GILES A Flashcards

Question

A physical therapist treats a patient status post CVA. Which action would be MOST likely to facilitate elbow extension in a patient with hemiplegia? A. Turn the head to the affected side B. Turn the head to the unaffected side C. Extend the lower extremities D. Flex the lower extremities

Answer 1

Turn the head to the affected side Correct Answer: A Patients status post CVA are likely to exhibit abnormal tonic reflexes. Eliciting the reflexes will produce sustained posturing and abnormal movement patterns. A. The asymmetrical tonic neck reflex produces extension of the affected upper extremity when the patient's head is turned toward the affected side. The upper extremity on the skulls ide will flex. B. If the patient's head is turned toward the unaffected side, the unaffected upper extremity will extend and the affected upper extremity will flex due to the influence of the asvmmetrical tonic neck reflex (ATNR) C. The symmetrical tonic labyrinthine reflex (STLR) promotes a tendency for extension when a patient is in supine and reduced extensor influence when the patient is in prone. STLR would not facilitate elbow extension in isolation as noted with ATNR. D. Flexion of the lower extremities does not have a direct influence on upper extremity flexion or extension.

Answer 2

Communicate the information to the referring physician Correct Answer: B Physical therapists must be aware of any signs or symptoms of infection, particularly in patients following surgery. Common signs of infection include elevated body temperature, purulent exudate, swelling, edema, and redness. A. The patient's presentation requires the physical therapist to take formal action, but would not be indicative of an emergent condition that requires the patient to be seen in the emergency room. B. The possibility of infection in a patient three days status post surgery warrants immediate consultation with the referring physician. C. the Subjective and objective information gathered by the physical therapist should be documented in the medical record, however, this action would not address the primary issue which is the possibility of an infection. D. Asking the patient to make an appointment with the physician is not an appropriate action since it places the burden solely on the patient. The physical therapist is responsible for communicating any potential change in a patient's medical status to the physician in a timely manner.

Answer 3

Increased oxygen consumption Correct Answer: A An acute burn produces hypermetabolism that results in increased oxygen consumption, increased minute ventilation, and an increased core temperature. Intravascular, interstitial, and intracellular fluids are all diminished. A. Pulmonary function is affected by the presence of a burn injury. In addition to increased oxygen consumption, the patient can also experience increased minute ventilation up to five times the normal value. B. Hyponatremia or low sodium concentration, initially occurs (within the first 36 hours) secondary to extracellular changes from the increased cellular permeability. In patients that sustain burns above 20% of the total body surface area, fluid and electrolyte replacement is a component of immediate medical management in order to control the hypermetabolic cycle that results from the burn. C. Intravascular-fluid will decrease due to the increased vascular permeability and overall hematologic changes. Cardiac output can decrease secondary to a combination of an increase in blood viscosity, decrease in intravascular fluid, and an overall increase in peripheral resistance. D. A patient with significant burn injury is at risk for an increased core temperature due to the increased metabolic and catabolic activity. The one to two degree increase occurs secondary to the "recalibrating" of the hypothalamic temperature centers in the brain. Patients that have sustained extensive burns require a warmer ambient temperature in order to reduce their metabolic rate. Average room temperature will create continued heat loss and perpetuate the hypermetabolic state.

Answer 4

22.5 percent of the body Correct Answer: B The "rule of nines" is commonly utilized to assess the percentage of the body surface affected by a burm. Each area of the body has a specific percentage allocated to it in order to approximate the total percentage of the body surface affected. The values are as follows: head (95), each upper extremity (9%), the trunk (36%), each lower extremity (18%), and the genital area (1%). A. A value of 13.5% is less than the percentage of body surface affected. A candidate may gave generated an answer of 13.5 by allocating only 9% for the anterior trunk instead of 18% and then adding 4.5% for the anterior surface of the upper extremity. B. The anterior surface of the right upper extremity equals 4.5% and anterior surface of the trunk equals 18% (4.5% + 18% =22.5%) C. A value of 27% is greater than the percentage of body surface affected in the described scenario. A candidate may have generated an answer of 27% by incorrectly allocating 9% for the anterior surface of the right upper extremity and then adding 18% for the anterior surface of the trunk. D. The entire trunk is valued at 36% of the body using the "rule of nines."

Answer 5

Grave's disease Correct Answer: B When assessing a patient's posture, a plumb line can be used as a line of reference to determine areas of abnormal posture and the extent of these abnormalities. In normal posture, the stationary plumb line runs through the external auditory meatus. A. Ankylosing spondylitis is a systemic condition that is characterized by inflammation of the spine and largert peripheral joints. Symptoms include back pain, morning stiffness, and impaired spinal extension. The tendency of a patient with ankylosing spondylitis to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line. B. Grave's disease is an autoimmune disease in which certain antibodies produced by the immune system stimulate thyroid gland causing it to become overactive. Symptoms are consistent with hyperthyroidism including mild enlargement of the thyroid gland (goiter), heat intolerance, nervousness, tremor, and palpitations. Graves' disease is not typically associated with postural changes. C. Osteoporosis is a metabolic condition that presents with a decrease in bone mass that subsequently increases the risk of fracture. Symptoms include compression and other bone fractures, loss of lumbar lordosis, deformities such as kyphosis, and postural changes. The tendency of a patient with osteoporosis to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line. D. Parkinson's disease is a movement disorder caused by the progressive degeneration of the dopamine-producing cells in the basal ganglia. Symptoms include difficulty initiating and stopping movement, festinating, and shuffling gait. The tendency of a patient with Parkinson's disease to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line.

Answer 6

60 inches Correct Answer: C The Americans with Disabilities Act was designed to provide a clear and comprehensive national mandate for the elimination of discrimination. Title III provides information on public accommodations including minimum accessibility standards. A. Thirty-two inches is the minimum required width of a doorway for wheelchair clearance, however, this space would not be adequate to turn 180 degrees in a standard wheelchair. B. Forty-eight inches would be 12 inches less than the minimum required space to turn 180 degrees in a standard wheelchair C. Sixty inches is the minimum required width to turn 180 degrees in a standard wheelchair according to the Americans with Disabilities Act. D. Seventy-two inches would be adequate to turn 180 degrees in a standard wheelchair, however, this value exceeds the minimum required space by 12 inches.

Answer 7

Crouched gait Correct Answer: A The treatment of spasticity will follow a continuum from conservative to aggressive based on the degree to which the spasticity interferes with overall function. Surgical procedures may be appropriate for patients that have been unsuccessful with more conservative treatment. Goals of surgery include lengthening of muscles and tendons, improving function, increasing range of motion, and correcting deformity. A. A crouched gait result from spasticity in the hip flexors and is associated with compensatory hip and knee flexion as well as lumbar hyperlordosis. The iliopsoas tendon is released from the lesser trochanter while maintaining its capsular attachments This will effectively weaken the iliopsoas and decrease crouching. B. Lower limb scissoring results from spasticity of the hip adductors. A partial obturator neurectomy is performed if contracture is not the cause of the gait deviation. This will effectively weaken the hip adductors and decrease the scissoring during gait. C. Equinovarus deformity is the most common deformity of the lower extremity and results from spasticity of the gastrocnemius, soleus, and anterior tibialis. A split anterior tibialis tendon transfer (SPLATT) procedure is performed to create an eversion force in an attempt to rebalance the forefoot deformity. D. A knee flexion contracture results from spasticity of the hamstrings. The distal hamstrings muscles are released along with a transfer of the distal hamstrings insertion if necessary.

Answer 8

Greater tubercle of the humerus Correct Answer: B Impingement syndrome is a commonly used term describing mechanical impingement of the rotator cuff tendon beneath the anteriorinferior portion of the acromion. Symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm, and weakness of the shoulder muscles. A. The subscapularis muscle originates on the subscapular fossa of the scapula and inserts on the lesser tubercle of the humerus. The muscle is innervated by the subscapular nerve. B. The supraspinatus muscle inserts on the greater tubercle of the humerus. The muscle is innervated by the suprascapular nerve. C. The supraspinatus muscle originates on the supraspinous fossa of the scapula. The question asks about the insertion of the muscle. D. The deltoid tuberosity is the insertion point for the three heads of the deltoid. The anterior deltoid originates on the lateral third of the clavicle, the middle deltoid originates on the acromion process, and the posterior deltoid originates on the spine of the scapula. The deltoid is innervated by the axillary nerve.

Answer 9

Impaired secretion clearance Correct Answer: C Auscultation of the lungs with a stethoscope is an examination procedure physical therapist use to identify abnormalities in lung sounds. Abnormal lung sounds may suggest problems with ventilation or airway clearance. A. Pleural effusion is the accumulation of fluid in the pleural space. Lung sounds are usually decreased, but a pleural friction rub may be heart if the pleural surfaces are inflamed. B. Pulmonary fibrosis is a type of restrictive lung dysfunction characterized by changes to the alveoli and lung architecture from an inflammatory process. The inflammatory changes cause scarring and fibrotic lesions in the lungs which result in decreased lung compliance, lung volumes, diffusing capacity, increased pulmonary arterial pressure, and work of breathing Auscultation often reveals decreased breath sounds. C. Crackles or rales are abnormal breath sounds heard during auscultation of the lungs with a stethoscope. Crackles are extra sounds caused by the "popping open" of small airways blocked by secretions or fluid and may be heard during both the inspiratory and expiratory phases of the breathing cycle. D. Localized stenosis is not a term associated with breath sounds.

Answer 10

Patient or problem, intervention, comparison, outcome (P-I-C-O) Correct Answer: B Asking a patient-centered clinical question is the first step in searching the literature for information about the effectiveness of a therapy. A. Subjective, objective, assessment, and plan (S.O.A.P.) refer to the elements commonly used for recording daily notes of a patient's physical therapy sessions. B. The acronym P-I-C-O helps to focus on the appropriate pieces of information needed to search the literature for information about the effectiveness of a therapy. The P refers to the target population or characteristics of the patient or problem of interest. The I refers to the intervention being considered. The C refers to the comparison or control condition that may be considered along with the intervention and is most appropriate when the need is to compare the effectiveness of two or more interventions. The O refers to the outcomes or measurements that will be relevant to understanding the effect of the interventions. C. Validity, reliability, and applicability are properties of measurements. D. Diagnosis, prognosis, and intervention are elements of the patient/client management models as described in the Guide to Physical Therapist Practice, along with examination, and evaluation.

Answer 11

Landau reflex Correct Answer: C Integration of a reflex refers to the period of time when a reflex is no longer present despite an appropriate stimulus. A. The asymmetrical tonic neck reflex is stimulated when the head is turned to one side. The response is a fencing posture (arm and leg on face side are extended, arm and leg on scalp side are flexed). The normal age of a response is from 28 weeks of gestation to 5 months. B. The Moro reflex is stimulated when an infant's head is suddenly dropped into extension for a few inches. The response is that the arms abduct with fingers open, then cross the trunk into adduction; often followed immediately by crying. The normal age of the response is from 28 weeks of gestation to 5 months. C. The Landau reflex is an equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body. Although the response begins around three months of age, it is not fully integrated until the child's second year. D. The symmetrical tonic neck reflex is stimulated by the head moving into flexion or extension. When the head is in flexion, the arms are flexed and the legs are extended. When the head is in extension, the arms are extended and the legs are flexed. The normal age of the response is from 6-8 months.

Answer 12

complete the vertebral artery test as far Into the available cervical range of motion as tolerated Correct Answer: B The vertebral artery test is performed with the patient positioned in supine. The therapist places the patient's head in extension, lateral flexion, and rotation to the ipsilateral side. A positive test is indicated by dizziness, nystagmus, slurred speech or, loss of consciousness and may be indicative of compression of the vertebral artery. A. The vertebral artery test should be administered using the available cervical range of motion and as a result it would not make sense to utilize only a portion of the available range of motion. B. The physical therapist should perform the test and clear the patient's vertebral artery for their available range of motion. As the patient gains additional range of motion the test can be readministered. C. The vertebral artery test can be performed on patients that possess less than full cervical range of motion. D. Direct cervical treatment techniques are often employed on patients with less than full cervical range of motion. In many cases it is still necessary to clear the vertebral artery using the patient's available cervical range of motion.

Answer 13

canalith repositioning maneuvers Correct Answer: B Benign paroxysmal positional vertigo (BPPV) is an intense and intermittent vertigo that occurs in relation to rapid movement of the head in a particular direction and is believed to be a mechanical disorder of the labyrinths. Canaliths develop and float into the semicircular canals causing the brain to interpret their presence as an intense rotation of the head. A. Dix-Hallpike maneuver is not a treatment for BPPV but rather a diagnostic tool. A patient that presents with BPPV will have torsional nystagmus when performing this maneuver. The patient moves from an upright posture to supine with the head hanging over the surface extended and rotated to 45 degrees. Nystagmus will occur in this position when the affected ear is toward the floor and should fatigue within 60 seconds. B. Canalith repositioning maneuvers are a highly effective treatment for BPPV and are designed to dislodge the provoking canaliths. This treatment technique attempts to move the canalith debris out of the affected semicircular canal and back to the otolith. Canalith repositioning maneuvers begin in the Dix-Hallpike position to provoke vertigo. Repeated head rolling utilizes gravity to assist with movement of the debris. Treatment continues until no further nystagmus is noted. C. A singular neurectomy is a surgical procedure that can assist with BPPV, but is rarely performed. This is not a physical therapy treatment but rather a selective surgical transaction of the nerve supply to the posterior canal. D. Gaze stability exercises are frequently used in the treatment of unilateral vestibular hypofunction with the goal of improving the vestibuloocular reflex and other systems that provide gaze stability while the head is in motion.

Answer 14

radial deviation of the radiocarpal joint and ulnar deviation of the fingers Correct Answer: B Rheumatoid arthritis is a systemic autoimmune disorder of unknown etiology. The disease presents with a chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule. Rheumatoid arthritis is diagnosed based on the clinical presentation of involved joints, the presence of blood rheumatoid factor, and radiographic changes. A. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint, however, the fingers would tend to be positioned in ulnar deviation. B. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint and ulnar deviation of the fingers. The radiocarpal changes include a distinct loss of joint space and erosive bone changes. Ulnar displacement of the extensor tendons and an increased ulnar approach of the flexor tendons contribute to the ulnar deviation of the fingers. C. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint and ulnar deviation of the fingers. This option is opposite of the typical positioning of a wrist and hand affected by rheumatoid arthritis. D. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint. They would, however exhibit ulnar deviation of the fingers.

Answer 15

hip Internal rotators Correct Answer: D The FABER or figure-4 position occurs with the patient assuming a supine position with the involved leg flexed, abducted, and externally rotated at the hip so that the ankle is resting on the opposite leg. FABER stands for flexion, abduction, and external rotation. A. The hip abductors are stretched when the hip is positioned in adduction. The FABER position requires the hip to be in abduction. B. The hip flexors are stretched when the hip is positioned in extension. The FABER position requires the hip to be in flexion. C.The hip external rotators are stretched when the hip is positioned in internal rotation. The FABER position requires the hip to be in external rotation. D. The hip internal rotators are stretched when the hip is positioned in external rotation. The FABER position requires the hip to be in external rotation.

Answer 16

Attention Correct Answer: A Attention is defined as the capacity of the brain to process information from the environment or from long-term memory. The complexity and familiarity of the task determines the degree of attention required to complete the task. A. Attention can be assessed by asking a patient to count from one to twenty-five by increments of three. The task should be relatively easy for most individuals, however, it requires the person to exert a sustained, consistent effort. Attention deficits are common with many neurological disorders including brain injury, stroke, and dementia. B. Constructional ability can be assessed by asking a person to copy figures consisting of varying sizes and shapes or to draw a known item such as a clock. C. Abstract ability can be assessed by asking a person to interpret a common proverb or to describe similarities or differences between two obiects. D. Orientation can be assessed by asking a person to identify time (e.g, day, month, season), person (e.g., name), and place (e.g., city, state).

Answer 17

platelets Correct Answer: D Normal wound healing occurs as damaged tissues move through distinct yet overlapping phases of repair. The phases of repair occur in a predictable sequence with complex cellular activity and chemical reactions occurring at each phase. A. Endothelial cells stimulate the production of new blood vessels as well as transport oxygen and nutrients into the wound environment. Endothelial cells are most active in the proliferative phase of wound healing. B. Fibroblasts produce a wound matrix that consists of collagen elastin, and proteoglycans. Fibroblast activity is facilitated by macrophages that are present from the inflammatory phase. Fibroblasts are most active in the proliferative phase of wound healing. C. Leukocytes (i.e., white blood cells) arrive at the wound site in response to the coagulation cascade. Leukocytes include both monocytes and granulocytes. Leukocytes are most active in the inflammatory phase of wound healing, however, they arrive at the wound site after the platelets. D. Platelets are the first cells to arrive at the wound site. The cells attach to exposed collagen at the injury site and release chemicals that attract more platelets. Collectively the platelets form a platelet plug to temporarily stop the bleeding. Platelets are most actlive in the hemostasis phase of wound healing.

Answer 18

posterior glenohumeral dislocation Correct Answer: B A reverse Hill-Sachs fracture (i.e., reverse Hill-Sachs lesion) is an impaction fracture of the anterior medial humeral head Management of this injury is primarily based on the size of the impression defect. A. A Hill-Sachs fracture, sometimes referred to as a Hill-Sachs lesion, is characterized as an impaction fracture of the posterior superior humeral head and is frequently diagnosed in patients who have repeatedly sustained anterior glenohumeral dislocations. Approximately 95% of dislocations occur in an anterior direction. B. A reverse Hill-Sachs fracture is typically associated with a posterior glenohumeral dislocation. Patients with a posterior glenohumeral dislocation typically present holding their arm medially rotated and adducted and may exhibit flattening of the anterior shoulder and a prominent coracoid process. C. A fracture of the greater tuberosity can result in a rotator cuff tear, however, this is not associated with a reverse Hill-Sachs fracture. D. A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone. The biceps may rupture proximally (i.e., shoulder) or distally (i.e., elbow). A biceps tendon rupture is rarely associated with a fracture.

Answer 19

passive range of motion Correct Answer: D The Modified Ashworth Scale (MAS) is an instrument that is used to assess muscle spasticity. The MAS uses ordinal scoring, with a grade of "O" indicating the absence of spasticity and a grade of" 4" indicating the presence of rigidity. A. Strength testing may be used for patients who have had a stroke to determine which muscles have been affected as a result of the neurological damage. However, strength testing would not provide valuable information when using the MAS since the instrument is used to assess spasticity B. Deep tendon reflex testing may be used for patients who have had a stroke to determine if the patient has hyporeflexia or hyperreflexia as a result of the neurological damage. However, deep tendon reflex testing would not provide valuable information when using the MAS since the instrument is used to assess spasticity. C. Active range of motion may be used for patients who have had a stroke to determine the patient's functional use of their extremities. However, active range of motion would not provide valuable information when using the MAS since the instrument is used to assess spasticity, which requires a passive assessment. D. The MAS is an assessment tool that is used to grade spasticity. Spasticity is defined as increased resistance to passive stretch that is velocity-dependent, therefore, passive range of motion would be the most appropriate method for measuring spasticity.

Answer 20

extension of the great toe Correct Answer: B The tibial nerve is a branch of the sciatic nerve that supplies innervation to the muscles of the posterior lower leg. In the foot, the tibial nerve branches into the medial and lateral plantar nerves. A. Ankle plantar flexion is performed by several muscles that are innervated by the tibial nerve, including the gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, and flexor digitorum longus. A patient with a tibial nerve injury would have significant difficulty performing ankle plantar flexion. B. Extension of the great toe is performed by the extensor hallucis longus and extensor hallucis brevis. These muscles are innervated by the deep peroneal nerve, which is a branch of the common peroneal nerve. A patient with a tibial nerve injury would have no difficulty performing extension of the great toe. C. Flexion of the great toe is performed by the flexor hallucis longus and flexor hallucis brevis. These muscles are innervated by the tibial nerve. A patient with a tibial nerve injury would have significant difficulty performing flexion of the great toe. D. Flexion of toes 2-5 is performed by the flexor digitorum longus and flexor digitorum brevis. These muscles are innervated by the tibial nerve. A patient with a tibial nerve injury would have significant difficulty performing flexion of toes 2-5.

Answer 21

use an elevated platform when placing boxes on the belt Correct Answer: D Physical therapists often perform work site evaluations and make recommendations to modify existing work activities. A. A pelvic stabilization program may be helpful to improve core stability, however, the question provides ample evidence that the problem is more likely related to the height of the elevated conveyor belt. B. An abdominal strengthening program would also improve core stability, but would not accommodate for the height of the elevated convevor belt. C. Reviewing proper body mechanics may be desirable however, the question states that the patient is unable to prevent hyperextension of the spine. Failure to prevent hyperextension of the spine is more likely to occur because of the height of the conveyor belt rather than lack of knowledge of proper body mechanics. D. In order to eliminate hyperextension of the spine it may be necessary to modify the workstation. The most reasonable modification would be to utilize an elevated platform in order to minimize the height of the conveyor belt. In many instances, it is possible to modify a work site without utilizing large amounts of resources (e.g. time, money).

Answer 22

discharge the patient with a home exercise program Correct Answer: D Physical therapists should discharge patients from physical therapy when the anticipated goals or expected outcomes have been achieved or the patient is no longer benefitting from physical therapy services. A. Physical therapists are not permitted to offer pro bono services to selected patients based on factors such as reimbursement or the ability to pay. Therapists should strive to treat all patients equitably. B. A payment plan permits a patient to pay for incurred physical therapy services in a gradual manner. This may be a more desirable option when a patient requires ongoing physical therapy services, but does not have adequate financial resources. C. Requesting additional physical therapy visits from the third party payer is a possible option, however, based on the patient's diagnosis and post-operative progression additional visits may not be warranted. D. A patient 12 weeks status post anterior cruciate ligament reconstruction that has experienced an unremarkable recovery should be able to function independently using a well designed home exercise program. The program should incorporate activities such as jogging, strengthening, and agility drills.

Answer 23

Students in a physical therapy program with high scores on the Scholastic Aptitude Test tend to have high grade point averages. Correct Answer: B Correlation coefficients quantitatively describe the strength and magnitude of the relationship between two variables. The symbol "r" denotes the Pearson product-moment correlation coefficient which is used to evaluate the strength and direction of the linear relationship between two continuous variables on the interval or ratio scales. The Pearson "" can take values ranging from - 1.00 (a perfect negative relationship) to 1.00 (a perfect positive relationship). A. Correlation does not imply a causal relationship between two variables. A strong relationship between X and Y does not suggest that X causes Y or that Y causes X. Therefore, it cannot be said that the r-0.87 suggests that a high score on the Scholastic Aptitude Test causes a high grade point average. B. A r-0.87 indicates a good to excellent relationship between the Scholastic Aptitude Test (SAT) and grade point average (GPA). That is, low scores on the SAT tend to be associated with low GPAs and high scores on the SAT tend to be associated with high GPAs. C. No relationship between grade point average and performance on the Scholastic Aptitude Test would be indicated by a 1=0.0 D. Ar-0.87 indicates a positive or direct relationship between grade point average in a physical therapy program and performance on the Scholastic Aptitude Test. A negative correlation coefficient would indicate an inverse relationship.

