Fortinberry - Chapter 4 (PT Apps) Flashcards
Interventions
1
Q
During a home health visit, the physical therapist observed several items that require modification in the home of an elderly patient. In terms of priority, the environmental hazard that needs the most immediate attention is
The cracked toilet seat
A malfunctioning thermostat
A throw rug
A cluttered kitchen
A
A throw rug
2
Q
A 55-year-old patient sees a physical therapist for an examination of upper extremity function 1 week after Botox to the patient’s finger flexors in the right upper extremity. The patient had a stroke 1 year ago and is continuing to work on increasing function. During your examination you find that you are unable to fully extend the wrist and the fingers. One of the goals you establish with the patient is to increase ROM in this area. The best way to achieve this goal is by
AROM
PROM
Splinting to provide low load prolonged stretch
Stretching and weight bearing
A
Splinting to provide low load prolonged stretch
2
Q
A physical therapist is treating a patient with a Colles fracture. The patient’s forearm has been immobilized for 3 weeks and will require 4 additional weeks in the cast before the patient can begin functional tasks. An initial focus of treatment should be
Passive ROM (PROM)
Placement of the extremity in a sling
Movement of the joints surrounding the fracture
To avoid treatment until the cast is removed
A
Movement of the joints surrounding the fracture
2
Q
During a treatment session, the physical therapist observes that the patient can flex the affected shoulder through its full ROM in a side-lying position. The PT should progress to activities that place the extremity in
A gravity-assisted position
A gravity-eliminated position
A neutral position
An antigravity position
A
An antigravity position
2
Q
Which activity of daily living (ADL) activity would the PT caution a patient with a recent hip replacement to avoid?
Tying shoes
Pulling up pants
Putting on shirt
Bathing the back
A
Tying shoes
3
Q
During a treatment session, the PT stimulates the need for the client to walk up stairs to a kitchen with a painful/weak left leg. The patient should be instructed to move the
Left leg up to the next step with the cane
Right leg up to the next step with the cane
Right leg up and then his left leg/cane
Left leg up and then his right leg/cane
A
Right leg up and then his left leg/cane
3
Q
You are working with a 53-year-old client who has had a right CVA. The patient is lying on a therapy mat, and you are performing passive ROM to her left arm. Once you have the patient’s arms in 90 degrees of flexion, the patient complains of some discomfort and pain. The best course of action would be to
Continue as tolerated, because passive ROM must be maintained
Begin the ROM again and make sure the scapula is gliding
Continue and do not go past the point of pain
Consult an orthopedic specialist
A
Begin the ROM again and make sure the scapula is gliding
3
Q
The BEST strategy to use with a contracted joint that has a soft end field is to
Perform tendon gliding exercises
Apply low-load, long duration stretch
Use a quick stretch technique
Perform active ROM
A
Apply low-load, long duration stretch
4
Q
Which of the following is considered an absolute contraindication to manipulation?
Smoking and hypertension
Whiplash injury
Birth control pills and smoking
Acute myelopathy
A
Acute myelopathy
5
Q
Which of the following disc herniations would you expect to respond MOST favorably to traction therapy?
Medial to the nerve root
Lateral to the nerve root
Anterior to the nerve root
Posterior to the nerve root
A
Lateral to the nerve root
6
Q
For the best protection of lumbar mechanics, the driver’s car seat should be positioned
As far from the steering wheel as possible
With the front of the seat lower than the back of the seat
With the entire seat bottom level with the floor of the car
As close to the steering wheel as practical
A
As close to the steering wheel as practical
7
Q
A pitcher is exercising in a clinic with a sports cord mounted behind and above his head. The pitcher simulates the pitching motion using the sports cord as resistance. Which proprioceptive neuromuscular facilitation (PNF) diagonal is the pitcher using to strengthen the muscles involved in pitching a baseball?
D1 extension
D1 flexion
D2 extension
D2 flexionD2 extension
A
D2 extension
8
Q
A therapist is mobilizing a patient’s right shoulder. The movement taking place at the joint capsule is not completely to end range. It is a large-amplitude movement from near the beginning of available range to near the end of available range. What grade mobilization, according to Maitland, is being performed?
Grade I
Grade II
Grade III
Grade IV
A
Grade II
9
Q
A 29-year-old woman is referred to a therapist with a diagnosis of recurrent ankle sprains. The patient has a history of several inversion ankle sprains within the past year. No edema or redness is noted at this time. Which of the following is the best treatment plan?
Gastrocnemius stretching, ankle strengthening, and ice
Rest, ice, compression, elevation, and ankle strengthening
Ankle strengthening and a proprioception program
Rest, ice, compression, elevation, and gastrocnemius stretching
A
Ankle strengthening and a proprioception program
10
Q
The therapist is treating a male patient for a second-degree acromioclavicular sprain. The patient has just finished the doctor’s prescription of 2 sessions/week for 4 weeks. The therapist is treating the patient with iontophoresis (driving dexamethasone), deltoid-strengthening exercises, and ice. The patient reports no decline in pain level since the initial examination. Which of the following is the best course of action for the therapist?
a. Phone the doctor and request continued physical therapy
b. Tell the patient to go back to the doctor because he is not making appropriate progress
c. Discharge the patient because he will improve on his own
d. Take the problem to the supervisor of the facility
A
Tell the patient to go back to the doctor because he is not making appropriate progress
11
Q
A therapist working in an outpatient physical therapy clinic examines a patient with a diagnosis of rotator cuff bursitis. The physician’s order is to examine and treat. During the examination the following facts are revealed:
- Active shoulder flexion = 85 degrees with pain;
- Passive shoulder flexion = 177 degrees;
- Active shoulder abduction = 93 degrees with pain;
- Passive shoulder abduction = 181 degrees;
- Active external rotation = 13 degrees with pain;
- Passive external rotation = 87 degrees
- Drop arm test = positive;
- Impingement test = negative;
- Biceps tendon subluxation test = negative;
- Sulcus sign = negative.
Of the following, which is the best course of action?
a. Treat the patient for 1 week with moist heat application, joint mobilization, and strengthening. Then suggest to the patient that he or she return to the physician if there are no positive results.
b. Treat the patient for 1 week with ultrasound, strengthening, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.
c. Treat the patient for 1 week with a home exercise program, strengthening, passive range of motion by the therapist, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results
d. Treat the patient for 1 week with strengthening, a home exercise program, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results
A
d. Treat the patient for 1 week with strengthening, a home exercise program, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results
12
Q
The therapist is crutch training a 26-year-old man who underwent right knee arthroscopy 10 hours ago, The patient’s weight-bearing status is toe-touch weight-bearing on the right lower extremity. If the patient is going up steps, which of the following is the correct sequence of verbal instructions?
a. “Have someone stand below you while going up, bring the left leg up first, then the crutches and the right leg.”
b. “Have someone stand above you while going up, bring the left leg up first, then the crutches and the right leg.”
c. “Have someone stand below you while going up, bring the right leg up first, then the crutches and the left leg.”
d. “Have someone stand above you while going up, bring the right leg up first, then the crutches and the right leg.”
A
a. “Have someone stand below you while going up, bring the left leg up first, then the crutches and the right leg.”
13
Q
What is the best way to first exercise the postural (or extensor) musculature when it is extremely weak to facilitate muscle control?
Isometrically
Concentrically
Eccentrically
Isokinetically
A
Isometrically
14
Q
A 42-year-old receptionist presents to an outpatient physical therapy clinic complaining of low back pain. The therapist decides that postural modification needs to be part of the treatment plan. What is the best position for the lower extremities while the patient is sitting?
a. 90 degrees of hip flexion, 90 degrees of knee flexion, and 10 degrees of dorsiflexion
b. 60 degrees of hip flexion, 90 degrees of knee flexion, and 0 degrees of dorsiflexion
c. 110 degrees of hip flexion, 80 degrees of knee flexion, and 10 degrees of dorsiflexion
d. 90 degrees of hip flexion, 90 degrees of knee flexion, and 0 degrees of dorsiflexion
A
d. 90 degrees of hip flexion, 90 degrees of knee flexion, and 0 degrees of dorsiflexion
15
Q
A 67-year-old woman presents to an outpatient facility with a diagnosis of right adhesive capsulitis. The therapist plans to focus mostly on gaining abduction range of motion. In which direction should the therapist mobilize the shoulder to gain abduction range of motion?
