrophicvaginitis Also referred to as "Urogenital atrophy," atrophic vaginitis has an incidence level somewhere between 10 to 40 of postmenopausal women. Both vaginal and urethral tissue is estrogen dependent. A history of smoking, nonvaginal deliveries, certain immune disorders, and noncoital status are some of the risk factors for developing atrophic vaginitis.

Question 211

An 80-vear-old female complains of daily urinary accidents. She says that when she gets the urge to urinate, she simply cannot get to the bathroom in time. She has had a total hip replacement (6 months ago), has had a long history of getting up in the middle of the night to urinate, and has 3 children and 5 grandchildren with whom she enjoys spending time. What "tvpe" of incontinence would this patient most closely match? A. Urge incontinence B. Stress incontinence C. Functional incontinence D. Mixed incontinence

Answer 211

Functional incontinence Though this patient may have some symptoms that also match urge incontinence, the definition of functional incontinence is the following: Functional incontinenceoccurs when a person recognizes the need to urinate, but cannot physically make it to the bathroom in time because of limited mobility. Causes of functional incontinence include confusion; dementia; poor eyesight: poor mobility; poor dexterity; and unwillingness to toilet because of depression, anxiety, or anger, or being in a situation in which it is impossible to reach a toilet.

Question 212

A therapist receives an order to examine a patient on the telemetry floor of a hospital. The therapist is informed at the nurses' station that an evaluation will not be necessarv because the patient went into shock earlier that morning and died. The patient suffered a myocardial infarction, resulting in damage to the left ventricle. Given information, what is the most likely type of shock? A. Vascular shock B. Anaphylactic shock C. Toxic shock D. Cardiogenic shock

Answer 212

Cardiogenic shock A myocardial infarction that involves the left ventricle is likelv to cause cardiogenic shock. Cardiogenicshock is a rapid decline in cardiac output. Vascular shock is widespread vasodilation. Toxic and anaphylactic shock occur when the body is exposed to a toxin or allergin, respectively.

Question 213

Children who utilize training programs will not improve A. Strength B. Anaerobic conditioning C. Balance D. The ratio of "fast twitch" muscle fibers to "slow twitch" muscle fibers

Answer 213

The ratio of "fast twitch" muscle fibers to "slow twitch" muscle fibers Improvement in strength, anaerobic conditioning, balance, and many other areas can be gained with the proper training program in all ages. A child is "born with" a fixed ratio of fast/slow twitch fibers. Athletes can improve reaction time with proper training,

Question 214

A sports preparticipation examination for prepubescent children is not designed to A. Determine the general health of the athlete and detect conditions that place the participant at additional risk and to identifv relative or absolute medical contraindications to participation B. Identify sports that may be played safelv and to educate the athlete C. Assess maturitv and overall fitness D. Assess the eye-hand coordination of the athlete

Answer 214

Assess the eye-hand coordination of the athlete Preparticipation screenings accomplish all the objectives mentioned in the question. Many times children with serious medical conditions are barred from athletic participation. Eye-hand coordination is beyond the scope of the preparticipation examination in this population.

Question 215

Which of the following is false for the child versus the adult? A. Children have less tolerance for exercise in the heat. B. Children have similar nutritional requirements. C. Children need more hydration in all situations. D. Children should follow the same weight-training routines.

Answer 215

Children have similar nutritional requirements. Children require more caloric intake (and hydration as well) than an adult in athletics. Children have a greater surface area per body weight and a decreased ability to sweat versus an adult. This makes exercise in the heat more of a concern for the adolescent athlete. An adult weight training program should be much more aggressive than a child's program. Aggressive weight training in children can cause many musculoskeletal dysfunctions.

Question 216

A patient informs the physical therapist that he self-medicates with over the counter (OTC) drugs and has done so for some time and seems to be doing well. The physical therapist should inform the patient that A. This is ok since OTC drugs contain such low drug concentrations they do not cause serious adverse reactions B. OTC drugs should not be used for more than 2 weeks without a physician's consent C. OTC drug use does not have to be mentioned to a physician, since they are not prescription drugs D. This is a waste of money since OTC drugs have been found to be generally ineffective

Answer 216

OTC drugs should not be used for more than 2 weeks without a physician's consent It is recommended that OTC drugs should not be used for more than 2 weeks without the advice of a physician since they are effective but can mask a serious problem, interact with prescription drugs, and have adverse reactions.

Question 217

Which of the following are common signs and symptoms seen by a patient using OTC diphenhydramine? A. Poor coordination and fatigue B. Increased blood pressure and irregular heart beat C. Excessive sweating and cold extremities D. Weight gain and ankle edema

Answer 217

Poor coordination and fatigue Diphenhydramine is an antihistamine that blocks histamine or H1 receptors and is being used for allergic conditions (type I only). It can cause sedation, dry mouth, blurred vision, dry mouth and skin contact lens intolerance, constipation and urinary hesitancy (mostly via its anticholinergic actions, which are more pronounced in the elderly).

