FORTINBERRY CH3 Flashcards
The most serious complication of lower extremity thrombophlebitis is
A. Cerebral infarction
B. Pulmonary infarction
C. Myocardial infarction
D. Kidney infection
B.
Thromboembolus formation is a common complication of thrombophlebitis in lower legveins. Thrombi can pass through the heart and obstruct major pulmonary arteries.
A 50-year-old man has a persistent cough, purulent sputum, abnormal dilation of bronchi, more frequent involvement of the left lower lobe than the right, hemoptysis, and reduced forced vital capacity. What is the most likely pulmonary dysfunction?
A. Chronic bronchitis
B. Emphysema
C. Asthma
D. Bronchiectasis
D.
These are signs and symptoms of a patient with bronchiectasis.
Which of the following are tests for peripheral arterial involvement in a patient with complaints of calf musculature pain?
A. Claudication time
B. Homan’s sign
C. Percussion test
D. Hoffa’s test
A.
Claudication is a lack of blood flow. This testis performed byhaving a patient walk on a treadmill and recording how long the patient can walk before the onset of claudication.
Homan’s signs a test performed to see whether a patient may have a deep vein thrombosis. The percussion test is designed to assess the integrity of the greater saphenous vein. Hoffa’s test checks the integrity of the Achilles tendon.
A patient presents to a clinicwith decreased tidal volume (TV). What is the most likely cause of this change in normal pulmonary function?
A. Chronic obstructive pulmonary disease
B. Restrictive lung dysfunction
C. Emphysema
D. Asthma
B.
A decreased tidal volume is caused by a
restrictive lung dysfunction. An increased tidal volume is caused by an obstructive lung dvsfunction. Choices C and D are in the family of obstructive pulmonary disease.
A patient presents with tachypnea, corpulmonale, hypoxemia, rales on inspiration, and decreased diffusing capacity. What is the probable cause?
A. Restrictive lung dysfunction
B. Chronic obstructive pulmonary disease
C. Asthma
D. Emphysema
A.
These signs are consistent with restrictive lung dysfunction. All other choices are obstructive lung dysfunctions.
A physician instructs the therapist to educate a patient about the risk factors of atherosclerosis.
Which of the following is the most inappropriate list?
A. Diabetes, male gender, and excessive alcohol
B. Genetic predisposition, smoking, and sedentary lifestyle
C. Stress and inadequate exercise
D. Obesity, smoking, and hypotension
D.
Hypertension is a risk factor in atherosclerosis.
A therapists ordered by a physician to treat a patient with congestive heart failure in an outpatient cardiac rehabilitation facility. Which of the following signs and symptoms should the therapist not expect?
A. Stenosis of the mitral valve
B. Orthopnea
C. Decreased preload of the right heart
D. Pulmonary edema
C.
Patients with congestive heart failure often develop an enlarged heart because of the burden of an increased preload and afterload.
At team meeting, the respiratory therapist informs the rest of the team that the patient, just admitted to the subacute floor, experienced breathing difficulty in the acute care department. The respiratory therapist describes the breathing problem as a pause before exhaling after a full inspiration. Which of the following is the therapist describing?
A. Apnea
B. Orthopnea
C. Eupnea
D. Apneusis
D.
Apneusis can be described as an inspiratory cramp. Orthopnea is difficulty with breathing in a lying position. Eupnea is normal breathing. Apnea is the absence of breathing.
A therapist is performing chest physiotherapy on a patient who is coughing up a significant amount of sputum. The therapist later describes the quality of the sputum in his notes as mucoid.
This description tells other personnel which of the following?
A. The sputum is thick.
B. The sputum has a foul odor.
C. The sputum is clear or white in color.
D. The patient has a possible bronchopulmonary infection.
C.
Mucoid sputum is clear or white and is not usually associated with infection. Thick sputum is referred to as tenacious. Foul-smelling sputum is called fetid and is often associated with infection.
A therapist is sent to provide passive range of motion to a patient in the intensive care unit.
The chart reveals that the patient is suffering from pulmonary edema. The charge nurse informs the therapist that the patient is coughing up a thin, white sputum with a pink tint. Which of the following terms best describes this sputum?
A. Purulent
B. Frothy
C. Mucopurulent
D. Rusty
B.
Frothy sputum is thin and white or has a slight pink color. This type of sputum is commonly present with pulmonary edema.
Purulent sputum resembles pus, with a vellow or green color. Mucopurulent sputum is yellow to light green in color. Rusty sputum is a rust-colored sputum often associated with pneumonia.
Strengthening exercises for persons with hemophilia should
A. Begin as soon as a joint bleed is recognized
B. Never include isokinetic exercises
C. Be increased using high repetition, low load PREs
D. Only occur in joints that demonstrate muscle weakness
C.
All exercises for this population should
avoid the possibility of joint bleeding. High velocity isokinetics or high weight. low repetition exercises are a contraindication.
Provided there is no active bleeding, exercise to any joint is indicated.
A patient with cryoglobulinemia presents to outpatient physical therapy with complaints of lumbar pain. Which of the following should the physical therapist avoid during intervention for this diagnosis?
A. Moist heat packs
B. Weight-bearing exercises
C. Muscle energy techniques
D. Cold pack application
D. In cryoglobulinemia, ischemia can be caused by abnormal blood proteins gelling at low temperatures. Moist heat will not affect this condition.
A physical therapist is assessing the endurance of a 12-year-old female with cystic fibrosis.
Which objective screening tool would be most appropriate to quantify the patient’s endurance level?
A. Six-minute walk test
B. Tinetti Performance-Oriented Mobility
Assessment
C. VOMax Test
D. Rombergtest
A.
The six-minute-walk-testis used to determine a patient’s functional exercise capacity.
A physical therapist is performing an examination for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would not likely be present?
A. Bradvcardia
B. Poor weight gain
C. Decreased respiratory rate
D. Lower extremity swelling
A.
An infant with a congenital heart defect often has a labored breathing pattern, increased respiratory rate, diaphoresis, tachycardia, edema, and feeding difficulties.
Besides the anterolateral abdominal muscles, which muscle assists in forced expiration, coughing, sneezing, vomiting, urinating, defecating, and fixation of the trunk during strong movements of the upper limb?
A. Piriformis
B. Pelvic diaphragm
C. Trapezius
D. Gluteus maximus
B.
The pelvic diaphragm is composed of the levatorani and coccygeus muscles. This pelvic diaphragm assists in forced expiration, coughing, sneezing, vomiting, urinating, defecating, and fixation of the trunk during strong movements of the upper limb.
Which muscle does NOT flex the knee and extend the hip?
A. Semitendinosus
B. Hamstring portion of the adductor magnus
C. Long head of the biceps femoris
D. Semimembranosus
B.
All four muscles are hamstring muscles of the posterior thigh. All four muscles extend the hip. Only the hamstring portion of adductor magnus does not cross the knee. It inserts on the adductor tubercle of the femur. The other three muscles cross the knee posteriorly and therefore flex the knee.
History taking revealed that a patient experiences pain after horseback riding or skating. The pain is located over the anteromedial thigh and is aggravated by resisted abduction. What is the MOST likely preliminary diagnosis?
A. Piriformis svndrome
B. Trochanteric bursitis
C. Adductor longus strain /tendonitis /tendinosis
D. Avascular necrosis
C.
Adductor longus, rectus femoris, and iliopsoas are the muscles typically involved in hip muscle strain/tendonitis/tendinosis. Pain is aggravated by activity or in resistance testing.
Adductor strains arise in horseback riders, skiers, and skaters.
A patient has dull posterior hip pain radiating down the leg. He says that he has a limp and that his painis aggravated by turning his leg outside or with deep pressure near the middle of the right buttock. What is the MOST likely preliminary diagnosis?
A. Piriformis syndrome
B. Trochanteric bursitis
C. Adductor longus strain/tendonitis /tendinosis
D. Avascular necrosis
A.
History and type/site of pain are the most important features to direct the examination. Piriformis irritation often presents as dull posterior hip pain radiating down the leg, mimicking radicular symptoms. Limping, pain aggravated by active external rotation, or passive internal rotation on palpation of sciatic notch is a salient feature.
What is the BEST imaging modality for detecting the changes in the articular cartilage seen with chondromalacia patella?
A. Plain film radiography
B. Bone scan
C. Magnetic resonance imaging (MRI)
D. Computed tomography (CT)
C.
While direct visualization of articular cartilage is possible with both MRI and CT, MRI gives better resolution and detail. Neither bone scan nor plain film radiography will show the cartilage.
Which of the following imaging modalities does
NOT give a radiation dose to the patient?
A. MRI
B. СТ
C. Mammography
D. Bone scan
A.
MRI does not provide any form of radiation to the patient.
A therapist is examining a 3-year-old child, who is positioned as follows: supine, hips flexed to 90 degrees, hips fully adducted, and knees flexed. The therapist passively abducts and raises the thigh, applying an anterior shear force to the hip joint. A click at 30 degrees of abduction is noted by the therapist. What orthopedic test is the therapist performing, and what is its significance?
A. Ortolani’s test, hip dislocation
B. Appley’s compression/distraction test.
cartilage damage
C. McMurray test, cartilage damage
D. Piston test, hip dislocation
A.
Ortolani’s test is used to detect a congenitally dislocated hip in an infant. Choices B and C are common meniscus damage tests for the knee. Choice D is performed by placing the infant in supine position with the hip at 90 degrees of flexion and slight abduction and the knee flexed to 90 degrees. The examiner then moves the infant’s hip anterior and posterior in an effort to detect abnormal joint mobility.
A teenager comes to an outpatient facility with complaints of pain at the tibial tubercle when playing basketball. The therapist notices that the tubercles are abnormally pronounced on bilateral knees. What condition does the patient most likelv have?
A. Jumper’sknees
B. Anterior cruciate ligament sprain
C. Osgood-Schlatter disease
D. Sever’s disease
C.
Osgood-Schlatter disease is severe tendinitis of the patellar tendon. It is characterized by pronounced tibial tubercles.
The increased size of the tubercles is attributed to the patellatendon pulling away from its insertion. Jumper’s knees (or normal patella tendinitis) does not necessarily present with tubercle enlargement. Sever’s disease involves the Achilles tendon pulling away from its insertion on the calcaneus.
A patient presents to physical therapy with complaints of pain in the right hip due to osteoarthritis. Which of the following is not true about this type of arthritis?
A. Osteoarthritis causes pain that is usually svmmetric because it is a systemic condition.
B. Osteoarthritis is not usually more painful in the morning.
C. Osteoarthritis commonly involves the distal interphalangeal joint.
D. Osteoarthritis mainly involves weight-bearing joints.
A.
Choice A describes rheumatoid arthritis, a systemic condition. All of the other choices are signs and symptoms of osteoarthritis (OA). Sometimes 0A can involve symmetric joints, but it is not systemic.
Which of the following is used to treat a patient referred to physical therapy with a diagnosis of
Dupuytren’s contracture?
A. Knee continuous passive motion (CPM)
B. Work simulator set for squatting activities
C. Hand splint
D. A 2-pound dumbbell
C.
Dupuytren’s contracture is a
progressive thickening of the palmar aponeurosis of the hand. The progression is gradual, and the interphalangeal joints are pulled into flexion.
A 17-year-old football player is referred to the outpatient physical therapy clinic with a diagnosis of a recent third-degree medial collateral ligament sprain of the knee. The patient wishes to return to playing football as soon as possible. Which protocol is the best?
A. Fitthe patient with a brace that prevents him from actively moving the knee into the last available 20 degrees of extension. Prescribe general lower extremity strengthening with the exception of side-lying hip adduction.
B. Do not fit the patient with a brace. All lower extremity strengthening exercises are indicated.
C. Fit the patient with a brace that prevents him from actively moving the knee into the last available 20 degrees of extension. Avoid all open-chain strengthening for the lower extremity.
D. Do not fit the patient with a brace.
Prescribe general lower extremity strengthening with the exception of side-lying hip adduction.
A.
The screw home mechanism that is present in the last few degrees of terminal knee extension stresses the MCL. Side-lying hip adduction also places the MCL in a position of stretch.
