GILES C Flashcards
A physical therapist designs an exercise program for a patient several weeks following cardiac transplantation. Which of the following would be MOST essential to incorporate into the patient’s exercise program based on the transplantation?
A. Increased warm-up and cool down period
B. Increased duration of training sessions
C. Increased target heart rate range during exercise
D. Increased monitoring of exercise intensity through heart rate
Increased warm-up and cool down period
A patient with cardiac transplantation would require an increased warm-up and cool down period. For several months after the transplant, the transplanted heart falls to respond normally to sympathetic nervous stimulation. Specifically, the heart rate responses to exercise and recovery is delayed, thus requiring the increased warm-up and cool down periods.
A physical therapist participates in a scoliosis screening as part of a health and wellness fair. Which individual would be the BEST candidate to participate in the screening process?
A. 10-year-old male
B. 13-year-old male
C. 8-year-old female
D. 16-year-old female
13-year-old male
A 13-year-old male is entering adolescence and is therefore a good candidate for scoliosis screening. According to the American Academy of Orthopedic Surgeons, peak incidence of the development of scoliosis is 13-14 years in males.
A physical therapist administers a special test to a patient with suspected hand pathology. The pinch test demonstrated would be used to assess the integrity of which nerve?
A. Posterior interosseous nerve
B. Anterior interosseous nerve
C. Deep radial nerve
D. Ulnar nerve
Anterior interosseous nerve
The anterior interosseous nerve is a branch of the median nerve that innervates the deep muscles on the anterior forearm, except the medial half of the flexor digitorum profundus. Inability to maintain tip-to-tip pinch is most likely due to weakness of the flexor pollicis longus.
A physical therapist applies passive overpressure to the spine of a patient referred to physical therapy with back pain. The patient reports back and leg symptoms with extension overpressure, however, he denies the presence of symptoms with flexion. This finding is MOST consistent with:
A. Lumbar disk lesion
B. Lumbar muscle strain
C. Sacroiliac joint sprain
D. Spinal stenosis
Spinal stenosis
Spinal stenosis refers to narrowing of the spinal column that causes pressure on the spinal cord and potentially narrowing of the neural foramina. Patients with spinal stenosis often experience back and leg symptoms with extension overpressure. Flexion overpressure does not typically produce back and leg svmptoms.
A patient who recently underwent a total knee arthroplasty is treated in his home by a physical therapist.
While reviewing the patient’s medical history and hospital discharge instructions, the therapist notes that the surgical incision was closed with staples. This form of wound closure is BEST classified as:
A. Primary intention
B. Delayed primary intention
C. Secondary intention
D. Tertiary intention
Primary intention
Healing by primary intention is most commonlv associated with acute wounds which have minimal associated tissue loss (e.g., surgical wound, laceration, puncture wound). In these wounds, clean edges, are reapproximated and closed with sutures, staples or adhesives to facilitate re-epithelialization.
A physical therapist works with a patient who has been instructed to take non-steroidal anti- inflammatory durgs (NSAIDs) to help control their symptoms of arthritis. The therapist educates the patient that overuse of NSAIDs can result in gastrointestinal damage. This side effect is caused by the inhibition of the production of which hormones?
A. Angiotensin
B. Ervthropoietin
C. Prostaglandins
D. Gastrin
Prostaglandins
Prostaglandins are a group of hormones that help protect the lining of the stomach by inhibiting gastric acid secretion and increasing the production of mucous in the stomach lining. NSAIDs inhibit the production of these protective prostaglandins, which results in the stomach becoming more susceptible to damage form the gastric acids.
A physical therapist treats a 30-year-old female in an acute care setting that was admitted with insidious respiratory issues and small, red nodules (granulomas) on her face, particularly surrounding her mouth
These clinical findings are typical of:
A. Systemic sclerosis
B. Bronchietasis
C. Sarcoidosis
D. PhenvIketonuria
Sarcoidosis
Sarcoidosis occurs primarily between the ages of 20 and 40 and has a higher incidence in women than men. It is also approximately four times more prevalent in African than Caucasians. The impact of sarcoidosis is dependent on the magnitude and region of the granulomas. Prognosis is typically favorable, however, there are some instances where it can be life-threatening.
An 18-vear-old male sustained a patella fracture in a motor vehicle accident. The patient’s knee is maintained in extension using a straight leg knee immobilizer. Which gait deviation would be MOST likely when using this type of immobilizer?