Posteriorly
Anteriorly
Inferiorly
Superiorly
A
Inferiorly
16
Q
A patient is positioned in the supine position. The involved left upper extremity is positioned by the therapist in 90 degrees of shoulder flexion. The therapist applies resistance into shoulder flexion, then extension. No movement takes place. The therapist instructs the patient to “hold” when resistance is applied in both directions. Which of the following proprioceptive neuromuscular facilitation techniques is being used?
Repeated contractions
Hold-relax
Rhythmic stabilization
Contract-relax
A
Rhythmic stabilization
17
Q
The therapist is treating a patient who recently received a below-knee amputation. The therapist notices in the patient’s chart that a psychiatrist has stated that the patient is in the second stage of the grieving process. Which stage of the grieving process is this patient most likely exhibiting?
Denial
Acceptance
Depression
Anger
A
Anger
18
Q
A 32-year-old man is referred to physical therapy with the diagnosis of a recent complete anterior cruciate ligament tear. The patient and the physician have decided to avoid surgery as long as possible. The therapist provides the patient with a home exercise program and instructions about activities that will be limited secondary to the diagnosis. Which of the following is the best advice?
a. There are no precautions
b. The patient should avoid all athletic activity for 1 year.
c. The patient should avoid all athletic activity until there is a minimum of 20 difference in the bilateral quadriceps muscle as measured isokinetically
d. The patient should wear a brace and compete in only light athletic events.
A
d. The patient should wear a brace and compete in only light athletic events.
19
Q
A physician has ordered a physical therapist to treat a patient with a chronic low back pain. The order is to “increase gluteal muscle function by decreasing trigger points in the quadratus lumborum.” What is the first technique that should be used by the physical therapist?
Isometric gluteal strengthening
Posture program
Soft tissue massage
Muscle reeducation
A
Soft tissue massage
19
A 60-year-old woman is referred to outpatient physical therapy services for rehabilitation after receiving a left total knee replacement 4 weeks ago. The patient is currently ambulating with a standard walker with a severely antalgic gait pattern. Before the recent surgery the patient was ambulating independently without an assistive device. Left knee flexion was measured in the initial examination and found to be 85 degrees actively and 94 degrees passively. The patient also lacked 10 degrees of full passive extension and 17 degrees of full active extension. Which of the following does the therapist need to first address?
Lack of passive left knee flexion
Lack of passive left knee extension
Lack of active left knee extension
Ability to ambulate with a lesser assistive device
Lack of passive left knee extension
20
A home health physical therapist sent to examine a 56-year-old man who has suffered a recent stroke. The patient is sitting in a lift chair, accompanied by his 14-year-old nephew. He seems confused several times throughout the examination. The nephew is unable to assist in clarifying much of the subjective history. The patient reports to the therapist that he is independent in ambulation with a standard walker as an assistive device and in all transfers without an assistive device. Based on the above information, which of the following sequence of events, chosen by the therapist, is in the correct order?
a. Ambulate with the standard walker with the wheelchair in close proximity; transfer sit to stand in front of the wheelchair; transfer wheelchair to bed; assess range of motion and strength of all extremities in supine position
b. Ambulate with the standard walker with the wheelchair in close proximity; transfer wheelchair to bed; assess range of motion and strength of all extremities in supine position transfer sit to stand at bedside
c. Assess range of motion and strength of all extremities in the lift chair; transfer sit to stand in front of the lift chair; ambulate with the standard walker with the wheelchair in close proximity; transfer wheelchair to bed
d. Assess range of motion and strength of all extremities in the lift chair; ambulate with the standard walker with the wheelchair in close proximity transfer sit to stand in front of the wheelchair transfer wheelchair to bed
c. Assess range of motion and strength of all extremities in the lift chair; transfer sit to stand in front of the lift chair; ambulate with the standard walker with the wheelchair in close proximity; transfer wheelchair to bed
21
A patient is receiving crutch training 1 day after a right knee arthroscopic surgery. The patient’s weight-bearing status is toe-touch weight-bearing on the right lower extremity. The therapist first chooses to instruct the patient how to perform a correct sit-to-stand transfer. Which of the following is the most correct set of instructions?
a. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the right hand; (3) press on the left arm rest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm
b. (1) slide forward; (2) put one crutch in each hand, holding the grips; (3) place crutches in a vertical position; (4) press down on the grips; (5) stand up, placing more weight on the left lower extremity.
c. (1) slide forward to the edge of the chair (2) put both the crutches in front of you and hold both grips together with the left hand; (3) press on the right arm rest with the right hand and the grips with the left hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the right arm, then under the left arm
d. (1) Place crutches in close proximity; (2) slide forward; (3) place hands on the arm rests; (4) press down and stand up; (5) place weight on the left lower extremity; (6) reach slowly for the crutches and place under the axilla
a. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the right hand; (3) press on the left arm rest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm
21
A 20-year-old man with anterior cruciate ligament reconstruction with allograft presents to an outpatient physical therapy clinic. The patient’s surgery was 5 days ago. The patient is independently in ambulation with crutches. He also currently has 53 degrees of active knee flexion and 67 degrees of passive knee flexion. He lacks 10 degrees of passive knee flexion and 10 degrees of full knee extension actively and 5 degrees passively. What is the most significant deficit on which the physical therapist should focus treatment?
Lack of active knee extension
Lack of passive knee extension
Lack of active knee flexion
Lack of passive knee flexion
Lack of passive knee extension
21
A physical therapist is ordered to examine and treat in the acute setting a patient who received a left total knee replacement 1 day ago. Before surgery, the patient was independent in all activities of daily living, transfers, and ambulation with an assistive device. The family reports that ambulation was slow and guarded because of knee pain. The physician’s orders are to ambulate with partial weight bearing on the left lower extremity and to increase strength/range of motion. At this point, bed-to-wheelchair transfers, sit-to-stand transfers, and wheelchair-to-toilet transfers require the minimal assistance of one person. The left knee has 63 degrees of active flexion and 77 degrees of passive flexion. The left knee also lacks 7 degrees of full extension actively and 3 degrees passively. Right hip strength is recorded as follows:
* hip flexion and abduction = ⅘,
* hip adduction and extension = 5/5,
* knee flexion = ⅘,
* knee extension = 5/5,
* ankle plantar flexion = ⅘, and
* dorsiflexion = 5/5.
Left lower extremity strength is recorded as follows:
* hip flexion = ⅗ ,
* hip abduction and adduction = ⅗,
* hip extension = ⅗
* knee flexion and extension = 3-/5,
* ankle dorsiflexion = ⅗, and
* plantar flexion = 3/5 .
The patient is currently able to ambulate 30 feet x 2 with a standard walker and minimal assistance of one person on level surfaces. She also ambulates with a flexed knee throughout the gait cycle. According to the physician, she most likely will be discharged home (with home health services), where she lives alone, within the next 2 to 3 days. Which is the most important long-term goal in the acute setting?
a. In 3 days the patient will be independent in all transfers
b. In 3 days the patient will ambulate with a quad cane independently, with no gait deviations, on level surfaces 50 feet x 3.
c. In 3 days the patient will increase all left lower extremity manual muscle testing grades by one half grade
d. In 3 days the patient will have active left knee range of motion from 0 to 90 degrees and passive range of motion from 0 to 95 degreesIn 3 days the patient will be independent in all transfers
a. In 3 days the patient will be independent in all transfers
21
A patient presents to therapy with poor motor control of the lower extremities. The therapist determines that to work efficiently toward the goal of returning the patient to his prior level of ambulation, he must work in the following order regarding stages of control
a. Mobility, controlled mobility, stability, skill
b. Stability, controlled stability, mobility, skill
c. Skill, controlled stability, controlled mobility
d. Mobility, stability, controlled mobility, skill
d. Mobility, stability, controlled mobility, skill
21
A 23-year-old woman arrives at an outpatient physical therapy clinic with a prescription to examine and treat the right hand. One week earlier the patient underwent surgical repair of the flexor tendons of the right hand at zone 2. She also had her cast removed at the physician’s office a few minutes before coming to physical therapy. What is the best course of treatment for this patient?
a. Ultrasound to decrease scarring
b. Gentle grip strengthening with putty
c. Splinting the distal interphalangeal joint and proximal interphalangeal joints at neutral
d. Splinting with the use of rubber bands to passively flex the fingers
Splinting with the use of rubber bands to passively flex the fingers
22
A 67-year-old man with a below-knee amputation presents to an outpatient clinic. His surgical amputation was 3 weeks ago, and his scars are well healed. Which of the following is incorrect information about stump care?