During an examination, the therapist taps on the flexor retinaculum of the patient’s wrist. which causes tingling in the thumb. What test is this? For what condition does it screen?
A. Phalen’s test, carpal tunnel
B. Finkelstein test, De Quervain’s disease
C. Tinel’s sign, De Quervain’s disease
D. Tinel’s sign, carpal tunnel
D.
A positive Tinel’s sign screens for carpal tunnel syndrome when the tapping force is performed over the carpal tunnel itself. In Phalen’s test, the therapist places the patient’s wrists in maximal flexion and holds for 1 minute. The test is positive if there is paresthesia in the median nerve distribution.
The Finkelstein test screens for De Quervain’s disease by allowing the patient to make a fist with the thumb wrapped in the fingers. The test is positive if there is pain over the adbuctorpollicislongus and extensor pollicisbrevis tendons.
A physical therapist is treating a patient with balance deficits. During treatment, the physical therapist notes that large-amplitude changes in the center of mass cause the patient to lose balance. The patient, however, can accurately compensate for small changes nearly every time a change is introduced. What muscles most likely need to be strengthened to help alleviate this dysfunction?
A. Tibialis anterior, gastrocnemius
B. Peroneuslongus/brevis, tibialis posterior
C. Rectus abdominis, erector spinea
D. Iliopsoas, gluteus maximus
D.
The hip strategy is used to compensate for large movements in the center of mass, and the ankle strategy is used to compensate for small movements.
The physical therapist is reading the physician’s interpretation of an x-ray that was taken of the left humerus of a 7-vear-old patient. The physician notes in the report the presence of an incomplete fracture on the convex side of the humerus. Which type of fracture is the physician describing?
A. Comminuted
B. Avulsion
C. Greenstick
D. Segmental
C.
This scenario describes a greenstick fracture, which is common in young people. In a comminuted fracture, the bone is broken into pieces. An example of an avulsion fracture is when the tibial tuberosity is pulled off the tibia.
A bone that has a segmental fracture is fractured in two places.
A physical therapist is beginning an examination of a 5-vear-old bov. The mother indicates that she pulled the child from a seated position by grasping the wrists. The child then experienced immediate pain at the right elbow.
The physician’s orders are for right elbow range of motion and strengthening. Which of the following is the most likely diagnosis?
A. Radialhead fracture
B. Nursemaid’s elbow
C. Erb’s palsy
D. Ulnar coronoid process fracture
B.
Nursemaid’s elbow is defined as dissociation of the radial head from the annular ligament. Choices A and D are usually to the result of a fall on an extended elbow. Erb’s palsy is due to cervical trauma.
A child presents to physical therapy with a diagnosis of right Sever’s disease. What joint should be the focus of the therapist’s examination?
A. Right knee joint
B. Right hip joint
C. Right wrist joint
D. Right ankle joint
D.
Sever’s disease is traction apophysitis of the gastrocnemius tendon in children. In other words, the gastrocnemius attempts to pull away from the calcaneus, causing an inflammatory condition.
A 10-year-old boy presents to outpatient physical therapy with complaints of diffuse pain in the right hip, thigh, and knee joint. The patient was involved in a motor vehicle accident 3 weeks ago. He is also obese and has significant atrophy in the right quadricep. The right lower extremity is held by the patient in the position of flexion, abduction, and lateral rotation. Which of the following is most likely the source of the patient’s signs and symptoms?
A. Greater trochanteric bursitis
B. Avascularnecrosis
C. Slipped femoral capital epiphysis
D. Septicarthritis
C.
The signs and symptoms are most consistent with a slipped capital epiphysis.
Bursitis presents with pain located over the bursa and is associated with overuse or rheumatoid arthritis. Avascular necrosis most frequently involves men 30 to 50 years of age. Septic arthritis is usually present in children 2 years of age or younger and often is due to steroid use or fever.
A high-school athlete is considering whether to have an anterior cruciate ligament reconstruction. The therapist explains the importance of this ligament, especially in a person that is young and athletic. Which of the statements is correct in describing part of the function of the anterior cruciate ligament?
A. The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during flexion of the femur at the knee joint.
B. The anterior cruciate ligament prevents excessive anterior roll of the femoral condyles during flexion of the femur at the knee joint.
C. The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during extension of the femur at the knee joint.
D. The anterior cruciate ligament prevents excessive anterior roll of the femoral condyles during extension of the femur at the knee joint.
A.
The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during flexion of the femur at the knee joint.
Which tendon is most commonly involved with lateral epicondvlitis?
A. Extensor carpi radialislongus
B. Extensor carpi radialisbrevis
C. Brachioradialis
D. Extensor digitorum
B.
The extensor carpi radialisbrevis absorbs most of the stress placed on the involved upper extremity in the position of wrist flexion, ulnar deviation, forearm pronation, and elbow extension (as with a backhand swing in tennis).
A patient who has suffered a zone 2 rupture of the extensor tendon of the third digit presents to physical therapy. This patient had a surgical fixation of the avulsed tendon. During the period of immobilization, which of the following deformities is most likely to develop?
A. Boutonniere deformity
B. Clawhand
C. Swan neck deformity
D. Dupuytren’s contracture
C.
Swan-neck deformity involves
hyperextension of the proximal interphalangeal
(PIP) joint and flexion of the distal interphalange al (DIP) joint. Splinting to avoid this deformity is the treatment of choice.
Boutonniere deformity involves flexion of the
PIP joint and DIP joint hyperextension.
Dupuytren’s contracture is contracture of the palmar aponeurosis. Claw hand is the result of laceration of the ulnar nerve.
Which of the following muscle tendons most commonly sublux in patients who suffer from rheumatoid arthritis?
A. Flexor digitorumprofundus
B. Extensor carpi ulnaris
C. Extensor carpi radialislongus
D. Flexor pollicislongus
B.
The extensor carpi ulnaris is frequently subluxed after rupture of the triangular fibrocartilage complex. Subluxation leads to many mechanical changes in the wrist that are common in patients with rheumatoid arthritis.
A therapist is scheduled to examine a patient with a chronic condition of “hammer toes.”
Where should the therapist not expect to find callus formation?
A. The distal tips of the toes
B. The superior surface of the interphalangeal joints
C. The metatarsal heads
D. The inferior surface of the interphalangeal ioints
D.
A patient with hammer toes exhibits
hyperextension of the distal interphalangeal joints and metatarsophalangeal joints and flexion of the proximal interphalange al joints.
Each of these factors influences the probability of scoliosis curve progression in the skeletally immature patient except
A. Magnitude
B. Gender
C. Race
D. Age
C.
Race has no role in progression of scoliosis, idiopathic or congenital.
The child with clubfoot will have
A. Alarger than normal calcaneus
B. Forefoot valgus
C. Significant tibial shortening
D. Fixed equinas
D.
In clubfoot, the calcaneus is small, the hindfoot is in varus, and there is equinas of the ankle. There is typically no tibial involvement.
Differential diagnosis in the infant born with severe calcaneovalgus includes
A. Congenital vertical talus
B. Metatarsus adductus
C. Accessory navicular
D. Tarsal coalition
A.
In calcaneovalgus, the fore foot is lateral, the hind foot is in valgus, and the foot is in full dorsiflexion. This results simply from a large infant in too small of a space, and the condition improves spontaneously. Calcaneovalgus should not be confused with a vertical talus. A vertical talus is a serious deformity involving malalignment of the talus and navicular. The forefoot is dorsiflexed, the hind foot is plantar flexed, and the foot bends at the instep.
What clinical examination technique will establish whether an infant’s hip is dislocated but reducible?
A. Barlow test
B. Ortolani’s maneuver
C. Hoffman test
D. Galeazzi maneuver
B.
Ortolani’s maneuver involves
dislocation of the hip in flexion and adduction.
Gentle flexion, abduction, and traction reduce the hip. Ortolani’s maneuver indicates a more unstable hip than the Barlow test.
All of the following may be part of the clinical picture of a child in the first 48 hours after onset of osteomvelitis EXCEPT
A. Radiographs are positive for signs of infection and avascular necrosis.
B. Needle aspiration may or may not be produce pus.
C. The child does not appear sick and has no fever.
D. High fever and refusal to walk.
A.
Osteomyelitis is a rapid infection of the
bone in adolescents often in the distal femur or proximal tibia. Radiographic changes are not seen until 7 to 14 days after onset.
In a child, the most common site of transient synovitis, slipped epiphysis and septic arthritis is the
A. Shoulder
B. Hip
C. Knee
D. Ankle
B.
Although these diagnoses can occur in most joints, the hip is the most common site of occurrence.
All of the following are common in children who have slipped capital femoral epiphysis EXCEPT
A. Knee pain
B. Obesity
C. Nohistory of trauma
D. Negative findings on a frog lateral radiograph
D.
Hip pain is common with this diagnosis, as is a traumatichistory; However, a slipped capital femoral epiphysis can have a chronic onset as well. Because a standard anterior or posterior view can miss the slip, the frog leg radiograph will need to be viewed to determine the correct diagnosis.
Which of the following conditions are not implicated in overuse injuries in vouth?
A. Training erTors
B. Musculotendinous imbalances
C. Anatomicmalalignment of the lower extremity
D. Constant practice on turf (grass)
D.
Training errors are common if the correct techniques are not taught vigorous.
Musculotendinous imbalances can occur if training overemphasizes a certain muscle group over its antagonist. Malalignment of the lower extremities is seen with muscular imbalances over a period of time. Grass or turf has not been shown to increase risk of overuse injury.
The signs and symptoms of juvenile rheumatoid arthritis include all of the following except
A. Swollen joints
B. Neurologic impairments
C. Stiffness
D. Muscle weakness
B.
Since juvenile rheumatoid arthritis attacks the joint as in adult rheumatoid arthritis, there are no neurologic signs or symptoms.
Which of the following as 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
D.
A third degree heart block can appear as dizziness and fatigue and may require a pacemaker.
Fourteen weeks after surgical repair of the rotator cuff, a patient presents with significant deltoid weakness. Range of motion (ROM) 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 of this dvsfunction?
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
D.
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.
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 ROM
D.
The other choices will be important later in the rehabilitation of this diagnosis. ROM is important early to reduce abnormal scar tissue formation.
A 35-year-old patient presents with complaints of pain and point tenderness slightly anterior to the temporomandibular joint. The tissue that likely is causing the pain is the
A. Temporalis tendon
B. Masseter
C. Maxillary sinus
D. Parotid gland
B.
The masseter muscle (deep portion) is likely the cause of the pain. The temporalis tendon is located anterior to the masseter on the coronoid process, the maxillary sinuses are located under the cheeks, and the parotid glands are located on the masseter. Parotid infection involves swelling and problems producing saliva.
A 72-year-old female comes into the clinic complaining of new onset of sudden severe right temporal headache and pain with chewing.
The likelv cause of her headache is
A. Migraine
B. Subarachnoid hemorrhage
C. Temporal arteritis
D. Cervicogenic headache
C.
The likely cause of her headache is temporal arteritis. Giant cell arteritis can affect the temporal artery. It is an inflammatory vascular condition of the temporal arteries and can cause intermittent claudication of the masseter with pain on chewing. The age, new onset of headache, and acute severity of temporal headache are a red flag the patient should see the physician because of possible progressive blindness.
A patient cannot open the jaw greater than 15 mm interincisal with active and passive opening. Lateral jaw movements are 8 mm bilaterally and protrusion is 6 mm. What type of disorder do these symptoms indicate?
A. Anterior disc displacement with reduction
B. Anterior disc displacement without reduction
C. Trismus
D. Capsulitis
C.
The disorder has to be muscular because of the normal mobility of lateral and protrusive movements. If it were a joint dvsfunction, both ioints would be involved and there would be diminished mobility oflateral and protrusive movements.
A 15-year-old patient complains of acute jaw pain. The patient opens to 23 mm active and passive with deflection to the right. Right laterotrusion is 8 mm, left laterotrusion is 2 mm and protrusion is 3 mm with deflection to the right. Palpation is negative for crepitus. What type of disorder do these symptoms indicate?