A. Vaulting
B. Antalgic gait
C. Increased plantar flexion
D. Trendelenburg gait
Vaulting
Vaulting is characterized by heel elevation during the stance in combination with hip and knee extension. Vaulting is performed to raise the pelvis in order to clear the contralateral limb during the swing phase. When the knee is locked in extension, the normal degree of knee flexion required during the swing phase does not occur resulting in difficulty clearing the foot. Vaulting can be an effective compensatory strategy when the knee is unable to flex.
A physical therapist hypothesizes that a patient’s chronic lower extremity swelling is due to lymphedema.
Which of the following symptoms is MOST consistent with the later stages of this condition?
A. Swelling that is relieved b elevation
B. Swelling proximal to the site of lymph dysfunction
C. Fibrotic changes of the dermis
D. Pitting edema
Fibrotic changes of the dermis
In the later stages of the condition, fibrotic changes occur within the dermal layer of the skin. Fibrosis results in hardening of the limbs which eventually leads to increasing size of the limbs.
A physical therapist grades a patient’s ankle strength as 4+/5 for the dorsiflexors and a 3+/5 for the plantar flexors. Assuming that the patient demonstrates no compensation for the muscular impairments, which deviation is MOST likely during the foot flat to midstance phase of gait?
A. Excessive dorsiflexion
B. Foot maintained on plantar flexion
C. Inadequate toe off
D. Decreased knee flexion
Excessive dorsiflexion
During the foot flat to midstance phase of gait, the gastrocnemius and soleus function eccentrically to oppose the dorsiflexion moment at the ankle and control the advancement of tibia. Weakness of these muscles would result in excessive dorsiflexion during this phase of gait, assuming no compensations were made by the patient.
A 16-year-old female walks with a toe-in gait. Which objective findings would MOST likely contribute to this type of gait deviation?
A. 15 degree Q angle
B. 20 degree Q angle
C. 18 degrees femoral anteversion
D. 7 degrees femoral anteversion
18 degrees femoral anteversion
Femoral anteversion is measured by the angle formed between the femoral neck and femoral condyles. At birth, it is approximately 30 degrees, and decreases to 8-15 degrees by adulthood. A value of 18 degrees of femoral anteversion would be considered excessive and may contribute to a “toe-in” gait.
A physical therapy works with a patient diagnosed with congestive heart failure who presents with dyspnea during ambulation. The patient has an ejection fraction of less than 55 percent. Which of the following interventions would be the MOST appropriate?
A. Instruction in pursed-lip breathing
B. Progressive resistive exercises
C. Education on energy conservation
D. Instruction in diaphragmatic breathing
Education on energy conservation
The primary goals of treating a patient with congestive heart failure include improving exercise tolerance and increasing knowledge of the disease process. Since the heart is unable to meet the metabolic demands of the body, pacing and enrgy conservation techniques are necessary for the patient to improve their tolerance for activities of daily living and potentially exercise.
A physical therapist treats a patient with end-stage renal disease for general deconditioning. Which other symptoms would this patient MOST likely demonstrate?
A. Increased urine output and polycythemia
B. Increased urine output and anemia
C. Decreased urine output and polvevthemia
D. Decreased urine output and anemia
Decreased urine output and anemia
With renal failure, the kidneys have a decreased ability to adequately filter fluids, therefore, urine output is significantly decreased or absent. Due to the kidneys’ role in the production of erythropoietin, patients with ESRD often display signs and symptoms of anemia.
A physical therapist attempts to determine if a patient with known heart disease is an appropriate candidate for an exercise program. Which scenario would MOST likely exclude the patient from participating?
A. The patient has an ejection fraction of 45%.
B. The patient had an uncomplicated myocardial infarction two months ago.
C. The patient’s electrocardiogram shows ST segment depression of one millimeter.
D. The patient has ventricular arrhythmias at rest
The patient has ventricular arrhythmias at rest
A patient with ventricular arrhythmias at rest would be classified as high risk for increased morbidity and mortality. Additionally, the AACVPR recommends that patients with uncontrolled arrhythmias be excluded from exercise.
A physical therapist attempts to implement a formal exercise program for a patient three weeks following cardiac transplantation. Which physiologic response should the therapist anticipate based on the transplantation?