Answer 24

paresthesias of the long and ring fingers Correct Answer: D Involvement of a specific nerve root often results in predictable impairments including diminished sensation, muscle weakness impaired reflexes, and paresthesias. A. Diminished sensation on the anterior arm and index finger is characteristic of a C6 nerve root injury and is assessed using light touch from a cotton ball. B. Weakness in the biceps and supinator muscles is characteristic of a C6 nerve root injury and is assessed through resistive testing as part of an upper quarter screening examination and/or specific manual muscle testing. C. A diminished brachioradialis reflex is characteristic of a C6 nerve root injury and is assessed by striking the blunt end of a reflex hammer at the distal end of the radius with the patient's elbow flexed to 90 degrees and the upper extremity supported by the therapist. D. Paresthesias of the long and ring fingers are commonly associated with the C7 nerve root. Other findings of a C7 nerve root injury include weakness of the triceps and wrist flexors, and a diminished triceps reflex.

Answer 25

place a patch over one of the patient's eyes Correct Answer: B Diplopia refers to double vision resulting from defective function of the extraocular muscles that is typically caused by damage to the brain. A patient with diplopia is often instructed to wear a patch alternately over one of their eyes. Specific strengthening exercises of the extraocular muscles can serve to improve the patient's vision. A. Verbal instruction is often more desirable than non-verbal instruction since double vision would tend to minimize the effectiveness of non-verbal instruction. B. A patient with diplopia will actually see two sets of the environment. If wearing the patch over the alternate eye does not resolve the problem, the patient may require prism glasses. C. The patient will not alleviate diplopia through positioning of the head. Double vision can result from damage to the brain and requires strengthening and the use of an eye patch.

Answer 26

soleus Correct Answer: D When prescribing exercises designed to increase muscular flexibility, the physical therapist must be aware of a muscle's attachment sites and orientation to maximize the effectiveness of a stretch. The physical therapist must also consider the differences in technique required when stretching a one-joint muscle versus a two-joint muscle. A. The rectus femoris originates from the anterior inferior iliac spine and inserts into the tibial tuberosity. It is responsible for producing hip flexion and knee extension, therefore, the patient would have to extend the hip and flex the knee to maximally stretch this muscle. The depicted-image does not include hip extension. B. The biceps femoris originates from the ischial tuberosity and inserts into the fibular head and lateral tibia. It is responsible for producing hip extension and knee flexion, therefore, the patient would have to flex the hip and extend the knee to maximally stretch this muscle. The depicted image does not include knee extension. C. The gastrocnemius originates from the femoral condyles and inserts into the calcaneus. It is responsible for producing knee flexion and ankle plantar flexion, therefore, the patient would have to extend the knee and dorsiflex the foot to stretch this muscle. The depicted image does not include knee extension. D. The soleus originates from the proximal tibia and fibula and inserts into the calcaneus. Because the soleus is a one-joint muscle, it is only responsible for producing ankle plantar flexion. To maximally stretch the muscle, the patient must dorsiflex the ankle. By performing the stretch with the knee in flexion, the influence of the two-joint gastrocnemius is eliminated.

Answer 27

lengthened PR Interval Correct Answer: B Digitalis is a medication given to increase the force of myocontractility and is often prescribed for patients with heart failure. Increased contractility increases cardiac output and decreases preload, cardiac workload, and myocardial oxygen demand, thus reducing the clinical effects of congestive heart failure A. Sinus tachycardia is a fast heart rate (greater than 100 bpm) that has its origin in the SA node. B. Digitalis prolongs the PR interval on the ECG by increasing conduction time through the AV node. C. The QT interval measures the depolarization and repolarization time of the ventricles and extends from the beginning of the QRS complex to the end of the T wave. Digitalis may produce shortening of the QT interval. D. The ST segment represents the beginning of ventricular repolarization and is generally isoelectric. The ST segment is elevated in an acute myocardial infarction, however, digitalis may produce sagging in the ST segment.

Answer 28

proximal muscle weakness Correct Answer: B Duchenne muscular dystrophy is an inherited disorder, characterized by rapidly worsening muscle weakness that starts in the proximal muscles of the lower extremities and pelvis, and later affects all voluntary muscles A. Distal muscles are affected later in the course of the disease process. B. Muscle weakness and atrophy begin in the proximal muscles of the lower extremities and pelvis, then progress to the muscles of the shoulders and neck, followed by loss of upper extremity muscles and respiratory muscles. C. The muscles of respiration are not initially affected in patients with Duchenne muscular dystrophy. D. As the condition progresses, weakness begins to interfere with activities of daily living.

Answer 29

Spondylolisthesis Correct Answer: C There are a variety of commonly encountered medical conditions that significantly impact the lumbar spine. Physical therapists should be familiar with the clinical presentation and management of these medical conditions A. Spondylitis refers to inflammation of a vertebra. B. Spondylolysis refers to a defect in the pars interarticularis or the arch of the vertebra. This is most common in the L5 vertebra, but can also occur in other lumbar or thoracic vertebrae. C. Spondylolisthesis refers to the forward displacement of one vertebra over another. The x-ray involves spondylolisthesis at the L5-S1 level. Individuals involved in physical activities such as weight lifting, gymnastics or football are particularly susceptible to this condition. The severity of the spondylolisthesis is classified on a scale of 1-5 based on how much a given vertebral body has slipped forward over the vertebral body beneath it. D. Spondyloptosis refers to the condition where a vertebral body has shifted completely off of the adjacent vertebral body (grade 5).

Answer 30

manual contacts with pressure over the lateral borders of the ribs with the patient in supine Correct Answer: B Applying direct pressure with the hands on the lateral borders of the ribs with the patient in supine can promote a more efficient breathing pattern. Physical therapy management for a child with cystic fibrosis may include postural drainage techniques, chest percussion, vibration, and suctioning. A. Manual percussion over the posterior ribs with the patient in prone describes the postural drainage position and technique used for airway clearance, not expansion, of the posterior basal lung segments. B. Direct pressure of the hands over the lateral ribs can facilitate expansion of the basal lobes of the lungs. C. Manual vibration over the lateral portion of the ribs in sidelying describes the postural drainage position and technique used for airway clearance, not expansion, of the lateral basal lung segments. D. The epigastric area refers to the upper central region of the abdomen. Manual cues on this area would not encourage expansion at the base of the lungs.

Answer 31

Leukopenia Correct Answer: A Silver sulfadiazine is a topical antibiotic that works by interfering with bacterial nucleic acid production by disrupting folic acid synthesis in susceptible bacteria. The antibiotic is a broad spectrum agent that can be applied directly to the skin. Additional problems encountered with sulfa drugs include gastrointestinal of distress and allergic reactions A. Silver sulfadiazine is a sulfa drug that can produce a decrease in the number of circulating white blood cells (leukopenia), usually below 5,000 mm?. B. Peripheral edema refers to the swelling of tissues in the lower limbs due to the accumulation of fluid. Peripheral edema frequently is associated with heart failure, venous insufficiency, pregnancy, kidney disease, and selected pharmacological agents, however, it is not a side effect of silver sulfadiazine. C. Hypokalemia refers to an abnormally low potassium concentration in the blood. The condition can be caused by vomiting, diarrhea, burns, uncontrolled diabetes mellitus, diuretic therapy, and steroid therapy, however, it is not a side effect of silver sulfadiazine. D. The pH is a measure of the degree to which a solution is acidic or alkaline. A pH of 70 indicates neutrality, a pH of less than 7.0 indicates acidity, a pH of more than 7.0 indicates alkalinity. The body's fluids are usually between 7.35- 7.45. Topical agents such as mafenide acetate would be more likely to alter pH.

Answer 32

the regularity of the atrial rhythm Correct answer: A Atrial flutter is a frequently occurring abnormal heart rhythm characterized by rapid atrial tachycardia. This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart. Atrial fibrillation is an arrhythmia characterized by erratic electrical conductivity within the atria. A. In atrial flutter, the heart beats fast, but in a very regular rhythm producing sawtooth P waves. In atrial fibrillation, the heart also beats fast, however, the rhythm is irregular. B. Atrial flutter is characterized by a rapid rate of atrial contraction (ie., 250-350 beats per minute) in a consistent and predictable rhythm. An irregularity of the atrial rhythm is characteristic of atrial fibrillation. C. Both atrial flutter and atrial fibrillation are characterized by extremely rapid rates of atrial depolarization. This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart. D. Both atrial fitter and atrial fibrillation are characterized by extremely rapid rates of atrial depolarization. A slow rate of atrial depolarization would be more characteristic of bradycardia which refers to a heart rate of less than 60 beats per minute.

Answer 33

congestive heart failure Correct Answer: D Lasix (furosemide) is a loop diuretic often used in the treatment of edema or hypertension. Lasix increases the excretion of sodium and chloride in the kidneys, thereby increasing urination and decreasing the volume of fluid that is retained within the body. A. Atrial flutter is a type of cardiac arrhythmia characterized by a rapid contraction rate of the atria. Digoxin is an example of a medication that may be used to treat atrial flutter B. Deep vein thrombosis is a condition where a blood clot forms in a vein, most commonly in the lower extremities. Thrombolytic drugs would be administered to help break up an already existing blood clot. C. Hyperlipidemia is a condition characterized by high levels of lipids (i.e., triglycerides, cholesterol) within the blood. Atorvastatin (Lipitor) is an example of a medication that may be used to treat hyperlipidemia. D. Congestive heart failure is a condition characterized by an inability of the heart to effectively pump blood to meet the metabolic demands of the body. Chronic heart failure can result in pulmonary edema or peripheral edema, depending on the side of the heart that is affected. Lasix is a medication that is commonly prescribed to help lessen the edema associated with chronic heart failure.

Answer 34

vital capacity Correct Answer: D Vital capacity is the maximum volume of gas that can be exhaled after a maximum inhalation A. Expiratory reserve volume (ERV) is the additional volume of air that can be exhaled beyond the normal tidal exhalation. ERV is one component of vital capacity. B. Inspiratory reserve volume (IRV) is the additional volume of air that can be inhaled beyond the normal tidal inhalation. IRV is one component of vital capacity. C. Total lung capacity is the maximum volume to which the lungs can be expanded. It is the sum of vital capacity and residual volume: TLC=VC + RV. D. Vital capacity is the maximum volume of gas that can be exhaled after a maximum inhalation. It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume: VC= IRV + TV + ERV.

Answer 35

Hyperkalemia Correct Answer: B Electrolytes play a critical role in maintaining homeostasis within the body. Examples of critical roles played by electrolytes include regulating cardiac function, fluid balance, acid-base balance, and neurologic activity. The most serious electrolyte imbalances involve abnormalities in the level of calcium, potassium, and sodium. A. Hypercalcemia refers to an excessive level of calcium in the blood. Normal serum calcium is 8.4-10.2mg/DI. The condition is most commonly associated with hyperparathyroidism since excessive parathyroid hormone raises the level of circulating calcium above normal. Symptoms typically include constipation, pain, nausea, and vomiting. B. Hyperkalemia refers to an excessive level of potassium in the blood. Normal serum potassium Is 3.5-5.0 mEq/L. Levels higher than 7 mEg/L can have significant hemodynamic and neurologic consequences, while levels exceeding 8.5 mEg/L can cause respiratory paralysis or cardiac arrest. Symptoms typically are related to abnormalities in muscular or cardiac function. C. Hypermagnesemia refers to an excessive level of magnesium in the blood. Normal serum magnesium is 1.5-2.0 mEq/L. This condition is relatively rare since the kidneys are able to eliminate excess magnesium by rapidly reducing its tubular absorption. Hypermagnesemia is most often caused by renal failure. Symptoms typically include hypotension and respiratory depression. D. Hypernatremia refers to an excessive level of sodium in the blood. Normal serum sodium is 135-145 mEq/L. The condition results when there is a net water loss or a sodium gain and reflects too little water in relation to total body sodium and potassium. Hypernatremia is most often caused by impaired thirst or restricted access to water and can be facilitated by pathologic conditions with increased fluid loss. The primary symptom of this condition is thirst.

Answer 36

Specific Correct Answer: B The validity of a diagnostic test, such as the FEV test, is evaluated by its accuracy in assessing the presence or absence of a target condition such as airway obstruction. A test is considered to be specific when the test is negative in persons who do not have the disease. A highly specific test will rarely be positive when a person does not have the disease. A. Sensitivity is the probability of obtaining a positive test among individuals who have the disease. In this example neither condition was met: the test result was negative for airway obstruction and the individuals tested did not have lung disease. B. Specificity is the probability of obtaining a negative test among individuals without the disease (who should test negative). Since 99 of 100 individuals without lung disease had a negative FEV1 test for airway obstruction, the test is highly specific. C. Reliability refers to the extent to which a test or measurement is consistent or yields the same result on repeated trials. In this example, there is no indication that the FEV, was administered more than once, therefore no estimate of reliability is possible. D. Validity refers to the degree to which a test or measurement accurately reflects or assesses the specific concept the clinician is attempting to measure. Validity is concerned with the success at measuring what was set out to be measured. In this example, the data does not provide useful information for assessing the extent to which FEW, is a valid way to identify airway obstruction.

Answer 37

ventricular tachycardia Correct Answer: C An AED is a portable electronic device that automatically diagnoses the potentially life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia. The electrical current potentially stops the abnormal rhythm and allows the heart to begin to beat normally by administering an electrical shock. A. Atrial fibrillation is a common arrhythmia where the atria are depolarized between 350 and 600 times/minute. Atrial fibrillation occurs in healthy hearts and in patients with coronary artery disease, hypertension, and valvular disease. B. Premature atrial contractions occur when an ectopic focus in the atrium initiates an impulse before the SA node. Premature atrial contractions are relatively common and generally benign. C. Ventricular tachycardia refers to three or more consecutive premature ventricular contractions occurring at a ventricular rate of>150 beats/minute. Ventricular tachycardia longer than 30 seconds is a life-threatening arrhythmia and requires immediate medical intervention. This type of abnormal heart rhythm can be recognized and potentially treated by an AED. D. First degree ventricular heart block is characterized by a PR interval that is longer than 0.2 seconds, but relatively constant from beat to beat. First degree ventricular heart block results in no associated symptoms or significant changes in cardiac function.

Answer 38

neurogenic claudication Correct Answer: D Physical therapists should be familiar with the unique characteristics of commonly encountered medical conditions. This knowledge should include information such as actions which improve or exacerbate a patient's symptoms. A. The facet joints are paired joints located on the posterior aspect of the spine at each spinal level. The facet joints provide stability to the spine and limit excess motion. Patients with facet joint irritation tend to experience less discomfort when in a flexed position since an extended position is consistent with the close packed position of the joint (i.e., maximal congruence between joint surfaces). B. Spinal stenosis refers to narrowing of the spinal column and intervertebral foramen resulting in increased pressure an the spinal cord and associated nerve roots. Patients with spinal stenosis tend to experience less discomfort when in a flexed position since an extended position further narrows the size of the spinal column. C. Disk herniation refers to a condition when the disk is pushed outside of its normal position between the vertebrae, often resulting in pressure being applied to adjacent spinal nerves. Patients with disk herniation tend to experience less discomfort when in an extended position and more discomfort when in a flexed position. D. Neurogenic claudication is a common side effect of spinal stenosis where the spinal nerves become compressed by narrowing of the spinal column. The condition is characterized by weakness, cramping, and pain in the legs that is often exacerbated by activity. Patients with neurogenic claudication tend to experience less discomfort when at rest. Although a flexed position may also potentially relieve symptoms, the cessation of activity typically offers the greatest improvement in the patient's condition.

Answer 39

elbow extension Correct Answer: B Archimedes' principle of buovancy states that there is an upward force on the body when immersed in water equal to the amount of water that has been displaced by the body. When an individual exercises in water, the buoyant force works in opposition to the gravitational force. A. Elbow flexion is a sagittal plane motion that would best be classified as buoyancy assisted since the motion occurs in the same direction as the buoyant force. As a result, the buoyant force would make performing elbow flexion significantly easier for the patient. B. Elbow extension is a sagittal plane motion that would best be classified as buoyancy resisted since the motion occurs in the opposite direction as the buoyant force. As a result, the buoyant force would make performing elbow extension more difficult for the patient. C. Shoulder abduction is a frontal plane motion that would best be classified as buoyancy assisted since the motion occurs in the same direction as the buoyant force. As a result, the buoyant force would make performing shoulder abduction easier for the patient. D. Shoulder medial rotation is a transverse plane motion that would best be classified as buoyancy supported since the motion occurs parallel to the bottom of the pool. The buoyant force would assist to support the arm, but would not be resisted by buoyancy.

Answer 40

calcific tendonitis Correct Answer: B The greater the density of the tissue, the more visible it will appear on x-ray. The majority of inflammatory conditions of the shoulder would be formally diagnosed using magnetic resonance imaging. A. Bicipital tendonitis is an inflammatory process of the tendon of the long head of the biceps. The condition is characterized by subjective reports of a deep ache directly in front and on top of the shoulder, made worse with overhead activities or lifting. Repeated full abduction and lateral rotation of the humeral head can lead to irritation that produces inflammation, edema, microscopic tears within the tendon, and degeneration of the tendon itself. B. Calcific tendonitis Is often visible on x-ray due to the relative density of calcium. The greater the density of the tissue, the more visible it will appear on x-ray. The supraspinatus and infraspinatus tendons are common sites for calcific tendonitis. C. Supraspinatus impingement is caused by an inability of a weak supraspinatus muscle to adequately depress the head of the humerus in the glenold fossa during elevation of the arm. The patient may experience a feeling of weakness and identify the presence of a painful arc of motion most commonly occurring between 60 and 120 degrees of active abduction. D. Subacromial bursitis refers to inflammation of the subacromial bursa which lies between the deltoid muscle, supraspinatus tendon, and the fibrous capsule of the shoulder joint. The clinical presentation of the condition is very similar to the clinical presentation of supraspinatus impingement.

Answer 41

circumferential measurements Correct Answer: B Physical therapists must utilize appropriate tests and measures to quantify the relative effectiveness of selected interventions. Therapists should carefully consider the reliability and validity of selected tests and measures when analyzing the collected data. A. Common anthropometric measurements used for adults include height, weight, body mass index (BMI), waist-to-hip ratio, and percentage of body fat. These measures are then compared to reference standards to assess items such as weight status and the risk for various diseases. B. Circumferential measurements using a flexible tape measure allow physical therapists to obtain a gross estimate of edema in the knee. Pre-test and post-test measurements provide information on the effect of the electrical stimulation on the edema C. Goniometric measurements are obtained with a goniometer are designed to quantify available range of motion. If electrical stimulation is effective in reducing the edema, the patient may have improved range of motion, however, this would still not directly quantify the relative change in edema. D. Volumetric measurements are often used to quantify the presence of edema in the wrist and hand by examining the amount of water displaced following immersion. Comparison with the uninvolved extremity provides a baseline measure. It would be impractical to attempt this type of measurement with the knee joint.

Answer 42

flattened lumbar curve, exaggerated thoracic curve Correct Answer: B Ankylosing spondylitis is a form of systemic rheumatic arthritis that is associated with an increase in thoracic kyphosis and loss of the lumbar curve. Ankylosing spondylitis occurs three times more often in males than females with a typical age of onset of 20-40 years. A. A posterior thoracic rib hump is characteristic of scoliosis. The rotated vertebrae cause a rotation in the corresponding rib segments and result in posterior displacement of the rib cage. B. The clinical presentation of ankylosing spondylitis initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension. Chronic inflammation causes destruction of the ligamentous-osseous junction with subsequent fibrosis and ossification. The patient may exhibit flexion at the hips, spinal kyphosis, fatigue, weight loss, and peripheral joint involvement. If the costovertebral joints are affected there may be impaired chest mobility, compromised breathing, and decreased vital capacity. C. Excessive lumbar curve with a flattened thoracic curve is opposite from the typical clinical presentation of ankylosing spondylitis. D. Lateral curvature of the spine with fixed rotation of the vertebrae is descriptive of scoliosis.

Answer 43

Galant reflex Correct Answer: D Integration of a reflex refers to the period of time when a reflex is no longer present despite an appropriate stimulus. A. The plantar grasp reflex is stimulated by placing pressure on the ball of the foot, generally in standing. The response is flexion and curling of the toes. The normal age of the response is from 28 weeks of gestation to nine months. B. The Moro reflex is stimulated when an infant's head is suddenly allowed to fall into extension. The action causes a "startled look" followed by upper extremity abduction with the fingers open, then crossing the trunk into adduction. The normal age of the response is from 28 weeks of gestation to five months. C. The Landau reflex is an equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body. Although the response begins around three months of age, it is not fully integrated until the child's second year. D. The Galant reflex is stimulated by touching the skin along the spine from the shoulder to the hip. The response is lateral flexion of the trunk to the side of the stimulus. The normal age of the response is from 30 weeks of gestation to two months.

Answer 44

a heavily exuding wound that has a fetid odor Correct Answer: D Foam dressings can be made up of a single layer or multiple layers and are usually made from a polyurethane material. These dressings are ideal for absorbing exudate and maintaining a wound bed with a normal moisture level. Foam dressings can be used as a primary or secondary dressing. A. A foam dressing should not be used on a dry wound since it is a highly absorptive dressing. Other dressings may be more appropriate for dry wounds, such as hydrogels. B. The charcoal impregnated into the foam dressing can be beneficial in treating wounds that have strong odors. However, a foam dressing should not be used on a dry wound due to its absorptive properties. C. Foam dressings are useful in treating heavily exuding wounds since they have high absorbency. However, the charcoal would not be beneficial in treating infection. Dressings impregnated with silver may be more useful in treating infection secondary to the antimicrobial properties of silver D. A foam dressing would be beneficial for treating a heavily exuding wound due to its absorptive properties. The charcoal in the dressing is beneficial for decreasing fetid odors associated with the wound.