A. Righttemporomandibular anterior disc displacementwith reduction
B. Righttemporomandibular anterior disc displacement without reduction
C. Trismus
D. Lefttemporomandibular anterior disc displacement with reduction
B.
The right TM] is hypomobile, and the left is moving normally. An anterior disc displacement with reduction should displav clicking, and the passive opening will increase with overpressure. Trismus would displav normal range of motion of laterotrusion and protrusion.
What is a temporomandibular reciprocal click?
A. Clicking that occurs during the end of opening
B. Clicking that occurs during the beginning of opening
C. Clicking that occurs during the middle of opening
D. Clicking that occurs during opening and closing
D.
Temporomandibular reciprocal click is clicking that occurs during opening and closing.
Reciprocal clicking is caused by the disc being displaced partially anteriorly. The condyle slides under the disc and clicks into its normal position during opening then slips back out during closing.
A 28-year-old male complains of pain in his right jaw and his bite not touching on the right side after biting into beef jerky 5 days ago. What is the probable disorder?
A. Right acute anterior disc displacement without reduction
B. Right acute anterior disc displacement with reduction
C. Right acute osteoarthritis
D. Right acute capsulitis
D.
If the right TM] is inflamed, swelling may cause the bite to change and shift to the opposite side.
What are signs and symptoms of an acute TM] anterior displaced disc without reduction?
A. Clicking and pain in the TM] joint
B. Absence of clicking and opening limited to 26 mm to 30 mm. lateral movements limited to contralateral side, deflection to same side with protrusion
C. Crepitation and limitation to 26 mm
D. Absence of clicking and opening is limited to 26 mm to 30 mm, lateral movements limited to ipsilateral side, deflection to same side with protrusion
B.
For example: the right joint is locked.
Anterior translation primarily occurs after 26 mm; therefore, opening will be restricted at 26 mm and deflection will occur to the right (same side). Lateral movement to the opposite side (movement to the left, or contralateral side) will be restricted because the right joint cannot translate: protrusion will deflect to the hypomobile side (right) and be restricted.
A physical therapist is completing a manual muscle testing (MMT) examination of a patient with right lateral hip pain. The standing alignment reveals anterior pelvictilt and associated hip flexion. During the MMT of the right posterior gluteus medius, which substitution is likely to occur?
A. Increase in hip flexion angle to substitute with the tensor fascia late
B. Increase in lateral rotation to substitute with the tensor fascia late
C. Forward rotation of the pelvis to substitute with the gluteus minimus
D. Knee flexion to substitute with the lateral hamstrings
A.
Patients tend to posteriorly rotate the pelvis to substitute with the tensor fascia latae or the gluteus minimus. These muscles are medial rotators not lateral rotators like the posterior gluteus medius. The lateral hamstrings are not hip abductors.
Osgood-Schlatter’s disease is primarily
A. An inflammatory process
B. An injury to apophyseal cartilage
C. An injury in adolescent females
D. Caused by tight calf muscles
B.
Osgood-Schlatter’s is an injury to
apophyseal cartilage. It is not an inflammatory condition and occurs mainly in young boys.
A swollen knee immediately following trauma indicates
A. Blood in the joint
B. Blood or svnovial fluid accumulation
C. Possible gout
D. Underlying arthritic de generation
A.
An immediate knee effusion after trauma always indicates bleeding from fracture, ligament tear, meniscus tear, or patella dislocation.
The most likely cause for a baseball pitcher to injure the throwing arm is
A. Throwing side-arm
B. High pitch counts
C. Throwing curve balls
D. “Dead arm” syndrome
B.
High pitch counts have been shown in several studies to be responsible for the majority of shoulder problems in pitchers.
The ulnar collateral ligament of the elbow is injured during which phase of the baseball pitch?
A. Early cocking phase
B. Late cocking phase
C. Acceleration phase
D. Deceleration phase
C.
The acceleration phase is the phase where maximum valgus stress is placed on the elbow and ulnar collateral ligament.
Anterior “black line” tibia stress fracture
A. Is a failure in compression
B. Heals predictably with rest and splinting
C. Requires bone stimulation to heal
D. May require intramedullary rodding to heal
D.
Black line tibial stress fractures occur on the anterior cortex and form because of stress in tension. They can be extremely difficult to heal and require intrameddulary rodding to achieve union.
Ankle pain anteriorly
A. Is usually a bone bruise
B. Is usually osteochondritisdissecans
C. Is usually ligament pain following sprain
D. Is usually soft tissue impingement
D.
Soft tissue ankle impingement is recognized as a common source of anterior ankle pain following injury. It is more common than bone injury.
Swimmer’s shoulder
A. Occurs in all swimmers
B. Is a rotator cuff tear
C. Is worse with backstrokers
D. Is an impingement syndrome
D.
Swimmer’s shoulders an impingement of the greater tuberosity against the anterior acromial arch and coracoacromial ligament.
During manual muscle testing of knee flexion strength, the physical therapist wishes to differentiate between medial and lateral hamstrings. To test medial hamstrings, the therapist positions the patient in hip
A. External rotation to test semimembranosis and biceps femoris
B. Internal rotation to test
semimembranosis and semitendinosis
C. External rotation to test
semimembranosis and semitendinosis
D. Internal rotation to test biceps femoris
B.
Internal rotation to test semimembranosis and semitendinosis. This position places the physical therapist in the line of pull for the medial hamstrings. The biceps femoris is oriented laterally and therefore is not a medial hamstring.
A patient is involved in a rear-end motor vehicle accident and now complains of neck pain, muscle spasm, and decreased cervical range of motion. After performing your subjective examination, the next thing you would most appropriately do is
A. Ligamentous testing
B. Muscle testing
C. Active range of motion testing
D. Passive motion testing
C.
Based on the history of trauma you must first test AROM before you touch the patient. Ifthere happens to be something serious such as a fracture in the upper cervical spine then motion will be restricted. You will need to send the patient back to a physician before risking injury.
The piano key sign is a test used to assess the
A. Glenoid labrum
B. Long head of the biceps
C. Acromioclavicular joint
D. Anterior shoulder stability
C.
The piano key sign is used specifically for testing for an acromioclavicular separation.
Pushing down on the distal clavicle that is elevated from iniurv will cause it to come back up once the force is released.
Your patient is a 16-year-old male who injured his left knee playing football. There was an onset of immediate swelling, a locking sensation, and restricted range of motion. You hypothesize the most likelv structure involved is
A. A collateral ligament
B. A tear of the retinaculum
C. A meniscal injury
D. The cruciate ligament
C.
Based on the symptoms, the most likely cause of the injury is a torn meniscus. There is immediate swelling with blood in the joint, and locking of the joint with restricted range. A and B are extraarticular and will not cause bleeding inside the joint. You will not typically find joint locking with this injury. Cruciate ligament injuries do not usually get immediate swelling unless accompanied by a meniscal injury.
You suspect that your patient has a torn rotator cuff. Which three tests would best confirm this diagnosis?
A. The lift off test, the anterior apprehension test, and Speed’s test
B. The drop arm test, crank test, load and shift test
C. The belly press test, drop arm test, and lift off test
D. Internal rotation lag sign, drop arm test, crank test
C.
The only correct answer is C. The load and shift test assesses anterior instability. The crank test in answers B and D is a test for stability of the labrum. Speed’s test assesses the long head of the biceps and the anterior apprehension tests for shoulder instability.
A cause of a noncapsular pattern might be which of the following?
A. Arthrosis in the knee
B. Hemarthrosis of the shoulder
C. Septicarthritis in the knee
D. Loose body in the shoulder
D.
A, B, and C will present with the typical capsular patterns in their respective joint. A loose body in the shoulder will inhibit one plane of motion but will not limit any other motions.
Hence, it would not be a capsular pattern.
In the single leg stance, when the contralateral hip drops because of weakness, it is considered
A. A compensated hip varus
B. An uncompensated Trendelenberg
C. A compensated Trendelenberg
D. An uncompensated hip varus
B.
The only possible correct answer is B. It is the typical pattern one sees with a
Trendelenberg gait, where because of weakness of the gluteus medius on the weight-bearing leg, the hip on the contralateral side lowers.
Your patient has sustained a fracture of the coronoid process. Which of the following is most true about these fractures?
A. Itis more commonly an isolated fracture.
B. Itis more often accompanied by avulsion of the biceps.
C. Fractures of the coronoid process account for better than 50of elbow fractures.
D. Fractures of the coronoid process are usually accompanied by a radial head fracture.
D.
Coronoid fractures seldom are isolated fractures. They are usually accompanied by radial head fractures. The brachialis is the muscle usually avulsed. Coronoid fractures only account for 1 to 2 of all elbow fractures.
A 45-year-old male electrician presents with a gradual onset of left shoulder pain. He notes it is most prominent with overhead activities and throwing. The position that hurts his shoulder the most is 90 degrees of flexion with internal rotation. This most likely indicates
A. ASLAPlesion
B. Anterior instability of the shoulder
C. Impingement syndrome
D. Posterior instability of the shoulder
C.
This is a classic sign of an impingement.
The position of 90 degrees of flexion with internal rotation is actually the position for a Hawkins Kennedy test. A patient with instability will present with a loose joint that feels like it is going to sublux. Patients with SLAP lesions will complain of intermittent painful popping. clunking, or clicking in the shoulder with occasional catches. An impingement will be most painful in certain positions such as extreme overhead reaches and with the test position just described.
Your patient presents with pain and tenderness over the distal radial forearm and pain with resistive thumb extension after using a screwdriver repeatedly for several days. Based on this history, the most likely diagnosis is
A. Scaphoid instability
B. Gout in the thumb
C. De Quervain’s syndrome
D. Radial carpal syndrome
C.
This is a classical description of a De
Quervain’s syndrome, which is a tendinitis of the abductor pollicuslongus and extensor pollicusbrevis. Gout will cause the thumb to be painful, but will not respond to stretch because it affects the joint and not the surrounding musculature. A scaphoid instability will be painful to certain movements accompanied by pops and cracks. It is an inert tissue and will not respond to stretch or resistance. Radial carpal syndrome is an impingement syndrome that takes place at the wrist.
You find that a patient has a leg length discrepancy. Upon review of their radiographs, you notice that the angle of the neck of the femur to the femoral shaft is less than 120 degrees. You have determined that the apparent leg length difference is due to
A. A pelvic obliquity
B. A coxavarum
C. A coxavalgum
D. An acetabular tropism
B.
This is classic description of a
coxavarum, first described radiographically by Hofmeister in 1894. A coxavalgum has an angle of above 140 degrees. An acetabular tropism describes changes in the acetabular surface.
Pelvic obliquity describes angulation of the pelvis from the horizontal in the frontal plane, possibly secondaryto a contraction below the pelvis (e.g., of the hip joint).
Your patient presents with a non-contact injury from a quick stop. He reports an audible “pop” at the time of injury. He complains of pain on either side of his patella. He now complains of difficulty with cutting and pivoting when running. The patient did not have immediate swelling or joint line tenderness. The structure most likelv involved is the
A. Medial meniscus
B. Medial collateral ligament
C. Posterior cruciate ligament
D. Anterior cruciate ligament
D.
The anterior cruciate is one of the most
commonly injured ligaments without contact.
Injuries to the posterior collateral ligament
(PCL) do not usually feel the “pop” that the ACL does. They are usually injured from hitting a dash board or falling on a bent knee in sports.
The meniscus injury will present with popping, catching, locking, and immediate joint swelling.
The medial collateral ligament usually is exquisitely tender over the ligament and usually is torn with a lateral force.
Your patient has been diagnosed as having pronator syndrome. You have determined that the structure involved is the lacertus fibrosis.
The maneuver that would verify this is
A. Elbow flexion of 120 to 135 degrees
B. Resisted forearm supination
C. Resisted forearm pronation
D. Resisted long finger flexion
B.
There are four structures that are responsible for the pronator syndrome: the flexor digitorum arcade, the lacertus fibrosis, the pronator teres, and supraconcylar process.
The lacertus fibrosis is tested by resisted supination.