Question 218

A patient asks if they can use OTC niacin to lower high cholesterol and lipid levels since this has been recommended by friends. How should the phvsical therapist answer? A. Yes, it is ok if the friends feel fine. B. No, because niacin is not effective in lowering cholesterol and lipid levels. C. Yes, a try can do no harm since it is offered OTC. D. No, because the use of niacin requires periodic lab tests to check liver functions.

Answer 218

No, because the use of niacin requires periodic lab tests to check liver functions. OTC niacin is effective, but its use requires periodic lab tests that only a physician can order.

Question 219

A patient on cancer chemotherapeutic drugs might experience all of the following adverse reactions except A. Easy bruising and bleeding B. Fatigue and anemia C. Constipation with fecal impact D. Jaundice and hepatotoxicity

Answer 219

Constipation with fecal impact All the listed adverse reactions can occur due to suppression of platelet and red blood cell formation and liver damage (some drugs only), but GI problems include diarrhea, which can often be severe.

Question 220

A patient on cancer chemotherapy must be careful not to use other drugs including OTC drugs. In particular, you must warn the patient not to use A. NSAIDs B. Psyllium C. Hypnotics D. Anxiolytics

Answer 220

NSAIDs Chemotherapy affects the GI tract and problems are made worse by NSAIDs, which also affect and irritate the stomach. The others should not present problems.

Question 221

A patient on long-term corticosteroids during therapy might show all of the following except A. Depressed mood B. Orthostatic hypotension C. Anemia D. Muscle loss

Answer 221

Orthostatic hypotension All of the listed effects can be expected plus fat shifts (moon face, buffalo hump), hypertension, muscle wasting, cataracts, increased intraocular pressure and osteoporosis but not orthostatic hypotension.

Question 222

A patient using diuretics during strenuous exercise might experience all of the following except A. Easy bruising B. Dehydration C. Muscle cramping D. Dyspnea

Answer 222

Easy bruising Easy bruising would not be expected, but dehvdration with electrolvte changes, muscle cramping, and dyspnea are expected.

Question 223

An individual consumes one glass of wine (100 ml, 10% alcohol). Most of the alcohol has been metabolized and eliminated after about A. 15 min B. 1hr C. 2 hr D. 4 hr

Answer 223

1hr A glass of wine (100 ml) contains about 10 ml of alcohol or ethanol (about 10%:). The average person metabolizes about 10 ml within an hour.

Question 224

A geriatric patient using OTC cimetidine might experience all of the following except A. Confusion B. Orthostatic hypotension C. Dizziness D. Sedation

Answer 224

Orthostatic hypotension Cimetidine is an H2 blocker that blocks acid-releasing H2 receptors in the stomach and is associated with all of the listed reactions except orthostatichypotension.

Question 225

A patient is on long-term NSAIDs therapy. These drugs reduce inflammatory processes by A. Inhibiting the enzyme lipoxygenase B. Reducing the formation of prostaglandins C. Inhibiting formation of inflammatory white blood cells D. Stimulating the enzymes COX I and II

Answer 225

Reducing the formation of prostaglandins NSAIDs inhibit the enzymes COX I and II (except celecoxib, which only acts on II) and reduce formation of pain, fever, and inflammation-causing prostaglandins, but they also reduce their protective effects in the stomach.

Question 226

A patient with severe sleep problems and using sedative/hypnotic drugs should A. Preferably be seen in the morning B. Preferably be seen in the afternoon C. Beadvised not to take the medication 2 davs before therapy D. Be advised that the addition of St. John's wort might help the medications

Answer 226

Preferably be seen in the afternoon Sleep drugs can cause some residual effects or some drowsiness in the morning. If so, schedule the patient in the afternoon. Do not recommend St. John's wort.

Question 227

The patient has a dysfunction of the tenth rib; however, he complains of nausea and fullness. This is an example of A. Viscero-viscero reflex B. Viscero-somatic reflex C. Somatic-viscero reflex D. Somatic-somatic reflex

Answer 227

Somatic-viscero reflex It is possible to get these reflexes because the somatic and visceral afferents enter the spinal cord at the same level. Somatic sources that create visceral symptoms are known as somatic-visceral reflexes.

Question 228

Knowledge of pharmacology is important to differential diagnosis because A. Management of the physical therapy patient cannot be enhanced by medications B. Medication side effects can contribute to the signs and symptoms that patients present with C. Physical therapists may need to alter the patient's medications to improve disease control D. Medications do not provide any additional risk to patient health issues

Answer 228

B. Medication side effects can contribute to the signs and symptoms that patients present with Medications are an integral part of current medical practice, and therapists need to be aware of the use, benefits, and risks associated with these medications. Part of our responsibility is to monitor patients for potential side effects, but it is generally not in the physical therapist's scope of practice to change the medications.