Use a light lotion on the stump after bathing each night.
Continue with use of a shrinker 12 hours per day
Wash the stump with mild soap and water
Use scar massage techniques
Continue with use of a shrinker 12 hours per day
23
A physical therapist is teaching a class in geriatric fitness/strengthening at a local gym. Which of the following is not a general guideline for exercise prescription in this patient population?
a. To increase exercise intensity, increase treadmill speed rather than the grade
b. Start a low intensity (2 to 3 METs)
c. Use machines for strength training rather than free weights
d. Set weight resistance so that the patient can perform more than 8 repetitions before fatigue
a. To increase exercise intensity, increase treadmill speed rather than the grade
24
A 76-year-old woman received a cemented right total hip arthroplasty (THA) 24 hours ago. The surgeon documented that he used a posterolateral incision. Which of the following suggestions is inappropriate for the next 24 hours?
Avoid hip flexion above 30 degrees
Avoid hip adduction past midline
Avoid any internal rotation
Avoid abduction past 15 degrees
Avoid abduction past 15 degrees
25
The therapist is examining a 38-year-old man who complains of right sacroiliac joint pain. The therapist decides to assess leg length discrepancy in supine versus sitting position. When the patient is in supine position, leg lengths are equal; however, when the patient rises to the sitting position, the right lower extremity appears 2cm shorter. Which of the following should be a part of the treatment plan?
Right posterior SI mobilization
Right anterior SI mobilization
Left posterior SI mobilization
Left anterior SI mobilization
Right posterior SI mobilization
26
In taping an athlete's ankle prophylactically before a football game, in what position should the ankle be slightly positioned before taping to provide the most protection against an ankle sprain?
Inversion, dorsiflexion, abduction
Eversion, plantar flexion, adduction
Eversion, dorsiflexion, abduction
Inversion, plantar flexion, adduction
Eversion, dorsiflexion, abduction
27
A physical therapist is treating a 35-year-old man with a traumatic injury to the right hand. The patient has several surgical scars from a tendon repair performed 6 weeks ago. What is the appropriate type of massage for the patient’s scars?
Massage should be transverse and longitudinal
Massage should be circular and longitudinal
Massage should be transverse and circular
Massage is contraindicated after a tendon repair
Massage should be transverse and circular
28
A patient is being treated in an outpatient facility after receiving a meniscus repair to the right knee 1 week ago. The patient has full passive extension of the involved knee but lacks 4 degrees of full extension when performing a straight leg raise. The patient’s active flexion is 110 degrees and passive flexion is 119 degrees. What is a common term used to describe the patient’s most significant range of motion deficit? What is a possible source of this problem?
Flexion contracture, quadricep atrophy
Extension lag, joint effusion
Flexion lag, weak quadriceps
Extension contracture, tight hamstrings
Extension lag, joint effusion
29
A physical therapist is attempting to increase a patient’s functional mobility in a seated position. To treat the patient most effectively and efficiently, the following should be performed in what order?
Weight shifting of the pelvis
Isometric contractions of the lower extremity
Trunk range of motion exercises
Isotonic resistance to the quadriceps
1, 2, 3, 4
2, 3, 1, 4
4, 3, 2, 1
3, 2, 1, 4
3, 2, 1, 4
30
A physical therapist is speaking to a group of avid tennis players. The group asks how to prevent tennis elbow (lateral epicondylitis). Which of the following is incorrect information?
Primarily use the wrist and elbow extensors during a backhand stroke
Begin the backhand stroke in shoulder adduction and internal rotation
Use a racket that has a large grip
Use a light racket
Primarily use the wrist and elbow extensors during a backhand stroke
31
A physical therapist is fabricating a splint for a patient who received four metacarpophalangeal joint replacements. The surgical joint replacement was necessary because of severe rheumatoid arthritis. Which of the following is the correct placement of the metacarpophalangeal joints in the splint?
Fill flexion and slight radial pull
Full flexion and slight ulnar pull
Full extension and slight radial pull
Full extension and slight ulnar pull
Full extension and slight radial pull
32
A therapist ordered to fabricate a splint for a 2-month-old infant with congenital hip dislocation. In what position should the hip be placed while in the splint?
Flexion and adduction
Extension and adduction
Extension and abduction
Flexion and abduction
Flexion and abduction
33
A physical therapist is discharging a 32-year-old man from outpatient physical therapy. The patient received therapy for a traumatic ankle injury that occurred several months earlier. The surgery performed on the patient’s ankle required placement of plates and screws, which resulted in a permanent range of motion deficit of 10 degrees of active and passive dorsiflexion. Strength in the ankle is 5/5 with manual muscle testing. Of the following, which is the highest functional outcome that the patient can expect?
Independent ambulation with no gait deviations
Ambulation with a cane with minimal gait deviations
Running with no gait deviations
Ascending or descending stairs with no gait deviations
Independent ambulation with no gait deviations
34
A physical therapist is performing passive range of motion on the shoulder of a 43-year-old woman who received a rotator cuff repair 5 weeks ago. During passive range of motion, the therapist notes a capsular end feel at 95 degrees of shoulder flexion. What should the therapist do?
Begin isokinetic exercise at 180 degrees per second
Begin joint mobilization
Schedule the patient an appointment with the physician immediately
Begin aggressive supraspinatus activity
Begin joint mobilization
35
In which of the following situations should the therapist be more concerned about the complications resulting from grade IV joint mobilization techniques?
a. A 37-year-old man with a Colles fracture suffered 10 weeks ago
b. A 23-year-old woman with a boxer’s fracture suffered 10 weeks ago
c. A 34-year-old man with a scaphoid fracture suffered 12 weeks ago
d. A 53-year-man with a Bennett’s fracture suffered 12 weeks ago
c. A 34-year-old man with a scaphoid fracture suffered 12 weeks ago
36
Which of the following is an appropriate exercise for a patient who received an anterior cruciate ligament reconstruction with a patella tendon autograft 2 weeks ago?
Lateral step-ups
Heel slides
Stationary bike
Pool walking
Lateral step-ups
37
A physical therapist is speaking to a group of receptionists about correct posture. Which of the following is incorrect information?
a. Position computer monitors at eye level
b. Position seats so that the feet are flat on the floor while sitting
c. Position keyboards so that the wrists are in approximately 20 degrees of extension
d. Take frequent stretching breaks
c. Position keyboards so that the wrists are in approximately 20 degrees of extension
38
A physical therapist is treating an automobile mechanic. The patient asks for tips on preventing upper extremity repetitive motion injuries. Which of the following is incorrect advice?
a. Use your entire hand rather than just the fingers when holding an object
b. Position tasks so that they are performed below shoulder height
c. Use tools with small straight handles when possible
d. When performing a forceful task, keep the materials slightly lower than the elbow
d. Use tools with small straight handles when possible
39
A patient presents to physical therapy with a long-standing diagnosis of bilateral pes planus. The therapist has given the patient custom-fit orthotics. After using the orthotics for 1 week, the patient complains of pain along the first metatarsal. The therapist decides to use joint mobilization techniques to decrease the patient’s pain. In which direction should the therapist mobilize the first metatarsal?
Inferiorly
Superiorly
Laterally
Medially
Inferiorly
40
A 14-year-old boy with a diagnosis of osteosarcoma of his right distal femur underwent resection of the distal third of his femur and implantation of an expandable endophrosthetic device 2 months ago. He is now referred to outpatient physical therapy with no restrictions except PWB gait with crutches. What impairment would you expect to most interfere with function at the time of the examination?