A patient reports to physical therapy with a referral from his primary care physician that reads &suspected partial biceps tear, evaluate and treat. The patient sustained the injur 2 days ago during soccer practice. Which of the following objective findings would be most consistent with the patient’s condition during the physical examination?
A. Pain with passive shoulder abduction
B. Pain with resisted shoulder extension
C. Pain with resisted forearm supination
D. Pain with resisted elbow extension
C.
Resisting forearm supination should place stress on the biceps brachi which functions as both an elbow flexor and forearm supinator. Resisting the action of the muscles, which is suspected of have a lesion, is one way to implicate or verify involvement of the tissue structure. Any decision is based on the pattern of pain elicited by both active and passive movements. The findings in the clinical case presented in the question begin to implicate or verifies involvement of the biceps.
During ambulation, a physical therapist notices that the patient is exhibiting genu recurvatum during the stance phase of the gait cycle. Of the choices, the MOST LIKELY cause for the observed gait deviation is
A. A tight gluteus maximus
B. Tight hip flexors
C. A tight gastrocnemius-soleus complex
D. Tight ankle dorsiflexors
C.
Tightness of the gastrocsoleus muscle complex can cause a loss of dorsiflexion at the ankle. Having adequate ankle dorsiflexion throughout the stance phases of gait is important to the kinematics of tibial movement.
When there is inadequate ankle dorsiflexion, which can occur due to gastrocsoleus tightness, one common finding is knee hyperextension or genu recurvatum.
A physical therapist is performing a manual muscle test on a patient with reported lower extremityweakness. When examining the patient’s ability to plantarflex the foot in a prone position, suspicion arises that the patient is using the tibialis posterior as a substitute for significant gastrocnemius-soleus weakness. The therapist’s hypothesis is based on the following observation
A. The foot moves into eversion and plantar flexion
B. The foot moves into inversion and plantar flexion
C. The forefoot moves into plantar flex
D. The toes flex as the foot plantar flexes
B.
The observed action of the foot would be consistent with motion produced by the tibialis posterior. The tibialis posterior plantar flexes and inverts the foot.
A physical therapist is examining passive range of motion in a patient reporting hip pain. When measuring with a goniometer, the patient had O to 60 degrees of passive hip internal rotation.
This finding is
A. Normal
B. Indicative of hypomobility
C. Indicative of hypermobility
D. Indicative of a capsular pattern
C.
Based on the values provided by the
American Academy of Orthopedic Surgeons, the clinical finding exceeds the expected normal range of motion for hip internal rotation, which is 0 to 45 degrees.
A physical therapist is treating a patient who has bilaterally “weak” knee and hip extensors.
The patient is most likely to have the greatest difficulty performing which of the following functional activities?
A. Transferring from a wheelchair to a mat
B. Rolling from supine to side-lying
C. Transferring from sitting to supine
D. Transferring from sitting to standing
D.
Transferring from a sitting to a standing position will pose the greatest challenge because of the need to generate force in the extensor muscles. Going from sitting to standing requires the recruitment of the hip and knee extensors.
Your patient is a 21-year-old male who reports to you with complaints of low back pain and stiffness. This has been ongoing for the past several months. He has been experiencing difficulties breathing and has noticed a difficulty with cervical flexion. The stiffness is most prevalent in the morning, He has noticed a low grade fever over the past several weeks. What pathology is mostly likely the source of the patient’s symptoms?
A. Ankylosing spondylitis
B. Rheumatoid arthritis
C. Systemiclupus erythematosis
D. Myasthenia gravis
A.
Classic symptoms of anklylosing
spondylitis include insidious onset of worsening, dull, lumbosacral back pain; progressive morning stiffness: pain in the sacroiliac region; prolonged stiffness with inactivity; absence of neurologic signs; tenderness at the sacral ligaments; and chest pain with deep breathing.
A 16-year-old male basketball player complains of pain in lower back and notes that the pain increases after landing from a jump. After a supine-to-sit test, the therapist notes that the right lower extremity appears longer in supine and shorter in sitting. What is the most likely cause of this problem?
A. Posterior rotation of the right innominate
B. Anterior rotation of the left innominate
C. Anterior rotation of the right innominate
D. Inflare of right innominate
C.
The supine to sit test demonstrates a functional left length difference resulting from a pelvic dysfunction caused by pelvic torsion or rotation.
A patient with an upper motor neuron spinal cord lesion at C6 began receiving occupational therapy 2 weeks after the injury. During the third week. the therapist notices an increase in spasticity. The therapist should
A. Conclude that symptoms are typical after spinal shock
B. Conclude that the patient maybe in respiratory distress
C. Suspect that a contracture is developing
D. Look for signs of autonomic dysreflexia
A.
An initial spinal cord lesion results in spinal shock, which lasts for 1 week to 3 months.
During spinal shock, the spinal cord may function as though it is alive both above and below the level. The problem is one of communication: the brain cannot receive sensory information beyond the lesion site and cannot volitionall control motor function below that point. Eventually, this subsides, and in upper motor neuron lesion, spasticity normally increases.
At the caudallevel of the medulla, what percentage of the fibers of the corticospinal tract cross at the pyramidal decussation?
A. 90to 100
B. 80 to 90
C. 70 to 80
D. 60 to 70
B.
Most anatomists agree that 80 to 90 of the fibers of the corticospinal tract cross over.
This descending tract, the _______________
originates in the superior colliculus and is involved with the orientation toward a stimulus in the environment by reflex turning of the head.
A. Rubrospinal
B. Reticulospinal
C. Tectospinal
D. Vestibulospinal
C.
The rubrospinal tract originates in the red nucleus; the reticulospinal tract originates in the medullary and pontine reticular formation; and the vestibulospinal tract originates in the lateral vestibular nucleus.
Which is the LEAST likely cause of dementia in the elderly?
A. Stroke
B. Alzheimer’s disease
C. Depression
D. Cerebrovascular accident
C.
Alzheimer’s and stroke
(cerebrovascular accident) are the two most common causes of dementia in the elderly.
Depression mav coincide with dementia but is not a cause.
Postinfectious ascending paralysis and radiculoneuropathy are characteristics of what condition?
A. Guillain-Barre syndrome
B. Myasthenia gravis
C. Amyotrophiclateral sclerosis
D. Multiple sclerosis
A.
About two thirds of the cases of
Guillain-Barré syndrome are preceded by an acute influenza-like illness. It is also characterized by weakness beginning in the distal limb and advancing to affect the proximal muscles and inflammation and demvelination of spinal nerve roots and peripheral nerves.
A 41-year-old woman presents with sudden onset of numbness and drooping of the left side of her face and pain directly behind her left ear.
Further questioning and a general assessment of the patient revealed asmmetric facial expression lateralizing to the right side, mild slurring of speech, dysgeusia, hyperacusis, and difficulty drinking noted as the “dribbling” of a beverage. She was recently diagnosed with a viral upper respiratory infection 3 days ago and treatment consisted of rest and fluids. Ms. Ryan denies a traumatic episode, headache, vertigo, lightheadedness, tinnitus, use of oral contraceptives, and smoking of cigarettes. What is the most likely diagnosis?
A. Guillain-Barre syndrome
B. Bell’s palsy
C. Lyme disease
D. Stroke
B.
Bell’s palsy is a disease process affecting the seventh cranial nerve leading to abrupt facial paralysis/weakness and the symptoms presented in the case study; it is usually unilateral and self-remitting within a few months to a vear. Several possible causes have been linked to the onset or recurrence of the disease process, one of which is a recent viral infection. Obvious physical examination findings involve those structures innervated by the seventh cranial nerve. Other areas of the body are not affected with Bell’s palsy, as would be evident with Lyme disease, Guillain-Barre syndrome, and stroke. In stroke, the patient is able to wrinkle the forehead.
A 50-year-old man presents to your office with the following presentation: 2 muscle strength with left shoulder abduction and elbow flexion; 5 muscle strength of left elbow extension and the intrinsic muscles of the hand; bicipital reflex absent on the left and hypotonia of the biceps and deltoid muscles; triceps reflex 2 with normal triceps muscle tone;
spasticity and hyperreflexia in the left lower extremity. Based upon this presentation, where is the MOST likely site of the lesion?
A. Leftside of the spinal cord at C5
B. Leftside of the spinal cord at C7
C. Rightside of the spinal cord at T1
D. Right side of the spinal cord at C5
A.
Spinal cord lesions usually present with uppermotor neuron signs below the level of the lesion; however, if the lesion involves the anterior horn cells, there will also be lower motor neuron signs at the site of the lesion.
Therefore, based on the information provided in the question, the lesion must be located at C5 on the left side of the spinal cord and involving the anterior horn cells.
A patient recently diagnosed with multiple sclerosis presents to a physical therapy clinic.
The patient asks the therapist what she needs to avoid with this condition. Which of the following should the patient avoid?
A. Hot tubs
B. Slightly increased intake of fluids
C. Application of ice packs
D. Strength training
A.
The danger in using a hot tub for a person with multiple sclerosis is that it may cause extreme fatigue. There is no need to avoid the other activities listed.
The therapist is examining a patient with a diagnosis of cerebral palsy. The therapist notes that all of the extremities and the trunk are involved. Further assessment also reveals that the lower extremities are more involved than the upper extremities and that the right side is more involved than the left. This patient most likely has which classification of cerebral palsy?
A. Spastic hemiplegia
B. Spastic triplegia
C. Spastic quadriplegia
D. Spastic diplegia
D.
A child with spastic diplegia most often presents with the lower extremities and trunk more involved than the upper extremities. Also one side is often more involved than the other side.
The therapist receives an orderto treat a 42-year-old man admitted to the hospital 3 davs ago with a stab wound to the left lower thoracic spine. The patient is unable to move the left lower extremity and cannot feel pain or temperature differences in the right lower extremity. What is the most likely type of lesion?
A. The patient most likely has an anterior cord svndrome.
B. The patient most likely has a Brown-Sequard syndrome.
C. The patient most likely has a central cord svndrome.
D. The patient is equally as likely to have anterior cord syndrome as he is to have
Brown-Sequard syndrome.
B.
The question describes a hemisection of
the spinal cord, which is classified as a Brown-Sequard lesion. Anterior spinal cord injuries present with loss of motor function and insensitivity to pain and temperature bilaterally.
Central cord injuries are characterized by loss of function in the upper extremities and normal function in the trunk and lower extremities.
The therapist receives a referral to examine a patient with a boutonnière deformity.
With this injury the involved finger usually presents in the position of
A. Flexion of the proximal interphalangeal
(PIP) joint and flexion of the distal interphalangeal (DIP) join
B. Extension of the PIP joint and flexion of the DIP joint
C. Flexion of the PIP joint and extension of the DIP ioint
D. Extension of the PIP joint and extension of the DIP joint
C.
Choice B describes a swan-neck deformity.
A therapist receives an order to examine and treat a 76-year-old woman who was involved in a motor vehicle accident 2 days ago. The patient’s vehicle was struck in the rear by another vehicle. The patient has normal sensation and strength in bilateral lower extremities but paralysis and loss of sensation in bilateral upper extremities. Bowel and bladder function are normal. The patient most likely has what type of spinal cord injury?
A. The patient most likely has an anterior cord syndrome.
B. The patient most likely has a Brown-Sequard syndrome.
C. The patient most likely has a central cord syndrome.
D. There is no evidence of an incomplete spinal cord lesion.
C.
This scenario describes a central cord lesion. It is common in the geriatric population after cervical extension injuries (such as whiplash).
A 31-year-old man has loss of vision in one eve, staggering gait, numbness in bilateral upper extremities, and decreased bowel and bladder control. The episodes of these symptoms have occurred every few weeks for the past 6 months.
Each episode has been slightly worse than the last. What is the most likelv condition?
A. Parkinson’s disease
B. Guillain-Barre syndrome
C. Multiple sclerosis
D. Amyotrophiclateral sclerosis
C. This set of signs and symptoms most likely points to multiple sclerosis. The other conditions listed are progressive, but the best answer is multiple sclerosis.
A 35-year-old woman suffered brain injury in a motor vehicle accident and presents with an intention tremor, nystagmus, hypotonia, and dysdiadochokinesia. What is the most likely location of the lesion?
