FORTINBERRY CH2 Flashcards
A patient who suffered a myocardial infarction is participating in an exercise test. The therapist notes ST-segment depression of 1.7 mm on the patient’s current rhythm strip. What is the most appropriate course of action?
A. Stop the exercise session immediately and send the patient to the emergency room.
B. Continue with the exercise session.
C. Contact the patient’s cardiologist about continuing exercise.
D. Stop the exercise session to take the patient’s heart rate and blood pressure.
Continue with the exercise session.
Exercise testing should be terminated at 2 mm of ST depression.
The therapist is treating a patient who received an above-elbow amputation 2 years ago. The prosthesis has a split cable that controls the elbow and the terminal device. With this type of prosthesis, the patient must first lock the elbow to allow the cable to activate the terminal device. This is accomplished with what movements?
A. Extending the humerus and elevating the scapula
B. Extending the humerus and retracting the scapula
C. Extending the humerus and protracting the scapula
D. Extending the humerus and depressing the scapula
Extending the humerus and depressing the scapula
To lock the elbow with this type of prosthesis, the patient must extend the humerus and depress the scapula.
A physical therapist is treating a patient who is participating in cardiac rehabilitation. Because the patient complains of chest pain, the therapist attempts to assess heart sounds with a stethoscope. Which of the following is true about the first sound during auscultation of the heart?
A. The first sound is of the closure of the aortic and pulmonic valves.
B. The first sound is of the closure of the mitral and tricuspid valves.
C. The first sound is of the beginning of ventricular diastole.
D. The first sound is usually the loudest.
The first sound is of the closure of the mitral and tricuspid valves.
The first sound heard corresponds with the closing of the mitral and tricuspid valves.
The second sound corresponds to closing of the aortic and pulmonic valves. Therefore, the first sound is indicative of the onset of ventricular systole, and the second sound is indicative of the onset of ventricular diastole. The first sound is usually lower in pitch and longer than the second.
A 53-vear-old man with chronic obstructive pulmonary disease reports to an outpatient cardiopulmonary rehabilitation facility.
Pulmonary testing reveals that forced expiratory volume in 1 second (FEV1) and vital capacity (VC) are within 60; of predicted values.
What is the appropriate exercise prescription?
A. Exercise at 75to 80of the target heart rate 3 times/week.
B. Begin exercise with levels of 1.5 METs and increase slowly 3 times/week.
C. Exercise at 75 to 80 of the target heart rate 7 times/week.
D. Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.
Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.
This patient has moderate lung disease.
Because the intensity of exercise is low, frequency should be increased to 5 to 7 times/week.
- A patient reports throbbing pain in the lower extremities accompanied by trophic changes and diminished pulses. The pain is aggravated by activity and was not influenced by spinal movements. What source of pain is most likely responsible for these complaints?
A. Peripheral neuropathy
B. Restless leg syndrome
C. Vascular pain
D. Neurogenic pain
Vascular pain
This scenario describes vascular
claudication. The lack of pain or svmptoms with spinal movements rules out peripheral neuropathy. Neurogenic pain is usually represented by a stocking distribution around the ankle, and restless leg syndrome occurs during periods of rest only.
A physical therapist is working with a patient who has chronic obstructive pulmonary disease.
If the patient’s level of oxygen being carried by arterial blood is measured, a Pa02 finding of ___________ is considered normal.
A. 35 to 45 mm Hg
B. 60 to 80 mm Hg
C. 80 to 100 mm Hg
D. 100 to 120 mm Hg
80 to 100 mm Hg
Normal Pa02 ranges from 80 to 100 mm Hg and is an important determinant of when it is safe to exercise a patient either with or without supplemental oxygen. Pa02 is determined by examining the concentration of oxygen present in arterial blood. Understanding the parameters under which a patient may safely perform exercise is important.
Whiplash injury from a rear-end collision would tearwhich of the following ligaments?
A. Posterior longitudinal ligament (PLL)
B. Anterior longitudinal ligament (ALL)
C. Ligamentum nuchae
D. Ligamentum flavum
Anterior longitudinal ligament (ALL)
Whiplash injury includes
hyperextension of cervical vertebrae that may tear the anterior longitudinalligament 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.
Where is the most common site of fracture in osteoporosis?
A. Metacarpals
B. Skull
C. Proximal radius
D. Vertebral bodies
Vertebral bodies
Osteoporosis affects all bones of the body, but most commonly it produces symptoms in the major weight-bearing bones.