A. Increased resting heart rate
B. Increased heart rate response with exercise
C. Increase peak heart rate during exercise
D. Increased age-predicted maximal heart rate
Increased resting heart rate
The patient would likely experience an increased resting heart rate following cardiac transplantation because of the lack of parasympathetic innervation. The heart rate is usually greater than 80 beats per minute.
A physical therapist emploved in an outpatient private practice receives a referral for a patient diagnosed with spondylolisthesis. Which of the following scenarios would be MOST consistent with the medical diagnosis?
A. A 13-year-old female gymnast with no significant medical history
B. A 17-year-old female tennis player with a 15 degree lateral curvature of the spine
C. A 28-vear-old male machinist with a history of recurrent low back pain
D. A 67-year-old male with a previous diagnosis of ankylosing spondylitis
A 13-year-old female gymnast with no significant medical history
Children ages 10-15 who are involved in activities such as gymnastics, weight lifting, volleyball, and pole vaulting are particularly susceptible to spondylolisthesis.
A patient diagnosed with Cushing’s syndrome is referred to physical therapy. Which of the following signs and svmptoms is NOT consistent with this svndrome?
A. Distension of the abdomen
B. Swelling in the facial area
C. Adrenal hypoplasia
D. Cardiac hypertrophy
Adrenal hypoplasia
Cushing’s syndrome is a condition characterized by hyperfunction of the adrenal cortex. Addison’s disease is a condition characterized by hypoplasia of the adrenal cortex.
After palpating a patient’s foot and ankle, a therapist concludes that the majority of the patient’s discomfort is located in an area depicted by the red marking on the image This type of finding is MOST consistent with:
A. Ganglion cyst
B. Sever’s disease
C. Tarsal tunnel syndrome
D. Plantar fasciitis
Sever’s disease
Sever’s disease (i.e., calcanel apophysitis) is a painful bone disorder that results from inflammation of the growth plate in the heel. The disease most commonly occurs during adolescence and rarely occurs once an individual reaches skeletal maturity. The pain is typically located on the posterior surface of the calcaneus.
A physical therapist works with a patient status post left CV A with right hemiplegia. Which therapeutic position would be MOST difficult for the patient to maintain based on their diagnosis?
A. Half-kneel with involved leg anterior
B. Half-kneel with involved leg posterior
C. Bilateral tall kneeling
D. Bilateral lower extremity bridge
Half-kneel with involved leg posterior
Half-kneel with the involved leg posterior is the most difficult position for the patient to maintain since the posterior leg is responsible for increased body weight as compared to tall kneeling. The overall increased stability demands placed on the affected posterior limb provides additional challenge to all of the supporting muscles in order to maintain hip extension and lower trunk control.
A physical therapist treats a patient diagnosed with Parkinson’s disease. When working on controlled mobility, which of the following would BEST describe the physical therapist’s objective?
A. Facilitate postural muscle control
B. Promote weight shifting and rotational trunk control
C. Emphasize reciprocal extremity movement
D. Facilitate tone and rigidity
Promote weight shifting and rotational trunk control
Controlled mobility activities should emphasize weight shifting and trunk control with rotation. This type of activity may serve to decrease rigidity and improve the fluidity of gait in a patient with Parkinson’s disease.
A physical therapist assesses the strength of selected lower extremity muscles on a patient rehabilitating from a knee injury. The pictured test would be MOST effective to examine the strength of the:
A. Hip abductors
B. Hip adductors
C. Hip medial rotators
D. Hip lateral rotators
Hip lateral rotators
The strength of the hip lateral rotators is assessed with the patient in sitting. The physical therapist should apply pressure to the medial side of the leg above the ankle, pushing the leg outward in an attempt to rotate the thigh medially.
A 42-year-old female is admitted to a rehabilitation hospital after sustaining a stroke. During the examination the physical therapist identifies significant sensory deficits in the anterolateral spinothalamic svstem. Which sensation would be MOST affected?
A. Barognosis
B. Kinesthesia
C. Graphesthesia
D. Temperature
Temperature
Temperature information is transmitted through the spinothalamic system. The system consists of small diameter and relatively slow conducting afferent fibers. Conversely, the dorsal columns consist of large diameter, rapidly conducting afferent fibers.
A 13-year-old girl discusses the possibility of anterior cruciate ligament reconstruction with an orthopedic surgeon. The girl injured her knee while playing soccer and is concerned about the future impact of the injury on her athletic career. Which of the following factors would have the GREATEST influence on her candidacy for surgery?