Question 229

A patient cannot find his dentures when they are on his crowded bedside table. His visual acuity tests at 20/20 with the Snellen eve chart. The physical therapist suspects problems with A. Figure-ground discrimination B. Body scheme awareness C. Agraphia D. Vertical orientation

Answer 229

Figure-ground discrimination Figure-ground discrimination. The patient has difficulty finding an item within a crowded visual field. This is figure-ground discrimination. Agraphia is the inability to write. Vertical orientation and body scheme awareness relate to the patient's self-awareness.

Question 230

You will be performing an examination on a patient diagnosed with Down's syndrome. Which are the correct phenotypic features in Down's syndrome? A. Leukemia, hypotonia, joint hypomobility B. Developmental delay, simian crease, hypertonia C. Large cerebellum and brainstem. atlantoaxial instability, leukemia D. Developmental delay, leukemia, atlantoaxial instability

Answer 230

Developmental delay, leukemia, atlantoaxial instability The phenotypic features in Down Syndrome are flat facial profile, low nasal bridge, shortened palate, joint hypermobility, hypoplastic pelvis, atlantoaxial instability, simian creases, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, hypotonia, mental retardation, developmental delay, small cerebellum and brainstem, and leukemia.

Question 231

A patient who is 3 months pregnant asks advice on activities. Previous prepartum activities included rock climbing, soccer, and hiking. Which of the activities would you recommend? A. Rock climbing B. Soccer C. Nothing, she's pregnant D. Hiking

Answer 231

Hiking A review of current "safe exercise guidelines" would indicate avoiding exercises that risk direct trauma to the abdominal region. However, continuing an exercise program, in moderation, is highly recommended for both the health of the baby and mom during the pregnancy.

Question 232

Which is NOT a reason for the common postural changes seen during pregnancy? A. Ligamentlaxity B. Posterior shift in COG C. Increased breast size D. Enlarging uterus

Answer 232

Posterior shift in COG A posterior shift in the center of mass would create the opposite presentation in terms of posture. Secondary to anterior weight gain, a posterior shift does not make sense in this case.

Question 233

Which of the following comprise the diagnostic criteria for "female athlete triad" svndrome? A. Dieting, dizziness, and weakness B. Drop in blood pressure, fatigue, and disordered eating C. Stress fracture, fatigue, cold hands and feet D. Disordered eating, osteoporosis, amenorrhea

Answer 233

Disordered eating, osteoporosis, amenorrhea Frequently missed by coaches and health professionals, choice D is the definition of female athlete triad. Consequences of this disorder include early osteoporotic fractures, delayed healing, and an inability to regain appropriate bone mineral density.

Question 234

In a patient who has a uterine or bladder prolapse, which of the following findings do you expect? A. Decreased pelvic floor tone and strength, elongated pelvic floor muscles B. Increased pelvic floor tone and good pelvic floor strength C. Decreased pelvic floor tone and good pelvic floor strength D. Increased pelvicfloor tone and poor pelvic floor strength

Answer 234

Decreased pelvic floor tone and strength, elongated pelvic floor muscles Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.

Question 235

Which of the following will not be compressed with an enlarged uterus (pregnancy)? A. Bladder B. Vulvar veins C. Breasts D. Inferior vena cava

Answer 235

Breasts Owing to the location of the baby, all but the breasts may be compressed at some point during a pregnancy.

Question 236

Which of the following is not a strong predictor of persistent low back pain after pregnancy? A. Low BMI B. High BMI C. Early onset of pain during pregnancy D. Hypermobility of the spine

Answer 236

Low BMI Predictors include significantly earlier onset of pain during pregnancy, higher maternal age, higher body mass index (BMI), and a higher proportion of women with joint hypermobility are affected.

Question 237

Which of the following antibiotics is classified as a beta-lactam? A. Penicillin B. Levofloxacin C. Azithromycin D. Tetracycline

Answer 237

Penicillin Beta-lactam antibiotics are so named because of a unique chemical ring structure that all drugs in this class possess. Oftentimes, beta-lactams are referred to as the penicillins, penicillin being the first drug in this class to be described. Levofloxacin is a flouroquinolone; azithromycin is a macrolide, and tetracycline is the prototype tetracycline.

Question 238

An athlete is being treated for sinusitis with Augmentin (amoxicillin + clavulanic acid. He mentions that he is allergic to penicillin. He's been taking Augmentin for 2 days now, but his symptoms are not improving, andhe's starting to get red, itchy rashes on other parts of his body. What do you tell him? A. Even though he's allergic to pencillin, he should not be allergic to Augmentin and he should keep taking it. B. Sinusitis is usually a viral infection, so the Augmentin should work and he should keep taking it. C. He is probably developing an allergic reaction to the Augmentin and should stop taking it and call his doctor. D. He is experiencing a normal side effect of the medication.