Leg length discrepancy
Limited right knee ROM
Limited right hip ROM
Pain at the site of surgical intervention
Limited right knee ROM
41
A 4-year-old child diagnosed with osteosarcoma of the distal femur, is scheduled for resection of the distal third of the femur. What surgical intervention would provide the best long term functional outcome?
Allograft
Endoprosthetic implant
Hip disarticulation
Rotationplasty
Rotationplasty
42
A 6-month-old infant with acetabular dysplasia of the right hip diagnosed by radiograph, with a history of a dislocatable hip at birth, would usually be treated with
Arthrogram and closed reduction
Spica cast
Pavlik harness
Open reduction
Spica cast
42
Which degree of strain in the following joints would normally take the longest amount of time to rehabilitate?
a. Grade I medial collateral ligament of the knee injury
b. Grade I anterior cruciate ligament injury
c. Grade II ulnar collateral ligament of the elbow injury
d. Grade III anterior talofibular ligament injury
d. Grade III anterior talofibular ligament injury
43
It is 6 weeks after acromioplasty and a patient is showing difficulty performing shoulder flexion and scaption exercises correctly. The patient shows shoulder “hike” above 70 degrees of shoulder flexion. Which of the following interventions would most quickly improve this problem?
Eccentric elbow flexion
Heavy resistance supraspinatus exercise
Gravity resistance supraspinatus exercise
Upper trapezius strengthening
Gravity resistance supraspinatus exercise
43
Shoulder ROM is restricted in a patient 8 weeks after rotator cuff repair. Internal rotation and horizontal adduction are the most restricted motions. Which portion of the shoulder capsule should be stretched or mobilized?
Anterior
Posterior
Inferior
Superior
Posterior
44
A patient who underwent an acromioplasty 8 weeks ago presents with complaints of pain when reaching overhead and during the last 30 degrees of shoulder flexion. End range pain is also felt when using PROM into horizontal adduction, shoulder flexion, and shoulder abduction. Which of the following treatments would be most helpful for this patient?
a. Shoulder mobilizations for the anterior shoulder capsule
b. Shoulder mobilizations for the superior capsule
c. Acromioclavicular joint mobilization with the upper extremity in 20 degrees of shoulder flexion
d. Acromioclavicular joint mobilization with the upper extremity in 140 degrees of shoulder flexion
d. Acromioclavicular joint mobilization with the upper extremity in 140 degrees of shoulder flexion
44
A patient who underwent shoulder acromioplasty 6 days ago presents with pain and limited use for the involved upper extremity during ADLs. What is the most appropriate advice to decrease this patient’s pain while at home?
a. Discontinue use of sling and ice at home
b. Use a sling during waking hours and ice throughout the day
c. Begin progressive resistance exercises at home
d. Discontinue use of a sling and use a moist heat pad at home
Use a sling during waking hours and ice throughout the day
45
Considering a patient with recent anterior capsulolabral reconstruction, when can active range of motion (AROM) of the shoulder be initiated?
As soon as 1 to 2 days after surgery
2 to 3 weeks post operatively
4 to 6 weeks post operatively
6 to 8 weeks post operatively
As soon as 1 to 2 days after surgery
46
In an outpatient physical therapy clinic, a patient presents with complaints of pain with elbow flexion at the anterior shoulder. He underwent anterior capsulolabral reconstruction 10 weeks ago. Shoulder ROM is restricted in internal rotation, but all other motions are normal. Elbow ROM is normal, but painful at 90 to 100 degrees of elbow flexion. What is the most appropriate course of action by the physical therapist?
a. Shoulder posterior mobilization, and treatment for biceps tendonitis
b. Shoulder anterior mobilization, and treatment for biceps tendonitis
c. Shoulder posterior mobilization only
d. Shoulder anterior mobilization only
Shoulder posterior mobilization, and treatment for biceps tendonitis
47
During an intervention session, a patient with recent (1 week ago) rotator cuff repair complains of cervical pain. His complaints are in the upper trapezius and medial scapular area of the involved upper extremity. What is the most appropriate course of action by the physical therapist?
Apply ice to the area of complaint
Assure the patient this is normal and continue with PROM treatments
Call the physician immediately
Examine the cervical spine
Examine the cervical spine
48
A baseball pitcher underwent rotator cuff repair 8 weeks ago. Which portion of the shoulder capsule does not need to be mobilized under normal conditions?
Anterior
Posterior
Superior
Inferior
Anterior
49
A patient complains of pain in the ear, what structure does not refer to the ear?
Sternocleidomastoid trigger point
Deep masseter trigger point
Anterior digastric trigger point
Temporomandibular joint
Anterior digastric trigger point
50
What symptoms are indicative of a temporomandibular dysfunction problem?
Limited range of motion or altered mechanics
Tinnitus and hyperacousia
Dizziness and spinning
Retro-orbital headache and sinus pain
Limited range of motion or altered mechanics
51
What is a reasonable rehabilitation goal for active opening after arthroscopy of the TMJ for an anterior disc displacement without reduction?
Opening to 58 mm
Opening to 28 mm
Opening to 38 mm
Opening to 48 mm
Opening to 38 mm
52
What is the best evidence based intervention for a painful anterior displace disc with reduction in the TMJ?
Exercises that avoid painful click such as hinge axis and midline opening
Aggressive mobilization to reduce the clicking
Wide opening exercises to reduce the clicking
Ice and no exercise
Exercises that avoid painful click such as hinge axis and midline opening
53
When is a dental splint not indicated for a TMJ patient?
a. Aggressive bruxers when exercises are not enough to decrease the clench/grind habit
b. Osteoarthritic joints, bite changes
c. Muscle incoordination, bite changes, cannot find a position to rest the jaw
d. Anterior disc displacement without reduction
Anterior disc displacement without reduction
54
What is the long-term prognosis for an anterior disc displacement without reduction without surgery of the TMJ?
a. Osteoarthritis will develop
b. The range of motion will be limited to a 30 mm opening
c. Clicking and pain will be persistent
d. With or without surgery, the joint will adapt and have functional opening with little or no pain
With or without surgery, the joint will adapt and have functional opening with little or no pain
55
What is the best intervention for an acute anterior displaced disc without reduction?
Ultrasound and heat to calm the joint pain and no exercises
Aggressive PT to manipulate joint to unlock in 3 to 4 visits
Referral to the dentist for splint therapy
Exercises to limit opening
Aggressive PT to manipulate joint to unlock in 3 to 4 visits
56
Distal radius fractures
Are always best treated surgically
Are always best treated in a cast
Can be allowed to heal with some deformity
Are a “solved” problem in orthopedics
Can be allowed to heal with some deformity
57
Stiffness at the MCP joints following casting
Is caused by tightness of the sagittal bands
Can always be avoided by proper casting
Is unavoidable
Requires surgical correction
Is caused by tightness of the sagittal bands
58
A patient sustained a Colles fracture of the wrist. Her cast was removed and she now lacks wrist extension. To increase her passive closed chain wrist extension, mobilize the
Distal concave radius on the convex ulna
Concave distal radius on the convex proximal carpals
Convex distal radius on the concave distal carpals
Concave distal ulna on the convex proximal carpals
Concave distal radius on the convex proximal carpals
59
A pediatric patient is referred to physical therapy with a diagnosis of right torticollis. The physical therapist is developing a home program. What position does the patient need to move his head to correct his posture?
Right cervical rotation and left lateral cervical flexion
Right cervical rotation and right lateral cervical flexion
Left cervical rotation and right lateral cervical flexion
Cervical flexion and scapular retraction
Right cervical rotation and left lateral cervical flexion
60
How much cervical spine rotation will your patient have after a complete cervical spine fusion at level C1-C2?
Complete loss of cervical rotation
25%; loss of cervical rotation
50%; loss of cervical rotation
No loss of cervical rotation
50%; loss of cervical rotation
61
Your patient has limited knee flexion in the preswing phase of gait. You suspect the following
Hamstring weakness
Plantar flexor spasticity
Plantar flexor weakness
Dorsiflexor weakness
Plantar flexor spasticity
62
A patient demonstrates excessive hip adduction in the swing phase of gait. What are the hypothesized causes for this deviation?