Answer 45

endoskeletal shank and solid ankle cushion heel (SACH) foot Correct Answer: B An endoskeleton or modular shank is designed to incorporate a synthetic foam cover shaped like the opposite leg. As a result, the device is more cosmetically attractive and would likely make the patient more socially comfortable. A SACH foot is the most frequently prescribed foot-ankle assembly. It is considered to be a nonarticulated foot since it does not incorporate a mechanical joint at the ankle. A. An endoskeletal shank would be an appropriate choice given the patient's concerns, however, a single-axis articulated foot-ankle assembly would be heavier and requires more maintenance than the SACH foot. Since the patient is of retirement age and does not plan on heavy activity, this type of foot would not be appropriate. B. Since the patient is of retirement age and expects low impact on the prosthesis, the endoskeletal shank and SACH foot will provide the patient with durability, low maintenance, and cosmesis. C. An exoskeletal shank would not be appropriate for the patient since it is less cosmetically desirable and heavier with the hard, thermoplastic resin shell. The single-axis articulated foot-ankle assembly would also be heavier and requires more maintenance than the SACH foot. D. An exoskeletal shank would not be as desirable for the patient as the endoskeletal shank. The SACH foot is appropriate for the patient.

Answer 46

limited dorsiflexion Correct Answer: D A patient with limited dorsiflexion may compensate with a vault or bounce through mid to late stance. Approximately ten degrees of dorsiflexion is required for late stance through toe off. A. Weakness of the dorsiflexors will typically create a "steppage gait pattern." The patient will present with foot slap at initial contact and compensate by lifting the knee higher than normal to clear the foot and avoid dragging the toe. B. Weakness of the hip abductors (gluteus medius and minimus) will typically create a contralateral dip of the pelvis during the stance phase of the weak side, also known as a Trendelenburg gait pattern. The observed contralateral dip of the pelvis results from the inability of the weak hip abductors to stabilize the pelvis during contralateral swing phase. C. Limited plantar flexion would not result in a vaulting gait pattern. The patient would require plantar flexion to vault (ascend onto the toes) during gait. Plantar flexion of 0-20 degrees is required for normal gait biomechanics with approximately 15 degrees during the loading response and 20 degrees during the pre-swing phase. D. Limited dorsiflexion will typically result in premature elevation of the heel during midstance. The patient will appear to have a bounce during gait secondary to the gastrocnemius-soleus tightness.

Answer 47

Choreoathetosis Correct Answer: B Parkinson's disease is a movement disorder caused by the progressive degeneration of the dopamine-producing cells in the basal ganglia. The disease is characterized by difficulties in planning, initiation, and execution of movement. Levodopa is a medication commonly used to improve motor function and general mobility in patients with Parkinson's disease. A. Bradykinesia (i.e., slowness of movement) is a common characteristic of Parkinson's disease which would improve with the administration of levodopa. B. Choreoathetosis is a type of dyskinesia characterized by uncontrolled, involuntary movements. The onset of dyskinesias can occur as soon as three months after first receiving levodopa therapy. C. Shuffling gait is a common characteristic of Parkinson's disease which would improve with the administration of levodopa. D. Rigidity is a common characteristic of Parkinson's disease which would improve with the administration of levodopa.

Answer 48

protective muscle guarding of the hamstring muscles Correct Answer: C The Lachman test is designed to assess the integrity of the anterior cruciate ligament. The test is performed with the patient positioned in supine with the knee flexed to 20-30 degrees. The therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia. The therapist applies an anterior directed force to the tibia on the femur. A positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point. A false negative in this scenario refers to a negative Lachman test when there is in fact an anterior cruciate ligament injury. A. Moderate effusion of the knee joint capsule would not likely contribute to a false negative when performing the Lachman test. A more dramatic change in the volume of fluid in the knee (i.e, hemarthrosis) would likely be necessary B. Twelve millimeters of anterior translation of the tibia on the femur would be considered serious knee instability and therefore would not likely contribute to a false negative when performing the Lachman test. Mild instability = 5 millimeters or less; moderate instability = 5-10 millimeters; severe instability = greater than 10 millimeters. C. The semitendinosus and semimembranosus insert on the posteromedial surface of the proximal tibia, while the biceps femoris inserts on the lateral condyle of the tibia and the head of the fibula. Protective muscle guarding of the hamstring muscles could limit the translation of the tibia on the femur and contribute to a false negative when performing the Lachman test. D. A previous injury involving the anterior cruciate ligament would make a positive Lachman test more likely and therefore would not contribute to a false negative when performing this test.

Answer 49

rhomboids Correct Answer: B High guard position is characterized by the arms being held near shoulder level with retraction of the scapulae. The position increases midline trunk stability against the pull of gravity. High guard positioning may be observed in a number of different postures including sitting, tall kneeling, or erect standing. A. The pectoralis major acts to adduct and medially rotate the humerus. The muscle receives dual motor innervation by the medial pectoral nerve and the lateral pectoral nerve. The pectoralis major would likely be active when assuming a high guard position, however, would not be as essential as the rhomboids. B. The rhomboids act to adduct and downwardly rotate the scapula. The muscle originates on the nuchal ligaments and spinous processes of the C7-T5 vertebrae and inserts on the medial border of the scapula. The rhomboids are innervated by the dorsal scapular nerve. The rhomboids' ability to adduct the scapula provides assistance to the trunk extensors when maintaining an upright posture. C. The serratus anterior acts to protract and upwardly rotate the scapula during humeral elevation. The serratus anterior is innervated by the long thoracic nerve. A high guard position requires retraction of the shoulder, not protraction. D. The trapezius is a large superficial muscle that consists of three different components (ie, upper, middle, lower). The lower fibers depress and upwardly rotate the scapula and would not allow for the necessary adduction of the scapula required for the high guard position. The middle fibers of the trapezius would be a better option since they function to adduct the scapula. The middle fibers originate on the spinous processes of the first through fifth thoracic vertebrae and insert on the spine of the scapula.

Answer 50

co-treat the patient with another more experienced therapist Correct Answer: B Physical therapists must make decisions that are consistent with their professional training. Since the therapist is concerned about his ability to provide appropriate treatment, he is in need of some form of external assistance. A. Informing the patient of their area of expertise would likely make the patient question the therapist's competence. B. By co-treating the patient, the therapist receives external assistance and at the same time improves his skills with a particular patient population. C. The question states that the therapist is concerned about his ability to treat the patient. This type of admission makes it inappropriate to simply treat the patient without utilizing available resources. D. Refusing to treat the patient would not be necessary since the therapist has available resources to offer assistance.

Answer 51

10 degrees of metatarsophalangeal hyperextension Correct Answer: D Rancho Los Amigos stages of gait include initial contact, loading response, midstance, terminal stance, pre-swing, initial swing, midswing, and terminal swing. Each stage requires a specific amount of available range of motion at each of the lower extremity joints. Terminal stance begins when the stance limb's heel rises and ends when the other foot touches the ground. A. The hip is in 10-20 degrees of hyperextension at the end of terminal stance. B. The knee is in neutral (i.e., O degrees) at the end of terminal stance. C. The ankle is in neutral (i.e., O degrees) at the end of terminal stance. D. The metatarsophalangeal joints are in 30 degrees of hyperextension at the end of terminal stance.

Answer 52

systolic blood pressure decreased by 25 mm Hg from resting level Correct Answer: C Physical therapists should closely monitor the response to exercise of patients in a phase cardiac rehabilitation program. Any abnormal responses observed during the cardiac rehabilitation program should be documented and shared with other members of the medical team. A. An increase in heart rate of 18 beats per minute above resting heart rate is acceptable. Most guidelines for phase I cardiac rehabilitation recommend that heart rate not exceed 130 beats per minute or a heart rate more than 20 beats above resting for post myocardial infarction patients or a heart rate more than 30 beats above resting for post-surgical patients. B. Dyspnea is a reason to terminate exercise during phase I exercise. However, a respiration rate of 18 breaths per minute is at the upper limit of the normal range and would not typically cause a patient to report a sense of dyspnea. C. A decrease in systolic pressure of 25 mm Hg exceeds the 10 mm Hg limit allowed during exercise in a phase I cardiac rehabilitation program. D. A diastolic blood pressure of 110 mm Hg is considered the upper limit for exercise in phase I cardiac rehabilitation. A diastolic pressure less than 110 mm Hg is acceptable.

Answer 53

complete blood count Correct Answer: B When treating a patient with a hematologic disorder, a physical therapist should monitor a patient's complete blood count (CBC) along with the coagulation profile to determine the potential risk for bruising, decreased oxygen carrying capacity at rest or with exercise, or thrombus formation. This information will allow a therapist to modify or defer physical therapy intervention if warranted secondary to abnormal lab values. A. Hemoglobin is the iron-containing pigment in red blood cells that functions to carry oxygen in the blood. Low hemoglobin may indicate anemia or blood loss; elevated hemoglobin suggests polycythemia or dehydration. Hemoglobin is important to monitor, but not in isolation. A patient with a hematologic disorder requires monitoring of all components of a CBC to assess the patient's status. B. A CBC measures red blood cell count, total white blood cell count, white blood cell differential, platelets, hemoglobin, and hematocrit. A CBC is performed to assess health to diagnose and monitor a medical condition, and to monitor the effects of medical treatment. A patient with a hematologic disorder requires daily monitoring of a CBC to allow the therapist to determine trends and to recognize abnormal lab values that may require modification or deferment of services. C. Arterial blood gases are collected to evaluate acid-base status (pH), ventilation (PaCO2), and oxygenation of arterial blood (Pa02). This profile is typically not affected by a hematologic disorder and therefore would not require daily monitoring in this scenario. D. Blood glucose refers to sugar that is transported through the bloodstream to supply energy to all the cells. Daily monitoring of blood glucose is most appropriate for a patient diagnosed with diabetes mellitus. This is imperative to prevent the effects of hyperglycemia or hypoglycemia. This profile is typically not affected by a hematologic disorder and therefore would not require daily monitoring in this scenario.

Answer 54

sigmoid colostomy Correct Answer: C A colostomy is a surgical opening in the colon created for the elimination of feces. This type of procedure can be required when an injury or pathology prohibits the colon from functioning properly. There are several unique types of colostomies including ascending, transverse, descending, and sigmoid. The farther along the intestinal tract that fecal material travels, the more it resembles the consistency of normal stool. A. The ascending colon, located on the right side of the abdomen, is the beginning portion of the large intestine. The ascending colon extends upward to a bend in the colon called the hepatic flexure. An ascending colostomy results in only a very short portion of the colon remaining active and as a result the output is primarily liquid containing many digestive enzymes. B. The descending colon, located on the left side of the abdomen, follows the transverse colon and the splenic flexure. A descending colostomy results in a large portion of the colon remaining active and therefore the output is often firm, although tends to be somewhat irregular. C. The sigmoid colon is the final portion of the large intestine and serves as a connection to the rectum. A sigmoid colostomy is the most common type of colostomy, located a few inches lower than a descending colostomy. As a result, this type of colostomy has additional working colon. A sigmoid colostomy produces normal stool consistency and discharge can be regulated. D. The transverse colon, located across the upper portion of the abdomen, follows the ascending colon and the hepatic flexure. The transverse colon ends with a bend in the colon called the splenic flexure. A transverse colostomy may produce soft or loose stool at infrequent intervals.

Answer 55

posterior rotation of the pelvis Correct Answer: C The hamstring muscles consist of the semitendinosus, semi- membranous, and biceps femoris. The semitendinosus and semimembranosus are considered the medial hamstrings since they insert on the medial surface of the tibia. The biceps femoris is considered the lateral hamstrings since the muscle inserts on the lateral surface of the tibia and the lateral surface of the head of the fibula. A. Weight shifting to the contralateral side in short sitting without other compensatory movement would have minimal impact on measured hamstrings length. B. Anterior rotation of the pelvis would tend to make the apparent hamstrings length shorter than the actual length due to the hamstrings origin on the tuberosity of the ischium. C. Posterior rotation of the pelvis would tend to make the apparent hamstrings length longer than the actual length due to the hamstrings origin on the tuberosity of the ischium. Patients often attempt to posteriorly rotate the pelvis in short sitting by leaning backwards. D. Hip hiking of the contralateral limb may cause the patient to weight shift toward the involved side. This adaptation would have minimal impact on measured hamstrings length

Answer 56

apply a perturbation to alter the body's center of gravity Correct Answer: B Balance requires complex integration of the vestibular, visual, and somatosensory systems. Each system is responsive to specific stimuli and therefore can be assessed individually or collectively. A. Cutaneous sensation is commonly assessed as part of a neurological examination, however, would not be directly associated with the vestibular system. Cutaneous sensory receptors include free nerve endings, Ruffini endings, hair follicle endings, and Meissner's corpuscles. B. The vestibular system reports information to the brain regarding the position and movement of the head with respect to gravity and movement. Assessment of the vestibular system often includes perturbations that require the body to make automatic adiustments that restore normal alignment. C. The somatosensory system provides information about the relative orientation and movement of the body in relation to the support surface. Examining proprioception in a weight bearing posture would be a common method used for assessment of the somatosensory system. D. The visual system allows individuals to perceive movement and detect the relative orientation of the body in space. Visual receptors allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway, and movements of the head and neck. Visual acuity and depth perception contribute to the feedback gathered by the visual system

Answer 57

10 METS Correct Answer: C One metabolic equivalent is the amount of oxygen consumed at rest and is equal to approximately 3.5 milliliters of oxygen per kilogram of body weight per minute. This measure allows therapists to describe the energy requirements of an activity as a multiple of the metabolic rate. A. Maximal aerobic capacity of 3 METs is extremely low regardless of age and gender. For example, walking three miles per hour on a level, firm surface is approximately 3.5 METS. A maximal aerobic capacity of 3 METs is likely associated with significant pathology or illness. B. Maximal aerobic capacity for older men and women typically ranges from 5-8 METs. The patient's age and activity level make it likely that the patient's maximal aerobic capacity is significantly greater than 6 METs. C. Maximal aerobic capacity for men and women typically ranges from 8-12 METS. The patient's age and activity level make it likely that the individual's anticipated maximal aerobic capacity would fall within this range. D. Maximal aerobic capacity for highly trained men and women has been shown to reach 15-20 METS. This is unlikely for the described patient given the available information.

Answer 58

hallux valgus Correct Answer: B Hallux valgus, or bunion, is a prominent bony formation on the medial aspect of the first metatarsophalangeal (MTP) joint that results from lateral deviation of the hallux and foot pronation. This disorder is typically the result of wearing shoes with a triangular toe box over a sustained period of time. A. Sesamoiditis refers to the inflammation surrounding the sesamoid bones under the first metatarsal head. Shoe prescription would include a transverse metatarsal bar to redistribute pressure from the metatarsal heads to the metatarsal shafts. A rocker sole can be used to reduce motion of the painful joint. B. Shoe prescription for hallux valgus would include a high and wide toe box to reduce friction and pressure to the first MTP joint. Medial support is required to decrease pronation while reduced heel height decreases forefoot pressure. A contoured posterior counter of the shoe better controls the subtalar joint. C. Pes cavus refers to an exaggerated longitudinal arch that results in a plantar flexed forefoot, retracted toes, and increased weight bearing stress to the metatarsal heads and heel. Shoe prescription would include a cushion sole to absorb shock, a metatarsal bar to shift weight from the metatarsal heads, and a lateral flare to increase overall stability D. Metatarsalgia refers to pain around the metatarsal heads secondary to compression of the plantar digital nerve. Shoe prescription would be identical to the recommendations described for sesamoiditis.

Answer 59

C8 nerve root lesion Correct Answer: A Atrophy refers to the partial or complete wasting of muscle tissue in a defined anatomical region. Atrophy is often classified as disuse or neurogenic. Causes of atrophy can potentially include loss of innervation, impaired circulation or diminished activity. A. A C8 or TI nerve root lesion often results in atrophy of the thenar eminence. The muscles assoclated with the thenar eminence include the abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis. The nerves that innervate each of the muscles arise from the C8-TI nerve roots. The abductor pollicis brevis and opponens pollicis are innervated by the median nerve. The superficial head of the flexor pollicis brevis is innervated by the median nerve and the deep head is innervated by the ulnar nerve. B. Paralysis of the interossei often results in a deformity characterized by hyperextension of the metacarpophalangeal joints. C. A radial nerve lesion often results in a deformity characterized by wrist drop with increased flexion of the wrist, flexion of the metacarpophalangeal joints, and extension of the distal interphalangeal joints. D. An ulnar nerve lesion often results in a deformity characterized by atrophy of the hypothenar eminence and a clawed hand with flexion of the fourth and fifth digits.

Answer 60

superficial partial-thickness Correct Answer: B The extent and severity of a burn is dependent on a variety of factors including age, duration of burn, type of burn, and affected area. Burns are most appropriately classified according to the depth of tissue destruction. A. A superficial burn involves only the outer epidermis. The involved area may be red with slight edema. Healing occurs without evidence of scarring. B. A superficial partial-thickness burn involves the epidermis and the upper portion of the dermis. Healing occurs with minimal to no scarring in approximately two weeks. A superficial partial-thickness burn is relatively common since many scalding water burns and intense sunburns fall into this category. The primary difference in appearance between superficial and superficial partial-thickness burns is the presence of blistering. This category of burn is the most painful since all nerve endings remain intact. C. A deep partial-thickness burn involves complete destruction of the epidermis and the majority of the dermis. The involved area may appear discolored with broken blisters and edema. Damage to nerve endings may result in only moderate levels of pain. Healing occurs with hypertrophic scars and keloids. D. A full-thickness burn involves complete destruction of the epidermis and dermis along with partial damage of the subcutaneous fat layer. The involved area often presents with eschar formation and minimal pain. Patients with full-thickness burns require grafts and may be susceptible to infection.

Answer 61

muscle weakness in the supinator and wrist extensors Correct Answer: A Involvement of a specific nerve root often results in predictable impairments including diminished sensation, muscle weakness impaired reflexes, and paresthesias. A. Muscle weakness of the supinator (C5, C6, C7) and the extensor digitorum (C6, C7, C8) is associated with C6 involvement. B. Diminished sensation in the deltoid area and the anterior aspect of the entire arm to the base of the thumb is associated with the C5 dermatome. C. Muscle weakness of the deltoid (C5, C6) and the biceps (C5, C6) is associated with the C5 myotome. D. Diminished biceps (C5, C6) and brachioradialis (C5, C6) reflexes are associated with C5 involvement.

Answer 62

T4 paraplegia Correct Answer: A Autonomic dysreflexia is caused when a noxious stimulus below the level of the lesion triggers the autonomic nervous system causing a sudden elevation in blood pressure. Symptoms include profuse sweating, bradycardia, goose bumps, headache, and vasodilation (flushing) above the level of the injury. This condition should be treated as a medical emergency. A. Autonomic dysreflexia is common in patients with spinal cord lesions above the T6 level. The condition should be treated as a medical emergency. Immediate medical management includes assisting the patient to a sitting position in an attempt to reduce blood pressure and examining the urinary drainage system since this often serves as the noxious stimulus that triggers the autonomic response. B. A patient with T12 paraplegia would not typically be at risk for autonomic dysreflexia since the level of the lesion is below Тб. C. Cauda equina injury occurs below the L1 spinal level where the long nerve roots transcend. Characteristics include flaccidity, areflexia, and impairment of bowel and bladder function. Full recovery is not typical due to the distance needed for axonal regeneration. D. Posterior cord syndrome refers to a relatively rare incomplete lesion caused by compression of the posterior spinal artery and is characterized by loss of proprioception, two-point discrimination, and stereognosis. Motor function is preserved

Answer 63

on the anterolateral surface of the lower leg Correct Answer: B A motor point refers to a point on the skin where the application of an electrical stimulus via an electrode will cause the contraction of an underlying muscle. A physical therapist can attempt to identify a motor point based on their knowledge of a muscle's origin and insertion. A. The popliteal fossa refers to an area or shallow depression located on the posterior surface of the knee. The area is significantly superior to the origin and insertion of the peroneus longus and therefore could not serve as a motor point for the muscle. B. The peroneus longus originates on the head and upper two-thirds of the lateral surface of the fibula and inserts on the lateral side of the base of the first metatarsal and the medial cuneiform. The muscle acts to evert the foot and assists in plantar flexion of the ankle joint. The anterolateral surface of the lower leg is consistent with the muscle's motor point. C. A motor point proximal to the first metatarsophalangeal joint would likely be associated with one of the intrinsic muscles of the foot. D. While the location immediately inferior to the lateral malleolus would correspond to an area that the peroneus longs passes over, by the time the muscle reaches this distal point, it is mostly tendon and therefore an electrical stimulus would not produce the desired motor response.

Answer 64

benzodiazepines Correct Answer: B Many medications can contribute to an increased fall risk particularly in an elderly population. Evidence is strongest for an association of falls with the use of hypnotic-anxiolytic drugs particularly benzodiazepines. Other medications commonly associated with an increased fall risk include diuretics antihypertensives, and selected antiparkinsonian medications. A. Nonopioid analgesic agents provide analgesia and pain relief, produce anti-inflammatory effects, and initiate anti-pyretic properties. Side effects include nausea, vomiting, vertigo, abdominal pain, gastrointestinal distress or bleeding, and ulcer formation. Common trade names of nonopioid analgesic agents include Tylenol, Advil, and Aleve. B. Benzodiazepines promote sleep through increasing inhibitory effects on the central nervous system synapses where GABA (gamma-aminobutyric acid) is found. Side effects include drowsiness, decreased motor performance, anterograde amnesia. and diminished alertness. Common trade names of benzodiazepines include Xanax, Valium, and Klonopin. C. Thrombolytics facilitate clot dissolution through conversion of plasminogen to plasmin. Plasmin breaks down clots and allows occluded vessels to reopen to maintain blood flow. Side effects include hemorrhage, allergic reaction, and cardiac arrhythmia. Common trade names of thrombolytics include Activase, Kinlytic, and Streptase. D. Antidiarrheal agents are used to slow the debilitating effects of dehydration associated with prolonged diarrhea. Side effects Include constipation and abdominal discomfort. Common trade names of antidiarrheal agents include Imodium, Motofen, and Pepto-Bismol.

Answer 65

staging of cancer Correct Answer: B Lung cancer is the most frequent form of cancer in the United States and refers to a malignancy of the epithelium of the respiratory tract. The staging of the cancer is used to estimate prognosis and to determine appropriate intervention strategies. A. The patient's premorbid lifestyle is relevant, however, would not be the primary factor when establishing the plan of care and associated goals. B. The TNM Classification System (T-tumor, N=node, M-metastasis) is a commonly used cancer classification system that describes the extent of a particular malignant tumor. "T"' refers to the extent of the primary tumor, "N" refers to the absence or presence and extent of regional lymph node metastasis, and "M refers to the absence or presence of distant metastasis. This type of staging offers guidance to health care professionals when determining treatment options, life expectancy, and prognosis for complete resolution. C. Past medical history provides a basic snapshot of a patient's overall health status. This information would be considered when establishing the plan of care and associated goals, but it would not be as critical as other pieces of information (i.e. cancer staging). D. Motivation level is particularly important once a plan of care is established, however, the patient's motivation level would be of only modest value when establishing the plan of care and associated goals.