Answer 238

He is probably developing an allergic reaction to the Augmentin and should stop taking it and call his doctor Hypersensitivity reactions to penicillin are the most common side effect of this antibiotic. Amoxicillin falls into the class of penicillins (or beta-lactam antibiotics), and therefore, the rash is most likely the result of an allergic reaction to the amoxicillin. Sinusitis is a type of bacterial infection; therefore, treatment with an antibiotic is justified.

Question 239

Nasal decongestants used in the treatments of colds and allergies A. Bind to alpha-1 receptors to cause vasoconstriction B. Include pseudoephedrine, which is administered as a nasal spray C. Cause adverse effects such as drowsiness, lethargy, and dry mouth D. Can cause rebound congestion when taken orally

Answer 239

Bind to alpha-1 receptors to cause vasoconstriction Abnormal swelling of the vessels in the nasal cavity usually causes nasal congestion. Treatment with a medication that binds to alpha-receptors will cause these vessels to contract or shrink and will help improve symptoms. Pseudoephedrine is only taken orally. Rebound congestion is only seen with nasal sprays. All drugs in this category are more likely to cause CNS stimulation, excitabilitv, nervousness rather than drowsiness, or dry mouth (these are tvpical anti-cholinergic side effects).

Question 240

Excretion (or elimination) of a drug A. Is the removal of the drug from the body B. Occurs only via the kidney C. Is how the body breaks down medications D. Begins only after a toxic amount has accumulated in the body

Answer 240

Is the removal of the drug from the body Excretion is the pharmacokinetic term used to describe how the body removes drugs from the body. Drugs can be eliminated in a variety of ways including via urine, sweat, feces, bile, and other means. Excretion is not a static process and occurs as soon as the drugs able to be eliminated.

Question 241

Which drug works by competitively inhibiting the enzyme HMG-CoA reductase to reduce cholesterol levels? A. Gemfibrozil (Lopid) B. Niacin (Vitamin B12) C. Atorvastatin (Lipitor) D. Ezetimide (Zetia)

Answer 241

Atorvastatin (Lipitor) The "statins" are a group of drugs that inhibit the rate-limiting step in cholesterol synthesis. The enzyme HMG-CoA reductase catalyzes this rate-limiting step.

Question 242

Excessive femoral anteversion in children may result in all of the following except A. Toeing in during gait B. Increased hip internal rotation range of motion C. Increased external rotation range of motion D. Decreased external rotation range of motion

Answer 242

Increased external rotation range of motion Increased external rotation range of motion. Excessive femoral anteversion has been shown to be related to increased internal rotation and decreased external rotation ROM. Also, it has been shown that it results in a reduced hip abductor moment arm.

Question 243

Your patient has a lesion of the left superior gluteal nerve. When your patient is in left unilateral stance you may observe the A. Right ASIS is higher than the left ASIS B. Right ASIS is anterior to the left ASIS C. Trunkside bending to the left D. Lumbar spine is side bent to the right

Answer 243

Trunkside bending to the left Trunk side bending to the left. The superior gluteal nerve innervates the gluteus medius muscle. A lesion would result in a Tredelenberg stance, leading to left side bending of the spine (to maintain an upright posture).

Question 244

Standing on the left leg and flexing your right hip up requires you to use all the following muscles except the A. Right lumbar rotators B. Leftgluteus minimus C. Rightquadratuslumborum D. Left gluteus medius

Answer 244

Right lumbar rotators Choice A, right lumbar rotators, is the correct answer. The single leg stance would result in activation of all of the left-sided hip abductors and the right quadratus lumborum.

Question 245

A smaller than normal angle of inclination at the hip is called A. Anteversion B. Retroversion C. Coxa vara D. Coxa valga

Answer 245

Coxa vara Choice C, coxa vara, is the correct answer. Coxa valga would be a larger than normal angle of inclination at the hip. Anteversion is the angle made by the femoral neck and the femoral condyles (as measured from the coronal plane). Excessive medial rotation is anteversion, and excessive lateral rotation is retroversion.

Question 246

Hip extension may be limited by all of the following tissues except A. Iliofemoralligament B. Iliopsoas muscle C. Ischiofemoral ligament D. Gluteus minimus posterior fibers

Answer 246

Gluteus minimus posterior fibers Choice D, gluteus minimus posterior fibers, is the correct answer. Hip abductors and hip extensors do not limit hip extension. All the other choices may.limit hip extension.