Adductor hypertonicity of the swing leg
Quadriceps weakness of the swing leg
Plantar flexor weakness of the swing leg
Gluteus mediushypertonicity of the swing leg
Adductor hypertonicity of the swing leg
63
Your patient is recovering from ACL surgery and is 8 weeks post operative. They have difficulty with flexion beyond 10 degrees. You have determined that the most appropriate way to restore extension would be to mobilize the
Tibia posteriorly on the femur
Femur anteriorly on the tibia
Tibia anteriorly on the femur
The patella distally in the trochlear groove
Tibia anteriorly on the femur
64
Your patient has been diagnosed as having thoracic outlet syndrome. You perform the Adson’s maneuver and it is positive. As a result you have determined that the best way to address this problem is to stretch the
Pectoralis minor
Clavopectoral fascia
Anterior scalenes
Sternocleidomastoids
Anterior scalenes
65
A physical therapist is providing intervention to a 6-month-old infant diagnosed with right torticollis. The therapist instructs the family in a home exercise program that stretches the patient’s neck into
Left side bend and left rotation
Left side bend and right rotation
Right side bend and right rotation
Right side bend and left rotation
Left side bend and right rotation
66
You are performing an examination on a 2-year-old patient diagnosed with leukemia who has been hospitalized for 1 month and is currently undergoing chemotherapy. Upon observation, you notice that the patient has difficulty with transitioning from low to high kneel. You would suspect which primary muscle is weak?
Biceps femoris
Gastrocnemius
Gluteus maximus
Iliopsoas
Gluteus maximus
67
The physical therapist is treating a patient with a history of coronary artery disease. During the treatment, the patient complains of recurring angina that increases when performing activities in standing. The MOST appropriate course of action by the PT is to
Stop treatment and contact the physician
Stop treatment until symptoms subside
Assist patient in taking medication for chest pain
Perform treatment in a sitting position
Stop treatment and contact the physician
68
A patient who sustained a severe heart attack was categorized at a metabolic equivalent table (MKET) level of 2 to 3. The patient has completed the goal of doing homemaking activities, such as washing dishes and ironing. The physical therapist should progress intervention to include the occupational task of
Driving an automobile
Performing upper and lower extremity dressing
Gardening in the yard
Preparing 1 to 2 meals per day
Preparing 1 to 2 meals per day
69
A patient with emphysema complains of shortness of breath and generalized weakness in the upper extremities when performing daily chores. The physical therapist should encourage
Pursed-lip breathing when working
Gravity assisted exercises before performing chores
Use of oxygen with daily activities
Avoidance of activities that consume a lot of energy
Pursed-lip breathing when working
70
Persuading a sedentary patient to become more active, the therapist explains the benefits of exercise. Which of the following is an inappropriate list of benefits?
a. Increased efficiency of the myocardium to obtain oxygen, decreased high-density lipoprotein (HDL) cholesterol, and decreased cholesterol
b. Decreased low-density lipoprotein (LDL) cholesterol, decreased triglycerides, and decreased resting blood pressure
c. Increased efficiency of the myocardium to obtain oxygen, decreased cholesterol, and decreased LDL
d. Decreased resting blood pressure, decreased LDL, and increased HDL
a. Increased efficiency of the myocardium to obtain oxygen, decreased high-density lipoprotein (HDL) cholesterol, and decreased cholesterol
71
The therapist is working in an outpatient cardiac rehabilitation facility. A 50-year-old healthy man inquires about the correct exercise parameters for increasing aerobic efficiency. Which of the following is the most correct information to convey to this individual?
Exercise at 80% to 90% of maximal volume of oxygen utilization
Exercise with heart rate between 111 and 153 beats/minute
Exercise at approximately 10 beats/minute
Exercise at level 17 to 18 on the Borg rating of perceived exertion (RPE) scale
Exercise with heart rate between 111 and 153 beats/minute
72
What lobe of the lungs is the therapist attempting to drain if the patient is in the following position? Resting on the left side, rolled one quarter turn back, supported with pillows, and the foot of the bed raised 12 to 16 inches.
Right middle lobe-lingular segment
Left upper lobe-lingular segment
Right upper lobe-posterior segment
Left upper lobe-posterior segment
Right middle lobe-lingular segment
73
he therapist works in a cardiac rehabilitation setting. Which of the following types of exercises are most likely to be harmful to a 64-year-old man with a history of myocardial infarction?
Concentric
Eccentric
Aerobic
Isometric
Isometric
74
The patient is referred by a physician to begin outpatient cardiac rehabilitation. Which of the following is not a contraindication to enter an outpatient program?
Resting systolic blood pressure of 210 mm Hg
Third-degree atrioventricular block
Resting ST displacement less than 1 mm
Acute fever
Resting ST displacement less than 1 mm
75
In order to determine if an exercise session should be terminated, the patient is asked to assess the level of exertion using the Borg Rating of Perceived Exertion Scale (RPE). The patient rates the level of exertion as 9 on the 6 to 19 scale. A rating of 9 corresponds to which of the following?
Very, very light
Very light
Somewhat hard
Hard
Very light
76
A physician orders stage II cardiac rehabilitation for a patient. The orders are to exercise the patient below 7 metabolic equivalents (METs). Which of the following is a contraindicated activity?
Riding a stationary bike at approximately 5.5 mph
Descending a flight of stairs independently
Ironing
Ambulate independently at 5 to 6 mph
Ambulate independently at 5 to 6 mph
77
A therapist is treating a patient with cystic fibrosis who has just walked 75 feet before experiencing significant breathing difficulties. In an effort to assist the patient in regaining her normal breathing rate, the therapist gives a set of instructions. Which of the following set of instructions is appropriate?
a. “Take a slow deep breath through pursed lips, and exhale slowly through your nose only.”
b. “Take small breaths through your nose only, and exhale quickly through pursed lips.”
c. “Breathe in through your nose, and exhale slowly through pursed lips.”
d. “Breath in through pursed lips, and breathe out slowly through pursed lips.”
“Breathe in through your nose, and exhale slowly through pursed lips.”
78
A physical therapist is treating a 65-year-old man with COPD. The patient questions the benefits of the flow incentive spirometer left in the room by the respiratory therapist a few minutes ago. Which of the following is an appropriate response to the patient’s question?
“It gives visual feedback on lung performance.”
“You should use this for the rest of your life”
“You need to ask the respiratory therapist question.”
“It really doesn’t do anything useful.”
“It gives visual feedback on lung performance.”
79
Which of the following is not an indication for pulmonary suctioning?
Unproductive coughs
Breath sounds of wet rales
Respiratory distress
Hyperoxygenation
Hyperoxygenation
80
Which of the following exercises does not increase strength of the muscles of forceful inspiration?
Active cervical flexion exercises
Active glenohumeral extension exercises
Shoulder shrugs
Crunches
Crunches
81
A 63-year-old man presents to an outpatient physical therapy clinic with a diagnosis of sciatica. The MRI report is negative for lumbar disc involvement. During the examination the physical therapist cannot reproduce the symptoms of radiculopathy with any test. Lower extremity strength is equal bilaterally and is not weak in any particular pattern. The patient informs the therapist that the pain is bilateral, located in the gastrocnemius area, and increases with prolonged ambulation. The pain stops soon after resting in a seated position. What is the most likely source of this patient’s pain?
Impingement of the L5 dorsal root
Multiple sclerosis
Compartment syndrome
Intermittent claudication
Intermittent claudication
82
An 81-year-old woman with right-side hemiparesis due to stroke is being treated by a physical therapist through home health services. The therapist is attempting to increase the functional reach of the right upper extremity. The patient currently has 120 degrees of active flexion. The therapist decides to use trunk mobility/stability facilitation techniques to help achieve the patient’s functional goals. Which of the following skills need to be mastered by the patient to attain the ability to reach 2 feet in front of her wheelchair and 2 feet to the right of midline at 125 degrees of shoulder flexion with the right upper extremity?
a. Weight shifting to the left buttock and right-side trunk elongation
b. Weight shifting to the left buttock and left-side trunk elongation
c. Weight shifting to the right buttock and right-side trunk elongation
d. Weight shifting to the right buttock and left-side trunk elongation
Weight shifting to the right buttock and right-side trunk elongation
83
The physical therapist in beginning examination of a patient in an outpatient cardiac rehabilitation facility. A chart review shows that this patient has active atrial fibrillation with a controlled ventricular rate. What is the most appropriate intervention for this patient?