Answer 66

educate the patient about incontinence Correct Answer: D Incontinence refers to an inability to control the release of urine feces or gas and is a common occurrence for many men and women. The causes of incontinence may include weak pelvic floor muscles or medical conditions such as an enlarged prostate, prostatitis, cancer, neurological disorders or obstruction. Proper diagnosis is necessary in order to effectively treat this condition A. The use of a support group would be a potential adjunct activity for the patient, however, at this time, education is the appropriate action. B. It would be inappropriate to begin pelvic floor exercises without a referral from a physician since the cause of the incontinence is unknown. C. The physical therapist should not discontinue resistive exercises since strengthening is a necessary component of a rehabilitation program for a patient following a tibial plateau fracture. This action also does not directly address the current issue of uncontrolled voiding of urine. D. The patient may significantly benefit from formal education about incontinence. The action would provide the patient with necessary information and make the patient more likely to see a physician about this issue. A vast majority of patients with incontinence can be successfully treated with non-invasive measures such as pelvic floor exercises.

Answer 67

a 23-year-old male (weight: 240 pounds, height: 72 Inches) Correct Answer: A Maximum oxygen consumption (VO2max) is generally considered the best indicator of cardiorespiratory endurance and aerobic fitness. Maximum oxygen consumption decreases with age at a rate of approximately 10% per decade after the age of 25. A. A 23-year-old male (weight: 240 pounds; height: 72 inches) would be expected to have the largest maximum oxygen consumption. Males have a higher maximum oxygen consumption than females and maximum oxygen consumption is directly proportional to height and weight. B. A 25-year-old female (weight: 160 pounds; height: 66 inches) would not be expected to have the largest maximum oxygen consumption of the presented options. This individual would, however, likely have a larger maximum oxygen consumption than the 47-year-old female since she is younger, heavier, and taller. C. A 53-year-old male (weight: 210 pounds; height: 69 inches) would not be expected to have the largest maximum oxygen consumption of the presented options since the other male option is younger, heavier, and taller. D. A 47-year-old female (weight: 130 pounds; height: 62 inches) would likely have the lowest maximum oxygen consumption of the presented options.

Answer 68

Dysarthria Correct Answer: A The cerebellum is responsible for a person's equilibrium, posture, muscle tone, and initiation and force of movement. Cerebellar pathology is often associated with an impaired ability, to execute accurate, smooth, controlled movements. A. Dysarthria is an Impairment of speech that involves the motor component of speech articulation. The condition is characterized as speech that is slow, slurred, hesitant, and contains prolonged syllables or inappropriate pauses. Pathology of the cerebellum can result in dvsarthria. B. Chorea is a movement disorder characterized by involuntary, rapid, irregular, and jerky movements involving multiple joints. The condition is an impairment associated with a lesion of the basal ganglia. C. Hemiballismus is a movement disorder characterized by large amplitude, sudden, violent, flailing motions of the arm and leg on one side of the body. The condition is an impairment associated with a lesion of the basal ganglia. D. Hypertonia is characterized by an increase in muscle tone and is usually the result of damage to upper motor neurons. Cerebellar pathology is more typically associated with hypotonia

Answer 69

weighted vest Correct Answer: B Sensory integration is the process in which the central nervous system accepts, organizes, and modulates afferent sensory information and produces a response. A child with sensory integration dysfunction has difficulty processing sensory information and producing an appropriate response. Therapists can provide children with opportunities to experience sensory input in a controlled environment using sensory modulation. Dyspraxia refers to difficulty planning a new motor act and is often caused by difficulty interpreting and modulating tactile input. A. Swings are used for children with sensory integration disorders in order to provide vestibular input. The vestibular system plays a role in the development of body posture, muscle tone, ocular-motor control, integration of reflexes and equilibrium reactions. Addressing the vestibular system would not directly address the child's dyspraxia. B. A weighted vest can provide proprioceptive input and can be worn by a child with a sensory processing disorder. The proprioceptive input provides the child with an improved sense of position and understanding of where joints and muscles are in space. Proprioceptive input contributes to the ability to plan movement and would directly address the child's dyspraxia. C. A sit and spin can provide vestibular input to a child with a sensory processing disorder. Children with difficulty processing vestibular information may be intolerant to movement. The sit and spin provides them with the opportunity to experience movement in a controlled environment. Addressing the vestibular system would not directly address the child's dyspraxia. D. A rocking chair can provide vestibular input to a child with a sensory processing disorder. Children with sensory integration dysfunction may have difficulty modulating their behavior, presenting with either hypo-arousal or hyper-arousal. Rocking chairs can be used to provide vestibular input to calm a child who is over-aroused. The additional vestibular input would not address the child's dyspraxia.

Answer 70

shoulder extension and elbow flexion Correct Answer: A Deep tendon reflexes are performed to test the integrity of the spinal reflex. A physical therapist should assess a deep tendon reflex by placing the tendon on slight stretch. A reflex hammer is used to sharply tap over the tendon. Reflexes can be graded as normal, exaggerated (hyper) or depressed (hypo) or can be graded on a scale of 0-4. A. Shoulder extension and elbow flexion would be the most appropriate position to test the triceps reflex. The reflex is best elicited with the patient in sitting or standing with the arm supported by the physical therapist. The therapist strikes the triceps tendon with a reflex hammer where it crosses the olecranon fossa. An acceptable alternate position to test the triceps reflex would be shoulder abduction and elbow flexion. B. Shoulder flexion and elbow extension would not place the triceps tendon on adequate stretch to elicit the triceps reflex. C. Shoulder extension and elbow extension would result in an ineffective position to elicit the triceps reflex since the triceps is already in a maximally shortened position. D. Shoulder flexion and elbow flexion place the triceps on total stretch secondary to the origin and insertion of the triceps muscle. A deep tendon reflex should be tested with the tendon on slight stretch.

Answer 71

Bandage Correct Answer: A Application of a bandage does not require sterile technique since the bandage does not come in direct contact with the wound. All other aspects of the scenario require sterile technique to protect the wound and surrounding area, the patient, and the caregiver from contamination. A. A bandage is applied over a dressing. The function of a bandage is to keep the dressing in position, provide a barrier between the dressing and the environment, provide pressure, and protect the wound, Since the bandage does not come in direct contact with the area surrounding the wound, sterile technique is not required. B. A dressing for a wound is usually comprised of several layers. The function of a dressing is to prevent contamination to the wound, keep microorganisms within the wound from infecting other areas, assist with healing, apply pressure, absorb drainage, and prevent further injury to the wound. Application of all layers of a dressing requires sterile technique. C. The application of medication is part of the dressing in this scenario and should be applied using sterile technique. D. If the patient is using the towel directly on the area of the wound, the towel must be sterle and the therapist must use sterile technique to avoid contamination.

Answer 72

stage III Correct Answer: C The National Pressure Ulcer Advisory Panel pressure ulcer staging criteria was developed for use with pressure ulcers. The staging criteria range from I-IV. A. A stage I ulcer is characterized by an observable pressure related alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes in skin color, skin temperature, skin stiffness or sensation. B. A stage II ulcer is characterized by partial-thickness skin loss that involves the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, a blister, or a shallow crater. C. A stage III ulcer is characterized by full-thickness skin loss that involves damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. D. A stage IV ulcer is characterized by full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g., tendon, joint capsule).

Answer 73

presence of Ischemia Correct Answer: B An exercise stress test is used to determine the ability of the cardiovascular system to accommodate for increasing metabolic demand. Patients are typically tested using a bicycle ergometer, treadmill, or upper extremity ergometer. This form of testing provides a general link between a patient's impairment and overall functional capacity. A. A patient that performs an exercise stress test and demonstrates a balanced oxygen supply and demand would typically have a negative stress test. A negative stress test shows that a patient's cardiovascular system was able to handle the expected increasing metabolic demands without any form of ischemia present. B. An exercise stress test is used to determine the presence of ischemia and evaluate the overall functional capacity of a patient. The patient is typically monitored through a 12-lead electrocardiogram and vital signs. An echocardiogram is often used to further assess perfusion. Determination of the presence of ischemia is the goal of the exercise stress test. C. Since an exercise stress test attempts to determine the presence of ischemia, a positive test would typically be characterized by abnormal vital signs appearing at some point during the testing procedure. D. Cardiac arrhythmias are not necessary to have a positive stress test. The exercise stress test is designed to determine the presence of ischemia.

Answer 74

the involved extremity cannot be elevated Correct Answer: C There are a wide range of cryotherapeutic agents commonly used in physical therapy including cold whirlpool, ice packs, ice massage, cold sprays, and contrast baths. Physical therapists should be aware of the advantages and limitations of each of the identified cryotherapeutic agents. A. Cryotherapy decreases metabolic reactions including those involved in the inflammatory process. B. Cryotherapy initially causes local vasoconstriction of smooth muscles in an attempt to conserve heat. Vasoconstriction is responsible for decreasing the formation and accumulation of edema. C. Cold water immersion is an acceptable form of cryotherapy however, is not ideal when treating an acute lower extremity injury since the injured limb cannot be elevated. Inflammation is most effectively controlled if the cryotherapeutic agent is applied in conjunction with elevation and compression. Several other cryotherapeutic agents such as ice packs or Cryo Cuff may be more desirable interventions. D. Cryotherapy decreases the nerve conduction velocity of both sensory and motor nerves. Cryotherapy has the greatest effect on the conduction velocity of myelinated and small fibers, and the least effect on the conduction velocity of unmyelinated and large fibers.

Answer 75

latissimus dorsi tightness Correct Answer: B A posterior pelvic tilt results in the posterior superior iliac spines of the pelvis moving posteriorly and inferiorly. This motion results in hip extension and lumbar spine flexion. A. The capsular pattern at the glenohumeral joint is lateral rotation, abduction, and medial rotation. A capsular pattern of restriction at the glenohumeral joint would limit range of motion, however, would not be influenced by the position of the pelvis. B. Shortening of the latissimus dorsi often results in a limitation of shoulder flexion or abduction due to the muscle's origin on the external lip of the iliac crest and its insertion on the intertubercular groove of the humerus. C. Pectoralis minor tightness may have a direct effect on shoulder range of motion, however, would not be influenced by the position of the pelvis. Pectoralis minor tightness is often best identified by positioning a patient in supine with the arms at their side and the palms facing upward. The relative tightness of the muscle is determined by the extent to which the shoulder is raised from the table and the amount of resistance felt to downward pressure on the shoulder. D. Quadratus lumborum tightness may affect the ability of the pelvis to achieve the posterior pelvic tilt position required in the question, however, would not affect shoulder range of motion since the muscle does not directly attach to the shoulder joint.

Answer 76

Hypertension Correct Answer: A Anorexia nervosa is an eating disorder characterized by the inability to maintain a normal weight secondary to extreme dietary and exercise habits. Patients with anorexia have body dysmorphia as well as a fear of becoming overweight. Signs and symptoms associated with anorexia include bradycardia, hypotension alternating periods of dehydration and water retention, electrolyte imbalances, cardiac arrhythmias, amenorrhea, muscle weakness and decreased bone density. A. Hypertension is not a sign associated with anorexia. In fact, hypotension is far more likely with this condition. Hypotension occurs in response to the decreased basal metabolic rate that accompanies anorexia. B. Cardiac dysfunction is commonly seen with anorexia. Bradycardia and hypotension in conjunction with altered electrolyte levels can result in the onset of cardiac arrhvthmias. C. Self-starvation results in severe malnutrition for patients with anorexia. Hypokalemia (i.e., low levels of potassium in the blood is commonly observed and can cause a variety of symptoms, such as cardiac arrhythmias and fatigue. D. Low bone mineral density is commonly associated with anorexia. There are several causes for decreased bone density including low body weight, malnutrition, decreased physical activity, amenorrhea, estrogen deficiency, and high cortisol levels.

Answer 77

Independent self-range of motion of the lower extremities Correct Answer: D A patient with C6 tetraplegia does not have sufficient motor innervation to consistently perform independent self-range of motion of the lower extremities. The lowest motor innervations at the C6 level includes extensor carpi radialis, infraspinatus, latissimus dorsi, pectoralis major, teres minor, pronator teres, and serratus anterior. A. A patient with C6 tetraplegia can provide pressure relief using a wheelchair with push handles or loops attached. B. A patient with C6 tetraplegia can perform manual wheelchair propulsion with friction surface handrims or rim projections C. A patient with C6 tetraplegia can perform assisted to independent transfers using a sliding board. A patient with C7 tetraplegia is typically independent with transfers with or without a sliding board. D. A patient with C6 tetraplegia cannot typically perform self-range of motion of the lower extremities. The activity is more appropriate for a patient with C7 tetraplegia.

Answer 78

difficulty propelling the wheelchair Correct Answer: C Seat width is determined by measuring the widest aspect of the user's buttocks, hips or thighs and adding approximately two inches. This provides space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel. The standard seat width for an adult wheelchair is 18 inches A. Difficulty changing position within the wheelchair may be due to a wheelchair that is too small and constricts movement. A seat with excess width would not prohibit the patient from moving within the wheelchair. B. Insufficient trunk support may be due to a wheelchair that has less back support than is recommended. Back support is measured from the seat of the chair to the floor of the axilla with the patient's shoulder flexed to 90 degrees and then subtract approximately four inches. This will allow the back height to be below the inferior angles of the scapulae. The standard back height is 16-16.5 inches. C. Difficulty propelling a wheelchair may be due to excessive seat width. This will require the patient to stabilize at the shoulders and excessively abduct the upper extremities to reach the wheels. This produces a less functional push and increases the difficulty maneuvering through tight spaces. D. Increased pressure to the distal posterior thighs typically results from excessive seat depth. Seat depth is measured from the patient's posterior buttocks, along the lateral thigh to the popliteal fold; then subtract approximately two inches to avoid pressure from the front edge of the seat against the popliteal space. The standard seat depth for an adult wheelchair is 16 inches.

Answer 79

symmetrical tonic neck reflex Correct Answer: B Primitive reflexes are reflexes which begin in utero or in early infancy. Most of these reflexes become integrated as the infant ages. Integration denotes that the reflex is no longer present when the stimulus is provided. Failure to integrate primitive reflexes can lead to impaired movement. A. The Galant reflex is stimulated by stroking lateral to the spine. The response is lateral sidebending to the same side as the side of the stimulus. An infant would typically be able to maintain the quadruped position if this reflex was stimulated. B. Head positioning is the stimulus for the symmetrical tonic neck reflex. When the head is flexed, the upper extremities flex and the lower extremities extend. When the head extends, the upper extremities extend and the lower extremities flex. The reaction of the extremities would not allow the infant to maintain a quadruped position. C. The plantar grasp reflex is stimulated by placing pressure on the ball of the foot, generally in standing. The response is for the toes to curl or flex. The reflex will have no impact on an infant's ability to maintain quadruped since the balls of the feet are not in contact with the floor. D. The positive support reflex is stimulated by bearing weight through the feet. The response is for the lower extremities to extend, thereby allowing the infant to bear weight through the lower extremities. The reflex will have no impact on an infant's ability to maintain quadruped since they are not bearing weight through the feet.

Answer 80

schedule the patient with another physical therapist on Wednesday at 4:30 Correct Answer: C The Guide for Professional Conduct published by the American Physical Therapy Association states that physical therapists shall respect the rights and dignity of all individuals. It is therefore necessary for the physical therapist to consider not only what is best for the patient in question, but also what is best for all of the patients being treated by the physical therapist. A. Scheduling the patient on Wednesday at 4:30 will result in the physical therapist having three patients scheduled at the same time. It is unlikely that the physical therapist will be able to provide the requisite level of care for each patient given the number of patients. B. Attempting to move a patient who is already scheduled to another appointment is not considerate of the patient's particular needs. It is the physical therapist's responsibility to ensure that each patient in their care is treated with the utmost respect. C. Scheduling with another physical therapist will allow the patient to be seen two times per week as indicated on the referral and will accommodate the patient's schedule. D. Informing the physician that the patient cannot be seen two times per week in physical therapy is not usually considered necessary information to communicate to the physician. When possible, physical therapists should attempt to provide patients with the necessary frequency of physical therapy.

Answer 81

controls for differences between subjects Correct Answer: A Researchers may employ a number of design strategies to manipulate and control variables and measurements to strengthen the validity of their experiment and demonstrate a cause-and-effect relationship between the independent and dependent variables. A. In a repeated measures design all subjects experience all levels of the independent variable. This provides an efficient method for controlling differences between subjects because characteristics that may affect the outcomes, such as gender, age and physical characteristics, remain constant for each subject. Differences in outcomes can be attributed to the treatment. Since each subject acts as his own control, a repeated measures design is also called a within-subjects design. B. In its most complete form, blinding involves hiding the identity of group assignments from the subjects, from those who provide treatment, from those who measure the outcome variables, and from those who analyze the data. A repeated measures design may or may not include "blinding." C. The design strategy that ensures that subjects with similar characteristics are assigned to different treatment groups is called matching. A repeated measures design may or may not include matching. D. By selecting subjects who are homogenous with respect to a specific trait, the researcher eliminates these traits as variables that may interfere with the dependent variable. A repeated measures design may or may not use homogeneous subjects.

Answer 82

greater frequency Correct Answer: B Motor stimulation requires sufficient phase charge to elicit a muscle contraction. This is accomplished by using a low frequency and long phase duration. Sensory stimulation, also called conventional TENS, requires a sufficient phase charge to achieve a sensory response, but is below the motor threshold. This is accomplished by using a high frequency and short phase duration. A. Phase duration is shorter with sensory level stimulation compared to motor level stimulation. B. Frequency is significantly greater with sensory level stimulation compared to motor level stimulation. C. Sensory level stimulation requires lower amplitude than motor level stimulation D. Treatment time is highly variable with sensory and motor stimulation TENS.

Answer 83

acromioclavicular arthritis Correct Answer: C It is important for physical therapists to collect as much information as possible about a patient's present pain. Many diagnoses have characteristic patterns of pain which can be useful when engaging in differential diagnosis activities. A. A patient with anterior glenohumeral instability would be more likely to experience pain with terminal shoulder lateral rotation. B. A patient with posterior glenohumeral instability would be more likely to experience pain with terminal shoulder medial rotation. C. A patient with acromioclavicular arthritis would likely experience pain with terminal shoulder abduction. The acromioclavicular joint is a diarthrodial joint formed by the medial margin of the acromion and the lateral end of the clavicle. Degenerative changes of the acromoclavicular joint include narrowing of the joint space and the formation of osteophytes. D. A patient with bicipital tendonitis would be more likely to experience pain with shoulder extension with the elbow extended.

Answer 84

urge to urinate frequently Correct Answer: D Benign prostatic hyperplasia (BPH is an enlargement of the prostate that commonly occurs in men over 50 years old. The enlargement of the prostate squeezes the urethra and interferes with urinary function and, less frequently, sexual function. A. BPH is more commonly associated with lower abdominal, low back or thigh pain, not epigastric pain. B. Though a patient with BPH may experience urinary problems, painful urination is not typically one of the symptoms. Painful urination is more likely with conditions such as prostatitis. C. Though a patient with BPH may experience sexual dysfunction (e.g., difficulty attaining an erection), painful ejaculation is not typically one of the symptoms. Painful ejaculation is more likely with conditions such as prostatitis. D. Patients with BPH typically have issues passing urine due to the enlargement of the prostate and its position next to the urethra. Symptoms include hesitancy of urination, small amounts of urine when voiding, dribbling at the end of urination, urge to urinate frequently, and nocturia.

Answer 85

intravenous injection Correct Answer: A Bioavailability refers to the percentage of a drug that ultimately reaches the systemic circulation. The method of drug administration affects bioavailability since the drug must difluse across cell membrane barriers and may also experience liver metabolism. A. Intravenous injection is the only method of drug administration that ensures 100% bioavailability. By injecting the drug directly into the systemic circulation, the drug is fully available to the bloodstream and thus the target tissues. B. A drug administered orally would not be 100% bioavailable. The drug will travel down the gastrointestinal tract and must be absorbed through the intestines to reach the bloodstream. The entire dose of the drug may not pass through the intestinal wall. Even if the drug does pass through the intestinal wall, it then must travel through the liver (known as the first-pass effect). In the liver, the drug may experience significant metabolization before reaching the systemic circulation. C. A drug administered via inhalation must diffuse across the alveoli where it then enters the pulmonary circulation. From the pulmonary circulation, it is transported directly to the heart and enters the systemic circulation. Though this form of administration avoids the first-pass effect of the liver, the drug still needs to be absorbed across the alveolar membrane and therefore is not 100% bioavailable. Additionally, drug particles may be trapped by cilia and mucus within the respiratory tract and not even reach the alveoli. D. A drug administered sublingually is absorbed through the oral mucosa into the venous system. The veins carry the drug to the heart where it can then enter the systemic circulation. Though sublingual administration avoids the first pass effect of the liver, it still needs to be absorbed through the oral mucosa and is therefore not considered to be 100% bioavailable.

Answer 86

midstance to heel off Normal ankle range of motion needed for the stance phase of gait is 20 degrees of plantar flexion to 15 degrees of dorsiflexion Limited range of motion is one of several reasons a patient may demonstrate deviations in gait. Patients who are on bed rest may develop a plantar flexor contracture secondary to the positioning of the ankle under the sheets. A. Heel strike requires 0 degrees of dorsiflexion which progresses to 15 degrees of plantar flexion at foot flat. A patient with a plantar flexion contracture may have difficulty with heel strike, however, they would have greater difficulty with other phases of the gait cycle. B. Foot flat requires 15 degrees of plantar flexion which progresses to 10 degrees of dorsiflexion at midstance. A patient with a plantar flexion contracture may have difficulty with the end of this phase (i.e., midstance), however, they would have greater difficulty with other phases of the gait cycle. C. Midstance requires 10 degrees of dorsiflexion which progresses to 15 degrees of dorsiflexion at heel off. A patient with a plantar flexion contracture would have the most difficulty with this phase of gait since it requires the largest range of motion for dorsiflexion. D. Heel off requires 15 degrees of dorsiflexion which progresses to 20 degrees of plantar flexion at toe off. Though heel off requires the maximum amount of dorsiflexion (i.e., 15 degrees), the majority of this phase occurs with the ankle in plantar flexion. Therefore, the patient would have less difficulty with this phase than with the midstance to heel off phase.

Answer 87

zinc Correct Answer: D lontophoresis refers to the transcutaneous delivery of ions into the body for therapeutic purposes using an electrical current. Physical therapists must possess an in-depth awareness of the most appropriate ions to treat specific conditions A. Acetate, from acetic acid, is a negatively charged ion used to treat calcific deposits. B. Magnesium, from magnesium sulfate, is a positively charged ion used as a muscle relaxant and vasodilator. C. Lidocaine, from xylocaine, is a positively charged ion used to treat pain and inflammation associated with acute inflammatory conditions. D. Zinc, from zine oxide, is a positively charged ion used to promote healing, most often with open lesions and ulcerations.