A. Anthropometric measurements
B. Hamstrings/quadriceps strength ratio
C. Skeletal maturity
D. Somatotype
Skeletal maturity
Due to the potential impact on future bone growth, lack of skeletal maturity can be a contraindication to anterior cruciate ligament reconstruction surgery.
A physical therapist performs reflex testing on a patient with a suspected upper motor neuron lesion. The testing procedure shown in the image would MOST likely assess the status of the:
A. Glossopharyngeal nerve
B. Oculomotor nerve
C. Trigeminal nerve
D. Trochlear nerve
Trigeminal nerve
The jaw jerk reflex is a muscle stretch reflex used to assess the trigeminal nerve. Both the sensory and motor components of the reflex are through the trigeminal nerve.
A physical therapist uses the body mass index scale as a means of assessing a patient’s total body composition. The therapist determines the body mass index by dividing the body weight in kilograms by height in meters squared. Which of the following values would be the MOST representative of a healthy male or female?
A. 14 kg/m2
B. 22 kg/m2
C. 28 kg/m2
D. 37 kg/m2
22 kg/m2
A BMI from 18.5-24.9 is considered normal.
A physical therapist treats a patient referred to physical therapy with incontinence. The patient describes her difficulty beginning after the birth of her son. After completing an examination the therapist concludes that the patient has extremely weak pelvic floor muscles. When instructing the patient in a pelvic floor muscle strengthening program, the MOST appropriate position to initiate treatment is:
A. Sidelying
B. Sitting
C. Standing
D. Supine
Supine
Patients with extremely weak pelvic floor muscles should initiate strengthening exercises in a horizontal plane in order to avoid gravity exerting a downward force on the pelvic floor.
A physical therapist prepares to initiate an examination procedure by placing a patient in long sitting on a mat table. This position would be the MOST appropriate to initiate:
A. Craig’s test
C. Ely’s test
B. Dix-hallpike maneuver
D. Vertebral arterv test
Dix-hallpike maneuver
Dix-hallpike maneuver is a diagnostic tool for benign paroxysmal positional vertigo (BPPV). A patient that presents with BPPV will have torsional nystagmus when performing this maneuver. The patient moves from a long sitting position 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.
A physical therapist employed in a school setting observes a 10-year-old boy attempt to move from the floor to a standing position. During the activity, the boy has to push on his legs with his hands in order to attain an upright position. This type of finding is MOST commonly associated with:
A. Cystic fibrosis
B. Down syndrome
C. Duchenne muscular dystrophy
D. Spinal muscular atrophy
Duchenne muscular dystrophy
Gowers’ sign is a descriptive term used to describe a specific method patients with muscular dvstrophy often use to assume an upright position. The disease causes mechanical weakening and cell destruction Pseudohypertrophy of the calf muscles is often the first observed finding, however, all muscles are eventually affected including respiratory and cardiac muscles.
A physical therapist administers the Mini Mental State Examination to a patient recently admitted to an acute care medical facility. The MINIMUM patient score necessary in order to avoid being classified as possessing a cognitive impairment would be:
A. 18
B. 24
C. 30
D. 34
24
A score of 24 is the minimum score to avoid being classified as having a cognitive impairment.
A physical therapist employed in an inpatient rehabilitation center works with a patient rehabilitating from a total knee arthroplasty. Which treatment activity would be the MOST appropriate to delegate to a physical therapy aide?
A. Monitoring vital signs
B. Measuring knee range of motion with a goniometer
C. Observing a patient complete a mat exercise program
D. Recording modality parameters in the medical record
Observing a patient complete a mat exercise program
Observing a patient complete a mat exercise program could be considered an unskilled activity and therefore appropriate for the physical therapy aide. It would be inappropriate for the physical therapy aide to expand their duties beyond an observational role (i.e., modify, interpret, progress) since this would require clinical decision making.
A physical therapist notices a small area of skin irritation under the chin of a patient wearing a Philadelphia collar. The patient expresses that the area is not painful, but is becoming increasingly itchy. The MOST appropriate therapist action is:
A. Instruct the patient to apply 1% hydrocortisone cream to the area twice daily
B. Apply powder to the area and instruct the patient to avoid scratching
C. Provide the patient with a liner to use as a barrier between the skin and the orthosis
D. Discontinue use of the orthosis until the skin has become less irritated
Provide the patient with a liner to use as a barrier between the skin and the orthosis
Liners made from lambs’ wool are commonly utilized and prevent chafing and irritation of the patient’s skin. This liner is easily donned and provides an adequate barrier between the skin and orthosis.