Low intensity aerobic exercise
High intensity aerobic exercise
High intensity lower extremity exercise only
Low intensity lower extremity exercise only
Low intensity aerobic exercise
84
Which of the following is incorrect advice to give to a patient with a diagnosis of congestive heart failure who complains of shortness of breath and “smothering” while attempting to sleep?
Sleep with the head on 2 to 3 pillows
Sleep without any pillows
Sleep in a recliner during exacerbations
During exacerbations, come to a standing position for a short-term relief
Sleep without any pillows
85
A physical therapist is working with a patient who has a history of coronary artery disease and a reported history of chest pain. Which of the following from the medical interview is NOT a reason to refer a patient back to their physician for further follow-up?
Reported anginal pain is not relieved by rest
Chest pain is reported lasting 20 minutes or longer
There is a reported change in the pattern of angina
Nitroglycerine tablets are reported to relieve the angina
Nitroglycerine tablets are reported to relieve the angina
86
All of the following cardiopulmonary function variables will increase in children in response to training except
Heart volume
Respiratory rate
Stroke volume
Tidal volume
Respiratory rate
87
You are performing an examination and providing intervention to a patient diagnosed with hemophilia. You have confirmed that hemostasis has been achieved after an acute bleed in the right knee. During the objective examination, you determine that the knee has 100 degrees of knee flexion and there is a 5 degrees knee flexion contracture. All are appropriate therapeutic interventions except
Passive ROM of the right knee
Instruct patient and family in a home exercise program consisting of AROM and strengthening
Active resisted exercises
Isometrics of the quadriceps muscle
Passive ROM of the right knee
87
A patient with reflex sympathetic dystrophy syndrome (RSDS), or complex regional pain syndrome (CRPS), has severe edema and increased pain while performing simple grooming activities such as face washing. The initial care plan should focus on
Pain management
Using the uninvolved extremity
Gentle mobilization
Light activities, such as brushing teeth
Pain management
87
A 45-year-old patient is in the first stage of RSDS or CRPS with the classic signs of hand edema, fear of ROM, and pain in the shoulder and hand of the involved extremity. What is the FIRST priority of treatment?
Reduction of edema
Aggressive PROM
Instruct in self-ROM
Perform grip strength test
Reduction of edema
88
A patient with a spinal cord injury at the level of C8 would like to be independent in mobility. Based on the expected functional outcomes, the physical therapist would recommend the following piece(s) of adapted equipment
Manual wheelchair
A motorized wheelchair
A manual wheelchair and sliding board
A walker and wheelchair
A manual wheelchair and sliding board
88
A PT working in early intervention is helping a parent to get the baby to hold and drink from a bottle. Based on typical development, the therapist should begin to introduce this skill between
12 to 14 months
10 to 12 months
8 to 10 months
6 to 8 months
6 to 8 months
89
After 3 months of intervention, the physical therapist notices that the child is beginning to integrate the reflex that turns the head toward the child’s extended arm while in prone. This reflex is
Asymmetric tonic neck reflex
Symmetric tonic neck reflex
Moro reflex
Tonic labyrinthine reflex
Asymmetric tonic neck reflex
90
A physical therapist arrives at a child’s home to begin a treatment session. When the therapist enters the home, the child is running through the house screeching. The PT determines that the first step in the intervention session will be
Sitting still on a therapy ball
Placing the child in a high chair
Rhythmic linear swinging
Rapidly brushing extremities
Rhythmic linear swinging
91
A child has poor ability to maintain trunk and neck extension. The PT uses which of the following as the best technique to facilitate increased strength and control
a. Have child prone on a therapy ball and play with toys
b. Have child supine on a platform swing while playing with toys
c. Have child in side lying on a mat shield playing with toys
d. Have child sit on physioball while playing with toys
Have child prone on a therapy ball and play with toys
92
A PT is working with a child who has cerebral palsy. The child has limited range of motion (ROM) in bilateral upper extremities and is unable to reach out for objects. The PT provides intervention that focuses on allowing the child to participate in play activities. The best position to place the child in is
Side-lying
Prone
Supine
Sitting
Sitting
93
A child diagnosed with cerebral palsy has severe spasticity in the bilateral upper extremities. The occupational therapy referral states “fabricate splints to prevent hand deformities.” The theoretical approach for splinting should emphasize placement of the hands in the
Intrinsic minus position
Anticlaw position
Resting hand position
Reflex inhibiting position
Reflex inhibiting position
94
A spinal cord injury patient who can breathe on his own, uses a sip and puff switch to operate his power wheelchair and environmental control unit, and a mouth stick for writing, table games, and the computer would MOST likely have a spinal cord injury at this level
C3
C4
C5
C6
C4
95
The highest level of spinal cord injury at which you would expect a client to become independent in all self-care and driving with equipment would be
C7
C8
C5
C6
C6
96
You are treating a client that recently had a spinal cord injury at C5. The BEST piece of equipment to help the client with feeding, hygiene, grooming, writing, and driving a power wheelchair would be
Deltoid assist
Weighted pulley
Mobile arm supports
Suspension sling
Mobile arm supports
96
The MOST beneficial piece of adaptive equipment to aid a client with C6 tetraplegia to work toward independence with lower extremity dressing is
A trigger reacher to get the pants over the feet
Loops to manipulate the lower extremities
A universal cuff to assist with grip and closures
A standard dressing stick
Loops to manipulate the lower extremities
96
As a home health therapist, you are treating a 55-year-old who has a very supportive spouse and a caregiver during the day who helps with self-care and other tasks needed in the home. The patient enjoys their children and grandchildren who live in the immediate area. The patient is currently instage 3 of amyotrophic lateral sclerosis, with severe weakness of the ankles, wrists, and hands. The patient minimally ambulates and fatigues easily. An appropriate intervention would be
Light strengthening program
Help prioritize activities and provide work simplification
Learning how to cook three-course means
Worksite assessment
Help prioritize activities and provide work simplification
97
A 3-year-old has spina bifida and needs mobility augmentation to be able to move outdoors, in hallways, and in corridors. A mobility device that could be recommended would be a(n)
Hand-propelled tricycle model
Supine scooter
Aeroplane mobility device
Crocodile posterior walker
Hand-propelled tricycle model
98
You are visiting the home of a client recently diagnosed with Alzheimer’s. The environment is terribly cluttered and seems to add to the patient’s current level of confusion. You decide to
a. Clean up the place by yourself, throw away a lot, and put everything else away properly to help organize the environment for the client
b. Leave it alone and just recognize that this is how the person will be living
c. Engage family members in helping the client to sort through some of the cluttered items and make some choices about what to and what not to keep
d. Encourage the family to hire a housekeeper, who will make sure that the environment is clean and tidy all the time
c. Engage family members in helping the client to sort through some of the cluttered items and make some choices about what to and what not to keep
98
Which of the following is the most important to assess first during an examination of a patient with a recent stroke?
Sensory status
Motor control
Mental status
Ambulation potential
Mental status
99
A therapist receives an order to examine a 72-year-old woman who has suffered a recent stroke. The therapist needs to focus on pregait activities. Which of the proprioceptive neuromuscular facilitation (PNF) diagonals best encourages normal gait?
D1
D2
PNF is contraindicated
Pelvic PNF patterns only
D1
100
The following is a long-term goal for a patient with a spinal cord injury: independence in performing a manual cough without applying pressure to the abdomen. This goal is the most challenging and obtainable for a patient with a complete lesion at which of the following spinal cord levels?
C5
C7
T2
T10
C7
101
To treat effectively most patients with Parkinson’s disease, the therapist should emphasize which proprioceptive neuromuscular facilitation (PNF) pattern for the upper extremities?
D2 extension
D2 flexion
D1 extension
D1 flexion
D2 flexion
102
Which of the following is the most energy efficient and allows a T1 complete paraplegic the most functional mobility during locomotion?