Answer 88

place the hands on the left side of the chest below the axilla Correct Answer: A Segmental breathing, also known as localized breathing or thoracic expansion exercise, is intended to improve regional ventilation in patients with pulmonary disease and to prevent and treat pulmonary complications after surgery. The technique combines positioning with tactile and verbal cueing and resistance to enhance expansion of a specific lung segment to facilitate chest wall motion and increase ventilation. A. The lingula is a segment of the left upper lobe. Placing the hands on the left side of the chest below the axilla would provide tactile stimulation to facilitate expansion of the chest wall to improve ventilation of the left upper lobe. B. Placing the hands below the clavicle on the anterior chest wall would provide tactile stimulation to the anterior segments of the upper lobes, but not the lingula C. Placing the hands over the posterior aspect of the lower ribs would provide tactile stimulus over the lateral basal segments of the right and left lower lobes, not the lingula. D. Placing the hands on the right side of the chest below the axilla would be overlying the right middle lobe, not the lingula.

Answer 89

heart rate and workload Correct Answer: B Because maximal exercise testing is not always feasible, practitioners often rely on submaximal exercise tests to assess cardiorespiratory fitness. In addition to the heart rate response, it is recommended that the individual's functional response to exercIse is examined. A. Rate of perceived exertion (RPE) is one of the indices commonly measured as a response to exercise. However oxygen uptake cannot be determined from heart rate and RPE. B. The physical therapist can use the heart rate response to one or more submaximal workloads to predict maximum oxygen uptake. C. Rate of perceived exertion (RPE) and blood pressure are commonly measured as a response to exercise. However, oxygen uptake cannot be determined from blood pressure and RE D. Blood pressure is one of the indices commonly measured as a response to exercise. However, oxygen uptake cannot be determined from blood pressure and workload.

Answer 90

emphysema Correct Answer: D Due to the pathologic changes in alveoli, patients with emphysema often have increased total lung capacity from "air trapping." Over time, many patients develop a barrel-shaped configuration of the thorax. The anteroposterior diameter enlarges to approximate the transverse diameter. The diaphragm is depressed and the sternum pushed forward with the ribs attached in a horizontal, not angular, fashion. As a result, the chest appears continuously in the inspiratory position. A. Asthma is a chronic inflammatory disease of the airways. Clinical features include cough, dyspnea, and wheezing, but not an enlarged thorax. B. Bronchiectasis is a permanent, abnormal dilatation of one or more bronchi caused by destruction of the elastic and muscular components of the bronchial walls. Common clinical features include recurrent pulmonary infections with cough and copious mucopurulent sputum, but not an enlarged thorax. C. Chronic bronchitis is defined as hypersecretion of mucus sufficient to cause a productive cough on most days for three months during two consecutive years, but not an enlarged thorax. D. Emphysema is an obstructive pulmonary disease characterized by destruction of alveoli leading to hyperinflation of the lungs. A barrel-shaped configuration of the thorax is a common clinical feature of the disease.

Answer 91

tidal volume Correct Answer: A Tidal volume is the total volume of air inhaled or exhaled during quiet breathing. Total lung capacity is the maximum volume of air to which the lungs can be expanded. Normal tidal volume is approximately 10% of total lung capacity. A. While there is wide variability in tidal volume in the normal population, the average for a healthy adult is around 500 mL(# 100 mL). Total lung capacity is the maximum volume of air to which the lungs can be expanded, typically 4,000-6,000 mL Thus, normal tidal volume is approximately 10% of total lung capacity. B. Inspiratory reserve volume is the additional volume of air that can be inhaled beyond the normal tidal inhalation. The inspiratory reserve volume varies, however, should represent approximately 55% to 60% of total lung capacity. C. Residual volume is the volume of air remaining in the lungs after a forced expiratory effort. This volume is usually 1,000 mL and approximates 25% of total lung capacity. D. Functional residual capacity is the amount of air remaining in the lungs at the end of a normal tidal exhalation. This volume approximates 40% of total lung capacity.

Answer 92

posterior joint capsule Correct Answer: B The glenohumeral joint is a synovial ball and socket joint, in which the round head of the humerus (convex) articulates with the shallow glenoid cavity (concave) of the scapula. The glenohumeral joint has three degrees of freedom. The capsule of the glenohumeral joint is reinforced by the superior glenohumeral ligament, middle glenohumeral ligament, inferior glenohumeral ligament, and the coracohumeral ligament. A. A firm end-feel caused by the anterior joint capsule would most often be associated with lateral rotation of the glenohumeral joint as the humeral head slides anteriorly on the glenoid fossa. B. A firm end-feel caused by the posterior joint capsule would most often be associated with medial rotation ot the C. glenohumeral joint as the humeral head slides posteriorly on the glenoid fossa. A firm end-feel caused by the Inferior joint capsule would most often be associated with flexion and abduction of the glenohumeral joint. In flexion, the humeral head moves posteriorly and inferiorly, and in abduction the humeral head moves inferiorly. D. A firm end-feel caused by the superior joint capsule would most often be associated with extension and adduction of the glenohumeral joint. In extension, the humeral head moves anteriorly and superiorly, and in adduction the humeral head moves superiorly.

Answer 93

passive insufficiency of the knee extensors Correct Answer: C Passive insufficiency occurs when a two-joint muscle is passively stretched across two joints at the same time resulting in an inability to permit normal elongation simultaneously over both joints. When the muscle is in a lengthened position, the actin filaments are pulled away from the myosin heads so that they cannot create as many cross-bridges. Active insufficiency occurs when a two-joint muscle is incapable of shortening to the extent necessary to produce full range of motion at all joints crossed simultaneously. When the muscle is in a shortened position the overlap of actin and myosin reduces the number of sites available for cross-bridge formation A. Active insufficiency occurs with active movement and not passive movement. The question specifically asks about passive knee flexion. B. Active insufficiency occurs with active movement and not passive movement. C. Passive insufficiency refers to a lack of muscle length. When performing passive knee flexion the two-joint knee extensors are placed on stretch and therefore in the presence of insufficient length, may contribute to a limitation in knee flexion. D. When performing passive knee flexion, the knee flexors would shorten and therefore would not limit knee flexion range of motion.

Answer 94

use small electrodes Correct Answer: B Resistance refers to the opposition to electron flow in a conducting material. A. Water serves as a conductive substance that reduces electrode resistance. B. Small electrodes increase electrode resistance, while large electrodes decrease electrode resistance. C. Uneven or inadequate contact or pressure from the electrodes increases electrode resistance and can severely limit the effectiveness of electrotherapy. D. Hair can cause nonuniform conduction at the skin-electrode interface and therefore it is important that the skin be appropriately prepared by cleaning and potentially clipping if necessary.

Answer 95

meningitis Correct Answer: B Genetic testing can be used to identify a mutation that confirms a potential risk to an unborn child. Common testing procedures include amniocentesis, ultrasonography, serum marker screening, and genetic screening. A. Cystic fibrosis is characterized by the exocrine glands overproducing thick mucus that causes subsequent obstruction. The disease is an autosomal recessive genetic disorder located on the long arm of chromosome seven. Testing during pregnancy for cystic fibrosis most commonly includes chorionic villus sampling and amniocentesis. B. Meningitis is characterized by inflammation of the meninges of the brain and spinal cord. The condition is caused by a bacterial or viral Infection that spreads through the cerebrospinal fluid to the brain. A lumbar puncture is the gold standard for diagnosis. Early diagnosis is essential to avoid permanent neurological damage. Meningitis is not hereditary and therefore would not require genetic testing. C. Phenylketonuria is characterized by behavioral and cognitive issues secondary to an elevation of serum phenylalanine. The disease is an autosomal recessive inherited trait and is most common in Caucasians. Testing during pregnancy for phenylketonuria includes chorionic villus sampling and amniocentesis. All newborns in the United States are tested shortly after birth through a blood sample. The testing procedure is used to test for a variety of metabolic disorders including phenylketonuria. D. Tay-Sachs disease is characterized by the absence or deficiency of hexosaminidase A. This produces an accumulation of gangliosides within the brain. The disease is an autosomal recessive inherited trait that is carried primarily in the Eastern European (Ashkenazi) Jewish population. Testing during pregnancy for Tay-Sachs most commonly includes chorionic villus sampling and amniocentesis.

Answer 96

talipes equinovarus Positional deformities are abnormalities that are mechanically produced by the fetal environment. The deformities are most often caused by restrictions in fetal movement or fetal compression. Early identification of the deformities is critical to minimize the impact of the deformities on the developing newborn. A. Calcaneovalgus is a foot deformity characterized by the forefoot being curved out laterally, the hindfoot positioned in valgus, and full or even excessive dorsiflexion range of motion. Calcaneovalgus is an extremely common positional deformitv in newborns most often caused by intrauterine positioning. B. Metatarsus adductus is a foot deformity characterized by a medially curved forefoot while the hindfoot remains in normal alignment. The condition is believed to be caused by intrauterine positioning. The presence of metatarsus adductus would not impact a patient's dorsiflexion range of motion. C. Syndactyly refers to the presence of webbed toes or fingers. The genetic condition is most commonly observed between the second and third toes. The presence of syndactyly would not impact a patient's dorsiflexion range of motion. D. Talipes equinovarus, also known as "clubfoot," is a deformity characterized by adduction of the forefoot, varus positioning of the hindfoot, and plantar flexion at the ankle. The positioning associated with talipes equinovarus would likely result in a limitation in dorsiflexion range of motion.

Answer 97

shorter swing phase and shorter step length Correct Answer: A An injury to one extremity will invariably alter the movement pattern in both extremities. Physical therapists must carefully assess the impact of an injury on the entire body A. When an Injury occurs to a single extremity, an individual typically attempts to spend less time weight bearing on the affected extremity. This results in a shortening of the stance time on the affected extremity which requires the unaffected extremity to contact the ground sooner (1.., shorter swing phase). A shorter swing phase on the unaffected extremity typically produces a shorter step length. B. A shorter swing phase on the unaffected extremity tends to shorten step length. C. A longer swing phase on the unaffected extremity is unlikely since this would require the stance phase to be longer on the affected extremity. The amount of pain the patient is experiencing makes this unlikely. D. A longer swing phase on the unaffected extremity typically produces a longer step length, however, the longer swing phase on the unaffected extremity is unlikely for the reasons discussed in option 3

Answer 98

concurrent validity Correct Answer: C Concurrent validity refers to the relationship between test scores and either criterion states or measurements whose validity is known. A. Face validity refers to whether the test "looks valid" to those who take and administer it. It refers, not to what the test actually measures, but to what it appears superficially to measure. B. Predictive validity is a form of validity that is demonstrated when a score is helpful in predicting a specific future outcome. Examples of tests with predictive validity are career or aptitude tests, which are helpful in determining who is likely to succeed or fail in certain subjects or occupations. C. Concurrent validity is demonstrated when a test score correlates well with a measure that has previously been validated. This is the circumstance in the example, where the functional independence measure would have concurrent validity if a strong relationship can be shown between its scores and scores on a previously validated measurement. D. Content validity refers to the extent to which a measure represents all facets of a given concept or construct.

Answer 99

C6 Correct Answer: B The ability to independently transfer with a sliding board following a spinal cord injury is primarily dependent on the patient's available motor and sensory innervation. In addition to performing independent sliding board transfers, a patient with a C6 spinal cord injury should be able to perform independent bed mobility, coughing, skin inspection, and pressure relief with equipment and adaptations A. A patient with a C4 spinal cord injury would not have adequate upper extremity movement to be capable of completing the transfer. Primary muscles innervated include the diaphragm and trapezius. B. A patient with a C6 spinal cord injury would possess the requisite upper extremity strength to make the transfer feasible. Primary muscles innervated include the extensor carpi radialis, Infraspinatus, latissimus dorsi, pectoralis major, pronator teres, serratus anterior, and teres minor. C. A patient with a TI spinal cord injury would possess full upper extremity innervation and should be able to complete the transfer. The option is not the correct response since the item asks the highest spinal cord injury level where the transfer is feasible. D. A patient with a T3 spinal cord injury should also be able to complete the transfer. The patient's clinical presentation would be consistent with the patient at the TI level.

Answer 100

heel loops and/or toe loops There are a variety of wheelchair components that can assist patients to achieve maximum function, comfort, stability, and protection. The specific components selected are based on the unique needs of each patient. A. A hydraulic reclining unit would allow the patient to recline in the actual chair. Semi-reclining chairs recline to approximately 30 degrees from the vertical and fully reclining chairs recline to a horizontal position. B. Elevating legrests allow the entire front rigging to be elevated and maintained at varying heights. Patients with inadequate knee flexion, a long leg cast or circulatory compromise may use this type of adaptation. C. Heel loops and/or toe loops can maintain the foot on the footrest. This is often necessary in the presence of spasticity. D. Detachable swing-away legrests allow the front rigging to be pivoted outward away from the wheelchair frame. This adaptation allows the wheelchair to be positioned closer to objects and provides more unobstructed space to transfer.

Answer 101

epigastric area Correct Answer: B The degree of respiratory impairment is related to the level of the spinal cord injury, residual muscle function, trauma at the time of injury, and premorbid respiratory status. Weakness or paralysis of the external oblique muscles compromises the patient's ability to cough and expel secretions. A. The manubrium is the broad, quadrangular shaped upper part of the sternum. This region is too high to provide effective pressure support for coughing. B. The epigastric area is the upper central region of the abdomen, located between the costal margins and the subcostal plane. Applying manual hand pressure inwards and upwards over the epigastric area can assist the patient to cough and promote airway clearance. C. The xiphoid process is a small cartilaginous extension to the lower part of the sternum that is usually ossified in the adult. Pressure over this region should be avoided. D. The umbilical region is the area surrounding the umbilicus (i.e., belly button). This region is too low to provide effective pressure support for coughing.

Answer 102

posterior to the lateral malleolus Correct Answer: C The peroneus longus and brevis are innervated by the superficial peroneal nerve (L4, L5, S1) and act to evert the foot and assist in plantar flexion of the ankle joint. The peroneus longus also acts to depress the head of the first metatarsal. A. The sustentaculum tali is a horizontal eminence arising from the medial surface of the calcaneus. The bony prominence serves as the attachment for several ligaments including the plantar calcaneonavicular ligament, also known as the spring ligament. B. The sinus tarsi is a small osseous canal which runs into the ankle under the talus bone. The structure is at the same approximate level as the lateral malleolus C. The peroneus longus and brevis tendons pass posterior to the lateral malleolus. The peroneus longus inserts on the lateral side of the base of the first metatarsal and first cuneiform, while the peroneus brevis inserts on the tuberosity of the fifth metatarsal D. The tendon of the extensor digitorum longus can be palpated slightly anterior to the lateral malleolus.

Answer 103

increase the rest periods during existing treatment sessions Correct Answer: C The Rancho Los Amigos Levels of Cognitive Functioning Scale is used to describe cognitive and behavioral recovery in individuals following traumatic brain injury. A patient at level IV is labeled Confused-Agitated. A. Reducing the treatment sessions to 30 minutes in length would result in a fifty percent decrease in therapy time. It is possible that this may be necessary, however, the therapist should attempt to modify other parameters of treatment prior to implementing such a drastic reduction in therapy time. B. Reducing the frequency of the sessions to two times per week would likely have minimal impact on the patient's behavior without reducing the length of the sessions or incorporating more frequent rest periods. C. A patient functioning at level IV may be particularly susceptible to changes in behavior based on fatigue. Ideally, the physical therapist should attempt to maintain the integrity of the current treatment regimen, however, if increased rest periods do not produce an observable change in the patient's behavior it may be appropriate to modify other parameters such as the frequency or length of treatment. D. It is likely that the length of the session, currently 60 minutes, may be more challenging for the patient than the frequency of the sessions. As a result, increasing the duration of the treatment sessions to 90 minutes would likely exacerbate the current situation.

Answer 104

over the olecranon process Correct Answer: D According to the American Academy of Orthopedic Surgeons, normal shoulder medial rotation is 0-70 degrees. A. The lateral midline of the humerus using the lateral epicondyle as a reference should be used to align the moveable arm of the goniometer when measuring shoulder flexion and extension. B. The stationary arm of the goniometer should be aligned parallel or perpendicular to the floor when measuring medial rotation of the shoulder. C. The midaxillary line of the thorax should be used to align the stationary arm of the goniometer when measuring shoulder flexion and extension. D. The fulcrum of the goniometer should be aligned over the olecranon process. The moveable arm of the goniometer should be aligned with the ulna, using the olecranon and ulnar styloid as a reference when measuring medial rotation of the shoulder.

Answer 105

dependent edema Correct Answer: C Heart failure refers to the heart's inability to maintain a cardiac output that is adequate to meet the demands of the tissues due to an abnormality in the pumping ability of the heart muscle. Left-sided heart failure means it is the left side of the heart that is failing which causes fluid to build up behind the left ventricle. Left-sided failure is frequently caused by myocardial infarction hypertension, or aortic valve disease. A. Pulmonary edema is the abnormal accumulation of fluid in the alveolar spaces of the lungs. This is the "congestion" of congestive heart failure. It is often caused by increased pulmonary hydrostatic pressure from left-sided heart failure. B. Patients with left-sided failure may be in respiratory distress and have a cough that produces pink, frothy (blood-tinged) sputum. C. Dependent edema is associated with right sided heart failure. Fluid backs up behind the right ventricle and produces the accumulation of fluid in the liver, abdomen and ankles. D. Muscle weakness, fatigue, and decreased exercise tolerance are universal among patients with left-sided heart failure due to the decreased blood flow to the extremities.

Answer 106

psychotic disorder Correct Answer: D Tardive dyskinesia is an extrapvramidal adverse effect that can routinely occur with administration of neuroleptic (antipsvchotic) medications. Tardive dyskinesia presents with involuntary and fragmented choreoathetoid movements. Rhythmic movements of the tongue, mouth, and jaw are often present. A. Endometriosis refers to the development of endometrial tissue, which normally lines the uterus, in extrauterine locations within the abdomen and pelvis. The most common location of extrauterine endometrial growth occurs at the uterosacral ligaments. Pharmacological intervention may be indicated to alter hormonal balance using oral contraceptives and antigonadotropins. These medications are not associated with tardive dvskinesia. B. Rheumatoid arthritis is a systemic autoimmune disorder of unknown etiology. The disease presents with a chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule. Pharmacological management includes NSAIDs, corticosteroids, and disease-modifying antirheumatic medications. These medications are not associated with tardive dyskinesia. C. Hypertension in adults is a sustained elevation of systolic pressure ≥ 140 mm Hg or diastolic pressure ≥ 90 mm Hg. Classes of medications for hypertension include diuretics beta blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, and direct vasodilators. These medications are not associated with tardive dyskinesia. D. Psychosis is a severe mental disorder in which thoughts and emotions are impaired to an extent that contact is lost with external reality. Traditional antipsychotic agents produce increased extrapvramidal (motor) side effects, tardive dyskinesia, pseudoparkinsonism, constipation and dry mouth. Haldol and Thorazine are two examples of antipsychotic medications that can produce tardive dyskinesia.

Answer 107

walking on a treadmill at 3 mph Correct Answer: D One metabolic equivalent is the amount of oxygen consumed at rest and is equal to approximately 3.5 milliliters of oxygen per kilogram of body weight per minute. A. Level walking at 1 mph is approximately 1-2 METS B. Jogging at 5 mph is approximately 7-8 METs. C. Cycling at 10 mph is approximately 5-6 METs. D. Walking on a treadmill at 3 mph is approximately 3-4 METs.

Answer 108

anterior interosseous syndrome Correct Answer: B An understanding of the typical clinical presentation of common medical diagnoses is essential in developing an appropriate plan of care and determining realistic outcome expectations. A. Anterior compartment syndrome is a serious medical condition that causes compression of nerves and blood vessels in the anterior compartment of the lower leg. The result is a dangerous disruption of nerve conduction and blood flow that can threaten the viability of the limb. Anterior compartment syndrome would not impact upper extremity B. Anterior interosseous syndrome is characterized by an injury to the anterior interosseous nerve, a branch of the median nerve which is sometimes pinched or entrapped as it passes between the two heads of the pronator teres muscle. This leads to pain and functional impairment of the flexor pollicis longus, the lateral half of the flexor digitorum profundus, and the pronator quadratus muscles. C. Cubital tunnel syndrome is associated with compression of the ulnar nerve at the elbow. Complaints of pain paresthesia, and muscle weakness are typical in the ulnar nerve distribution (i.e., 4th and Sth digits). The flexor pollicis longus, flexor digitorum profundus, and pronator quadrates muscles would not be affected by involvement of the ulnar D. Erb's palsy is a term used to denote an upper brachial plexus injury or palsy that usually results from a difficult birth. The muscles affected are supplied by cervical roots CS and C6 which results in a loss of function of the rotator cuff, deltoid, brachialis, coracobrachialis, and biceps brachil. The flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles receive innervation from the roots of C8-TI

Answer 109

Dysarthria Correct Answer: B Phonetics is the study of sound in speech. It focuses on how speech is physically created and received. Phonetics is the primary focus in the treatment of dysarthria since articulatory precision is necessary to improve overall intelligibility. A. Broca's aphasia, also known as expressive aphasia, occurs with a lesion to the frontal lobe in the dominant (typically left hemisphere that results in impairment of speech and expression. The treatment emphasis includes family training, group therapy, and compensatory strategies for communication. A task-oriented approach is preferred since it allows for therapeutic intervention through performing familiar tasks. Therapists must avoid activities that require substantial verbal output from the patient and allow adequate time for the patient to process verbal information. B. Dysarthria is a motor disorder of speech that is caused by an upper motor neuron lesion. The condition affects the muscles that are used to articulate words and sounds. Speech is often noted as "slurred" and there may also be an effect on respiratory or phonatory systems due to weakness. Treatment focuses on improving the intelligibility of speech by strengthening all aspects of speech production through phonetics. Exercises will also work on coordination and articulatory precision. C. Verbal apraxia is a non-dysarthric and non-aphasic impairment of prosody (stress and intonation) and articulation of speech Verbal expression is impaired due to deficits in motor planning. A patient is unable to initiate learned movement (articulation of speech) even though they understand the task. Intonation drills and rhythmic techniques are used in the treatment of verbal apraxia. D. Dysphagia is the inability to properly swallow. Treatment focuses on proper body positioning and compensatory strategies to avoid aspiration when swallowing. Educational activities include topics such as the use of thick liquids and conscious swallowing.