A patient with muscle weakness and compromised balance uses a four-point gait pattern with two canes.
The physical therapist would like to instruct the patient to ascend and descend the stairs according to the normal flow of traffic. When ascending stairs the MOST practical method is to:
A. Use the handrail with the right hand and place the two canes in the left hand
B. Use the handrail with the left hand and place the two canes in the right hand
C. Place one cane in each hand and avoid using the handrail
D. Place the two canes in the left hand and avoid using the handrail
Use the handrail with the right hand and place the two canes in the left hand
Since the patient does not have unilateral weakness, it is most appropriate to ascend the stairs on the right in order to utilize the handrail and remain consistent with the normal flow of traffic.
A patient rehabilitating from a total hip arthroplasty receives home physical therapy services. The patient is currently full weight bearing and is able to ascend and descend stairs independently. The patient expresses that her goal following rehabilitation is to walk one mile each day. The MOST appropriate plan to accomplish the patient’s goal is to:
A. Continue home physical therapy services until the patient’s goal is attained
B. Refer the patient to an outpatient orthopedic physical therapy clinic
C. Design a home exercise program that emphasizes progressive ambulation
D. Admit the patient to a rehabilitation hospital
Design a home exercise program that emphasizes progressive ambulation
The physical therapist can assist the patient with her long-term goal by designing a home exercise program that incorporates ongoing exercise and progressive ambulation activities. This patient would not typically qualify for further phsical therapy services.
A phsical therapist instructs a patient to perform a stretch as shown in the image. This type of stretch would MOST likely be used to stretch the:
A. Pectoralis minor
B. Triceps
C. Middle trapezius
D. Upper trapezius
Pectoralis minor
The pectoralis minor muscle originates on ribs three to five and inserts on the coracoid process of the scapula. The muscle acts to stabilize the scapula by drawing it inferiorly and anteriorly against the thoracic well. The pectoralis minor is stretched in a manner similar to the various methods used to stretch the pectoralis major (e.g., corner wall stretch).
a patient requires inpatient physical therapy after sustaining brain damage in a motor vehicle accident. Upon entering the patient’s room, the physical therapist finds the patient as shown in the image. The patient’s MOST likely perceptual deficit is:
A. diplopia
B. apraxia
C. somatognosia
D. anosognosia
somatognosia
Somatoagnosia is an impairment of body schema where there is a lack of awareness of a body structure and its relationship to other body parts, to oneself or to others. This patient is attempting to brush their hair, however, does not realize that the mirror image is not the true body part.
A physical therapist reviews the medical record of a patient with a spinal cord injury. A note recently entered by the physician indicates that the patient contracted a respiratory infection. Which patient would be MOST susceptible to this condition?
A. A patient with complete C4 tetraplegia
B. A patient with a cauda equina lesion
C. A patient with Brwon-Sequard’s syndrome
D. A patient with posterior cord svndrome
A patient with complete C4 tetraplegia
A patient with complete C4 tetraplegia will have a reduced ventilator capacity due to muscle paralysis. The patient will exhibit limited ability to clear secretions, impaired chest mobility, and alveolar hypoventilation.
A physical therapist discusses common cognitive and behavioral changes associated with stroke with family members of a patient with right hemisphere damage and resultant left hemiplegia. Which term does NOT accuratelv describe the most tvpical patient presentation?
A. Poor judgment
B. Impulsive
C. Quick
D. Overly cautious
Overly cautious
Patients with left hemisphere damage often are described as cautious, anxious, and disorganized. They often have difficulties communicating and in processing information in a sequential manner.
A physicial therapist discusses the process of learning to drive an adapted van with a patient rehabilitating from a spinal cord injury. What is the HIGHEST spinal cord injury level where this activity would be a realistic independent functional outcome?
A. CA
B. С6
C. T1
D. T3
С6
A patient with a C6 spinal cord injury would possess the requisite upper extremity movement to drive an adapted van with hand controls and use a lift to get the wheelchair in and out of the vehicle. The extensor carpi radialis, infraspinatus, latissimus dorsi, pectoralis major, pronator teres, serratus anterior, and teres minor would be innervated.