Question 247

An angle of 170 degrees to 175 degrees in the frontal plane taken on the lateral side of the knee is considered A. Excess genu valgum B. Excess genu varum C. Normal D. Coxavara

Answer 247

Normal Choice C. normal. is the correct answer. Genu valgum is an abnormal inward "bowing of the knees (knock knee). Genuvarus is an outward anatomic presence of the knee (bow-legged).

Question 248

The pes anserine insertion is palpable at the _____ and includes the tendons of the______: A. Medial tibia, semimembranosus, semitendinosis, and gracilis B. Lateral tibia, biceps femoris, semitendinosus, and iliotibial band C. Medial tibia, sartorius, gracilis, and semitendinosus D. Medial femur, biceps femoris, semitendinosus, and iliotibial band

Answer 248

Medial tibia, sartorius, gracilis, and semitendinosus Choice C, medial tibia, sartorius, gracilis, and semitendinosus, is the correct answer. An interesting pneumonic to remember the pes anserine insertion is "Say Grace before SupperTime" Say = sartoriuos, Grace = gracilis, SupperTime = semitendinosus.

Question 249

As the knee extends and the patella moves superiorly in the trochlear groove, the sulcus angle ________ making the patellofemoral joint _______ stable. A. Increases, less B. Decreases, less C. Increases, more D. Decreases, more

Answer 249

Increases, less Choice A, increases, less, is the correct answer. As the patella rides superiorly out of the trochlear groove, the joint becomes less stable because less of the patellais in contact with the trochlear groove.

Question 250

The glenoid faces somewhat A. Lateral and inferior and posteriorly B. Lateral and superior and anteriorly C. Medial and superior and anteriorly D. Medial and inferior and posteriorly

Answer 250

Lateral and superior and anteriorly Choice B, lateral and superior and anteriorly, is the correct answer. This is the normal anatomic presentation of the glenoid.

Question 251

During normal scapulo humeral rhythm, the A. Scapula upwardly rotates 60 degrees and the humeral abducts 120 degrees B. Scapula upwardly rotates 2 degrees for every 1 degree of humeral abduction C. Scapulaabducts 60 degrees and upwardly rotates 120 degrees D. Scapula upwardly rotates 120 degrees and the humeral abducts 60 degrees

Answer 251

Scapula upwardly rotates 60 degrees and the humeral abducts 120 degrees The scapula upwardly rotates 60 degrees and the humeral abducts 120 degrees. The scapula upwardly rotates 1 degree for every 2 degrees of humeral abduction. Abnormalities of this relationship could signal deficiencies in the rotator cuff musculature.

Question 252

Anterior glenohumeral dislocations are often accompanied by A. A stretched subscapularis B. A Hill-Sachs lesion C. A fracture of the greater tubercle D. Rotator cuff full-thickness tears

Answer 252

A Hill-Sachs lesion Choice B. a Hill-Sachs lesion, is the correct answer. While many of these injuries are seen with sholder dislocation, a Hill-Sachs lesion is by far the most common. A Hill-Sachs lesion to the humerus is caused when the smooth surface of the humerus hits the outer rim of the glenoid fossa.

Question 253

Which of the following is false regarding biomechanics of persons with patellofemoral pain? A. Weakness of the hip abductors, external rotators, and extensors is frequently present B. Excessive hip internal rotation and/or hip adduction is frequently present C. Patella alta increases patellar instability D. Increased trochlear groove depth increases patellar instability

Answer 253

Increased trochlear groove depth increases patellar instability Increased trochlear groove depth increases patellar instability. An internally rotated femur causes the patella to tracklaterally. A lateral patella is unstable. Weakness of the hip exteral rotators will lead to a more internally rotated femur. A superior patella (as in patella alta), will move the patella out of the trochlear groove. However, increased trochlear groove depth makes the patella MORE stable.

Question 254

Two drugs, an agonist and a competitive antagonist, are given to a patient. The agonist drug exists at four times the serum concentration of the antagonist. Assuming no other variables are present, what will be the resulting drug effect? A. No effect B. increased agonist effect C. agonist effect D. antagonist effect

Answer 254

agonist effect The competitive antagonist will occupy 20 of available receptor sites because four parts agonist/one part antagonist = agonist effect.

Question 255

A drughas 60 bioavailability when given orally at the recommended dosage. What does this mean? A. 60 of the dose is excreted. B. 60 of the drug is available and active in the bloodstream. C. 40 willbe bound to plasma proteins and active in the serum. D. 40 of the drugs available and active in the bloodstream.

Answer 255

60 of the drug is available and active in the bloodstream. Bioavailability refers to the drug fraction available to produce the desired effect.