Manual wheelchair
Electric wheelchair
Bilateral knee-ankle orthoses and crutches
Bilateral ankle-foot orthoses and crutches
Manual wheelchair
103
To facilitate development of a functional tenodesis grip in a patient with a spinal cord injury, the treatment plan should include
Stretching of the fingers flexors and fingers extensors
Stretching of the fingers flexors
Allowing the finger flexors and finger extensors to shorten
Allowing the finger flexors to shorten
Stretching of the fingers flexors
104
A therapist is treating a patient with an injury at the T8 level and compromised function of the diaphragm. If no abdominal binder is available, what is the most likely position of comfort to allow him to breathe most efficiently?
Sitting position
Semi-Fowler’s position
Upright standing position using a tilt table
Supine
Supine
105
A therapist is assisting a patient with an injury at the C5 level in performing an effective cough. The patient has experienced significant neurologic damage and is unable to perform an independent, effective cough. If the patient is in a supine position, which of the following methods is most likely to produce an effective cough?
a. The therapist places the heel of one hand just above the xiphoid process, instructs the patient to take a deep breath while pressing down moderately on the sternum, and instructs the patient to cough
b. The therapist places the heel of one hand, reinforced with the other hand, just above the xiphoid process, instructs the patient to take a deep breath, instructs the patient to hold the breath, and presses moderately as the patient coughs.
c. The therapist places the heel of one hand on the area just above the umbilicus, instructs the patient to take a deep breath, applies moderate pressure just before the patient attempts to cough.
d. The therapist places the heel of one hand just above the umbilicus, instructs the patient to take a deep breath, and applies moderate pressure as the patient is instructed to cough.
d. The therapist places the heel of one hand just above the umbilicus, instructs the patient to take a deep breath, and applies moderate pressure as the patient is instructed to cough.
105
A physical therapist is ordered to examine a 65-year-old woman who has suffered a recent stroke. The occupational therapist informs the physical therapist that the patient has apraxia. She cannot brush her teeth on command. However, she can point out the toothbrush and verbalize the purpose of the brush. From this information, what sort of apraxia does this patient have? How should the physical therapist approach treatment?
a. Ideomotor apraxia; The physical therapist should speak in short, concise sentences
b. Ideational apraxia; The physical therapist should always give the patient 3-step commands
c. Ideomotor apraxia; The physical therapist should always give the patient 3-step commands
d. Ideational apraxia; The physical therapist should speak in short, concise sentences
Ideomotor apraxia; The physical therapist should speak in short, concise sentences
105
A 60-year-old woman who has suffered a recent stroke has right-side homonymous hemianopsia. Which of the following statements is true about placement of eating utensils in early rehabilitation?
a. The utensils should be placed on the left side of the plate.
b. The utensils should be placed on the right side of the plate
c. The utensils should be placed on both sides of the plate.
d. The plate and utensils should be placed slightly to the right
The utensils should be placed on the left side of the plate.
106
A 25-year-old man suffered C4 quadriplegia in a motor vehicle accident. The injury is acute, and the patient is beginning to work on increasing upright tolerance in the sitting position with an abdominal binder. He is looking to the therapist for encouragement. The therapist is attempting to convey realistic long-term goals for self-care ability and overall mobility, of the listed goals, what can this patient reasonably expect at his highest level of function in the future?
a. Transfer from wheelchair to bed independently with a sliding board
b. Use of a power wheelchair
c. Independent feeding without an assistive device
d. Donning a shirt independently and pants with minimal assistance
Use of a power wheelchair
106
A 17-year-old boy presents to therapy after being involved in a motor vehicle accident resulting in C7 quadriplegia. The therapist is setting long-term goals for the patient. The therapist is setting long-term goals for the patient. Which of the following goals represents the most reasonable and highest level of function that the patient should achieve?
a. Use of a wheelchair with power hand controls on even terrain
b. Negotiation of uneven terrain with a manual wheelchair
c. Ambulation for short distances on level surfaces with knee-ankle-foot orthoses
d. Use of a power wheelchair with head or chin controls on even surfaces
Negotiation of uneven terrain with a manual wheelchair
107
A therapist is treating a patient with a spinal cord injury. The therapist is discharging the patient after completion of all physical therapy goals. One of the completed long-term goals involved the ability to dress and bathe independently with assistive devices. This would be a most challenging but obtainable goal for which of the following
C5 quadriplegia
C7 quadriplegia
T1 paraplegia
C4 quadriplegia
C7 quadriplegia
108
A physical therapist is examining a 5-day-old infant with cerebral palsy. The infant has an abnormal amount of extensor tone. Which of the following is incorrect positioning advice for the family and nursing staff?
Keep the infant in a supine position
Keep the infant in a prone position
Keep the infant in a right side-lying position
Keep the infant in left side-lying position
Keep the infant in a supine position
109
A physical therapist is treating a 76-year-old woman with left lower extremity hypotonia secondary to a recent stroke. Which of the following is an incorrect method to normalize tone?
Rapid irregular movements
Approximation
Prolonged stretch
Tactile cues
Prolonged stretch
110
A therapist is attempting to open the spastic and flexed hand of a patient who has suffered a recent stroke. Which of the following does not inhibit hand opening?
Avoid touching the interossei
Apply direct pressure to the thenar eminence
Hyperextend the metacarpophalangeal joint
Apply direct pressure to the hypothenar eminence
Avoid touching the interossei
111
Which of the following is inappropriate for a physical therapist to include in the treatment plan of an infant with a gestational age of 27 weeks and Down’s syndrome?
a. Bottle feeding
b. Encourage side-lying position
c. Tactile stimulation with the entire hand rather than the fingertips of the examiner
d. Prone positioning
Bottle feeding
112
Which of the following sources of stimulation is least effective in obtaining functional goals when treating an infant with decreased muscular tone?
Vestibular
Weight bearing
Cutaneous
Vibratory
Vibratory
113
Which of the following is the most important goal in treating pediatric patients with postural reaction deficits?
Age-appropriate responses
Automatic responses
Conscious responses
Lower extremity control before upper extremity control
Automatic responses
114
A physical therapist is treating an 81-year-old man with Parkinson’s disease. The patient has been ambulating with a cane. He was referred to physical therapy because of a fall at home. The family reports a decrease in gait ability during the past several months. The therapist decides to begin gait training with a rolling walker. Which of the following is incorrect for the treatment of this patient?
a. Strengthening of the hip flexors, and stretching of the gluteals
b. Slow, rhythmical rocking techniques
c. Biofeedback during ambulation
d. Prolonged passive stretching of the gastrocnemius muscle group bilaterally
Strengthening of the hip flexors, and stretching of the gluteals
114
A patient who has suffered a recent stroke is being treated by a physical therapist. The patient exhibits increased extensor tone in the supine position along with an exaggerated symmetric tonic labyrinthine reflex (STLR). What position should be avoided if the therapist is attempting to initiate flexion movements of the lower extremity?
Prone position
Right side-lying position
Supine position
Let side-lying position
Supine position
114
A patient presents to outpatient physical therapy with tarsal tunnel syndrome. What nerve is involved? Where should the therapist concentrate treatment?
Superficial peroneal nerve, inferior to the medial malleolus
Posterior tibial nerve, inferior to the medial malleolus
Superficial peroneal nerve, inferior to the lateral malleolus
Posterior tibial nerve, inferior to the lateral malleolus
Posterior tibial nerve, inferior to the medial malleolus
115
Which of the following positions should be avoided in the right upper extremity with a patient who has a diagnosis of right hemiplegia secondary to a stroke?
a. Prolonged shoulder adduction, internal rotation, and elbow flexion
b. Prolonged shoulder abduction, internal rotation, and elbow flexion
c. Prolonged finger and thumb flexion
d. Prolonged wrist flexion and finger adduction
Prolonged shoulder abduction, internal rotation, and elbow flexion
115
A 35-year-old male patient has a diagnosis of rights C5-C6 cervical nerve root compression. He is being seen in physical therapy for gentle manual cervical traction. What position is ideal for traction with this patient?