Answer 110

manual muscle tests Correct Answer: C Physical therapists often form a clinical hypothesis and test the established hypothesis using clinical testing. The selected test or tests should help to accept or reject the established hypothesis. A. Passive joint motion testing is commonly used with a suspected capsular restriction. A capsular restriction would present with decreased passive and active range of motion with pain during motion. B. Special tests isolating flexibility are commonly used with a suspected musculotendinous limitation. A musculotendinous limitation would present with decreased passive and active range of motion. C. Manual muscle tests are commonly used with suspected muscle weakness. Muscle weakness would present with normal passive range of motion and decreased active range of motion. Normal knee flexion is 0-135 degrees. D. Diagnostic imaging is commonly used with suspected internal derangement. Internal derangement would present with decreased passive and active range of motion with pain during motion.

Answer 111

hyperactivity of the thyroid gland Correct Answer: D A physical therapist should possess a basic understanding of the pathophysiology associated with commonly encountered medical conditions. This information is critical when designing an appropriate plan of care in order to optimize patient outcomes and preserve patient safety. A. Inflammation of the lining of the digestive tract is associated with Crohn's disease. The condition is a specific form of inflammatory bowel disease. Symptoms may develop gradually or rapidly and typically include abdominal pain, cramping, and diarrhea. Other symptoms may include blood in the stool, gastrointestinal tract ulcers, diminished appetite and weight loss. B. Insufficient insulin production from the pancreas is associated with type 1 diabetes mellitus. Symptoms of diabetes mellitus include polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision, dehydration, and fatigue. C. Hypofunction of the adrenal cortex is associated with Addison's disease. Subsequently, there is decreased production of both cortisol and aldosterone. Symptoms may include hypotension, weakness, anorexia, and altered pigmentation. D. Hyperactivity of the thvroid gland is associated with Graves' disease. The condition is an autoimmune disease in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to become overactive. Symptoms include mild enlargement of the thyroid gland (goiter), heat intolerance, nervousness, tremor, weight loss, and palpitations.

Answer 112

corticosteroid agents Correct Answer: B Rheumatoid arthritis is a systemic autoimmune disorder that presents with a chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule. Pharmacological management typically includes nonopioid analgesic agents, corticosteroid agents, disease-modifying antirheumatic agents, and biologic response modifiers. A. Nonopioid analgesic agents (acetaminophen, Motrin) provide analgesia and pain relief, produce anti-inflammatory effects and initiate anti-pyretic (reduces fever) properties. These drugs promote a reduction of prostaglandin formation that decreases the inflammatory process. Nonopioid analgesic agents are not contraindicated for use with diabetes melitus. B. Corticosteroids (prednisone, Prednisolone) are the most powerful class of anti-inflammatory agents available, however, side effects of short and long-term use can be serious to life-threatening. Patients with diabetes mellitus may be unable to use corticosterolds since a side effect of use is the elevation of blood sugar. C. Biologic response modifiers (Enbrel, Humira) target proteins cells, and pathways responsible for many of the symptoms associated with rheumatoid arthritis. Biologic response modifiers affect immune system function resulting in patients becoming more susceptible to serious infections. These agents are not contraindicated for use with diabetes mellitus. D. Disease-modifying antirheumatic agents (methotrexate, gold) slow or halt the progression of rheumatic disease. They act to induce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease. These agents are not contraindicated for use with diabetes mellitus.

Answer 113

elevate the patient's head Correct Answer: C Postural drainage is the assumption of one or more body positions that allow gravity to drain secretions from each of the patient's lung segments. In each position, the segmental bronchus of the area to be drained is positioned perpendicular to the floor. Postural drainage to the anterior basal segment of the lower lobes would require the bottom of the bed to be elevated 18 inches. A. A subjective complaint of dizziness and mild dyspnea would exceed a "normal" patient response. The physical therapist must act based on the patient's comment even though it would not be entirely unexpected given the necessary patient position for postural drainage of the anterior basal segment of the lower- B. Assessing the patient's vital signs is a desirable option, however, only after the patient is repositioned with the head elevated. C. Dizziness and dyspnea are signs of intolerance to the head down postural drainage position required to drain the anterior basal segments of the lower lobes. Elevating the patient's head will likely relieve the symptoms. D. Calling for assistance is not necessary since the patient's symptoms should subside once the head is elevated.

Answer 114

muscle Correct Answer: B The patient interview provides a physical therapist with an opportunity to identify specific characteristics of pain. Subjective pain descriptors can provide valuable information related to a patient's condition. Characteristics to explore may include location, intensity, description, duration, and pattern. A. Nerve root pain is often characterized as sharp, shooting, and burning. The pain tends to travel in the distribution of the specific nerve root. B. Muscle pain is often characterized as cramping, dull, and aching. The pain tends to worsen when the involved muscle contracts or is lengthened. C. Bone pain is often characterized as deep, intolerable, boring, and highly localized. D. Vascular pain is often characterized as diffuse, throbbing, aching, and poorly localized. The pain is often referred to other parts of the body.

Answer 115

intrarater reliability Correct Answer: B Reliability, or the extent to which a measurement is consistent and free from error, is a prerequisite of any measurement. There are a number of types of reliability that may be estimated: test-retest rater (intrarater and interrater), alternate forms, and internal consistency. A. Interrater reliability refers to the reproducibility of measurements made by two or more raters who measure the same group of subiects. B. Intrarater reliability refers to the reproducibility of measurements made by one individual across two or more trials. C. Internal validity focuses on cause and effect relationships. Specifically, is there evidence that, given a statistical relationship between the independent variable and dependent variable in an experiment, one causes the other. D. External validity refers to the extent to which the results of a study can be generalized beyond the study sample to persons, settings, and times that are different from those employed in the experimental situation. External validity is concerned with the usefulness of the information outside the experimental situation.

Answer 116

signs of confusion and lethargy Correct Answer: A Confusion and lethargy in a patient with diabetes are signs of hypoglycemia or low blood glucose. If untreated, hypoglycemia can rapidly progress towards a life-threatening situation. A. It is important to treat hypoglycemia immediately using glucose tablets or sugar in order to raise blood glucose levels. B. An increase in systolic blood pressure of 20 mm Hg is a normal response to exercise. C. The lack of significant findings in the examination does not warrant immediate medical attention. D. Discovery of significant unknown medical history warrants referral to the physician for possible future examination and follow-up, but does not warrant immediate medical attention.

Answer 117

lateral aspect of the leg and dorsum of the foot Correct Answer: C The superficial peroneal nerve innervates the peroneus longus and brevis. It is a branch of the sciatic nerve. A. The sole of the foot receives cutaneous innervation from the medial and lateral plantar nerves, which are branches of the tibial nerve. The tibial nerve is a branch of the sciatic nerve. B. The plantar surface of the toes is innervated by the medial and lateral plantar nerves, which are branches of the tibial nerve. The tibial nerve is a branch of the sciatic nerve. C. A peripheral nerve injury affecting the superficial peroneal nerve often results in sensory alterations along the lateral aspect of the leg and dorsum of the foot. D. The triangular area between the first and second toes is innervated by the deep peroneal nerve. It is a branch of the sciatic nerve.

Answer 118

a 29-year-old female Correct Answer: A Systemic lupus ervthematosus (SLE) is a connective tissue disorder caused by an autoimmune reaction in the body. The primary manifestation of the condition is the production of destructive antibodies that are directed at the individual's own body. The chronic inflammatory disorder produces a variety of symptoms depending on the severity and extent of involvement. SLE can occur at any age, however, is most common during childbearing years. The disorder is 10-15 times more common in women than men. A. SLE is more common in females and a 29-year-old is within the period of peak incidence (i.e., 15-40 years of age). B. SLE is more common in females, however, a 67-year-old female is significantly older than the period of peak incidence (i.e., 15-40 years of age). C. SLE is less common in males. A 27-year-old is within the period of peak incidence (i.e., 15-40 years of age), however, the fact that the individual is a male makes this answer less likely to be consistent with the established risk profile. D. SLE is less common in males. In addition, a 61-year-old is significantly older than the period of peak incidence (i.e., 15-40 years of age).

Answer 119

a 38-year-old female with a Colles' fracture Correct Answer: A Volumetric measurements are commonly used to measure edema in the distal extremities. The measurement is typically performed by examining the amount of water displaced from a cylinder following immersion of an affected body part. It would be impractical to use this type of measurement in an area other than a distal extremity. A. A Colles' fracture refers to a fracture of the distal end of the radius. The injury would likely result in swelling in the wrist and hand which could be quantified with volumetric measurements. B. The location of the biceps tendon would require immersion of the upper extremity or the entire shoulder complex. The size of the upper extremity would make this unrealistic. C. The location of the rotator cuff would require immersion of the entire shoulder complex which would also be unrealistic due to the size of the area. D. Pulmonary edema refers to swelling or fluid accumulation in the lungs. This condition would be impossible to assess using volumetric measurements.

Answer 120

extinction Correct Answer: B By refusing to acknowledge the child's tantrums the physical therapist avoids reinforcing the behavior. As a result, the tantrums may decrease in frequency and eventually disappear. A. Aversive conditioning is a behavioral therapy technique which reduces the appeal of a behavior by associating the behavior with physical or psychological discomfort. In aversive conditioning, the individual is exposed to an unpleasant stimulus while engaging in the targeted behavior. The goal would be to create an aversion to the targeted behavior. B. Extinction is the withholding of reinforcement for a previously reinforced behavior which decreases the future probability of that behavior. The goal of extinction is a reduction or a loss in the strength of a conditioned response when the unconditioned stimulus or reinforcement is withheld. C. Operant conditioning is learning that takes place when the learner recognizes the connection between the behavior and its consequences. D. Rational emotive imagery is a form of intense mental practice for learning new emotional and physical habits. The behavioral technique focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives.

Answer 121

75 degrees of hip medial rotation and 25 degrees of hip lateral rotation Correct Answer: A Foot progression angle is defined as the angle between the longitudinal axis of the foot and a straight line progression of the body in walking. The obtained value is expressed as a negative number for in-toeing and a positive number for out-toeing. A. Exaggerated hip medial rotation (i.e., 75 degrees) and diminished hip lateral rotation (i.e., 25 degrees) are commonly observed with femoral anteversion which is the most common cause of in-toeing in children. A foot progression angle of - 10 degrees indicates 10 degrees of in-toeing. B. Diminished hip medial rotation (i.e., 35 degrees) and exaggerated hip lateral rotation (ie, 70 degrees) are indicative of femoral retroversion. This type of positioning would not be associated with in-toeing and is more characteristic of out-toeing. C. Diminished hip medial rotation (i.e., 30 degrees) and diminished hip lateral rotation (i.e., 20 degrees) would not necessarily be associated with in-toeing. Although the hip medial rotation value is greater than the hip lateral rotation value, which is characteristic of a negative foot progression angle, both values are well below the expected available range for a four-year-old. D. 45 degrees of hip medial rotation and 45 degrees of hip lateral rotation do not suggest the presence of a torsional condition The values are equivalent and only slightly below the expected sum for children of 95-110 degrees for hip medial and lateral rotation.

Answer 122

gastric ulcer disease Correct Answer: C Bacterial infections can be harmful and potentially life-threatening if left untreated. Bacteria will multiply and utilize nutrients of its host, produce direct tissue damage, and produce an immune response that can ultimately harm the host. Specific medications are used to treat bacteria based on their classification and microorganism. A. Meningitis is the inflammation of the membranes surrounding the brain and spinal cord. There are multiple forms of meningitis and multiple bacteria that can produce this condition. Neisseria meningitidis is one of the bacterium that is a leading cause of bacterial meningitis. It is treated primarily with penicillin G. B. Pneumonia refers to inflammation of the lungs due to bacterial, viral, fungal or parasitic infection. The common bacterium in most cases of communitv-acquired pneumonia is Streptococcus pneumonia. It is treated primarily with penicillin, ampicillin, or if penicillin-resistant, vancomycin. C. Gastric ulcer disease is often caused by the Gram-negative bacterium Helicobacter pylori that is found in the upper gastrointestinal tract. This infection is believed to be a potential cause of gastroduodenal ulcers and must be treated with antibiotics. It is treated primarily with amoxicillin or clarithromycin and may be combined with other medications to enhance the healing process of any ulcers that are present. D. Tetanus is an acute and often fatal disease if left untreated marked by a continuous state of muscular contraction and rigidity of voluntary muscles. The bacterium Clostridium tetani is a common cause of tetanus and it is treated with penicillin and vancomycin.

Answer 123

Diverticulitis Correct Answer: A Gastrointestinal (GI) symptoms can be related to various GI organ disturbances and differ in character depending on the organ which is affected. Some of the most clinically meaningful symptoms reported include abdominal pain, epigastric pain, dysphagia, Gl bleeding, constipation/diarrhea, and symptoms affected by food. A. Diverticulitis is the infection and inflammation that accompanies the perforation of one of the diverticula, which are weakened areas of the colon. Signs and symptoms of diverticulitis include left lower abdominal pain, nausea, abdominal bloating, flatulence, bloody stools, and either constipation or diarrhea. B. Appendicitis is an inflammation of the appendix that occurs most commonly in adolescents and young adults. A patient with appendicitis may experience nausea and loss of appetite however, their pain would more likely be reported in the right lower quadrant. C. Peptic ulcer is a loss of tissue lining the lower esophagus stomach, and/or duodenum. A patient with a peptic ulcer may experience nausea and loss of appetite, however, their pain would more likely be reported in the epigastric region. D. Pancreatitis is an inflammation of the pancreas that can be acute or chronic. A patient with pancreatitis may experience nausea and loss of appetite, however, their pain would more likely be reported in the epigastric region.

Answer 124

recommend a shoe with a wide toe box Correct Answer: A Hallux valgus is an abnormal medial deviation of the first metatarsal with or without rotation of the hallux. This is a common finding with rheumatoid arthritis and can lead to painful motion of the joint as well as difficulty wearing specific footwear. A. A patient with hallux valgus demonstrates lateral deviation of the great toe, swelling of the metatarsophalangeal (MTP) joint, shortening of the flexor hallucis brevis, and pain and tenderness of the great toe. The most effective intervention would be the use of a shoe with a wide toe box in order to reduce pressure and better accommodate the MT joint and great toe. B. Hallux valgus cannot be realigned through conservative management. A metatarsal bar would be more appropriately used to redistribute pressure with MTP joint dislocation or improve alignment of the toes as part of treatment for hammer or claw toes. C. Increasing flexion of the great toe is not an intervention that is used to improve hallux valgus. The typical shortening of the flexor hallucis brevis found with hallux valgus would require stretching in order to increase extension of the great toe. D. A heel cup would not serve to redistribute the weight bearing stresses found with hallux valgus. A heel cup would be more appropriately used to diminish pressure with a painful heel, particularly in the presence of a bone spur.

Answer 125

discontinue the exercise Correct Answer: D A quadriceps setting exercise requires the patient to perform an isometric contraction of the quadriceps muscle. The resistive activity places minimal stress on the knee compared to many other resistive activities and as a result is often utilized early in a post-operative program. A. Sidelying is often used to diminish the influence of gravity, however, in the described scenario the patient is performing an isometric activity with the lower extremity supported. As a result, it is possible that the patient would have more difficulty and associated pain completing the activity in sidelying. B. Flexing the knee prior to initiating the exercise may decrease the patient's discomfort, however, the severity of the pain makes it critical that the exercise is discontinued. C. Placing a pillow under the ankle would result in further extension of the knee. Given the patient's relative acuity secondary to their post-operative status, this position would likely increase the patient's pain. D. Severe pain in a patient rehabilitating from a surgical procedure is an acceptable reason to immediatelv discontinue an exercise. It is reasonable to attempt to modify an activity in the presence of pain, however, given the severity of the pain and the absence of information on the cause of the pain, discontinuing the exercise is a more desirable option.

Answer 126

check for unresponsiveness Correct Answer: A The first step in performing a primary survey is to determine responsiveness. A. To check for responsiveness, tap the victim on the shoulder and ask, "Are you all right?" If the patient is unresponsive (i.e., no movement or response to stimulation), the therapist should phone 911, get an automatic external defibrillator (AED), provide cardiopulmonary resuscitation, and use the AED, if necessary. B. Monitoring airway, breathing, and circulation are the primary elements of cardiopulmonary resuscitation. The current recommended sequence when performing CPR is compression, airway, and breathing. C. Positioning the patient is only necessary if the patient is unresponsive and needs cardiopulmonary resuscitation. If an unresponsive victim is face down, the therapist should roll the victim to a face up position to open the airway. D. The therapist should phone emergency medical services only after determining the patient is unresponsive.

Answer 127

osteopenia Correct Answer: B There are two parathyroid glands located on the posterior surface of each thyroid gland. They are responsible for secreting parathyroid hormone (PTH), which regulates the metabolism of calcium and phosphorus. The major cause of hyperparathyroidism is a tumor of the parathyroid gland, which leads to increased secretion of PTH. Elevated levels of PTH cause the release of calcium by the bones and a subsequent accumulation of calcium in the bloodstream. A. Cardiac arrhythmias are a common side effect of hypoparathyroidism. This condition results in low blood calcium levels which leads to altered function of many of the body's tissues including cardiac tissue (e.g., arrhythmias). B. Hyperparathyroidism results in the demineralization of bones due to the increased secretion of PTH and subsequent loss of bone density and strength (i.e., osteopenia). Other common symptoms include muscle weakness, loss of appetite, weight loss, nausea, vomiting, personality changes, and kidney stones. C. Muscle spasms are a common side effect of hypoparathyroidism. The low blood calcium levels lead to altered function of many of the body's tissues including neuromuscular tissue (e.g., muscle spasms). D. Hyperparathyroidism is more likely to result in diminished appetite and weight loss rather than obesity.

Answer 128

peroneal tenosynovitis Correct Answer: B Physical therapists should be familiar with the unique characteristics of commonly encountered medical conditions. This knowledge should include awareness of specific biomechanical forces associated with various medical conditions A. Tarsal tunnel syndrome is a compression neuropathy where the tibial nerve is compressed as it travels through the tarsal tunnel which is located posterior to the medial malleolus. Tarsal tunnel syndrome is more commonly associated with "flat feet" or pronation since this increases pressure in the tunnel region often resulting in nerve compression. B. Peroneal tenosynovitis refers to inflammation of the peroneal tendons. The peroneus longus and brevis tendons are located posterior to the lateral malleolus and are the structures most commonly affected. Peroneal tenosynovitis is typically associated with activities requiring repetitive ankle motion that result in overuse, trauma or recurrent ankle sprains. A supinated gait places additional stress on the peroneal tendons within the groove behind the lateral malleolus. C. Plantar fascitis refers to inflammation of the plantar fascia at the proximal insertion on the medial tubercle of the calcaneus. The plantar fascia is a broad structure comprised of connective tissue which spans from the calcaneus to the metatarsal heads. Plantar fasclitis is often associated with an acute injury from excessive loading of the foot or chronic irritation from an excessive amount of pronation or prolonged duration of pronation. D. Posterior tibial tenosvnovitis refers to an inflammation of the posterior tibial tendon. Patients often experience svmptoms immediately inferior to the medial malleolus. The posterior tibial tendon assists to support the arch of the foot. As a result, as the condition progresses the arch of the foot can become significantly flattened. Posterior tibial tenosvnovitis is more commonly associated with pronation.

Answer 129

a tear involving the outer third of the meniscus with reconstruction of the ACL Correct Answer: C Meniscal tears often occur in conjunction with anterior cruciate ligament injuries. In athletic-related ACL injuries, the incidence of meniscal tears approaches fifty percent. The medial and lateral menisci are firmly attached to the proximal surface of the tibia. The menisci are thick at the periphery and thinner at their internal unattached edges. Menisci function to deepen the articular surfaces of the tibia where they articulate with the femoral condyles. A. A surgically repaired tear involving the inner third of the medial meniscus is less likely to be successful since the inner third of the meniscus is avascular. Although ACL reconstruction increases success rates, the avascularity of the inner third of the meniscus remains a limiting factor. B. A surgically repaired tear involving the inner third of the medial meniscus is less likely to be successful since the inner third of the meniscus is avascular. In addition, conservative management (i.e., nonoperative) of the ACL increases the failure rate of the surgically repaired meniscus. C. A surgically repaired tear involving the outer third of the medial meniscus is more likely to be successful since the outer third of the meniscus is vascular. In addition, ACL reconstruction increases success rates. D. A surgically repaired tear involving the outer third of the medial meniscus is more likely to be successful since the outer third of the meniscus is vascular, however, conservative management (i.e., nonoperative) of the ACL increases the failure rate of the surgically repaired meniscus

Answer 130

Cellulitis Correct Answer: B A modified radical mastectomy includes removal of all tissues of the affected breast including the areola, nipple, and most of the axillary lymph nodes. The local lymphatic disruption and resultant impairment of local immune responses increases the likelihood of post-operative cellulitis. A. Dermatitis presents in numerous forms (e.g., contact, seborrheic, atopic), all of which involve some degree of general skin irritation. Although contact dermatitis may have a visible presentation similar to cellulitis, it would not typically be warm to touch nor is it consistent with the described clinical scenario. B. Cellulitis tends to develop in areas where the skin's protective barrier (e.g, surgical site, wound) and lymphatic flow (e.g., lymph node removal, excessive soft tissue, edema) have been disrupted. Cellulitis is a common post- operative complication of surgical breast cancer treatment. C. Mastitis is an infection of the fatty breast tissue typically associated with breast feeding. The infection may present with an appearance similar to cellulitis, but is further characterized by painful lumps within the breast tissue. D. Erysipelas is a specific form of cellulitis caused by streptococcal bacteria. Like cellulitis, the skin is typically warm and tender to the touch, however, it is much more defined in its appearance. Erysipelas is characterized by a raised, sharp demarcation of borders with an unmistakable bright red discoloration.

Answer 131

heat intolerance Correct Answer: A BMI describes relative weight for height and is a measurement used to identify increased risk for mortality and morbidity due to excess weight and obesity. Obesity (BMI of 30 kg/m~ or greater) refers to the state of excessive adipose tissue accumulation in the body contributing to a variety of chronic conditions that negatively impact multiple body systems and overall health. A. The excessive adipose tissue in obese patients can act as an extra layer of insulation and not allow heat to dissipate as expected. Obese patients are at high-risk for heat intolerance since they are often unable to appropriately respond to the thermal challenges of exercise. B. Asthma is a chronic inflammation of the airways caused by increased airway hypersensitivity to various stimuli. Obese patients are not at increased risk for asthma during exercise. C. Gastrosophageal reflux is the result of an incompetent lower esophageal sphincter that allows reflux of gastric contents. Obese patients are not at increased risk for gastrosophageal reflux during exercise, however, this is a post-operative complication of bariatric surgery. D. Orthostatic hypotension occurs due to a loss of sympathetic control of vasoconstriction in combination with absent or severely reduced muscle tone. Obese patients are not at increased risk for orthostatic hypotension during exercise. In fact, they are far more likely to experience an excessive rise in blood pressure during exercise.