A. Basal ganglia
B. Dorsal columns
C. Frontallobe
D. Cerebellum
D.
These signs and symptoms are most likely associated with damage to the cerebellum.
Injuries to the basal ganglia can present with: rigidity, resting tremor, choreiform movements (jerky movements), and difficulty with initiating movement. Frontal lobe lesions lead to a change in mood or overall personality. The dorsal columns are involved in proprioception and awareness of movement.
A 42-vear-old construction worker received a burst fracture in the cervical spine when struck by a falling cross-beam. Proprioception is intact in bilateral lower extremities. The patient has bilateralloss of motor function and sensitivity to pain and temperature below the level of the lesion. This type of lesion is most typical of which of the following syndromes?
A. Central cord syndrome
B. Brown-Sequard syndrome
C. Anterior cord svndrome
D. Conusmedullaris syndrome
C.
A burst fracture causes damage to the spinal cord because bony fragments are pushed posteriorly into the spinal canal. This type of fracture is often accompanied with anterior cord syndrome.
A 52-year-old man with sciatica presents to outpatient physical therapy. The patient indicates that he is experiencing paresthesia extending to the left ankle and severe lumbar pain. Straight leg raise test is positive with the left lower extremity. Ofthe following, which is the most likely source of pain?
A. A lumbar disc with a left posterior herniation or protrusion
B. A lumbar disc with a right posterior herniation or protrusion
C. Piriformis syndrome
D. Sacroiliac joint dysfunction
A.
The symptoms involving the left lower extremity are an indication that a disc is herniated or protruding onto a nerve root on the left side. A positive straight leg-raise test is also often an indication of a disc herniation or protrusion.
A patient who has suffered a recent fracture of the right tibia and fibula has developed foot drop of the right foot during gait.
Which nerve is causing this loss of motor function?
A. Posterior tibial
B. Superficial peroneal
C. Deep peroneal
D. Anterior tibial
C.
The foot drop is caused by a
lack of active dorsiflexion. The tibialis anterior is responsible for this motion and is innervated by the deep peroneal nerve.
An infant with Erb’s palsy presents with
the involved upper extremity in which of the following positions?
A. Hand supinated and wrist extended
B. Hand supinated and wrist flexed
C. Hand pronated and wrist extended
D. Hand pronated and wrist flexed
D.
The involved upper extremity is
in this position because of damage to the C5 and
C6 spinal roots.
When reviewing a patient’s chart, the therapist determines that the patient has a condition in which the caudaequina is in a fluid-filled sac protruding from the back. What form of spina bifida does the patient most likely have?
A. Meningocele
B. Meningomyelocele
C. Spinabifida occulta
D. Lipoma
B.
This form of spina bifida is
associated with direct involvement with the caudaequina. The muscles that are innervated by the caudaequina usually present with flaccid paralysis.
A physician is preparing a patient for an
upcoming procedure. The physician explains that the procedure will provide a detailed image that appears to be a slice of the brain. This image is obtained with a highly concentrated x-ray beam. What procedure is the patient scheduled to undergo?
A. Angiogram
B. Magnetic resonance imaging (MRI)
C. Positron emission tomography (PET)
D. Computed tomography (CT)
D.
This is a description of a CT
scan. A PET scan is performed by injecting a radioactive compound into the person being tested and then forming a picture of the brain with a computer that picks up the compound that reaches the brain tissue. An MRI picks up radiofrequency waves that are emitted by atomic particles displaced by radio waves in a magnetic field. An angiogram uses a high contrast dye that reveals the vessels of the brain by x-ray.
A therapist is scheduled to treat a
patient with cerebral palsy who has been classified as a spastic quadriplegic. What type of orthopedic deformity should the therapist expect to see in the patient’s feet?
A. Talipesequinovalgus
B. Talipesequinovarus
C. Hindfoot valgus
D. Abnormally large calcaneous
B.
A person with spastic
quadriplegia presents with talipesequinovarus.
This term is synonymous with clubfoot. The hindfoot will be in varus and the calcaneous will be abnormally small.
A 32-year-old construction worker fell
off a ladder. In his effort to prevent the fall, the worker reached for a beam with his right arm
This motion stretched the brachial plexus, resulting in decreased function in the right arm.
Full function returned after 2 1/2 weeks. What is the most likely type of injury?
A. Axonomesis
B. Neurotmesis
C. Neurapraxia
D. Nerve root avulsion
C.
Neurapraxia is not associated
with axon degeneration; it is associated instead with demyelination and complete recovery.
With axonotmesis there is wallerian degeneration below the site of the lesion. In neuromesis the damage is so severe that full function may not be regained.
A therapist is assessing a patient in an attemptto discover the source of her pain. She positions the patient’s cervical spine in different directions in an attempt to elicit the patient’s symptoms. In one such direction, the patient reports return of symptoms, including pain located at the right posterior scapular region. which extends down the posterior side of the right upper extremity to the ends of the fingers, and tingling in the second, third, and fourth digits. The patient also indicates that she often has a decrease in sensation on the dorsal side of the second and third digits. She also has noticeable weakness in the right triceps. Which nerve root is most likelv involved?
A. Fourth cervical root
B. Fifth cervical root
C. Sixth cervical root
D. Seventh cervical root
D.
Dermatome charts in
distribution vary from source to source, but one common aspect of C7 innervation is the middle finger. The triceps muscles are also innervated by C7.
A patient informs his therapist that his problem began 3 months after a bout of the flu.
The patient originally experienced tingling in the hands and feet. He also reports progressive weakness to the point that he required a ventilator to breathe. He is now recovering rapidly and is expected to returnto a normal functional level in 3 more months. From which of the following conditions is the patient most likely suffering?
A. Parkinson’s disease
B. Guillain-Barre syndrome
C. Multiple sclerosis
D. Amyotrophiclateral sclerosis
B.
This patient is suffering from
Guillain-Barré syndrome. Some permanent damage can result, with loss of sensory or motor function, but most patients make a full recovery in approximately 6 months.
The svndrome often starts after a person has had a bout of the flu or a respiratory infection.
A therapist is examining a patient in the intensive care unit. The therapist notices that the patient is moving his hands and fingers in slow, writhing motions. Which of the following terms best describes this type of movement?
A. Lead-pipe rigidity
B. Ballisms
C. Chorea
D. Athetosis
D.
This type of movement, known
as athetosis, also can involve the feet, proximal parts of the extremities, and face. Choreais rapid movements of the hands, wrist, or face.
Ballism refers to forceful and uncontrollable throwing of the extremities outward. Lead-pipe rigidity is increasing resistance of an extremity to passive ranging. All of the aforementioned can result from damage to the basal ganglia.
A 29-vear-old woman who is 8 months
pregnant presents to an outpatient clinic with complaints of “pain and tingling” over the lateral thigh. She also indicates no traumatic injury. The symptoms increase after she has been sitting for 30 minutes or longer, and the overall intensity of the symptoms has been increasing over the past 2 weeks. The therapist notes that repeated active lumbar flexion does not increase pain, and the patient’s lumbar range of motion is normal for a pregnant woman. There is also no motor weakness in the hip or pelvis, and the sacroiliac joint is not abnormally rotated. What is the most probable diagnosis?
A. L3 disc dvsfunction
B. Spondylolisthesis
C. L4 disc dysfunction
D. Meralgiaparesthetica
D.
Meralgiaparesthetica is the
compression of the lateral femoral cutaneous nerve of the thigh as it passes under the inguinal ligament near the anterior superior iliac spine. Examples of the source of this problem include periods of obesity, postural changes, and tight clothing. Lumbar disc involvement and spondylolisthesis are less likely choices because the question indicates normal range of motion, lack of motor weakness, and no change with repeated active lumbar flexion.
A 14-year-old girl placed excessive
valgus stress to the right elbow during a fall from a bicycle. Her forearm was in supination at the moment the valgus stress was applied.
Which of the following is most likely involved in this type of injury?
A. Ulnarnerve
B. Extensor carpi radialus
C. Brachioradialis
D. Annular ligament
A.
A valgus stress is most likely to
injure any medial elbow structures, such as the ulnar nerve. The structures on the lateral side are likelv to be inured with a varus stress.
Choice C originates on the lateral supracondylar ridge.
A patient presents to an outpatient
clinic with an order to examine and treat the right forearm and wrist secondary to nerve compression. The patient has the following signs and symptoms: pain with manual muscle testing of pronation, decreased strength of the flexor pollicislongus and pronator quadrates, and pain with palpation of the pronator teres.
What nerve is most likely compromised? What is the most likely area of compression?
A. Median nerve, carpal tunnel
B. Ulnarnerve, Guyon’s canal
C. Ulnarnerve, pronator quadratus
D. Median nerve, pronator teres
D.
These signs and symptoms are
common with median nerve compression as it travels through the two heads of the pronator teres. Carpal tunnel syndrome usually presents with a positive Tinel’s sign, a positive Phalen’s test, and decreased strength and sensation over the median nerve distribution. Ulnar nerve compression at Guyon’s canal typically presents with numbness, pain, and tingling along the ulnar nerve distribution.
The best predictor of ambulation in
young children with cerebral palsy is
A. Absence of primitive reflexes at 3 months
B. Absence of tonic neck reflexes
C. Independent sitting by 24 months of age
D. Independent standing by 1 year of age
C.
Cerebral palsy children are
slow to reach motor milestones. This is the most accurate choice. Studies show that his group of children will walk by age 8.
Which complication of spinal cord injury is more likely to occur in children and teenagers than in adults?
A. Hypercalcemia
B. Autonomic dysreflexia
C. Spasticity
D. Deep venous thrombosis
A.
While all of the choices do occur
in children with a spinal cord injury, choice A is the most appropriate. During the first year of spinal cord injury, 40of bone mineral density is lost through calcium excreted in the urine.
Recovery from spinal cord injury occurring over several years is most likely with which syndrome
A. Brown-Sequard
B. Anterior cord
C. Posterior cord
D. Caudaequina
D.
Cauda equine syndrome is the
most likely of the choices to regrow damaged axons, since it is essentially damage to the peripheral nerves. All other choices are damage to the spinal cord itself.
Which orthopedic complication is not
probable in a child with tetraplegic spinal cord injury?
A. Shoulder subluxation
B. Scoliosis
C. Heterotopic ossification
D. Hip dislocation
A.
The other choices are more
probable in a tetraplegic child.
All of the following are clinical signs of heterotopic ossification except
A. Pressure sores
B. Pain
C. Decreased range of motion
D. Joint swelling
A.
Since heterotopic ossification
involves pathologic bone formation around joints, pressure sores are not an indication of the presence of heterotopic ossification.
The most common clinical signs of a cerebellar brain tumor may include all of the following except
A. Hypotonia
B. Ataxia
C. Vomiting
D. Low back pain
D.
Low back pain is not an
indicator of a brain lesion.
Areas that a phvsical therapist can
address with a child with an acquired brain injury in terms of long-term health and wellbeing include all of the following except
A. Neurologic sequelae
B. Growth disturbance
C. Obesity
D. Arthritis
B.
A physical therapist can
provide intervention for all of the other choices listed regardless of the presence of a brain injury. Growth disturbances are out of the control of the therapist.
Based on recent studies in children with
traumatic brain injurv, vou would expect to see recover slow down after ______
in a child with a severe injury.
A. 6 months
B. 1 year
C. 3 years
D. 5 years
B.
Progress will slow to a halt 1
year after a severe injury. The actual length of recovery varies according to many factors such as area of the brain injured, type of injury, treatment after injury, and so on.
Research indicates there is a significant
correlation between functional restrictions in children with iuvenile rheumatoid arthritis and
A. The number of tender joints
B. Elbow flexion contractures of 10 to 20 degrees
C. Loss of motion in the hips or shoulders
D. Low back pain
C
Choice C involves the larger
joints. Loss of motion in these joints is more likely to impact daily function. Low back pain is common, but not debilitating, as is a minimal elbow flexion contracture.
What is necessary for an infant to have
mastered before sitting independently on propped upper extremities can be achieved?