Which one of the following conditions is characterized b reduced osteoclastic bone resorption?
A. Paget’s disease of the bone
B. Osteoporosis
C. Osteopetrosis
D. Osteomalacia
Osteopetrosis
Osteopetrosis is a genetic disorder characterized by osteoclast dysfunction that leads to excessive osteoid tissue formation.
Paget’s disease is an acquired disease in which the osteoclast dysfunction initially causes excessive removal of bone (osteolysis).
Osteomalacia is the softening of bone due to poor and delaved calcification. Osteoporosis is due to more than one etiological factor, acquired and genetic, accompanied by reduced amount of osteoid tissue.
Which of the following conditions is descriptive of osteoarthritis?
A. Itprovokes giant cell pigmented villonodular synovitis.
B. It is associated with decreased type II collagen, cytokines, and chondrolysis.
C. Ankylosis and follicular inflammation are predominant.
D. It is associated with increased cartilage matrix synthesis and deposition.
It is associated with decreased type II collagen, cytokines, and chondrolysis
Osteoarthritis is induced by aging, trauma, and genetic factors. Hence, fibrillation osteophytes, and decreased collagen I synthesis are the main features. In contrast, synovitis and inflammation occur in other forms, such as rheumatoid and giant villonodular arthritis.
An overweight 12-year-old presents with hip pain and weight-bearing difficulties. These symptoms presented rapidly following physical activity. On examination, limping is observed and passive ranges of motion are limited and painful. Which of the following is the MOST probable diagnosis?
A. Legg-Calve Perthes disease
B. Transient hip synovitis
C. Congenital hip dysplasia
D. Slipped femoral capital epiphysis
Slipped femoral capital epiphysis
Slipped femoral capital epiphysis is the
most common hip condition in adolescent boys (10 to 16 years old. Fifty percent of cases present with a traumatic history. Traumatic slipped femoral capital epiphysis is considered a Salter-Harris type I epiphyseal fracture.
A defining symptom of fibromyalgia is
A. Fatigue
B. Diffuse pain
C. Regional pain
D. Unexplained weight loss
Diffuse pain
Diffuse pain is a defining criterion of fibromyalgia. According to the American College of Rheumatologists’ 1990 criteria for the classification of fibromyalgia, widespread pain must be present for at least 3 months. Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, pain below the waist, and axial skeletal pain. Pain in 11 of 18 tender point sites on digital palpation must also be present in order to establish the diagnosis of fibromyalgia.
Morton’s neuroma is usually located between which metatarsal heads?
A. First and second
B. Second and third
C. Third and fourth
D. Fourth and fifth
Third and fourth
A painful neuroma in the space between the third and the fourth metatarsal heads is a
Morton’s neuroma.
A 50-year-old, slightly obese man presents with a 1-month history of right hip pain without radiation, a protective limp, and activity-induced symptoms. He improves with rest and has some mild morning stiffness. Examination reveals restricted and painful internal rotation of the hip. What is the MOST likely diagnosis?
A. Inflammatory arthritis
B. Osteoarthritis
C. Osteoporotic hip fractures
D. Iliopsoas tendinosis
Osteoarthritis
Patients older than 40 years of age with a new episode of hip pain presents evidence of osteoarthritis in 44%; of cases. Restricted and painful internal rotation is highly suggestive of osteoarthritis, and three-plane range of motion limitation is less sensitive but more specific.
What is the MOST common myofascial pain syndrome of the low back?
A. Piriformis
B. Quadratus lumborum
C. Iliopsoas
D. Tensor fascia late
Quadratus lumborum
Travell and Simons report that myofascial pain syndrome of the quadratus lumborum muscle is the most common mvofascial pain syndrome of the lower back.
What shoulder view BEST demonstrates the greater tubercle?
A. External rotation
B. Internal rotation
C. Babyarm
D. Transthoracic
External rotation
Due to the anatomic location of the greater tubercle, external rotation positions it in profile for best visualization.
The Waddell tests are used to identify
A. Pain of a nonorganic origin
B. Space-occupying lesions
C. Balance and coordination functions
D. History of alcohol or substance abuse
Pain of a nonorganic origin
Waddell testing is used to identify patients suffering from pain of a nonorganic origin.
While assessing the standing posture of a patient, the therapist notes that a spinous process in the thoracic region is shifted laterally.
The therapist estimates that T2 is the involved vertebra because he or she notes thatit is at the approximate level of the
A. Inferior angle of the scapula
B. Superior angle of the scapula
C. Spine of the scapula
D. Xiphoid process of the sternum
Superior angle of the scapula
The superior angle of the scapula
commonly rests at the same level as vertebra T2.