A physical therapist searches the literature to find an appropriate cardiovascular screening test to identify individuals with known cardiovascular disease who should have a medical examination before starting an exercise program. The physical therapist should choose a screening test with:
A. High positive predictive value
B. Low positive predictive value
C. High discriminant validity
D. High internal consistency
High positive predictive value
A positive predictive value estimates the probability that a person who tests positive on the screening test actually has the condition the screening test is intended to detect. A test with a high positive predictive value provides a strong estimate of the actual number of patients who have the condition.
A physical therapist uses repeated contractions to strengthen the quadriceps of a patient that fails to exhibit the desired muscular response throughout a portion of the range of motion. This proprioceptive neuromuscular facilitation technique (PNF) should be applied:
A. With the extremity placed into a shortened range within the pattern
B. At the point where the desired muscular response begins to diminish
C. At the end of the available range of motion
D. With a maximal contraction of the antagonistic muscle group
At the point where the desired muscular response begins to diminish
Repeated contractions, alternating isometrics, resisted progression, and timing for emphasis are all examples of PNF techniques that are applied with the goal and purpose of increasing strength.
The treatment plan for a patient with hemiplegia is based on the theory of reinforcing normal movement through key points of control and avoiding all reflex movement patterns and associated reactions. This approach MOST closely resembles:
A. Bobath
C. Rood
B. Kabat
D. Brunnstrom
Bobath
The Bobath approach recognizes that interference of normal brain function caused by central nervous system damage leads to a slowing down or cessation of motor development and the inhibition of righting reactions, equilibrium reactions, and automatic movements. Emphasis on normal movement and rotational patterns are key components of this therapeutic model.
A patient with several motor and sensory abnormalities exhibits signs of autonomic nervous system dysfunction. Which of the following is NOT an indicator of increased sympathetic involvement?
A. Anxiety, distractibility
B. Mottled, cold, shiny skin
C. Constriction of the pupils
D. Rapid, shallow breathing
Constriction of the pupils
Constriction of the pupils is characteristic of a parasympathetic response. The parasympathetic division will also decrease heart rate, stimulate digestion, constrict the lungs, and stimulate other internal organs.
A 55-vear-old patient, six months status post CVA with right hemiparesis, attends phsical therapy on an outpatient basis. As the patient lies supine on the mat, the physical therapist applies resistance to right elbow flexion. The therapist notes mass flexion of the right lower extremity as the resistance is applied. The therapist should document this as:
A. Raimiste’s phenomenon
B. Souques’ phenomenon
C. Coordination synkinesis
D. Homolateral synkinesis
Homolateral synkinesis
Homolateral synkinesis is a condition often associated with hemiplegia where there is mutual dependency between the involved upper and lower extremities. Certain theories of neurological rehabilitation avoid utilizing associated reactions while other theories utilize them to increase movement.
A child with a unilateral hip disarticulation works on advanced gait training activities. Which of the following activities would be the MOST difficult for the patient?
A. Rising from a wheelchair
B. Ascending stairs with a handrail
C. Descending stairs with a handrail
D. Ascending a curb
Ascending a curb
A child with a hip disarticulation would have the greatest difficulty ascending a curb during prosthetic training since there are no external supports (handrails) to assist with the activity.
A physical therapist assesses a patient with significant biceps brachi weakness and suspects there may be underlying neurological damage that is causing the weakness. Damage to which portion of the brachial plexus would MOST likely explain this finding?
A. Lateral cord
B. Posterior cord
C. Medial cord
D. Anterior cord
Lateral cord
The lateral cord branches off to become the musculocutaneous nerve, median nerve, and lateral pectoral nerve. The musculocutaneous nerve innervates the muscles of the anterior upper arm, including the biceps brachii.
A patient rehabilitating from extensive burns to the right upper extremity often complains of severe pain in the arm during physical therapy treatment sessions. The present plan of care emphasizes range of motion, stretching, and positioning. The MOST appropriate action to address the patient’s complaint is to:
A. Reduce the frequency and duration of the treatment sessions
B. Schedule treatment sessions when the patient’s pain medication is most effective
C. Avoid treatment activities that are uncomfortable for the patient
D. Request that the referring physician increase the dosage of the patient’s pain medication
Schedule treatment sessions when the patient’s pain medication is most effective
A patient should receive the optimal benefit of pain medication during their scheduled therapy session. Greater tolerance may allow the patient to make more rapid progress in therapy.
A physical therapist conducts an examination on a patient with suspected ulnar nerve palsy. Which finding is MOST consistent with the hypothesized diagnosis?