A. Rolling prone to supine and supine to prone
B. Translation of grasped objects from hand to hand
C. Extending the head and neck in prone, and controlling the pelvis while using the upper extremities in supine
D. Crawling and creeping
C.
Choice C is the most
appropriate. Some of the other choices may be mastered, but C is the most necessary. Choice B is achieved around 3 months of age, and D around 9 months of age.
When should sport-specific drills begin for the athlete following surgical repair of the anterior shoulder capsule?
A. When the involved upper extremity has
30strength of the uninvolved upper extremity.
B. When the involved upper extremity has
50strength of the uninvolved upper extremity.
C. When the involved upper extremity has
75 strength of the uninvolved upper extremity.
D. When the involved upper extremity has
100strength of the uninvolved upper extremity.
C.
Choice C is appropriate. This
level of strength would allow normal ROM throughout the specific skill involved. Less than this level of strength would risk damage to the joint or surgical repair.
During examination of a patient with neck pain and left arm pain, the therapist is suspicious of a C6 nerve root irritation. Which of the findings will help confirm that condition?
A. Weakness in shoulder abduction of left arm
B. Decreased triceps reflex on left compared to right
C. Decreased biceps reflex on left compared to right
D. Increased tone in left biceps
C.
Examination of root irritation
can be conducted by myotome, dermatome, or reflexes. The bicep brachii reflex is indicative of a C6 lesion. Increased tone is associated with uppermotor lesions. Shoulder abduction tests the C5 nerve root, while the tricepbrachii reflex is involves the C7 nerve root.
Your patient was in a car accident and now has a herniated nucleus pulposis at vertebrallevel C5-C6. She reports difficulty removing her shirt overhead. With nerve root injury at the level of C5-C6, what part of the motion will most likely be problematic for your patient and why?
A. Grasping the shirt due to weakness of all finger flexors
B. Internally rotating the shoulder due to weakness of teres minor
C. Shoulder flexion due to weakness of deltoid
D. Cervical flexion to remove shirt due to weakness of deep neck flexors
C. A herniation at C5-6 results in
nerve root compression of C5. This corresponds to the axillary nerve supplying the deltoid. The teres minor is also innervated by the axillary nerve; however it is an external rotator.
Cervical flexion is innervated by the cervical spinal nerves C1-C4. Finger flexors are innervated by the ulnar nerve arising from nerve root levels C7, C8 and T1.
A 55-year-old man with type I diabetes
mellitus reports double vision. On examination of his extraocular movements, he haslimited adduction, elevation, and depression of his right eve. The pupils are equal and reactive. The patient most likely has a lesion of the following right side cranial nerve
A. Abducens nerve VI
B. Trochlear nerve IV
C. Oculomotor nerve III
D. Optic nerve lI
C.
Oculomotor nerve III. The
occulomotor nerve innervates muscles that produce eve adduction, elevation, and depression.
An overweight patient presents with right lower thoracic and right shoulder pain.
She noted that the pain began after eating fried chicken at a fast food restaurant. You suspect it is a visceral pain coming from the
A. Gall bladder
B. Pancreas
C. Liver
D. Heart
A.
The answer that is most true is
that the gall bladder and liver both can refer pain to the right shoulder area. However, the liver is usually not affected by eating but rather lack of eating and alcohol. The pancreas refers pain to the middle of the back and left upper abdominal quadrant. The heart refers pain mostlv to the chest and left side of the face, neck. and arm. Occasionally it can refer to the opposite side. However, there would be other symptoms accompanying the pain such as clamminess and a change in vital signs. The gallbladder, if involved, responds poorly when fatty foods are ingested.
Your patient has an involvement of the 5th lumbar nerve root on the left secondary to a lumbar disc protrusion. Which of the following is true?
A. The ankle jerk is diminished or absent.
B. The patient has fatigueable weakness in the calf.
C. Sensation was diminished between the first and second toe.
D. Sensation was diminished on the plantar surface of the foot.
C.
The most consistent area of L5
sensation loss is between the first and second toe. The ankle jerk tests the S1 level. The nerve that comes out of L5-1 interspace is $1.
Sensation loss on the bottom of the foot could be S1 or S2 involvement. Weakness in the calf incriminates S1.
Your patient is a 65-year-old male who complains of pain radiating down both legs with static and dynamic standing, but with relief while sitting. In the absence of any serious disease he most likelv has a
A. Herniated disc
B. Lateral stenosis
C. Central stenosis
D. Schmorl’s node defect
C.
The narrowing of the central
canal can produce bilateral leg symptoms as can a large central disc dysfunction. However, pain from a disc dysfunction will increase with sitting because of a flexed posture. Backward bending will increase lateral stenosis and central stenosis pain, but typically but it is unilateral and mav onlv affect one dermatome or motor area, whereas central stenosis may affect several dermatomes. Sitting will provide reliefwith a central stenosis.
The classification of a nerve injury that
would produce pain, muscle wasting, complete motor and sympathetic function loss with a recovery time of months, with sensation restored before motor function best describes
A. Neuropraxia
B. Axonomesis
C. Neurotmesis
D. Axonopraxia
B.
According to Sunderland’s and
Seddon’s classification of nerve injuries, the description provided best describes axonomesis. Neurotmesis involves complete disruption of the nerve while neuropraxiais only transient, and there is little or no muscle wasting. Axonopraxia is a similar term for neuropraxia.
When performing resistive testing to determine the integrity of the C5 myotome, the physical therapist should examine which of the following movements?
A. Wrist radial deviation
B. Elbow extension
C. Thumb extension
D. Elbow flexion
D.
Myotome testing can be
important in localizing central and peripheral lesions. A lesion involving the C5 myotome will affect the client/patient’s ability to flex the elbow. Key muscles innervated at this level include the biceps brachi and the deltoid.
While performing an upper quarter screen, a physical therapist suspects neurologic system involvement. In examining the integrity of the C8 dermatome, the therapist should check sensation along the
A. Thumb and index finger
B. Ulnarborder of the hand
C. Middle three fingers
D. Radial border of the hand
B.
Several dermatomes, C6-C8, are
responsible for sensory innervation of the hand. The dorsum and palmer surfaces of the thumb, first finger and thenar eminence receive their sensory component from C6. Dermatome C7 is responsible for the palmar and dorsal surfaces of the third and fourth fingers and middle portion of the palm. The C8 dermatome specifically provides sensation along the ulnar boarder of the hand, including the fifth finger and is part of the screen for peripheral or central nervous system impairment.
A patient has been referred to physical
therapy for acute shoulder pain after shoveling snow in a driveway for 2 hours. Positive findings include pain and weakness with flexion of an extended upper extremity as well as scapular winging with greater than 90 degrees of abduction. The patient’s problem is MOST LIKELY the result of
A. Supraspinatus tendinitis
B. Compression of the long thoracic nerve
C. Compression of the suprascapular nerve
D. Subdeltoid bursitis
B.
Compression of the long
thoracic nerve will result in serratus anterior weakness, which has associated postural and motor disturbances. In terms of posture, weakness of the serratus anterior will result in scapular winging, Motor disturbances can also occur because of the action of the serratus anterior on the scapula during overhead reaching.
A physical therapist is conducting a physical examination with a patient diagnosed with an American Spinal Injuv Association
(ASIA). A spinal cord injury at the level of C6.
During manual muscle testing of the upper extremity, the patient should have function in all of the following muscles EXCEPT the
A. Biceps
B. Triceps
C. Deltoid
D. Diaphragm
B.
In a complete ASIA, A C6 lesion,
muscle function impairments would be expected below the indicated level of the identified lesion. The triceps is innervated by the radial nerve, which arises from spinallevels C7-C8. Spinallevels C3-C5 give rise to the phrenic nerve, which innervates the diaphragm.
The biceps is innervated by spinal levels C5-C6.
The axillary nerve, which runs to the deltoid, arises from the C5-C6 spinallevels.
A physical therapist is treating an 18-year-old male who had an ASIA T1 spinal cord injury (SCI) 6 months ago. Given the level and completeness of the lesion, what would be his EXPECTED functional capability for transfers?
A. Dependent with all mat mobility
B. Dependent with wheelchair to mat transfers
C. Independent with wheelchair to mat transfers
D. Independent with floor to wheelchair transfers
C.
Achieving independence for
wheelchair to mat transfers is a realistic expected level of function given the lesion.
According to Somers (Spinal Cord Injury:
Functional Rehabilitation) and Sisto, Druin and Sliwinski (Spinal Cord Injuries: Management and Rehabilitation), achieving independence is a realistic goal for the level and type of lesion.
Upper extremity function is present, which allows independence for most transfers; thus, that patient is not likely to be dependent for mat mobility and wheelchair to mat transfers.
Transferring from the floor to wheelchair may require assistance.
A physical therapist completes a developmental assessment and notes the child is able to crawl forward, pull to stand at furniture, and sits without hand support for extended periods of time. The most appropriate chronologic age of this child is
A. 4 to 5 months
B. 6 to 7 months
C. 8 to 9 months
D. 11 months
C.
Between 8 and 9 months the
patient is able to obtain quadruped from a prone position, sit without support, pivot in sitting, crawl forward, and cruise along furniture.
A physical therapist completes a developmental assessment and identifies that the infant is unable to roll from supine to side.
Which of the following reflexes could interfere with the action of rolling?
A. Asymmetric tonic neck reflex
B. Moro Reflex
C. Landau reflex
D. Symmetric tonic neck reflex
A.
Asymmetric tonic neck reflex
occurs when an infant’s head is positioned to one side with flexion of the contralateral upper extremity extension of the other. This would interfere with rolling.
An inpatient physical therapist is performing an examination of an 8-year-old female that sustained a traumatic brain injurv because of a motor vehicle accident. Which of the following standardized instruments would be most appropriate to measure the child’s level of consciousness?
A. MRI
B. Modified Ashworth Scale
C. Glasgow Coma Scale
D. Barthel Scale
C.
The Glasgow Coma scale is used
to assess the child’s ability to respond to various stimuli (eye opening, verbal responses, and motor responses).
A 12-year-old female with cerebral palsy is admitted to the hospital for a Baclofen test dose to determine if she is a candidate for a Baclofen pump. One hourpostinjection, the physical therapist assesses the tone in the lower extremities. There is marked increase in muscle tone through most of the ROM, but it is easily moved. What level is the ankle on the Modified Ashworth Scale?
A. 1
B. 0
C. 4
D. 2
D.
A 2 on the Modified Ashworth
Scale is defined by more marked increase in muscle tone through most of the ROM, but affected limbs easily moved.
You are performing an examination on a 36-month-old male who is able to ascend stairs with a step to pattern, jump off of a step and runs with decreased coordination. The patient is unable to maintain single limb stance.
What do you determine from this observation?
A. The patient is demonstrating age appropriate skills.
B. The patient is demonstrating skills at approximately the 10- to 12-month level.
C. The patient is demonstrating skills at approximately the 18-to 20-month level.
D. The patient is demonstrating skills at approximately the 30-to 32-month level.
A.
The 18-to 20-month-old
toddler will be able to ascend stairs with a step to pattern, run, and jump off of a bottom step.
Recovery of the upper arm after a
brachial plexus injury can occur for up to
A. 2 years
B. 1 year
C. 6 months
D. 9 months
A.
Continued recovery can occur
for up to 2 years in the upper arm and 4 years in the lower arm.
What is the maior concern of the
phvsical therapist treating a patient with an acute deep partial-thickness burn covering 27of the total body? The patient was admitted to the intensive care burn unit 2 days ago.
A. Range of motion
B. Fluid retention
C. Helping the family cope with the injured patient
D. Home modifications on discharge
A. A therapist’s main
responsibility with this patient is to maintain range of motion. Fluid retention is an important concern but for other medical staff. Choices C and D will be addressed later in the patient’s course of therapy.
A patient is referred to physical therapy services for care of a burn wound on the left foot. The majority of the wound is anesthetic.
There is significant eschar formation over the dorsum of the involved foot, and moderate subcutaneous tissue damage is present. What is the most likely classification of this burn?
A. Electrical
B. Superficial partial thickness
C. Deep partial thickness
D. Full thickness
D. A superficial partial-thickness burn and a deep partial-thickness burn are not deep enough to involve the subcutaneous tissue.