The spine of the scapula is approximately at T3.
The inferior angle of the scapula and xiphoid process represent T7.
While ambulating a stroke patient (the right side is the involved side), the therapist notes increased circumduction of the right lower extremity. Which of the following is an unlikely cause of this deviation?
A. Increased spasticity of the right gastrocnemius
B. Increased spasticity of the right quadriceps
C. Weak hip flexors
D. Weak knee extensors
Weak knee extensors
Choices A, B, and C would increase the functional length of the right lower extremity and possibly cause a circumduction during gait.
Choice D would not change the functional leg length.
The therapist is treating a 52-year-old woman afterright total hip replacement. The patient complains of being self-conscious about a limp.
She carries a heavy briefcase to and from work every day. The therapist notes a Trendelenburg gait during ambulation on level surfaces. What advice can the therapist give the patient to minimize gait deviation?
A. Carry the briefcase in the right hand.
B. Carry the briefcase in the left hand.
C. The patient should not carry a briefcase at all.
D. Itdoes not matter in which hand the briefcase is carried.
Carry the briefcase in the right hand.
The briefcase should be carried in the
right hand. Carrying the briefcase in the left hand would increase the amount of force that the right gluteus medius would have to exert to maintain a stable pelvis during gait.
Which of the following actions places the greatest stress on the patellofemoral joint?
A. When the foot first contacts the ground during the gait cycle
B. Exercising on a stair-stepper machine
C. Running down a smooth decline of 30 degrees
D. Squats to 120 degrees of knee flexion
Squats to 120 degrees of knee flexion
Patellofemoral joint reaction forces increase as the angle of knee flexion and quadriceps muscle activity increase. Choice D involves the greatest knee flexion angle and quadriceps activity.
While observing the ambulation of a 57-year-old man with an arthritic right hip, the therapist observes a right lateral trunk lean. Why does the patient present with this gait deviation?
A. To move weight toward the involved hip and increase joint compression force
B. To move weight toward the uninvolved hip and decrease joint compression force
C. To bring the line of gravity closer to the involved hip joint
D. To take the line of gravity away from the involved hip joint
To bring the line of gravity closer to the involved hip joint
Leaning the trunk over the involved hip decreases joint reaction force and strain on the hip abductors. These factors together decrease pain in the involved hip.
A therapist has been treating a patient who received a rotator cuff surgical repair with sessions consisting only of passive range of motion (for an extended period). The patient has just returned from a follow-up doctor’s visit with an additional order to continue with passive range of motion only. Which of the following is the best course of action for the therapist?
A. Continue with passive range of motion as instructed, and call the physician to consult with him or her about the initiation of active range of motion.
B. Begin active range of motion within the pain-free range, and continue passive range of motion.
C. Continue passive range of motion, and do not question the physician’s decision.
D. Perform passive range of motion and any other exercise that is within the normal protocol for this diagnosis.
Continue with passive range of motion as instructed, and call the physician to consult with him or her about the initiation of active range of motion.
It is best to consult with the physician because of an extended amount of passive range of motion. A therapist should not deviate from a physician’s order, but a telephone call to clarify the order is necessary when the therapist feels that another treatment plan is more appropriate.
A patient’s lawyer calls the therapist requesting his or her client’s clinical records. The lawyer states that he or she needs the records to pay the patient’s bill. What is the best course of action?
A. Tell the lawyer either to have the patient request a copy of the records or to have the patient sign a medical release.
B. Faxthe needed chart to the lawyer.
C. Mail a copy of the chart to the patient.
D. Call the patient and tell him or her of the recent development.
Tell the lawyer either to have the patient request a copy of the records or to have the patient sign a medical release.
A patient can obtain his or her medical records simply by signing a release form. Charts and records should never be given or faxed to an attorney unless the patient has signed a release.
A 35-year-old woman with a diagnosis of lumbar strain has a phvsician’s prescription with a frequency and duration of 3 sessions/week for 6 weeks. The physical therapy examination reveals radiculopathy into the L5 dermatome of the right lower extremity, increased radiculopathy with lumbar flexion, decreased radiculopathy with lumbar extension, poor posture, and hamstring tightness bilaterally at 60 degrees. What is the best course of treatment?