Question 256

The half-life of diazepam (Valium) is approximately 12 hours. If a 70-kg patient took 10 mg at 8:00 AM, what amount of drug would be present in his body the next day at 8:00 AM during his scheduled appointment with you? A. 5 mg B. 2.5 mg C. 1.25 mg D. 0.625 mg

Answer 256

2.5 mg A 24-hour period has elapsed, which is 2 half-lives. The serum drug concentration will be reduced by half during the first half-life period and half again during the second half-life time period. 1/2 x 10 mg = 5 mg, 1/2 x 5 mg = 2.5 mg.

Question 257

Aspirin, as acetvIsalicvlic acid, inhibits platelet aggregation like all NSAIDs, but is the drug of choice for thromboprophylaxis because A. It has a predictable irreversible mechanism of action B. It has a predictable reversible mechanism of action C. It has a longer half-life than other NSAID agents D. It has no COX II effect

Answer 257

It has a predictable irreversible mechanism of action Aspirin is unique among the NSAID agents in that its impact on thromboxane biosynthesis and platelet aggregation is an irreversible effect. The thromboprophylactic effect following aspirin administration therefore lasts about 8 to 10 davs, the lifespan of a platelet.

Question 258

In First-order kinetics A. A constant percentage of the drug is lost/metabolized per unit time B. A variable percentage of the drug is metabolized per unit time C. A constant amount (m) is metabolized perunit time D. A constant first-pass effect is produced

Answer 258

A constant percentage of the drug is lost/metabolized per unit time First-order kinetics refers to drugs metabolized in half-life patterns. Fifty percent of active drug is metabolized each half-life.

Question 259

Medications within the benzodiazepine (BZD) class of drugs have multiple indications and uses for phvsical therapy patients. Which of the following is not an indication for use of benzodiazepines? A. Alcohol withdrawal B. Reliefof anxiety C. Sleep aid D. Analgesia

Answer 259

Analgesia BZD agents do not produce analgesia.

Question 260

Which of the following benzodiazepine (BZD) medications is properly indicated for relief of anxietv? A. Xanax B. Valium C. Dalmane D. Klonopin

Answer 260

Xanax Xanax is specifically indicated for treatment of anxiety. Klonopin is indicated for convulsive disorders and Valium for skeletal muscle spasm and convulsive disorders. It is not a first-line agent for anxiety because of sedation and its long half-life.

Question 261

Angiotensin-converting enzyme (ACE) inhibitors are prone to producing a common, irritating side effect that may necessitate change to another drug agent. What is that side effect? A. Dry hacking cough B. Peripheral edema C. Visual color alteration of blue and green D. Atrial fibrillation

Answer 261

Dry hacking cough The dry hacking cough is a major irritant and problem with the ACE agents that often results in a change to an ARB class agent.

Question 262

Which of the following benzodiazepines (BZD) is contraindicated in the elderly because of an extremely long half-life? A. Alprazolam B. Lorazepam C. Temazepam D. Flurazepam

Answer 262

Flurazepam Flurazepam (Dalmane) has an extended half-life (12 to 24 hours), which is even longer in the elderly. Some sources note Dalmane may never be eliminated from the body of an elderly patient.

Question 263

Which of the following benzodiazepine medications is most properly indicated for outpatient-based treatment of convulsive disorders? A. Xanax B. Valium C. Dalmane D. Klonopin

Answer 263

Klonopin Klonopin is indicated as a first- line agent for treatment of convulsive disorders. Valium may be used in emergency room settings to treat status epilepticus, but it is not a first-line agent for outpatient care.

Question 264

Skeletal muscle relaxant agents fall into two main categories. Which of the following choices are those categories? A. Beta-1 and beta-2 B. COX-1 and COX-2 C. Prostaglandin and prostacyclin agonists D. Centrally and peripherally acting

Answer 264

Centrally and peripherally acting Skeletal muscle relaxants are primarily classified by the site of action. This is either the central nervous system (CNS) or peripheral nervous system (myoneural junction).

Question 265

A key side effect of Flexeril, Soma, Robaxin, and Norflex and other centrally acting skeletal muscle relaxants of note to therapists is A. Sedation B. Drug-induced spasticity in spinal cord patients C. Paralysis D. Rhabdomvolvis

Answer 265

Sedation All centrally acting muscle relaxants, by definition, produce CNS sedation.

Question 266

In what way is Flexeril (cyclobenzaprine) somewhat unique among muscle relaxants that affect the central nervous system? A. Flexeril has more peripheral effect. B. Flexeril shares pharmacologic characteristics with the tricyclic antidepressant agents. C. Flexerilis a GABA-agonist similar to barbiturates. D. Flexeril acts at the acetvlcholine (Ach) receptors, producing neuromuscular blockade.

Answer 266

Flexeril shares pharmacologic characteristics with the tricyclic antidepressant agents. Flexeril is related to the tricyclic antidepressant agents and may share some side effects including anticholinergic activity.