Answer 132

patient A is stronger than patient B Correct Answer: B Manual muscle test grades are examples of ordinal measurements which in essence represent labels specifying relative rank or position. Ordinal measurements are rank-ordered into categories that have a "greater than - less than" relationship. The intervals between ranks on an ordinal scale may not be consistent and may not be known. A. The numerical scale used in manual muscle testing ranks the strength by strongest (equivalent to the grade of 5) and weakest (equivalent to the grade of 0). In this situation, the grades are not equal, 4 does not equal 2, therefore, they cannot have equal strength. B. Based on the traditional 0-5 manual muscle grading scale, a grade of 4 represents more muscle strength than a grade of 2. C. The numerical scale does not provide an "absolute value, therefore, it is impossible to say that a grade of 4 is two times stronger than a grade of 2. Furthermore, the testing positions of these grades are not the same and as a result they cannot be compared in this manner. D. The numerical order of the manual muscle testing scale indicates that a grade of 5 is the strongest and a grade of 0 is the weakest. Therefore, a grade of 2 cannot indicate greater strength than a grade of 4

Answer 133

Clear Correct Answer: A It is normal during the stages of healing to observe exudates from a wound. The physical therapist should inspect the exudates and determine whether it is a normal response to healing or an abnormal response that needs to be reported. A. Serous exudate is described as a clear or light color fluid with a thin, watery consistency. This particular type of exudate is normal during the inflammatory and proliferative phases of healing. B. Serosanguineous (pink) exudate can be a normal exudate in a healthy healing wound. C. Sanguineous (red) exudate indicates a bloody discharge which may be indicative of either new blood vessel growth (normal healing tissue) or a disruption of blood vessels (abnormal). D. Purulent (yellow) exudate is generally indicative of infection.

Answer 134

enzymatic debridement Correct Answer: C Selective debridement involves removing only nonviable tissues from a wound. Non-selective debridement involves removing both viable and nonviable tissues from a wound. A. Whirlpool uses a turbine to produce agitation and aeration which creates movement of the water in the tank. The movement of the water results in the softening and loosening of adherent necrotic tissue. The inability to isolate necrotic tissue using whirlpool makes the intervention a form of non- selective debridement. B. Wet-to-dry dressings refer to the application of a moistened gauze dressing placed in an area of necrotic tissue. The dressing is then allowed to dry completely and is later removed along with the necrotic tissue that has adhered to the gauze. This type of debridement should be used sparingly on wounds with both necrotic tissue and viable tissue since granulation tissue will be traumatized in the process. As a result, a wet-to-dry dressing is a form of non- selective debridement. C. Enzymatic debridement is considered to be selective since the topical preparation of the enzymes used (collagenolytic, proteolytic) will greatly influence the treatment outcome. D. Wound irrigation removes necrotic tissue from the wound bed using pressurized fluid. Most devices permit varying pressure settings and provide suction for removal of the exudate and debris. Wound irrigation is a form of non-selective debridement.

Answer 135

Caucasian females over the age of 60 Correct Answer: A Osteoporosis is a metabolic bone disease characterized by increased bone resorption resulting in a reduction in bone mass. Osteoporosis is more prevalent in females than in males, in older than younger individuals, and in Caucasians than African Americans. A. Caucasian females experience an increased incidence of osteoporosis compared to African American females. The relative risk of osteoporosis Increases with age since there is decreased production of estrogen and a greater loss of bone density following menopause. B. African American females have an increased risk of osteoporosis with increasing age, however, this group is at less risk than Caucasian females because bone mass has a positive correlation to the color and pigmentation of the skin. Therefore, African American females generally have greater bone mass than the statistically equivalent Caucasian females. C. Caucasian females under the age of 40 are typically not at high risk for osteoporosis. Bone mass will normally peak between 25 and 35 years of age, followed by a progressive increase in bone resorption compared to bone formation that may result, decades later, in osteopenia and osteoporosis. D. African Americans under the age of 40 are typically not at high risk for osteoporosis. Bone mass will normally peak between 25 and 35 years of age. Bone resorption and bone formation occur in a similar manner as described in option 3.

Answer 136

decreased urge sensation Correct Answer: D Urinary incontinence occurs frequently in older adults due to a combination of physiological changes that may be exacerbated by underlying medical conditions. Commonly, a combination of reduced sensitivity to needing to urinate, along with reduced bladder capacity creates this condition. A. Kidney function decreases with age, however, it is not the primary reason for incontinence. Decreased kidney function is directly responsible for incomplete excretion of waste products. B. The bladder capacity does not increase with age, rather it becomes diminished leading to more frequent bouts of urination. However, with proper voiding this is not a major contributing factor in the development of incontinence. C. The detrusor muscle can become spastic in the company of neurological trauma, however, it is not a common reason for incontinence associated with aging. D. Decreased urge sensation is one of the leading reasons for incontinence in older adults. The bladder becomes full, but due to decreased bladder sensitivity the older adult may not recognize this and as a result experiences episodes of incontinence.

Answer 137

depression of the shoulder girdle Correct Answer: A Upper limb tension tests are types of neural provocation maneuvers. The tests require an ordered sequence of movements occurring at the shoulder, arm, elbow, forearm, wrist, and hand. Symptoms and relevant changes in symptoms should be identified after each step. A. Depression of the shoulder girdle is the first action that would occur when performing the upper limb tension test with radial nerve bias. B. The upper limb tension test with radial nerve bias requires medial rotation of the shoulder. Lateral rotation of the shoulder would be more appropriate when performing the upper limb tension test with ulnar nerve bias. C. The upper limb tension test with radial nerve bias requires extension of the elbow, however, this would not cecur until the shoulder girdle has already been depressed. D. The upper limb tension test with radial nerve bias requires flexion of the wrist, however, this would not be the first action to occur.

Answer 138

left lateral flexion of the cervical spine Correct Answer: B Upper limb tension tests are types of neural provocation maneuvers. The tests require an ordered sequence of movements occurring at the shoulder, arm, elbow, forearm, wrist, and hand. Symptoms and relevant changes in symptoms should be identified after each step. A sensitizer is often employed if symptoms are minimal or absent after the identified sequence since they tend to increase the tension on the spinal dura and nerve. A. Right lateral flexion of the cervical spine may be used as a sensitizer since in some cases sensitizers are assessed in both directions (i.e., right and left. However, since the radicular signs are in the patient's right upper extremity, left lateral flexion of the cervical spine would be the best option. B. Left lateral flexion of the cervical spine would serve as the best sensitizer since moving the head into left lateral flexion would place the greatest increase in stress on the spinal dura and median nerve in the affected right upper extremity. C. Rotation of the cervical spine would not tend to increase tension on the spinal dura and nerve to the same degree as lateral flexion. D. Rotation of the cervical spine would not tend to increase tension on the spinal dura and nerve to the same degree as lateral flexion.

Answer 139

allow the patient to rest, however, allow the elapsed time to continue Correct Answer: B The Six-Minute Walk Test is used to determine a patient's functional exercise capacity. The test is commonly used to monitor progress or decline throughout physical therapy. This tool is administered to various populations including those with cardiac impairments, pulmonary disease, chronic conditions, and patients recovering from orthopedic surgical procedures. The test requires the therapist to measure the distance the patient walks within a six-minute period with rest periods permitted as necessary. A. Rest periods are permitted as needed during the Six-Minute Walk Test, however, the elapsed time does not stop B. Rest periods are permitted as needed during the Six-Minute Walk Test, however, the elapsed time continues during rest periods. The test measures the distance walked in a six-minute period regardless of the number of rest periods. C. Rest periods are permitted as needed during the Six-Minute Walk Test. Following a rest period, the patient should resume walking at a time of their choosing until the elapsed time expires. D. The therapist should offer words of encouragement (e.g. "you're doing well," "keep up the good work," "you have three minutes to go") at regular intervals. The purpose of the encouragement is to allow the patient to perform to their abilities, not to avoid or delay rest periods.

Answer 140

increased blood pressure Correct Answer: C Increased blood pressure or hypertension is a side effect that is associated with heavy or prolonged use of corticosteroids (also known as glucocorticoids). Other side effects include osteoporosis, muscle wasting, skin breakdown, cataracts, adrenocorticosuppression, and hyperglycemia. A. A palpitation is a sensation in which a person is aware of an irregular, hard or fast heartbeat that may skip or beat irregularly. The word palpitation is sometimes used synonymously with arrhythmia, however, a palpitation may or may not be caused by an arrhythmia. Many palpitations are benign, but the underlying cause is important to diagnose B. An arrhythmia is defined as a significant deviation from normal sinus rhythm. Many medications have potential side effects of arrhythmias including other cardiac medications, tricyclic antidepressants, and minerals such as calcium. C. Corticosteroid use can increase blood pressure secondary to the sodium and water retention properties of the corticosteroid. Long-term use of corticosteroids must be closely monitored due to the stated adverse effects D. Tachycardia refers to a heart rate in excess of 100 beats per minute in an adult. It may occur normally in response to fever, exercise or excitement. Many substances have potential side effects of tachycardia including alcohol, caffeine, nicotine, and certain anti-anxiety and cardiac medications

Answer 141

32 Inches Correct Answer: C The Americans with Disabilities Act was designed to provide a clear and comprehensive national mandate for the elimination of discrimination. Title III provides information on public accommodations including minimum accessibility standards. A. The seat width in an average adult size wheelchair is 18 inches. As a result, 24 inches would not be nearly sufficient to accommodate the remainder of the wheelchair and still have adequate space available to propel the wheelchair through the doorway. B. A wheelchair would likely be able to traverse through a doorway that was 30 inches wide, however, it would not meet the minimum width required by the Americans with Disabilities Act. C. The Americans with Disabilities Act requires that the minimum width of a doorway is 32 inches D. The Americans with Disabilities Act requires that the minimum width of a corridor (hallway) is 36 inches. This width allows the patient to change the direction of the wheelchair within the corridor.

Answer 142

arrhythmias Correct Answer: B Myocardial infarction has four major complications: arrhythmias, heart failure, thrombolytic complications, and damage to the heart structures. A. Heart failure is a syndrome that reflects an inability of the heart to maintain a cardiac output sufficient to meet the oxygen and nutritional needs of the tissues. Heart failure is not as common as arrhythmias. B. Arrhythmias are caused by abnormalities in cardiac impulse generation, conduction, or both and occur in 90% of individuals who have experienced a myocardial infarction. C. Venous or mural thrombi can occur due to venous stasis after myocardial infarction. Thrombus formation is not as common as arrhythmias. D. Damage to the papillary muscle, ventricle wall, and intraventricular septum can occur after a myocardial infarction. Heart structural damage is not as common as arrhythmias.

Answer 143

6-8 towel lavers Correct Answer: C A hot pack must be stored in hot water between 158 to 167 degrees Fahrenheit (70 to 75 degrees Celsius). As a result, it is necessary to use a barrier between the hot pack's canvas or nylon covered case and the body part to be treated. Most often towels or hot pack covers are used. Hot pack covers count for two towel lavers because of their thickness. A. Two to four towel layers would be inadequate and would result in the patient being at risk for excessive heat. B. Four to six towel layers may be inadequate to properly protect the patient from excessive heat. It is possible to use only four to six towel layers in instances where the patient complains of not feeling enough heat or the therapist is aware that the hot pack may not possess its typical amount of heat. Therapists must be cautious, however, to avoid removing towels during the session since increased skin temperature may diminish the patient's thermal sensitivity and their ability to accurately assess heat tolerance. C. Six to eight towel layers placed between a hot pack and the treatment surface is generally adequate to allow for the necessary transmission of heat without jeopardizing patient safety. D. Eight to ten towel layers may be excessive and as a result would significantly diminish the transmission of heat.

Answer 144

15% Correct Answer: A The initial lymph vessels in the Imphatic svstem are located near blood capillaries and are responsible for collecting fluid from the interstitium that is not picked up by the venous system. The lymphatic system also transports the majority of extracellular proteins since they are often too large to be transported by the venous system. A. The lymphatic system is normally responsible for collecting 10-20% of the interstitial fluid, while the venous system collects the other 80-90%. A value of 15% would fall within the range for a normally functioning lymphatic system B. The lymphatic system is normally responsible for collecting 10-20% of the interstitial fluid. A value of 35% is above the normal range and may indicate that the venous system is not functioning normally. C. A value of 55% is far above the range for what the lymphatic system is normally responsible for collecting. This may indicate that the venous system is not functioning normally D. A value of 75% is far above the range for what the lymphatic system is normally responsible for collecting. This may indicate that the venous system is not functioning normally.

Answer 145

Froment's sign Correct Answer: C There are a variety of special tests designed to identify vascular compression in the shoulder. When performing the tests, a positive sign is often indicated by diminution or disappearance of a pulse or reproduction of neurological signs or symptoms. A. Adson maneuver is performed with the patient in sitting or standing. The therapist monitors the radial pulse and asks the patient to rotate their head to face the test shoulder. The patient is then asked to extend their head while the therapist laterally rotates and extends the patient's shoulder. A positive test is indicated by an absent or diminished radial pulse B. The Halstead maneuver is performed with the patient sitting over the edge of a table. The therapist palpates the radial pulse and applies a downward traction on the symptomatic side. The patient is then asked to extend the head and turn away from the tested side. A positive test is indicated by an absent or diminished pulse. C. Froment's sign requires a patient to grasp a piece of paper between the thumb and index finger. A positive test is indicated by flexion of the terminal phalanx of the thumb caused by paralysis of the adductor pollicis longus. The test is used to assess the integrity of the ulnar nerve. D. The Wright test or hyperabduction test is performed with the patient in sitting or supine. The therapist moves the patient's arm overhead in the frontal plane while monitoring the patient's radial pulse. A positive test is indicated by an absent or diminished radial pulse and may be indicative of compression in the costoclavicular space.

Answer 146

five minutes for an area that is two times the size of the transducer face Correct Answer: B The duration of ultrasound treatment is based on a number of variables including the treatment goal, the size of the area to be treated, and the effective radiating area of the transducer face. A. Two minutes would not be enough time to use ultrasound in an area that was two times the size of the transducer face. B. An accepted recommendation is that ultrasound can be administered to an area two to three times the size of the effective radiating area of the transducer face in a five minute period. This recommendation equates to roughly twice the size of the transducer face. C. There is not a specified maximum amount of time when using ultrasound. Most often ultrasound is used for periods ranging from five to eight minutes in duration. D. Ten minutes is a relatively long duration for treatment with ultrasound, however, this could be plausible in situations where the size of the area to be treated is large.

Answer 147

administering percussion to the anterior basal segments of the lower lobes Correct Answer: C Gastrosophageal reflux disease (GERD) is the result of an incompetent lower esophageal sphincter that allows reflux of gastric contents. The backwards movement of stomach aclds can cause esophageal tissue injury. Positioning with the head lower than the body significantly increases the likelihood of reflux and therefore should be avoided whenever possible. A. Diaphragmatic breathing can decrease the work of breathing by lowering respiratory rate, increasing tidal volume, and decreasing the use of accessory muscles by facilitating use of the diaphragm. The semi-Fowler position places a patient in supine with the head of the bed elevated to 45 degrees and pillows under the knees. The position would not be problematic for a patient with GERD since the patient is relatively upright. B. Ambulation on a treadmill is an appropriate activity for a patient with GERD. The activity is rhythmic, occurs in an upright position, and does not involve excessive movement of the stomach. C. To administer percussion to the anterior basal segments of the lower lobes, the patient is positioned in supine with the foot of the bed elevated 18 Inches. Percussion is applied over the lower ribs on the left and right side. Positioning with the head lower than the feet would significantly increase the likelihood of reflux. D. Tactile fremitus refers to the vibration of spoken words felt through the chest wall. The assessment procedure provides Information about the density of the lungs and the thoracic cavity. The option indicates that tactile fremitus is being assessed in an upright position and therefore would not be problematic for a patient with GERD.

Answer 148

avascular necrosis Correct Answer: A Legg-Calve-Perthes disease is characterized by degeneration of the femoral head due to a disturbance in the blood supply. Signs and symptoms of Legg-Calve-Perthes disease include pain, decreased range of motion, antalgic gait, and a positive Trendelenburg sign. A. Avascular necrosis refers to the death of bone tissue due to a lack of blood supply. The condition most commonly affects the head of the femur, talus, and scaphoid. The medial femoral circumflex artery is the primary vessel responsible for vascular distribution in the head and neck of the femur. B. Congenital hip dysplasia is a condition characterized by malalignment of the femoral head within the acetabulum. The condition develops during the last trimester in utero. The condition is not commonly associated with Legg-Calve-Perthes disease. C. Osteomyelitis is an infection of a bone by bacterial organisms. The condition can result in rapid destruction and deterioration of bone causing permanent damage. Although the condition often affects an adolescent population, it is not commonly associated with Legg-Calve-Perthes disease. D. Septic arthritis, also known as infectious arthritis, is most often caused by bacteria such as haemophilus influenza, staphylococcus, and streptococcus. The condition often affects only a single joint (e.g, hip, knee) and is most common in extremely young children (i.e., less than two years of age) and the elderly. The condition is not commonly associated with Legg-Calve-Perthes disease.

Answer 149

acute pulmonary edema Correct Answer: B Intermittent compression is effective in controlling edema since it increases the extravascular hydrostatic pressure and circulation. Intermittent compression is most commonly used to control edema due to venous insufficiency or lymphatic dysfunction. A. Venous stasis ulcers occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration. Intermittent compression improves venous circulation and facilitates the healing of previously formed ulcers. B. Acute pulmonary edema should not be treated with intermittent compression since the shift of fluid from the peripheral to the central circulation may significantly increase stress on the heart C. Intermittent claudication occurs when blood flow is not adequate to meet the demand of the peripheral tissue, most often during activity. The result is ischemia which produces symptoms such as muscle pain, numbness, tingling, and fatigue. Intermittent claudication would not be a contraindication for intermittent compression. D. Lymphedema refers to an abnormal accumulation of fluid in the interstitial spaces. Stagnation of the fluid promotes the inflammatory response and increases the probability of infection. Intermittent compression is commonly used to treat lymphedema.

Answer 150

Incentive spirometer Correct Answer: C An incentive spirometer provides visual or in some cases auditory feedback as the patient takes a maximum inspiration. Incentive spirometry increases the amount of air that is inspired and as a result, can be used as a treatment to prevent alveolar collapse after thoracic surgery. A. Inspiratory muscle trainers are handheld breathing training devices used primarily to increase the strength and endurance of the muscles of inspiration. They are not used to prevent alveolar collapse after thoracic surgery. B. Mechanical percussors are electronically or pneumatically powered devices employed as a substitute for manual percussion with the hands. They can be used to help mobilize bronchial secretions after thoracic surgery, but only if the patient was retaining secretions. C. Incentive spirometers are devices that provide visual or other feedback while the patient performs sustained maximal inspirations. The device is most often used following upper abdominal or thoracic surgery. Indications may include chest wall pain, loss of mobility, weakness of the muscles of inspiration, and the prevention or treatment of atelectasis. D. Flutter valves are mucus clearance devices that combine positive expiratory pressure with high frequency oscillations at the airway opening during exhalation.

Answer 151

axillary temperature Correct Answer: D Body temperature represents a balance between the heat produced and the heat lost by the body. Body temperature is measured through a variety of methods including oral temperature, tympanic membrane temperature, temporal artery temperature, axillary temperature, and rectal temperature. A. Tympanic membrane temperature reads the infrared heat waves released by the ear's tympanic membrane. An accurate measurement requires the examiner to pull the ear backward to straighten the ear canal. The tympanic membrane temperature is typically 0.5-1.0 degree Fahrenheit higher than the oral temperature value. B. Rectal temperature is obtained by placing a thermometer into the opening of the anus. The rectal (i.e., core) temperature value is typically 0.5-1.0 degree Fahrenheit higher than the oral temperature value. C. Oral temperature is obtained by placing the tip of a thermometer under one side of the tongue towards the back of the oral cavity. The thermometer is held in place for three minutes with a glass thermometer and approximately 30 seconds with an electronic thermometer. The oral temperature value is typically 0.5-1.0 degree Fahrenheit lower than the rectal temperature value. D. Axillary temperature is obtained by placing the tip of a thermometer in the armpit. The arm is then brought to the patient's side holding the elbow against the chest for 4-5 minutes. The axillary temperature value is typically 0.5-1.0 degree Fahrenheit lower than the oral temperature value.

Answer 152

trigeminal nerve The cranial nerves refer to twelve pairs of nerves that have their origin in the brain. The majority of cranial nerves contain both sensory and motor fibers, however, there are several exceptions including the oculomotor and trochlear nerves. A. The afferent component of the facial nerve (cranial nerve VII can be assessed by examining a patient's ability to accurately identify sweet and salty substances. The efferent component is tested by performing a manual muscle test of selected muscles involved in facial expression. B. The efferent component of the oculomotor nerve (cranial nerve III can be assessed by asking a patient positioned in sitting to follow an object such as a writing utensil with their eyes as it is moved vertically, horizontally, and diagonally. The therapist should make sure the patient does not rotate their head during the testing and should inspect the patient's eyes for asymmetry or ptosis. C. The afferent component of the trigeminal nerve (cranial nerve V) can be assessed by examining sensation of the face and jaw. The efferent component is assessed by examining the muscles of mastication. D. The efferent component of the trochlear nerve (cranial nerve IV can be assessed by asking a patient positioned in sitting to follow an object such as a writing utensil with their eyes as it is moved in an inferior direction. The therapist should make sure the patient does not move their head downward.

Answer 153

5 degrees Correct Answer: A Serial casting is a casting technique that is used to improve range of motion at a joint that has developed a contracture. The procedure consists of placing the joint in a submaximal position and then applying a cast. After wearing the cast for several days, it is removed. With each round of casting, the joint should make modest range of motion gains (e.g., 5-7 degrees). Serial casting can last for a few weeks or several months depending on the extent of the contracture and the relative success of the intervention. A. Five degrees is a realistic expectation for the increase in range of motion after a single round of casting. One round of serial casting usually yields roughly a 5-7 degree increase in range of motion. B. An increase of 15 degrees would be larger than the normally expected increase in range of motion from a single round of serial casting. This type of range of motion gain would be more likely in 2-3 rounds of serial casting. C. An increase of 25 degrees would be larger than the normally expected increase in range of motion from a single round of serial casting. This type of range of motion gain would be more likely in 4-5 rounds of serial casting. D. An increase of 35 degrees would be larger than the normally expected increase in range of motion from a single round of serial casting. This type of range of motion gain would be more likely in 5-7 rounds of serial casting

Answer 154

discuss how two objects are similar Correct Answer: C A patient with impaired abstract thinking may have involvement of the frontal lobe, diffuse encephalopathy or psychiatric illness. A. Orientation can be assessed by asking a person to identify time (e.g., day, month, season), person (..g, name), and place (e.g., city, state). Disorientation is most commonly associated with traumatic brain injury, delirium, and advanced dementia. B. Copying drawn figures of varying size and shape assesses constructional ability. Impairments in constructional ability are often associated with damage to the parietal lobe or stroke. C. Abstract ability is commonly tested using two specific methods. The first method is by asking a patient to describe how two items such as a cat and a mouse are similar. The other method is by asking a patient to interpret the meaning of a proverb such as "a rolling stone gathers no moss." Patients with difficulty in abstract thinking may provide answers that tend to be literal or concrete. D. The ability to recognize symbols, letters or numbers traced on the skin refers to graphesthesia. Patients with language or speech disorders secondary to stroke can identify the correct figure by pointing at an image located in a chart instead of through verbal identification.