A. Lumbartraction, hot packs, and ultrasound
B. McKenzie style lumbar extensions, a posture program, hamstring stretching, and a home exercise program
C. McKenzie style lumbar extensions, a posture program, hamstring stretching, home program, hot packs, and ultrasound
D. Lumbartraction, hot packs, ultrasound, and hamstring stretching
B.
Hot packs are not indicated because
there is no mention of abnormal muscle tone.
The entire lumbar area is too much surface area for ultrasound. An argument could be made for lumbar traction, but it is paired with heating modalities in all of the answers.
Which of the following does the therapist observe if a patient is correctly performing an anterior pelvic tilt in standing position?
A. Hip extension and lumbar flexion
B. Hip flexion and lumbar extension
C. Hip flexion and lumbar flexion
D. Hip extension and lumbar extension
B.
Choice B is the correct answer. Choice A is a posterior pelvic tilt.
At what point in the gait cycle is the center of gravity the lowest?
A. Double support
B. Terminal swing
C. Deceleration
D. Midstance
A.
The lowest point in the gait cycle occurs when both lower extremities are in contact with the ground (double support).
A 14-year-old girl with right thoracic scoliosis is referred to physical therapy. The therapist should expect which of the following findings?
A. Left shoulder high, left scapula prominent, and right hip high
B. Left shoulder low, right scapula prominent, and left hip high
C. Right shoulderhigh, right scapula prominent, and right hip high
D. Right shoulder low, right scapula prominent, and left hip high
B.
The patient probablv has a low left shoulder, prominent right scapula, and high left hip.
What is the most likely cause of anterior pelvic tilt during initial contact (heel strike?
A. Weak abdominals
B. Tight hamstrings
C. Weak abductors
D. Backpain
A.
Abdominal muscles attach to the lower
border of the ribs and the superior surface of the pelvis. Strong abdominals prevent excessive anterior rotation of the pelvis during gait.
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 L5
D. L5 and S1
B.
The fifth lumbar nerve root is impinged because it arises from the spinal column superior to the L4-L5 lumbar disc.
During examination of a patient, the therapist observes significant posterior trunk lean at initial contact (heel strike). Which of the following is the most likely muscle that the therapist needs to focus on during the exercise session in order to minimize this gait deviation?
A. Gluteus medius
B. Gluteus maximus
C. Quadriceps
D. Hamstrings
B.
This gait deviation is caused by the patient leaning back to decrease the flexion moment created at the hip at initial contact. The gluteus maximus is most responsible for counteracting this flexion moment.
A patient presents to an outpatient physical therapy clinic with a 140 degrees
kyphoscoliotic curve. What is the therapist’s greatest concern?
A. The patient’s complaint of low back pain
B. Gait deviations
C. Pulmonary status
D. Poor upright standing posture
C.
A curve greater than 120 degrees is often associated with restrictive lung dysfunction. The other factors listed are not life threatening.
After performing an examination, a therapist notes the following information: severe spasticity of plantar flexors in the involved lower extremity; complete loss of active dorsiflexion in the involved lower extremitv;
minimal spasticity between 0 degrees and 5 degrees of dorsiflexion, with increased spasticity when the ankle is taken into more than 5 degrees of dorsiflexion. Which ankle-foot orthosis (AFO) is most likely contraindicated for the patient, an 87-year-old man who had a stroke 4 weeks ago?
A. Dorsiflexion spring assist AFO
B. Posterior leaf spring AFO
C. Hinged AFO
D. SpiralAFO
A.
Choice A probably would activate
increased tone because of the resistance to plantar flexion offered by the spring.
The therapist is performing an orthopedic test on a 25-vear-old man with the chief complaint of low back pain. The patient has a positive Thomas test. With this information, what might the therapist need to include in the treatment plan?
A. Stretching of the hip abductors
B. Stretching of the hip adductors
C. Stretching of the hip extensors
D. Stretching of the hip flexors
D.
The Thomas test is a screen to determine whether the hip flexors are too tight.
A patient is positioned by the therapist with the cervical spine rotated to the right. The patient then extends the neck as the therapist externally rotates and extends the right upper extremity. The patient is then instructed to hold a deep breath. The radial pulse is palpated in the right upper extremity by the therapist. What type of special test is this, and for what condition is it testing?
A. Adson’s maneuver, cervical disc herniation
B. Lhermitte’s sign, cervical disc herniation
C. Adson’s maneuver, thoracic outlet svndrome
D. Lhermitte’s sign, thoracic outlet syndrome
C.
Adson’s maneuver tests for thoracic outlet syndrome. Lhermitte’s signtests for dural irritation in the cervical spine.