Question 267

Side effects of note among patients taking Baclofen include (1.267) A. Drowsiness and memory impairment B. Weight gain C. Weightloss D. Beta-1 suppression of maximum heart rate

Answer 267

Drowsiness and memory impairment Baclofen does not alter weight or have beta-1 adrenergic activity.

Question 268

Opium, derived from the poppy flower, contains two main natural opiates. What are they? (1.268) A. Codeine and demerol B. Heroin and codeine C. Hydrocodone and hydroxcodone D. Codeine and morphine

Answer 268

Codeine and morphine The two naturally occurring opiates within the poppy flower are codeine and morphine.

Question 269

The primary side effect, common among almost all oral hypoglycemic agents, of particular note during active physical therapy is (1.269) A. Hypoglycemia B. CNS depression C. Nephrolithiasis D. Increased deep tendon reflexes

Answer 269

Hypoglycemia With few exceptions, the oral hypoglycemic agents may produce hypoglycemia. Patients should be monitored to ensure dietary glucose intake is appropriate to their hypoglycemic agent dosage.

Question 270

A Tylenol with codeine #3 tablet (TC3) contains how much codeine? (1.270) A. 60 mg B. 30 mg C. 15 mg D. 7.5 mg

Answer 270

30 mg The old apothecary system used the grain as a unit of weight. One grain is approximately 63 mg. A Tylenol with codeine #4 contains 1 grain, nominally 60 mg. A #3 is half that amount, 30 mg; a #2 contains 15 mg: and a #1 contains 7.5 mg.

Question 271

Talwin and Stadol are examples of which opiate analgesic class? (1.271) A. Antagonist B. Agonist-antagonist C. Competitive agonist D. Agonist

Answer 271

Agonist-antagonist Both of these agents are classified as agonist-antagonist opiate agents and are among the more common seen in practice.

Question 272

Which of the paired drug interactions between an opiate and second drug agent is INCORRECT? (1.272) A. Alcohol/increased respiratory depression B. Tricyclic antidepressants/increased constipation C. Cigarette smoking/decreased opiate analgesic effect D. Diureticagents/hypertensive crisis

Answer 272

Diureticagents/hypertensive crisis Combining an opiate with a diuretic agent will not increase blood pressure but rather reduce blood pressure by virtue of ethanol's ability to relax vascular smooth muscle.

Question 273

Demerol (Meperidine) is combined with Vistaril (Hydroxyzine HCI) (an antihistamine), producing an enhanced analgesic effect of demerol. This allows decreased dosage and potential deleterious effects. This is an example of what drug interaction? (1.273) A. Additive B. Reversible antagonism C. Potentiation D. Antagonism

Answer 273

Potentiation Two dissimilar drugs one with the ability to multiply a specific effect of the other is potentiation.

Question 274

Which of the following is the only skeletal muscle relaxant that acts on the peripheral nervous system? (1.274) A. Diazepam (Valium) B. Baclofen (Lioresol) C. Orphenadrine (Norgesic) D. Dantrolene (Dantrium)

Answer 274

Dantrolene (Dantrium) The only skeletal muscle relaxant that acts directly on muscle is dantrolene.

Question 275

Cyclo-oxygenase I (COX-2) specific agents are now indicated only for patients with (1.275) A. History of GI or renal disorders B. Patients with hypersensitivity to aspirin C. Patients in need of postoperative thromboprophylaxis D. Patients hypersensitive to acetaminophen

Answer 275

History of GI or renal disorders Current prescribing protocol notes the only indication for a COX-2 agent is a patient with a GI or renal disorder. Even then, COX-2 agents are not the first-line drug because of their mild effect on both GI and renal function.

Question 276

The chief difference between acetaminophen and the nonsteroidal anti-inflammory drugs (NSAIDs) is that acetaminophen has no ________ or ___________ effect. A. Analgesic/antithrombotic B. Antipyretic/antithrombotic C. Anti-inflammatory/antithrombotic D. Antipyretic/anti-inflammatory

Answer 276

Anti-inflammatory/antithrombotic Acetaminophen has no peripheral anti-inflammatory effect and does not impede biosvnthesis of thromboxane and therefore has no impact on platelet aggregation.

Question 277

Your patient is unlikely to be compliant with a short half-life NSAID, so you select a long-acting agent. Which of these NSAID agents has the longest half-life? (1.277) A. Aspirin B. Feldene C. Naproxyn D. Daypro

Answer 277

Daypro Daypro exhibits one of the longest NSAID half-lives, over 50 hours.