Answer 155

hip extension and adduction Correct Answer: D A Pavlik harness is the primary method of treating developmental dysplasia of the hip (DDH). DDH is a subluxed or dislocated hip in infancy as a result of abnormal congruency of the femoral head and acetabulum. The Pavlik harness maintains the infant's hips in a position that enhances acetabular development. A. The Pavlik harness positions the infant's hips in flexion and abduction to maintain the femoral head within the acetabulum and promote acetabular development. The harness would actually promote, not restrict, these motions. B. The Pavlik harness positions the infant's hips in flexion and abduction, therefore it would restrict hip adduction, though it would promote hip flexion. C. The Pavlik harness positions the infant's hips in flexion and abduction, therefore it would restrict hip extension, though it would promote hip abduction. D. Because the Pavlik harness positions the infant's hips in flexion and abduction, it would restrict the opposing motions (i.e., extension and adduction). Studies have found that the positions of extension and adduction promote hip dislocation. The Pavlik harness attempts to minimize these motions and thus reduce the incidence of hip dislocation.

Answer 156

disappearance of spasticity Correct Answer: B Brunnstrom separates neurological recovery into seven separate stages based on progression through abnormal tone and spasticity. The seven stages of recovery describe tone, reflex activity, and volitional movement. A. In stage 2, movement occurs primarily in the form of associated reactions and spasticity begins to develop. In stage 3, voluntary movement begins within basic limb synergies. B. In stage 5, spasticity is still present although it continues to decrease. Stage 6 is characterized by the disappearance of spasticity and the ability to complete isolated joint movements in a coordinated fashion. C. In stage 4, movement patterns are not dictated solely by limb synergies and voluntary movement patterns begin outside of limb synergies. D. In stage 7, normal motor function is restored.

Answer 157

pronator teres Correct Answer: D Median nerve entrapment is often associated with racquet sports or with activities requiring repetitive gripping with pronation of the forearm and extension of the elbow. Patients with median nerve entrapment often experience sensory alterations in the lateral aspect of the hand and lateral three and a half fingers. Motor alterations may be found in the anterior forearm or the hand A. The abductor pollicis longus is innervated by the radial nerve and therefore would not contribute to median nerve entrapment. B. The flexor digit minim is innervated by the ulnar nerve and therefore would not contribute to median nerve entrapment. C. The medial aspect of the flexor digitorum profundus is innervated by the ulnar nerve while the lateral aspect is innervated by the median nerve. Although the lateral aspect of the flexor digitorum profundus is innervated by the median nerve, the muscle would not contribute to median nerve entrapment. D. The median nerve arises from the cubital fossa and passes between the two heads of the pronator teres. As a result the pronator teres can be a possible source of median nerve entrapment.

Answer 158

anterior inferior cerebellar artery Correct Answer: A The cerebellum is located at the posterior portion of the brain below the occipital lobes. The cerebellum is responsible for fine tuning of movement, maintaining posture and balance by controlling muscle tone, and positioning of the extremities in space. Blood supply to the cerebellum is from the anterior inferior cerebellar artery, posterior inferior cerebellar artery, and superior cerebellar artery. A. The anterior inferior cerebellar artery is one of three vessels that supplies blood to the cerebellum. Occlusion of the artery can result in a variety of symptoms including ataxia nystagmus, tremor, dysmetria, incoordination, and balance deficits. B. The anterior spinal artery supplies blood to the anterior portion of the spinal cord and arises from the vertebral artery in the region of the medulla oblongata. Occlusion of the artery can result in cortralateral hemiplegia, deviation of the tongue toward the affected side, dysphagia, and loss of the gag reflex. C. The basilar artery is part of the posterior cerebral circulation arising from the confluence of the left and right vertebral arteries at the base of the pons. Occlusion of the artery can result in contralateral hemiplegia and ipsilateral sensory los of the face. D. The middle cerebral artery is one of three major paired arteries that supplies blood to the cerebrum. Occlusion of the artery can result in contralateral hemiplegia, aphasia, apraxia, and cognitive deficits.

Answer 159

low back pain with passive shoulder and pelvis rotation occurring simultaneously Correct Answer: C Waddell's signs are five tests used to help differentiate between physical (1e., organic) and behavioral (1e., nonorganic) causes of back pain. A positive finding does not suggest that there is an absence of pain or that the patient is malingering, but rather there is a behavioral aspect to the patient's pain A. A positive Waddell's sign with the straight leg raise test would be characterized by the patient having different responses to the test in the supine and sitting positions. B. Sensory loss in a dermatomal pattern would be considered normal in the presence of low back pain. A positive Waddell's sign would be characterized by the patient reporting sensory loss in a "stocking" pattern (i.e., global sensory loss distal to a specific anatomical location). C. The acetabular rotation test occurs by having the therapist rotate the patient's pelvis and shoulders simultaneously while in standing. Because rotation is occurring at the pelvis and shoulders, no movement is occurring at the lumbar spine. A report of low back pain with this test would be considered a positive Waddell's sign. D. Localized tenderness in the low back is normal in a patient reporting low back pain. A positive Waddell's sign is more likely associated with deep tenderness felt over a wide area that crosses multiple somatic boundaries.

Answer 160

settling due to limb shrinkage Correct Answer: A Redness over the patella most often occurs when a patient's residual limb sits too low in the prosthesis. This is most often caused by shrinking of the residual limb or an inadequate number of residual limb socks. A. A physical therapist may elect to add additional one-ply socks to the residual limb of a patient with excessive redness over the patella in order to more normally distribute weight bearing forces. B. If the socket was improperly aligned, it would be unlikely that the residual limb would only receive excess pressure directly over the patella. C. If the patient's residual limb experienced excessive withdrawal during sitting, the patella would come further out of the socket as opposed to sitting lower within the socket. This would not cause excessive redness over the patella. D. An excessive number of residual limb socks would elevate the patella tendon above the patella tendon bearing surface of the prosthesis. This would cause the patella to move further out of the socket and therefore would be unlikely to cause redness over the patella.

Answer 161

slow reversal hold of the quadriceps and hamstrings Correct Answer: C The sympathetic division of the autonomic nervous system prepares the body for stressful situations using the "fight or flight" response. It increases heart rate, dilates the airways, and allows the body to release stored energy. This division also causes the palms to sweat, pupils to dilate, and hair to stand on end. A. Connective tissue massage is a technique that can be used to decrease sympathetic activity. Massage can influence muscle tension via the circulatory and autonomic systems with noted changes in vital signs and muscle tone. B. Passive rotation of the lower trunk while in a hooklying position is an example of rhythmical movement which produces reflexive autonomic changes and an overall calming effect. C. Slow reversal hold is a proprioceptive neuromuscular facilitation technique used primarily to improve stability surrounding a joint. The technique uses slow and resisted concentric contractions of agonists and antagonists around a joint with an isometric contraction that is performed at the end of each movement. Slow reversal hold would not decrease sympathetic activity. D. Maintained touch is used to promote a parasympathetic response and produce a generalized calming effect due to the stimulation of tonic sensory receptors. Gentle manual pressure to the abdomen is an example of maintained touch.

Answer 162

analysis of variance (ANOVA) test Correct Answer: D There are a variety of statistical tests that may be used as a means of analyzing data in a research study (e.g., t-test, z-test chi-square test, analysis of variance test). The statistical test used will depend on the dependent and independent variables that are being investigated. A. At-test would be used when a study is comparing the means of two different groups. In the described scenario, the researchers are comparing the means of three different groups (i.e., adolescents, teenagers, young adults), therefore, a t-test could not be used to analyze the data in this study. B. Az-test is similar to a t-test in that it compares the means of two different groups. However, a z-test would be used in situations where the variance of the population being studied is known. A t-test is used when the variance is not known. C. A chi-square test is a statistical test used to compare nominal data (e.g., gender, yes-no responses). The described scenario is comparing range of motion values, which would be considered ratio data. D. An analysis of variance (ANOVA) test is a statistical test that is used when three or more variables are being compared. In the described scenario, the researchers are comparing the means of three different groups, therefore, an ANOVA test would be the most appropriate statistical test.

Answer 163

symmetrical tonic labyrinthine reflex Correct Answer: A The symmetrical tonic labyrinthine reflex promotes a tendency for extension when a patient is in supine and reduced extensor influence when the patient is in prone. The persistence of a primitive reflex is generally seen with a neurological insult. A. The symmetrical tonic labyrinthine reflex serves to limit the child's ability to flex the neck when in a supine position. The child should lie in sidelying or in supine with hip flexion and/or knee flexion in order to decrease the influence of the reflex. B. The Moro reflex is elicited by a sudden change in the position of the head, usually having the head drop backwards. The typical response is crying along with extension and abduction of the upper extremities followed by flexion and adduction across the chest. C. The asymmetrical tonic neck reflex is elicited through rotation of the neck. If the patient's head is turned, the upper and lower extremities on the face side extend and the upper and lower extremities on the skull side flex. The asymmetrical tonic neck reflex does not influence the child's ability to flex the neck while in a supine position. D. The symmetrical tonic neck reflex is elicited by flexion or extension of the neck. When the head is flexed, upper extremities flex and lower extremities extend, When the head is extended, upper extremities extend and lower extremities flex. The symmetrical tonic neck reflex does not influence the child's ability to flex the neck while in a supine position.

Answer 164

macular degeneration Correct Answer: B The most common visual impairments experienced by older adults include cataracts, glaucoma, macular degeneration, and the normal loss of lens elasticity known as presbyopia. If left untreated, any of these conditions can result in an increased fall risk A. Cataracts cause opacity to the lens of the eye, which in turn results in the patient seeing light streaks and glare from light sources. This can be especially dangerous at night when driving. B. Macular degeneration involves the loss of central vision (looking forward) due to degenerative changes to the eyes. Individuals with macular degeneration can effectively see in the periphery of their visual field. C. Presbyopia is the normal loss of lens elasticity that is experienced with aging. This is commonly known as farsightedness and can be managed with eyeglasses. D. Glaucoma is an increase in the intraocular pressure of the eye that can damage the optic nerve. Early stages of glaucoma are characterized by loss of peripheral vision and sparing of central vision.

Answer 165

oral Correct Answer: D Enteral administration of drugs involves the esophagus, stomach, and small and large intestines. The most common routes of enteral administration are oral, sublingual, and rectal. A. Drugs that are in a gaseous or volatile state or that can be suspended as tiny droplets in an aerosol form can be administered through inhalation. Examples are general anesthetics and anti-asthmatic drugs. B. Injection allows drugs to be introduced systemically or locally. Common types of injection include intravenous, intra-arterial, subcutaneous, intramuscular, and intrathecal. Examples are insulin and narcotic analgesics. C. Topical administration refers to the application of drugs topically to the surface of the skin or mucous membranes. Topical administration is most often used to treat the outer laver of the skin and not other areas since most medications are absorbed poorly through the epidermis and into the svstemic circulation. D. Oral administration is considered the easiest form of taking medication when self-medication is required and is relatively safe since drugs enter the system in a fairly controlled manner.

Answer 166

select exercises consistent with the patient's rehabilitation Correct Answer: C Many factors can influence patient compliance with a home exercise program, however, regardless of the construction of the program it is essential that the program is designed to be consistent with the patient's rehabilitation goals. A. An exercise program that can be completed in a relatively short period of time is more likely to be completed since patients have a better opportunity to fit the program into their existing schedule. B. Limiting the number of exercises tends to promote compliance since it is easier for the patient to focus and complete each exercise. C. Patients are typically highly motivated to complete home exercise programs when they believe the exercises will help them to achieve their personal rehabilitation goals. Options such as limiting the length of the exercise program and limiting the number of exercises are helpful strategies to promote compliance, however, they would not be as critical as aligning the exercises with the patient's rehabilitation goals. D. There is no information presented which implies the patient is averse to physically demanding activities.

Answer 167

C5 Correct Answer: B Resisted isometric movements are designed to determine the role of contractile tissue in an injury. The therapist attempts to elicit a strong, static, voluntary muscle contraction. The therapist then classifies the movement as strong or weak and painful or pain-free. A. The C4 myotome is commonly assessed by examining the diaphragm. The therapist uses a tape measure to quantify the amount of rib expansion that occurs with a deep breath. This measurement is then compared to the same measurement performed with the patient at rest. B. The C5 myotome is commonly assessed by performing resisted isometric movements of the shoulder abductors or the shoulder external rotators. The image shows the therapist assessing the shoulder abductors by applying a downward force on the humerus while the patient resists the movement. The deltoid and supraspinatus muscles are the primary muscles active during this resisted test. C. The C6 myotome is commonly assessed by performing resisted isometric movements of the elbow flexors or shoulder internal rotators. D. The C7 myotome is commonly assessed by performing resisted isometric movements of the elbow extensors or wrist flexors.

Answer 168

Increased strength of the trunk extensors Correct Answer: B A propped sitting position is characterized by a forward trunk position where the infant uses their upper extremities to maintain the position. Ring sitting refers to an independent sitting position where the legs form the shape of a ring. The position allows the infant to use their upper extremities for reaching or grasping objects. A. Increased strength of the trunk flexors would not be useful to assist the infant to progress to ring sitting since the progression would require the infant to sit more upright using the trunk extensors B. Increased strength of the trunk extensors allows the infant to sit more upright with the pelvis remaining perpendicular to the surface. The increased strength of the trunk extensors allows the infant to maintain the sitting position without weight bearing through the upper extremities. The infant may gain additional stability in this position by maintaining a high guard position with the upper extremities. C. The symmetrical tonic neck reflex is stimulated by the head moving into flexion or extension. When the head is in flexion, the arms are flexed and the legs are extended. When the head is in extension, the arms are extended and the legs are flexed. Integration of the reflex would not assist with attaining ring sitting, but may assist the infant with reciprocal crawling and the ability to prop on the arms in a prone position. D. The asymmetrical tonic neck reflex is stimulated when the head is turned to one side. The response is a fencing posture (arm and leg on face side are extended, arm and leg on scalp side are flexed). Integration of the reflex would not assist with attaining ring sitting, but may assist the infant with feeding, use of the hands in midline, and rolling.

Answer 169

backward stepping Correct Answer: B A child who walks with an equinus gait pattern will have exaggerated plantar flexion during the swing phase and decreased heel strike with forefoot contact during stance. This gait pattern is typically a result of a shortened Achilles tendon from muscular imbalance secondary to spasticity or clubfoot. Hamstrings shortening may also be associated with an equinus gait pattern. A. Side stepping exercises require the patient to abduct and adduct the legs while moving laterally. These exercises will target the hip abductors and adductors, but will not directly address shortening of the plantar flexors. B. The goal of intervention is to restore muscle length in the shortened plantar flexors (i.e., gastrocnemius and soleus muscles). Backward stepping elongates the plantar flexors, along with the hamstrings, which are also typically shortened in children who walk with an equinus gait pattern. C. Activities in single leg stance will address standing balance but do not address lengthening of the plantar flexors D. Toe walking is an activity that can be useful to strengthen the plantar flexors or challenge dynamic standing balance, however, it will produce further shortening of the gastrocnemius and soleus muscles.

Answer 170

15 Correct Answer: C The Glasgow Coma Scale is a neurological assessment tool used initially after injury to determine arousal and cerebral cortex function. The assessment tool utilizes an ordinal scale ranging from 3-15 with a higher score representing a greater level of consciousness. The Glasgow Coma Scale examines eye opening, motor response, and verbal response. The scale was initially used to assess level of consciousness after head injury and is often used on selected patients in acute care or following trauma. A. A score of 8 or less is indicative of a severe head injury. B. A score of 9-12 is indicative of a moderate head injury. C. A score of 15 is the highest attainable score on the Glasgow Coma Scale. A score of 13-15 is indicative of a mild head injury. D. A score of 18 is not possible on the Glasgow Coma Scale since the maximum score is 15.

Answer 171

tension in the calcaneofibular ligament Correct Answer: D End-feel refers to the type of resistance that is felt when passively moving a joint through the end range of motion A. The anterior joint capsule experiences increased tension with passive plantar flexion range of motion which contributes to a firm end-feel. B. The tibialis anterior acts to dorsiflex the ankle joint and invert the foot. As a result, the muscle would experience increased tension whlie lengthening during passive plantar flexion range of motion. C. The anterior talofibular ligament resists movement into plantar flexion and inversion. The ligament would therefore experience increased tension during passive plantar flexion range of motion. D. Tension in the calcaneofibular ligament is often associated with the normal end-feel of dorsiflexion (i.e., firm). Other structures contributing to an end-feel associated with dorsiflexion include the posterior joint capsule, soleus, Achilles tendon, posterior portion of the deltoid ligament, and the posterior talofibular ligament.

Answer 172

incorporate a pulsed 20% duty cycle Correct Answer: C Physical therapists must select ultrasound treatment parameters that are consistent with the desired therapeutic outcome. Failure to select appropriate parameters can lead to poor outcomes and potentially jeopardize patient safety. A. The frequency of ultrasound selected primarily determines the depth of penetration. A frequency setting of 1 MHz is used for heating of deeper tissues (up to five centimeters). B. Limiting the treatment time to five minutes does effectively control the duration of ultrasound, but it does not address several other critical factors that significantly influence changes in tissue temperature (e.g., duty cycle, intensity). C. When ultrasound is used in a pulsed mode with a 20% or lower duty cycle, the heat produced during the on time of the cycle is dispersed during the off time and as a result there is no measurable net increase in temperature. Ultrasound using a 20% or lower dutv cvcle would tvpically be used for nonthermal effects. D. Limiting the intensity of ultrasound to less than 1.5 W/cm? is helpful to avoid exacerbating the patient's current inflammation, however, the patient's condition could still be exacerbated at many intensity levels below 1.5 W/cm?

Answer 173

an older man coerced to have surgery Correct Answer: B Individual autonomy is a principle that refers to the capacity to be one's own person and to live one's life according to reasons and motives that are taken as one's own, and not the product of manipulative or distorting external forces. A. An adult who refuses surgery is an example of a patient exhibiting autonomy since they are making an independent decision without any evidence of external influence. B. An adult coerced to have surgery is a clear violation of an Individual's right to autonomy. Coercion is defined as the practice of persuading an individual to do something using force or threats. This type of persuasion often results in patients selecting a different course of action than would have been selected if the patient was able to make an independent decision. C. An infant does not possess the mental capacity to make an informed decision that is in their best interest. As a result decisions are made by a legally qualified surrogate such as a parent, legal guardian or court appointed advocate. A parental decision for an infant to have surgery would therefore not be considered a violation of the patient's autonomy. D. An athlete electing to have a second opinion is an example of a patient exhibiting autonomy since they are making an independent decision without any evidence of external influence. Many patients obtain a second opinion in order to receive an independent medical assessment

Answer 174

mini-squats in standing Correct Answer: C Anterior cruciate ligament reconstruction refers to the use of a graft to replace a damaged anterior cruciate ligament. The graft is placed through drilled holes in the femoral and tibial tunnels and then anchored with a fixation device. The focus of the early post-operative period is to protect the healing graft and donor site, and at the same time avoid post-operative complications such as adhesions, contractures, and articular degeneration. A. Performing isokinetics at 30 degrees per second on a patient eight days status post anterior cruciate ligament reconstruction could potentially jeopardize the integrity of the graft. B. A unilateral leg press is similar to a squat, however, it is usually performed in a supine position. The exercise is not as desirable as the mini-squat given the patient's post-operative status since the leg press activity is unilateral and therefore the patient would not have the benefit of using the uninvolved lower extremity to assist, if necessary, in addition, the mini-squat implies limited range where the unilateral leg press does not. C. A mini-squat is a closed-chain exercise typically performed in standing that enables the patient to vary the force through the involved extremity by simply shifting their weight. This exercise significantly limits the amount of knee flexion and as a result does not place a great deal of stress through the reconstructed knee. When completing mini-squats in standing, it is important that the knees do not move anterior to the toes as the hips descend since this will increase the shear forces of the tibia and could unnecessarily stress the graft D. Active knee extension in short sitting is an open-chain activity that places a significant amount of force on the anterior surface of the knee and in particular, the patellar tendon donor area.

Answer 175

traction force Correct Answer: C A split traction table separates into two separate sections. When the sections are unlocked and traction is applied, the lower portion of the table slides away from the upper portion. A split traction table reduces the amount of friction between the patient and the table. A. Patient position during traction is based on the therapeutic objectives, patient tolerance, and medical diagnosis. The use of a split traction table would not influence the patient position. B. There are a variety of different types of stabilizing belts and harnesses used when performing traction, however, the type of equipment selected would only be minimally influenced by the use of a split traction table. C. When using a split traction table, the amount of traction force lost to friction is significantly diminished when compared to a non-split traction table. This occurs because the lower half of the patient's body moves with the lower section of the table when a traction force is applied. As a result, less traction force is necessary when using a split traction table D. The duration of traction is based on the therapeutic objectives and patient tolerance. The use of a split traction table would not influence the duration of traction.

Answer 176

resisted flexion of the metatarsophalangeal Joint Correct Answer: B The lumbricals act to flex the metatarsophalangeal joints and assist in extension of the interphalangeal joints of the second through fifth digits. The lumbricals are innervated by the tibial nerve. A. The extensor digitorum longus extends the metatarsophalangeal joints of the second through fifth digits. The extensor digitorum brevis extends the metatarsophalangeal joints of the first through fourth digits B. Resisted flexion of the metatarsophalangeal joint can be used to strengthen the lumbricals. This can be performed with manual resistance or by gathering a towel or another similar object placed on the floor. C. The dorsal interossei abduct the second through fourth digits from the axial line through the second digit and assist in flexion of the metatarsophalangeal joints. D. The plantar interossei adduct the third, fourth, and fifth digits toward the axial line through the second digit and assist in flexion of the metatarsophalangeal joints.