The therapist observes a patient with the latter stages of Parkinson’s disease during ambulation.
Which of the following characteristics is the therapist most likely observing?
A. Shuffling gait
B. Increased step width
C. Wide base of support
D. Increased cadence especially at the onset of gait
A.
A shuffling gait and difficulty with initiating gait are typical signs of Parkinson’s disease. This population would also present with a small base of support.
A therapist is examining the gait pattern of a patient and notes that the pelvis drops inferiorly on the right during the midswing phase of the right lower extremity. The patient also leans laterally to the left with the upper trunk during this phase. Which of the following is the most likely cause of this deviation?
A. Weak right gluteus medius
B. Weak right adductor longus
C. Weak left gluteus medius
D. Weakleft adductor longus
C.
The pelvis is dropping on the right side because the left gluteus medius is weak. The patient also may lean toward the left hip joint to move the center of gravity, making it easier to hold up the right side of the pelvis.
The therapist is performing an orthopedic test that involves (1) placing the patient in a side-lying position, (2) placing the superior lower extremity in hip extension and hip abduction, (3) placing the knee of the superior lower extremity in 90 degrees of flexion, and (4) allowing the superior lower extremity to drop into adduction. Failure of the superior lower extremity to drop indicates a tight
A. Iliopsoas
B. Rectus femoris
C. Iliotibial band
D. Hamstring
C.
This is called Ober’s test, which screens for a tight iliotibial band.
A therapist is assessing radial deviation range of motion at the wrist. The correct position of the goniometer should be as follows: the proximal arm is aligned with the forearm and the distal arm is aligned with the third metacarpal. What should be used as the axis point?
A. Lunate
B. Scaphoid
C. Capitate
D. Triquetrum
C.
The capitate is the axis.
The therapist is assessing a patient’s strength in the right shoulder. The patient has 0 degrees of active shoulder abduction in the standing position. In the supine position, the patient has 42 degrees of active shoulder abduction and 175 degrees of pain-free passive shoulder abduction. What is the correct manual muscle testing grade for the patient’s shoulder abduction?
A. 3-/5 (fair -)
B. 2+/5 (poor +)
C. 2-/5 (poor -)
D. 1/5 (trace)
C.
Because the patient does not have 50 of normal range of motion in the gravity eliminated position, 2-/5 is the appropriate grade. Some therapists argue that this is an example of a 1+/5 grade. Sources used in preparation of this exam indicate that there is no grade of 1+/5 with manual muscle testing.
A therapist is examining a patient with poor motor coordination. The therapist observes that when the patient is standing erect and still, she does not respond appropriately when correcting a backward sway of the body. With the body in a fully erect position a slight backward sway should be corrected by the body firing specific muscles in a specific order. Which list is the correct firing order?
A. Bilateral abdominals, bilateral quadriceps, bilateral tibialis anterior
B. Bilateral abdominals, bilateral tibialis anterior, bilateral quadriceps
C. Bilateral tibialis anterior, bilateral abdominals, bilateral quadriceps
D. Bilateral tibialis anterior, bilateral quadriceps, bilateral abdominals
D.
This sequence assists in propelling the center of gravity forward to maintain balance after a backward swav.
A physical therapist is performing a functional capacity evaluation on a patient with a L4-L5 herniated disc. Part of the evaluation consists of performing floor to waist lifts using 30 pounds as resistance. During the first trial, the physical therapist notices that the patient exhibits decreased anterior pelvic tilt. What should the physical therapist do during the second trial?
A. The therapist should correct the deviation verbally before the lift.
B. The therapist should correct the deviation with manual contact during the lift.
C. The therapist should correct the deviation both verbally and manually during the lift.
D. The therapist should not attempt to correct the lift.
D.
During a functional capacity evaluation, the physical therapist should not correct postural abnormalities. The therapist should only observe and record.
A physical therapist is examining a patient with muscular dystrophy. The patient seems to “waddle” when she walks. She rolls the right hip forward when advancing the right lower extremity and the left hip forward when advancing the left lower extremity. Which of the following gait patterns is the patient demonstrating?
A. Gluteus maximus gait
B. Dystrophic gait
C. Arthrogenic gait
D. Antalgic
B.
This is a description of a dystrophic gait pattern, also called penguin gait. Patients with muscular dystrophy commonly demonstrate this gait pattern. A gluteus maximus gait presents with the patient leaning the trunk back while striking the heel on the involved side (or lurching). An arthrogenic gait pattern presents with the patient circumducting and elevating the hip on the involved side. This pattern is present with severe stiffness or a fused joint in the involved lower extremity. An antalgic gait pattern is exhibited when a person has pain with weight bearing on the involved lower extremity.