Question 278

An example of the most common FIRST- LINE diuretic used in the treatment of hypertension would be (1.278) A. Hydrochlorothiazide (HCT) B. Lasix C. Spironolactone D. ACTH

Answer 278

Hydrochlorothiazide (HCT) HCT is a common first-line agent for initial treatment of hypertension. It is relatively safe and effective and maybe combined with second-line agents if needed

Question 279

Your 31-year-old male patient presents with his third episode of extreme pain at the first metatarsal phalangeal joint of the right foot. Clinical examination and laboratory results indicate gouty arthritis as the diagnosis. Which drug is LEAST appropriate for acute care? (1.279) A. Colchicines B. Indomethacin C. Probenecid D. Ibuprofen

Answer 279

Probenecid Probenicid acts by a different mechanism of action and is used to reduce uric acid synthesis as a means of preventing recurrent attacks rather than treatment of acute attacks of gouty arthritis. The other listed agents are used to treat acute episodes.

Question 280

Side effects of physical therapy concern with use of angiotensin-converting enzyme (ACE) inhibitor agents include all of the following EXCEPT (1.280) A. Headache B. Dizziness C. Postural hypotension D. Potassium depletion

Answer 280

Potassium depletion The ACE inhibitors inhibit biosynthesis of angiotensin ll and have no impact on potassium levels as do the thiazide andloop diuretics.

Question 281

Furosimide, 40 mg twice a day, is prescribed for your congestive heart failure (CHF) patient who is also taking Lanoxin. What is your chief monitoring concern? (1.281) A. Hypervolemia B. Hypokalemia C. Hypercalcemia D. Hyperkalemia

Answer 281

Hypokalemia Furosemide is a loop diuretic and will cause significant potassium loss in the urine. Potassium supplements are sometime required. Patients should be monitored for hypokalemia.

Question 282

Of what significance is the Edinger-Westphal response to you in monitoring your patient prescribed an opiate analgesic? A. The Edinger-Westphal response suggests opiate overdose. B. The Edinger-Westphal response suggests opiate antagonist effect. C. The Edinger-Westphal response correlates with concurrent Dantrium. D. The Edinger-Westphal response indicates the patient is receiving insufficient dosage for analgesic effect of the opiates.

Answer 282

The Edinger-Westphal response suggests opiate overdose. The Edinger-Westphal response is a direct drug action, rather than a side effect. Bilateral myosis suggests opiate overdosage.

Question 283

The angiotensin-receptor blockers (ARB agents) act by what mechanism of action? A. Antagonize Na+ ion receptors B. Angiotensin-receptor antagonism C. Angiotensin-converting enzyme antagonism D. Dilation of vascular smooth muscle

Answer 283

Angiotensin-receptor antagonism ARB agents are similar in effect to the ACE group but theirmechanism of action is at the angiotensin lI receptor site rather than enzymatic production of angiotensin.

Question 284

The main advantage of aldactone over thiazide is that aldactone is/causes A. Potassium sparing B. Lesshypotension C. Lesshypertension D. Receptor site specificity of alphal receptors

Answer 284

Potassium sparing Patients prone to hypokalemia or potassium-sensitive agents such as digoxin may require use of a "potassium-sparing agent" such as aldactone.

Question 285

The biguanide group of oral hypoglycemic agents includes metformin. Metformin has what characteristic of note to physical therapists? A. No hypoglycemic effect B. Interferes with carbohydrate absorption C. Delays carbohydrate absorption D. Will not cause nausea

Answer 285

No hypoglycemic effect Metformin is unique among oral hypoglycemic agents in that it does not produce hypoglycemia.

Question 286

What is true of the thiazolidinediones? A. Thiazolidinediones will not cause hypoglycemia. B. Thiazolidinediones' effect is independent of insulin production. C. Thiazolidinediones decrease insulin receptor site activity. D. Thiazolidinediones decrease lipids.

Answer 286

Thiazolidinediones decrease insulin receptor site activity This newer class of oral hypoglycemic agents exerts its effect at the peripheral insulin receptor, resulting in increased active diffusion of insulin across the cell membrane.

Question 287

Side effects of progestin include all of the following EXCEPT A. Weight gain B. Edema C. Manic episodes D. Possible mild androgenic effects

Answer 287

Possible mild androgenic effects Progestin is progesterone and will not produce male secondary sex characteristics.

Question 288

What side effect is shared by all benzodiazepine agents? A. Muscle weakness B. Hypertension C. Sedation D. Cross-sensitivity with penicillin-derived antibiotics

Answer 288

Sedation Sedation is the shared side effect of all BZD agents of note to PTs.

Question 289

The nonsteroidal anti-inflammatory drugs impede COX-2 activity. COX-2 produces inflammatory prostaglandins via biosynthesis of what substance? A. Serotonin B. Substance P C. Arachidonic acid D. Gamma butyric acid

Answer 289

Arachidonic acid All NSAID agents exert their myriad effects by blocking COX-1 and/or COX-2 biosynthesis from their precursor, arachidonic acid, which is naturally found on most cell surfaces in the body.