An electrical burn is complete destruction of the subcutaneous tissue. A full-thickness burn produces moderate subcutaneous tissue damage and little pain.
A therapist is examining a wound in a patient with the following signs: the right foot has a toe that is gangrenous, the skin on the dorsum of the foot is shiny in appearance, and no calluses are present. The patient has what type of ulcer?
A. Venous insufficiency ulcer
B. Arterial insufficiency ulcer
C. Decubitus ulcer
D. Trophic ulcer
B.
These signs are characteristic of
an arterial insufficiency ulcer. A venous ulcer often presents with the following symptoms: no pain around the wound, no gangrene, location typically on the medial ankle, pigmented skin around the ulcer, and significant edema. A trophic ulcer (also known as a pressure or decubitus ulcer) presents with decreased sensation, callused skin, and no pain and is located over bony prominences.
The most common hand deformity following burn injury in children is
A. Hyper-extension of fifth MCP
B. Radial deviation of wrist
C. Boutonniere deformity
D. Palmar contracture
D.
The relative weakness of the
musculature of a child will allow scar tissue to contract the palmar aponeurosis. Careful splinting of this area should be considered.
A physical therapist is assessing the skin integrity over the ischialtuberosities of a
17-year-old female with spastic cerebral palsy after being transferred out of the child’s wheelchair. The therapist notes that the wound extends to the bone. The therapist would stage this pressure sore as
A. Stagel
B. Stage lI
C. Stage III
D. Stage IV
D. A stage IV pressure sore is a full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures.
A 21-year-old female has sustained a
traumatic brain injury and is demonstrating significant neurologic impairments. The physical therapist notices on examination a blister with surrounding erythema on the patient’s sacrum. The physical therapist should document the patient as having which of the following?
A. Stage I pressure ulcer
B. Stage Il pressure ulcer
C. Stage IlI pressure ulcer
D. Stage IV pressure ulcer
B.
A stage lI pressure sore results
in partial-thickness skin loss involving the epidermis, dermis, or both. The ulceris superficial and presents clinically as an abrasion, blister, or shallow crater.
A diabetic patient is exercising
vigorously in an outpatient clinic. The patient informs the therapist that he or she received insulin immediately before the exercise session.
Of the following symptoms which is an unlikely sign of hypoglycemic coma?
A. Pallor
B. Shallow respiration
C. Bounding pulse
D. Dry skin
D.
Dry skin is a sign of a diabetic coma.
After arriving at the home of a home
health patient, the primary nurse informs the therapist that she has activated emergency medical services. The nurse found the patient in what appears to be a diabetic coma. Which of the following is most likely not one of the patient’s signs?
A. Skin flush
B. Rapid pulse
C. Weak pulse
D. Highblood pressure
D. A person in a diabetic coma has low blood pressure.
A therapist is treating a new patient in
an outpatient facility. The patient has recently been diagnosed with type 1 insulin-dependent diabetes mellitus. The patient asks the therapist the differences between tvpe 1 insulin-dependent diabetes mellitus and type 2 non-insulin-dependent diabetes mellitus. Which of the following statements is true?
A. There is usually some insulin present in the blood in type 1 and none in type 2.
B. Ketoacidosis is a symptom of type 2.
C. The age of diagnosis with type 1 is usually younger than the age of diagnosis with type 2.
D. Both conditions can be managed with a strict diet only, without taking insulin.
C.
A person is usually diagnosed
with type1 at 25 years of age or younger. A person is usually 40 years of age or older when diagnosed with type 2. Ketoacidosis is a symptom of type 1. Metabolism of free fatty acids in the liver causes this condition, which is an excess of ketones. A type 2 diabetic may be able to control his or her condition with diet only (depending on the severity of the condition), but a type I diabetic needs insulin.
A 65-year-old man presents to physical
therapy with complaints of pain due to compression fractures of the C2 and C3 vertebrae. The patient has an unusually large cranium. He describes his condition by stating.
“Much of my bone tissue is continually decreasing, then reforming.” The patient also indicates that the condition has caused limb deformity. Which of the following diseases does he have?
A. Paget’s disease
B. Achondroplastic dwarfism
C. Osteogenesisimperfecta
D. Osteopetrosis
A.
In Paget’s disease (also known
as osteitisdeformans), bone is resorped and deposited at different rates during different stages of the disease. One of the deformities sometimes present is an enlarged cranium. This increased weight can result in compression fractures of the more superior cervical vertebrae. The origin of this condition is not exactly known. It usually involves people over 60 vears of age.
Improved survival rates for cancer
increase the likelihood that a physical therapist will be treating patients with a past medical history of cancer and cancer treatment. Which statement does not accurately describe presentation of potential side effects of cancer treatment?
A. Increased risk of infections and bleeding due to bone marrow suppression
B. Debilitating fatigue that may persist in spite of rest
C. Demineralization and bone necrosis that increases risk of pathologic fractures
D. Symptoms that are easily distinguishable from cancer recurrence
D.
It is not always possible to
determine side effects of cancer treatment versus cancer recurrence. Therapists must therefore be aware of immediate and long-term effects of cancer treatment.
A physical therapist is discussing appropriate exercise parameters for a patient with tvpe Il diabetes. Which statement reflects inappropriate advice to the patient?
A. Do not begin exercise if blood glucose is above 100 mg/dl.
B. Be sure to stay adequately hydrated.
C. Avoid insulin injections in the active extremities within 1 hour before exercise.
D. Exercise at moderate intensity and use rate of perceived exertion to help determine response to exercise.
A.
Blood glucose levels should be
between 100 to 250 mg/dl. The other instructions are all appropriate for the diabetic patient.
Which of the following statements about lymph node palpation is true?
A. Normal lymph nodes are generally not visible or easilv palpable.
B. Anontender, immovable lymph node is not significant.
C. Only tender lymph nodes are important in differential diagnosis.
D. Lymph node palpation will confirm an infection.
A.
Normal lvmph nodes are
generally not palpable or visible. Current guidelines suggest any suspicious lymph node should be evaluated by a physician. Hard, immobile lymph nodes tend to raise suspicion of cancer. Tender, moveable nodes are associated with infections, allergies, or food intolerance. Lymph node palpation will not confirm a diagnosis, which is why medical referral is necessary.
A 5-year-old male diagnosed with
medulloblastoma is currently receiving chemotherapy. The physical therapist is preparing to treat this patient in an inpatient hospital setting. What lab value must the therapist consider before initiating treatment?
A. WBC
B. Glucose
C. HDL/LDL
D. Platelets
D.
A low platelet count or thrombocytopenia is a common side effect of chemotherapy. A low platelet count places the patient at risk for bleeding and therefore needs to be considered before intervention.
Differentiation of the sources of pain is
critical to the accurate diagnosis and appropriate treatment of patient conditions.
Which of the following would not describe pain or symptoms from a visceral source?
A. Itcan be produced by the heart and internal organs.
B. The symptoms tend to be well localized.
C. Hypersensitivity to touch or pressure often accompanies disease.
D. Generally associated signs and symptoms are present.
B.
Visceral sources of pain are not
welllocalized because of multisegmental innervation andlack of receptors in the structures. The other statements are all correct.
Your patient has complaints of loss of urine as soon as she has the urge to urinate. She also complains of deep pressure (NOT PAIN) in her lower pelvis area with prolonged standing.
What kind of incontinence do this patient’s symptoms most likely mimic?
A. Stress incontinence
B. Urge incontinence
C. Mixed incontinence
D. Functional incontinence
B.
Though this patient may also
have some pelvic organ descension, her symptoms are most likely matching urge incontinence, which is defined as “involuntarv loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is involuntary and inappropriate detrusor muscle contractions.”
A patient with fibromyalgia has
performance deficits in ADLs, including lack of a daily routine because of a loss of energy and motivation to engage in daily occupations, depression and anxiety, and difficulty managing home and instrumental activities of daily living (IADL) because of fatigue and pain. Based on these performance deficits, the initial focus of treatment should be
A. Completing IADL tasks independently
B. Establishing a new daily routine that can be done within the patient’s tolerance
C. Referring to a support group to address depression and anxiety
D. Energy conservation and activities for pain management
D.
An initial short-term goal is to
instruct in energy conservation and assist the patient in dealing with fatigue and pain.
Because energylevel and pain are more tolerable, the patient can establish a new daily routine. Creating a sense of control over the daily routine can lead to a feeling of success and may have an impact on anxiety and depression.
Which of the following is least likely in a woman in the eighth month of pregnancy?
A. Center of gravity anteriorly displaced
B. Heart rate decreased with rest and increased with activity (compared to heart rate before pregnancy)
C. Edema in bilateral lower extremities
D. Blood pressure increased by 5 (compared with blood pressure before pregnancy)
B.
During pregnancy awoman
normally experiences an increase in resting heart rate and a decrease in heart rate during exercise. This change is compared with the heart rate of the particular woman before pregnancy. The other answers about pregnancy are true.
A physical therapist receives an order
to evaluate a home health patient. The primary nurse states that the patient “mav have suffered a stroke because she cannot move the right leg when she stands.” The history that the therapist obtains from the patient and family members includes: (1) left total hip replacement 6 months ago, (2) inability to lift the right lower extremity off of the floor in a standing position,
(3) recent fall at home 2 nights ago, (4) left lower extremity strength with manual muscle testing in supine is 2/5 overall, (5) complaints of pain with resisted movement of the left lower extremity. (6) right lower extremity strength is 4/5 overall, (7) no pain with resisted movements with the right lower extremity, (8) no difference in bilateral upper extremity strength, (9) no decreased sensation, (10) no facial droop, (11) history of dementia but no decreased cognitive ability or speech level as compared with the prior level of function, and
(12) independence in ambulation with a standard walker before the recent fall. What should the therapist’s recommendation to the nursing staff be?
A. The patient should receive physical therapy for strengthening exercises to the right lower extremity with standing exercises and gait training.
B. The patient should receive a physician’s evaluation for a possible stroke.
C. The patient should receive a physician’s evaluation for a possible left hip fracture.
D. The patient should receive physical therapy for strengthening the left lower extremity and gait training.
C.
The right lower extremity is
still strong, and there is no facial droop or diminished sensation. Although these signs are not always present after a stroke, the other signs and symptoms, such as a history of a recent fall and the past total hip replacement, should lead the therapist to choice C. The patient cannot lift the right lower extremity in the standing position because it increases weight bearing on the fractured left lower extremity. The left leg also shows a definite strength loss as graded with manual muscle testing,
A patient has been diagnosed with
systemiclupus erythematosus. Which of the following is not a sign of this autoimmune disease?
A. Increased photosensitivity
B. Oral ulcers
C. Butterflv rash
D. Increased number of white blood cells
D.
The white cell count in a patient
with this diagnosis would decrease. Lupus affects mostly young women.
Which of the following circumstances would normally decrease body temperature in a healthy person?
A. Exercising on a treadmill
B. Pregnancy
C. Normal ovulation
D. Reaching age of 65 years or older
D.
The geriatric population usually
has a decreased body temperature due to poor diet, decreased cardiovascular status, and decreased metabolic rates.
A physical therapist is speaking to a group of pregnant women about maintaining fitness level during pregnancy. Which of the following statements contains incorrect information?
A. Perform regular exercise routines at least three times per week.
B. Perform daily at least 15 minutes of abdominal exercises in supine position during the second and third trimesters.
C. Increase caloric intake by 300 kcal per
day.
D. Exercise decreases constipation during pregnancy.
B.
Supine positioning after the
first trimester is associated with decreased cardiac output.
A 30-year-old woman who had a full-term infant 4 weeks ago presents to physical therapy with diastasis recti. The separation was measured by the physician and found to be 3 cm. Which of the following exercises is most appropriate to minimize the separation?
A. Sit-ups while using the upper extremities to bring the rectus abdominis to midline
B. Bridges while using the upper extremities to bring the rectus abdominis to midline
C. Dynamic lumbar stabilization exercises in quadraped position
D. Gentle head lifts in supine position while using the upper extremities to bring the rectus abdominis to midline
D.