A 48-year-old woman is being examined by a physical therapist. Her diagnosis is right rotator cuff tendinitis. She reports right shoulder weakness and pain for the past 2 months. The patient describes “pins and needles” over the lateral right shoulder and upper extremity, extending into the thumb. She also reports no causative trauma. Manual muscle testing in the right upper extremity reveals the following data:
flexion = 4/5, extension = 3/5, abduction
= 3/5, adduction = 4/5, internal rotation
= 3/5, and external rotation = 38#43;/5.
Manual muscle testing in the left upper extremity reveals the following data: flexion =
4/5, extension = 5/5, abduction = 5/5,
adduction = 4/5, internal rotation =
4+:/5, and external rotation = 4+:/5.
Active and passive shoulder range of motion is within normal limits and equal bilaterally. All thoracic outlet tests are negative. All shoulder special tests are negative. Which of the following steps would most likely assess the source of the patient’s problems?
A. Elbow strength and range of motion testing
B. Grip strength testing
C. Cervical spine testing
D. Scapular muscle strength testing
C.
The subjective complaints of “pins and needles” suggest that the source of the problem is either vascular or neurologic. Because thoracic outlet svndrome has been cleared, focus should be placed on the cervical spine.
A therapist is screening a patient complaining of pain at the anterior left shoulder region. The pain is increased when the examiner instructs the patient to position the left arm by his side with the elbow flexed at 90 degrees and to actively supinate the forearm against resistance (provided by the examiner). What test is being performed?
A. Froment’s sign
B. Yergason’s test
C. Waldrontest
D. Wilson test
B.
Yergason’s test detects tendinitis of the long head of the biceps. Froment’s sign is a test to determine adductor pollicis weakness due to ulnar nerve dvsfunction. In the Waldron test. the patient performs squats while the therapist assesses the patella region for crepitus or pain.
A positive test indicates possible chondromalacia. A positive Wilson test indicates possible osteochondritis dissecans.
The test is performed by asking the patient to extend the knee in the seated position with internal rotation and again with external rotation of the tibia. The test is positive if there is pain with internal rotation and no pain with external rotation of the tibia.
A therapist is examining a patient with traumatic injury to the left hand. The therapist asks the patient to place the left hand on the examination table with the palm facing upward.
The therapist then holds the second, third, and fifth digits in full extension. The patient is then asked to flex the fourth digit. What movement would be expected by a patient with an uniniured hand, and what muscle or muscles is the therapist restricting?
A. The fourth fingerwould flex at the distal interphalange al (DIP) joint only, and the muscle being restricted would be the flexor digitorum superficialis.
B. The fourth finger would flex at the proximal interphalangeal (PIP) joint only, and the muscle being restricted would be the flexor digitorum profundus.
C. The fourth finger would flex at the DIP joint only, and the muscles being restricted would be the lumbricals.
D. The fourth finger would flex at the PIP joint only, and the muscles being restricted would be the palmar interosseous.
B.
The flexor digitorum profundus has four tendons, each attaching to the distal phalanx. If the three mentioned in the question are restricted. flexion at the distal interphalangeal joint in the normal hand would not be possible.
A patient is in prone position with his head rotated to the left side. The left upper extremity is placed at his side and fully internally rotated.
The left shoulder is then shrugged toward the chin. The therapist then grasps the midshaft of the patient’s left forearm. The patient is then instructed to “try to reach your feet using just vour left arm.” This movement is resisted by the therapist. This test is assessing the strength of what muscle?
A. Uppertrapezius
B. Posterior deltoid
C. Latissimus dorsi
D. Triceps brachii
C.
This test assesses the strength of the latissimus dorsi. One of the functions of the latissimus is to push up from a sitting position.
This test simulates that movement.
Which of the following is the normal end-feel perceived by an examiner assessing wrist flexion?
A. Bone to bone
B. Soft tissue approximation
C. Tissue stretch
D. Empty
C.
A tissue stretch end-feel is also felt with
ankle dorsiflexion. An example of a bone-to-bone end-feel is with knee or elbow extension.
Knee flexion is an example of soft tissue approximation. In an empty end-feel, a patient stops the movement due to pain.