Upper cervical flexion and lower cervical extension
Cervical lateral flexion to right
Cervical extension
Cervical flexion
Cervical flexion
116
During physical therapy sessions, the physical therapist protects tenodesis of the patient with diagnosis of C6 tetraplegia. What position with diagnosis of C6 tetraplegia. What position must be maintained during upper extremity weight bearing and why?
a. Maintain finger flexion with wrist extension to protect extrinsic wrist extensors
b. Maintain wrist flexion to protect intrinsic finger extensors
c. Maintain finger flexion to protect extrinsic finger flexors
d. Maintain wrist extension to protect intrinsic finger flexors
Maintain finger flexion to protect extrinsic finger flexors
117
A patient on the acute rehabilitation unit was diagnosed with traumatic closed head injury. He is functioning at a Rancho Cognitive Level of Function IV. He has no significant muscle weakness or gait impairments and walks without assistance. The Team needs physical therapy’s input on recommendations for safety and supervision. The physical therapist recommends
a. No supervision is needed as the patient walks safely
b. Constant supervision is needed because of confusion and possible agitation
c. Intermittent supervision is needed to monitor his ability to follow a schedule
d. Occasional supervision is needed when faced with new situations or schedule changes
Constant supervision is needed because of confusion and possible agitation
118
Which is not a typical clinical finding of a patient with a brachial plexus injury?
Decreased ROM/contractures
Decreased muscle strength
Spasticity
Altered sensation
Spasticity
118
All are appropriate physical therapy goals for a 6-month-old patient with a brachial plexus injury except
a. Able to creep forward 5 cycles
b. Able to demonstrate protective reactions to each side in sitting
c. Able to prop on forearms in a prone position with the head elevated 90 degrees
d. Family independent with a home exercise program consisting of ROM and positioning
Gait training with a reciprocating gait orthosis
119
What would be the most appropriate intervention to include in the physical therapy plan of care for a 7-year-old female diagnosed with myelomeningocele at the T10-T11 level?
Aggressive ROM of the lower extremities
Gait training with a HKAFO and walker
Gait training with a KAFO and forearm crutches
Gait training with a reciprocating gait orthosis
Gait training with a reciprocating gait orthosis
120
An appropriate physical therapy program for an infant with a brachial plexus injury during the second week of life would include
a. Teaching the parents how to support the arm while dressing and moving the infant to prevent further injury
b. Daily PROM exercises including full shoulder abduction and elevation
c. Daily AROM exercises including full shoulder abduction and elevation
d. Splinting the shoulder in abduction and internal rotation
Teaching the parents how to support the arm while dressing and moving the infant to prevent further injury
121
Which of the following exercise programs is most appropriate for a 62-year-old, postmenopausal female patient with MS who has poor balance and decreased strength?
a. Stretching, posture, and balance program, with strengthening exercises as tolerated
b. Stretching and progressive hill training on treadmill
c. Warm water aquatic therapy
d. Progressive hill training on treadmill with plyometric training
Stretching, posture, and balance program, with strengthening exercises as tolerated
122
A therapist is instructed to provide electrical stimulation to a patient with a venous statis ulcer on the right lower extremity. What is the correct type of electrical stimulation to promote wound healing?
Biphasic pulsed current
Direct current
Interferential current
Transcutaneous electrical stimulation
Direct current
123
Which of the following is the best and first treatment for a wound with black eschar over 90% of the wound bed?
Lidocaine
Dexamethasone
Silvadene
Elase
Elase
124
A therapist is treating an acute full-thickness burn on the entire right lower extremity of a 27-year-old man. What movements need to be stressed with splinting, positioning, and exercise to avoid contractures?
a. Hip flexion, knee extension, and ankle dorsiflexion
b. Hip extension, knee flexion, and ankle plantar flexion
c. Hip extension, knee extension, and ankle dorsiflexion
d. Hip flexion, knee extension, and ankle plantar flexion
Hip extension, knee extension, and ankle dorsiflexion
125
A therapist is teaching a family how to care for a family member at home. The patient is totally bed-bound. To prevent pressure ulcers most effectively, what should be the maximal amount of time between position changes?
1 hour
2 hours
6 hours
8 hours
2 hours
126
Which of the following does not facilitate ambulation when the feet are burned?
a. Constant movement, avoiding standing still
b. Loosening or removing the bandages/wraps
c. Establishing a clear goal for walking (e.g. to a favorite person/place)
d. Exercise before standing upright
Loosening or removing the bandages/wraps
127
In which of the following wounds would the physical therapist consider using enzymatic debridement?
Black eschar over the would
Clean wound
A dry ischemic wound
A dry wound with active infection
Black eschar over the would
128
What is the most correct ambient temperature for a room that normally has a predominant population of burn patients?
65 ° F
72 ° F
78 ° F
85 ° F
85 ° F
129
A 47-year-old man with end-stage renal disease arrives at an outpatient facility. He has a physician’s order to examine and treat 3 times/week for 4 weeks secondary to lower extremity weakness. The patient also attends dialysis 3 times a week. If the clinic is open Monday through Friday, which of the following schedules is appropriate?
a. On the days that the patient has dialysis, schedule the therapy session before the dialysis appointment
b. On the days that the patient has dialysis, schedule the therapy session after the dialysis appointment
c. Contact the physician and obtain a new order to decrease the frequency to 2 times/week
d. Contact the physician and recommend home health physical therapy because outpatient therapy may be too aggressive
a. On the days that the patient has dialysis, schedule the therapy session before the dialysis appointment
130
Through relapses associated with multiple sclerosis (MS) tend to decrease during pregnancy, postpartum they increase. As physical therapists we are concerned with these patients’ ____ , ____ , and ____ to care for their new baby.
Sleeping patterns, strength, and attention
Vision, strength, and financing
Balance, fatigue and ability
Balance, posture and attention
Balance, fatigue and ability
131
Which is NOT a maternal response to mild-to-moderate exercise?
Increased cardiac output
Increased stroke volume
Normal to increased heart rate
Decreased respiratory rate
Decreased respiratory rate
132
You are working in home health and visit a woman who is 8 months pregnant. The doctor has just placed her on strict bed rest; she is only allowed up to go to the bathroom. In what position will you have the patient do most of her exercise?
Standing
Supine
Prone
Side-lying
Side-lying
133
Three weeks earlier, your patient delivered via C-section a healthy baby girl who weighed in at 8 pounds, 6 ounces. This was her first pregnancy/delivery. Besides the incisional pain, she is having trouble “making it to the bathroom” and is very nervous of reaching over to pick up the baby. Which combination of activities is appropriate to do/complete on her first visit?
a. MMT abdominals, education of abdominal exercises to help restore abdominal strength
b. Education of a pelvic floor exercises to help restore appropriate urinary frequency, body mechanics education
c. MMT pelvic floor, weight training exercises to help patient lift the baby and gear
d. ROM tests, electrical stimulation to help restore appropriate urinary frequency
Education of a pelvic floor exercises to help restore appropriate urinary frequency, body mechanics education
134
In developing the plan of care for a 28-year-old pregnant woman, which of the following muscles should be the focus of the strengthening exercises to maintain a strong pelvic floor?
Piriformis, obturatorinternus, and pubococcygeus
Obturator internus, pubococcygeus, and coccygeus
Rectus abdominis, iliococcygeus, and piriformis
Iliococcygeus, pubococcygeus, and coccygeus
Iliococcygeus, pubococcygeus, and coccygeus
135
You ask your patient to extend her knee. She lacks 10 degrees of reaching full extension. In order for the knee to extend fully in this situation (sitting), the
Tibia must rotate medially on the femur
Tibia must rotate laterally on the femur
Femur must rotate medially on the tibia
Femur must rotate laterally on the tibia
Tibia must rotate laterally on the femur
136
Your 40-year-old male patient was playing basketball and describes hearing a pop and feeling as though someone kicked him in the back of the leg, followed by pain and weakness in the lower leg. The most common injury and special test to assess the problem is
Anterior cruciate ligament tear, Lachman’s test
Achilles tendon rupture, Ober’s test
Anterior cruciate ligament tear, Thomas test
Achilles tendon rupture, Thompson test
Achilles tendon rupture, Thompson test