With a separation of this size,
the therapist should use gentle abdominal strengthening while binding the abdominal region.
Proper supportive positioning of an infant with osteogenesisimperfecta is important for all of the following reasons except
A. Keeping extremities immobilized to prevent fractures
B. Protection from fracturing
C. Minimizing joint malalignment and deformities
D. Promotion of muscle strengthening
A.
Immobilizing the extremities
would not allow for normal growth and development. Care must be taken for proper positioning and management of possible fractures, but immobilizing the extremities would not allow for motor milestones to be reached. Proper positioning will also promote muscle strengthening and bone mineralization.
A gross motor program for a school-aged child with osteogenesisimperfecta should not include
A. Muscle strengthening
B. Aerobic conditioning
C. Protected ambulation
D. Keeping extremities immobilized to prevent fractures
D.
Children with osteogenesis imperfecta should be allowed to mature at the same rate as other children. Social skill development mav be compromised if the child is not allowed to participate in some activities. Keeping the extremities immobilized will not allow for more normal growth and development.
In a child who has sustained a submersion injury, the physical therapist needs to be aware of neurologic and _ system changes before initiating treatment.
A. Integumentary
B. Orthopedic
C. Cardiopulmonary
D. Renal
C.
After the neurologic system is
compromised, the cardiovascular system will shut down, causing irreparable damage.
Although all systems are important, the cardiovascular is the most important.
Which of the following is the only appropriate exercise in the third trimester of pregnancy?
A. One-legged balance activities
B. Quadraped (crawling position) with hip
extension
C. Bilateral straight leg raise
D. Bridging
D.
Choice A may result in undue stress to the pubic svmphysis, or SI, and can be dangerous secondary to center of gravity changes. Hip extension in a quadraped position may cause abnormal hyperextension of the lumbar spine, and bilateral straight leg raises could cause a diastasis recti because of the additional stress to the abdominal muscle group.
A physical therapist is performing ultrasound over the lumbar paraspinals of a patient. Which of the following conditions would cause the therapist to use a lower intensity and shorter dosage of treatment?
A. Diabetes
B. Hypertension
C. Hypothyroidism
D. Parkinson’s disease
A.
Ultrasound treatments
performed on a diabetic may cause a reduction in blood sugar. All the other choices are not affected byultrasound.
A patient in the sixth month of pregnancy is in a physical therapy clinic for examination secondary to lumbar pain. Which of the following is incorrect advice to give to this patient?
A. Sleep on the left with a pillow between the knees.
B. Sleep on the right with a pillow between the knees.
C. Sleep supine with a pillow under the knees.
D. Sit with a lumbar support at all times.
C.
At this stage of pregnancy, the
weight of the uterus can compromise the vena cava. The supine position should only be assumed for 5 minutes at a time.
Elderly patients often present with atypical signs and symptoms. Which of the following best explains the atypical presentation of symptoms in the elderly?
A. The number of potential risk factors for disease may be greater.
B. They fail to make connections between their signs and symptoms.
C. The onset of new disease often presents in the most vulnerable systems.
D. They utilize home remedies that alter their signs and symptoms.
C.
Although the elderly often use
home remedies and have additional co-morbidities, the onset of a new disease generally presents with symptoms in the most vulnerable svstems. This explains the atvpical presentation of disease in these individuals. The elderly are not different from other patients in terms of failure to make connections between signs and symptoms.
In a direct access state, a physical therapist is examining a patient with joint pain complaints. The patient has had no diagnostic work-up before arrival at the clinic. Which finding would raise suspicion of rheumatoid arthritis rather than just osteoarthritic complaints?
A. Morning stiffness that resolves within
10 to 15 minutes after getting up
B. Development of joint pain in more than one joint with onset between 20 to 40 years of age
C. Unilateral joint pain in hip or knee
D. Absence of associated symptoms such as fatigue, weightloss, or malaise
B.
The onset of RA is most
common in persons between the ages of 20 and 40 years. Morning stiffness usually lasts 45 minutes or longer. RA tends to involve more than one joint, and frequently has associated signs and symptoms such as fatigue and malaise.
Which descriptors make you suspicious of a neuropathic pain source?
A. Aching, sore, dull
B. Dreadful, cruel, punishing
C. Burning, shooting, pricking
D. Throbbing pulsing pounding
C.
Pain descriptors provide clues
to the source of the pain. Choice C is a typical description for neuropathic pain. Choice A describes musculoskeletal symptoms. Choice B is a group of emotional complaints. Choice D communicates vascular patterns.
Which of the following statements is true relative to differentiation of dementia from depression in older adults?
A. Memorv loss associated with dementia is often noticed by the patient.
B. Disorientation is generally associated with dementia but not depression.
C. Difficulty concentrating is more common with dementia.
D. Writing, speaking, and motor impairments are more common with depression.
B.
Disorientation is present only
with dementia. Dementia patients do not tend to notice memory losses and do usually have trouble concentrating, They will also have writing, speaking, and motor impairments.
A patient is difficult to arouse and falls asleep without constant stimulation from the therapist. Even when the patient is aroused, he has difficulty interacting with the physical therapist. What would be the BEST description of the patient’s level of arousal?
A. Stupor
B. Lethargic
C. Obtunded
D. Alert
C.
Obtunded. This patient requires
continual stimulus to stay awake. The patient in a stuporis not interactive, while a lethargic patient stays interactive with stimulation during a session.
Mrs. Brown is a patient on the acute rehabilitation unit. She is sleepy, but easily roused when you enter the room. She knows hername but thinks she is at home. She is unable to give the year. She tries to get out of bed when you approach, and doesn’t seem to realize she has weakness on the left side. Briefly describe Mrs. Brown’s arousal, orientation, and cognition.
A. Alert, oriented x2, confused
B. Obtunded, oriented x1, confused
C. Lethargic, oriented x1, confused
D. Sleepy, oriented x3, confused
C.
Lethargic, oriented x1, confused.
The patient is best described in this way. Sleepy is not a proper clinical description. She is easily roused so obtunded does not apply. She is oriented to name only
A physical therapist is testing a patient
with diagnosis of vestibular impairment. Which of the following is most likely to be true?
A. The vestibulo-ocular reflex (VOR) is normal so you can rule out posterior canal benign paroxysmal positional vertigo (BPPV).
B. The VOR is delayed so you suspect a unilateral hypofunction.
C. The dynamic visual acuity test shows a two-line loss so you suspect a unilateral hypofunction.
D. The dynamic visual acuity test shows a four-line loss so you suspect posterior canal BPFV.
B.
The VOR is delaved so you
suspect a unilateral hypofunction. This question looks at several vestibulartests and interpretation of findings. The VOR is the vestibular ocular reflex. A normal reflex remains intact with BPPV. A delayed VOR indicates unilateral vestibular hypofunction.
The dynamic visual acuity tests horizontal canal function in upright. A two-line loss in visual acuity is normal. A four-line loss is positive for unilateral vestibular hypofunction, not BPPV.
Positive findings for posterior canal BPPV are with head positional changes only. The gold standard test for posterior canal BPPV is the Dix-Hallpike test.
Individuals with impaired vestibular system function are most likely to experience a loss of balance on the foam and dome test, or the Clinical Test of Sensory Integration and Balance (CTSIB), when information from the ________ is are altered during testing,
A. Spinal reticular system
B. Visual system
C. Somatosensory svstem
D. Somatosensory and visual svstems
D.
The foam and dome test, also
known as the Clinical Test of Sensory Integration and Balance, is an easy to use clinical test that attempts to identify the source of balance loss. In the presence of vestibular system dysfunction, altering information from two systems simultaneously can result in an immediate loss of the balance. While all three systems contribute to balance, the vestibular system has a roll in resolving visual-somatosensory conflicts that can lead to destabilization and falling. The CTSIB induces visual-somatosensory conflict that can only be resolved through effective function of the vestibular svstem.
Your patient is a 45-year-old female with complaints of right shoulder pain and paresthesias running down her right arm. No specific dermatome. Symptoms have been increasing in the past 3 months and now are continuous in nature. She has a history of smoking but quit 3 years ago. Her shoulder pain increases at night, as do her arm symptoms. She reports that in recent months she has been feeling tired more frequently and has been losing weight. What pathology is mostly likely the source of the patient’s symptoms?
A. Cancer
B. Rotator cuff tear
C. Cervical radiculopathy
D. Thoracic outlet syndrome
A.
Although the other answers
could be potential sources of the patient’s svmptoms, cancer is the answer that fulfills the most of the patient’s symptoms. Classic signs of cancer are continuous pain, fatigue, and weight loss. The history of smoking and paresthesias makes one suspect pancoast tumor to the right
lung.
An 18-vear-old male was involved in a
motorccle accident and has sustained a traumatic brain injury. The patient is starting to squeeze the therapist’s hand upon command, beginning to recognize his mother, and withdraws to pain. The patient is at what stage on the Rancho Los Amigos Levels of Cognitive Functioning?
A. Il-generalized response
B. III-localized response
C. IV-confused-agitated
D. V-confused-inappropriate, nonagitated
B. A patient functioning at Level
IlI (localized response) demonstrates withdrawal to painful stimuli, turns toward or away from auditory stimuli, begins to recognize family members, follows simple commands such as “Look at me” or “squeeze my hand,” reacts slowly and inconsistently, and begins to respond inconsistently to simple questions.
You will be performing an examination on a 20-week-old female and will be completing the Peabody Developmental Motor Scale to determine the severity of developmental delay.
In order to accurately score the patient, you must determine if the patient was born premature. During your examination, you learn that the patient was born at 32 weeks’ gestation.
What is the patient’s corrected/adjusted age?
A. No adjustment is needed for this patient.
B. The patient’s corrected/adjusted age 10 weeks.
C. The patient’s corrected/adjusted age 12 weeks.
D. The patient’s corrected/adjusted age 14 weeks.
C. A full-term pregnancy is 40
weeks. However, a patient is not considered premature and his her age does not need to be adjusted unless delivered earlier than 37 weeks.
This patient was born 8 weeks early (40 - 32) and therefore is considered premature. This patient’s age needs to be corrected in order to accurately determine the degree of developmental delay using a standardized test.
This patient’s corrected age is 12 weeks (20 - 8).
A patient requires examination 4 months following treatment for breast cancer and mastectomy. She is complaining of chest, arm, and shoulder pain with overhead activities. Which of the following conditions is most likely the source of her pain?
A. Torn rotator cuff
B. Adhesive capsulitis
C. Cervical pathology
D. Recurrence of the breast cancer
B.
Forty percent of women with
post-breast-therapy-pain-syndrome present with frozen shoulder/adhesive capsulitis symptoms. These symptoms coincide with neuropathic pain in the upper quarter of the surgical side of the breast cancer. Symptoms are defined as lasting longer than 3 months.
You observe that your patient walks with the spine in extension (increased lumbar lordosis. This could be due to all of the following except
A. Tight semitendinosis
B. Tight rectus femoris
C. Tight psoas major
D. Weak gluteus maximus
A.
The correct choice is tight
semitendinosis. Based on their attachmentto the pelvis, increased lumbar lordosis may be related to tightness of the anterior musculature (psoas, rectus femoris) or weakness of the posterior musculature (gluteals, hamstrings).
During normal gait, in single-limb
stance,
A. The center of mass is at its highest point
B. Potential energy is at a low point
C. Kinetic energy is at its highest point
D. The magnitude of the ground reaction force is always greater than body weight
A.
The correct answer is the
center of mass is at its highest point. The center of mass is at its highest during single-limb support.
Which of the following is false regarding osteoarthritis?
A. The initial biochemical changes include loss of proteoglycan and loosening of the collagen matrix.
B. In severe cases, ulnar deviation of the metacarpophalangeal joints is observed.
C. Later changes include cartilage thinning and joint space narrowing,
D. In severe cases, total joint replacements are a realistic treatment option.
B.
In severe cases, ulnar deviation
of the metacarpophalange al joints is observed.
Osteoarthritis is characterized by joint space narrowing. Ulnar deviation of metacarpophalangeal joints is commonly seen in rheumatoid arthritis as the joint fills with panus