A physical therapist is beginning an examination of a patient with a diagnosis of
“knee strain.” Range of motion limitation does not follow the normal capsular pattern of the knee. Which of the following are possible causes of the restriction in range of motion?
A. Ligamentous adhesions
B. Internal derangement
C. Extra-articularlesions
D. All of the above
D.
All of the choices are capable of causing a noncapsular pattern.
Which of the following statements best describes lower extremity positioning in standing during the first 2 years of life of a child with no dvsfunction?
A. Femoral anteversion, femoral external rotation, foot pronation
B. Femoral anteversion, femoral internal rotation, foot supination
C. Femoral retroversion, femoral external rotation, foot pronation
D. Femoral retroversion, femoral internal rotation, foot supination
A.
After the first 2 years of life, the femurs
rotate to a more neutral position, and the amount of anteversion decreases.
A patient with decreased function of the gluteus minimus is referred to physical therapy for gait training. During the examination, the therapist places the patient in prone position and instructs the patient to extend the hip. Knowing that the gluteus minimus is extremely weak, which of the following is most likely to happen?
A. The patient will abduct the hip more than usual when attempting to perform hip extension.
B. The patient will externally rotate the hip excessively when attempting to perform hip extension.
C. The patient will excessively flex the knee when attempting to perform hip extension.
D. The patient will not have difficulty performing straight hip extension.
B.
The patient is prone to excessive external rotation when attempting to extend the involved hip because the gluteus minimus counteracts the lateral rotational force created by the gluteus maximus.
A patient is placed in supine position with the knee in 90 degrees of flexion. The foot is stabilized by the therapist’s body on the examination table. The therapist then wraps his fingers around the proximal tibia so that the thumbs are resting along the anteromedial and the anterolateral margins. The therapist then applies a force to pull the tibia forward. What special test is being performed?
A. Pivot shift
B. Lachman’s test
C. Anterior drawer
D. Posterior drawer
C.
The tests in Choices A. B, and C assess the integrity of the anterior cruciate ligament.
The pivot shift test is performed with the patient in supine position. The therapist applies a valgus stress with the lower leg internally rotated while passively flexing and extending the knee. A positive testis associated with instability with this motion. Lachman’s test is similar to the anterior drawer test. but the knee is in slight flexion. In performing a posterior drawertest, the positioning is the same as for performing an anterior drawertest, but a posterior force is applied to the tibia to assess posterior cruciate ligament integrity. When performing these tests, the therapist is assessing the end-feel and amount of joint play to determine the integrity of the ligament.
A therapist is examining a patient who complains of frequent foot, ankle, and knee pain.
The therapist asks the patient to assume a standing position with the knees slightly flexed.
The therapist then demonstrates active bilateral foot pronation to the patient. When asked to perform this task, the patient has difficulty.
Which of the following limitations is a possible cause of the patient’s difficulty in performing this task?
A. Restriction limiting plantar flexion and lateral rotation of the talus
B. Restriction limiting dorsiflexion and medial rotation of the talus
C. Restriction limiting eversion of the calcaneus and medial rotation of the talus
D. Restriction limiting inversion of the calcaneus and lateral rotation of the talus
C. During pronation of the feet, the calcaneus everts, and the talus medially rotates and plantar flexes.
Ofthe following, which is the earliest period after surgery that an 18-year-old boy who received an uncomplicated partial meniscectomy of the right knee can perform functional testing, such as a one-leg hop test, for distance?
A. 1 week after surgery
B. 2 weeks after surgery
C. 6 weeks after surgery
D. 12 weeks after surgery
C.
At 1 to 2 weeks after surgery, the patient has an inflamed knee, and no functional testing can take place. Six weeks is an appropriate amount of time to allow inflammation to decrease enough for functional testing, Patients who have received a partial meniscectomy do not require as much healing time as patients who have received a meniscus repair.
A patient presents to therapy with an ankle injury. The therapist has determined that the injurv is at the junction of the distal tibia and fibula. Which of the following functions the most in preventing excessive external rotation and posterior displacement of the fibula?
A. Anterior inferior tibiofibular ligament
B. Posterior inferior tibiofibular ligament
C. Interosseous membrane
D. Long plantarligament
A.
This is the primary function of the anterior inferior tibiofibular ligament.
A physical therapist is examining a patient who complains of posterior ankle pain. The patient is positioned prone with the feet extended over the edge of the mat. The therapist squeezes the involved gastrocnemius over the middle third of the muscle belly. What test is the therapist performing? What indicates a positive test?
A. Thompson’s test, plantar flexion of the ankle
B. Homan’s test, plantar flexion of the ankle
C. Thompson’s test, no ankle movement
D. Homan’s test, no ankle movement
C.
Thompson’s test checks the integrity of the Achilles’ tendon. When this test is performed on an ankle with no dysfunction, squeezing the gastrocnemius causes passive plantar flexion of the ankle.
Which of the following is the correct method to test for interossei muscular tightness of the hand?
A. Passively flex the proximal interphalangeal (PIP) joints with the metaphalangeal (MP) joints in extension, then passively flex the PIP joints with the MP joints in flexion.
Record the difference in PIP joint passive flexion.
B. Passively extend the PIP joints with the
MP joints in extension, then passively extend the PIP joints with the MP ioints in flexion. Record the difference in PIP joint passive flexion.
C. Passively flex the PIPioints with the MP joints in extension, then passively extend the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion.
D. Passively extend the PIP joints with the
MP joints in extension, then passively flex the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion.
A.
Because the interossei cross the MP
joints and the PIP ioints, the PIP joints should be flexed with the MP ioints in flexion and extension.
A therapist is beginning an examination of a 34-year-old woman with a diagnosis of carpal tunnel syndrome. Part of the evaluation consists of grip strength testing. To accurately test strength of the flexor digitorum profundus, where should the grip dynamometer’s adjustable handle be placed?
A. 1 inch from the dynamometer’s nonadiustable handle
B. 3 inches from the dynamometer’s nonadiustable handle
C. 1.5 inches from the dynamometer’s nonadiustable handle
D. 4 inchesfrom the dynamometer’s nonadiustable handle
B.
The last position (3 inches) of the grip strength dynamometer tests the extrinsic muscles of the hand (muscles located in the forearm). The closer positions test the intrinsic muscles.
A physical therapist is examining a 17-year-old distance runner with complaints of lateral knee pain. During the evaluation, the therapist performs the following test: The patient is placed in supine position with the hip flexed to 45 degrees and the knee to 90 degrees. The therapist then places firm pressure over the lateral femoral epicondyle and extends the patient’s knee. Pain is felt by the patient at the point of palpation when her knee is 30 degrees from full knee extension. The positive result of this test suggests which of the following structures as the source of pain?
A. Iliotibial band
B. Bicepsfemoris
C. Quadriceps
D. Lateral collateral ligament
A.
The patient has an irritation of the iliotibial band as it passes over the lateral femoral epicondle. This occurs at approximately 30 degrees from full knee extension.
When ambulating on uneven terrain, how should the subtalar joint be positioned to allow forefoot rotational compensation?
A. The subtalar joint should be placed in pronation.
B. The subtalar joint should be placed in supination.
C. The subtalar joint should be placed in a neutral position.
D. The position of the subtalar joint does not influence forefoot compensation.
A.
When the hindfoot is pronated, the forefoot (transverse tarsal joints) can compensate for uneven terrain. If the hindfoot is supinated, the forefoot also is likely to supinate and possibly cause damage to the lateral ankle ligaments.
A physical therapist begins gait training for a patient with bilateral knee flexion contractures at 30 degrees at a long-term care facility. The therapist knows that the patient will have a forward trunk lean during gait because the patient’s line of gravity
A. Is anterior to the hip
B. Is anterior to the knee
C. Is posteriorto the ankle
D. Is posterior to the hip
A.
A patient with severe knee flexion
contractures has a line of gravity that is anterior to the hip, posterior to the knee, and anterior to the ankle. This causes a flexion moment at the hip, knee, and ankle.
What motion takes place at the lumbar spine with right lower extremity single limb support during the gait cycle?
A. Leftlateral flexion
B. Rightlateral flexion
C. Extension
D. Flexion
B.
To maintain balance, the lumbar spine must laterally flex toward the supporting lower extremity during single-limb support.
An outpatient physical therapist is gait-training a patient recently discharged from the hospital.
The inpatient therapist’s notes describe a decrease in left stride length due to pain with weight bearing on the right lower extremity.
The outpatient therapist knows that the patient’s gait deviation is an abnormally short
A. Distance from the left heel strike and the successive right heel strike
B. Amount of time between the left heel strike and the successive right heel strike
C. Amount of time in stance phase on the left lower extremity
D. Distance between the left heel strike and the successive left heel strike
D.
Choice D is the length of stride during one gait cycle. Choice A describes a decreased step length, choice B describes a decrease in step duration, and choice C describes a decrease in single-limb supporttime.