A. Wasting of the hypothenar eminence
B. Wrist drop with increased flexion of the wrist
C. Increased flexion of the metacarpophalangeal joint
D. Proximal interphalangeal joint hyperextension and slight flexion of the distal interphalangeal joint
Wasting of the hypothenar eminence
The hypothenar eminence consists of the opponens digiti minimi, flexor digiti minimi, and abductor digiti minimi. These muscles are innervated by the ulnar nerve. An ulnar nerve palsy would result in diminished activity in the hypothenar muscles resulting in atrophy.
A physical therapist instructs a patient to perform a standing stretch as shown in the image. This type of stretch would MOST likely be used to stretch the:
A. Horizontal abductors
B. Inferior capsule
C. Pectoralis major
D. Pectoralis minor
Inferior capsule
The capsule encompasses the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. The inferior portion of the capsule is tightened when the arm is raised overhead. A restriction in the inferior capsule often accompanies prolonged periods of immobilization and results in difficulty lifting the arm overhead.
A physical therapist observes that a patient is unable to heel walk during a neurological examination. This objective finding may indicate damage to the:
A. Corticospinal tract
B. Reticulospinal tract
C. Rubrospinal tract
D. Tectospinal tract
Corticospinal tract
The corticospinal tract originates from pyramid-shaped cells in the premotor, primary motor, and primary sensory cortices and is involved in skilled voluntary activity. Damage to the corticospinal (pyramidal) tracts results in a positive Babinski sign, absent superficial abdominal and cremasteric reflexes, and the loss of fine motor or skilled voluntary movement. Heel walking is a commonly utilized functional test to identify corticospinal tract involvement.
A physical therapist works with a patient who has been on bed rest in an acute care hospital for more than a month. Which muscle group and area of the body would the therapist anticipate being MOST affected by the immobilization?
A. Extensor muscles of the upper extremities
B. Flexor muscles of the upper extremities
C. Extensor muscles of the lower extremities
D. Flexor muscles of the lower extremities
Extensor muscles of the lower extremities
The lower extremities tend to be more affected by immobilization than the upper extremities. Research has demonstrated that bed rest for 30 days decreases knee extensor strength by 20 percent while knee flexor strength experiences a nonsignificant decrease. The loss of strength is primarily due to a decrease in muscle mass and cross sectional area.
A physical therapist employed in an acute care hospital observes that a patient appears to have recently gained weight. Which medical condition would MOST likely be associated with this type of scenario?
A. Addison’s disease
B. Crohn’s disease
C. Congestive heart failure
D. Grave’s disease
Congestive heart failure
Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body. The heart’s inability to pump a sufficient amount of blood occurs when there is insufficient or defective cardiac filling and or impaired contraction and emptying of the heart. Weight gain primarily results from an increase in the amount of fluid in the body. Pharmacological management, such as diuretics, helps to reduce the amount of fluid in the bodv.
A patient diagnosed with Meniere’s disease presents with vertigo. Which sign or symptom is inconsistent with this medical condition?
A. Hearing loss
B. Tinnitus
C. Vertigo lasting 30 minutes
D. Head tilt to one side
Head tilt to one side
Head tilting to one side is not typically associated with meniere’s disease. This sign is more commonly associated with a diagnosis of unilateral vestibular hvpofunction. Because the vestibular nerve is affected unilaterally, this condition is characterized by an ocular tilt reaction consisting of head tilt, conjugate eve torsion, skew deviation, and an abnormal weight shift to the side of the lesion.
A physical therapist reads in the medical chart that a patient is taking digitalis. The patient is MOST likely taking this medication to treat:
A. Angina
B. Atrial fibrillation
C. Hvpertension
D. Thrombus formation
Atrial fibrillation
Atrial fibrillation is an arrhythmia characterized by erratic electrical conductivity within the atria. By depressing electrical conductivity, digitalis can effectively prevent the conduction of atrial arrhythmias into the ventricles.
A physical therapist reads in a medical chart that a patient’s spinal cord injury was classified as “B” according to the ASIA Impairment Scale. What would be the MOST likely clinical presentation of this patient?
A. Intact anal sensation, normal bowel control
B. Intact anal sensation, absence of bowel control
C. Absent anal sensation, normal bowel control
D. Absent anal sensation, absence of bowel control
Intact anal sensation, absence of bowel control
A patient with intact anal sensation but no bowel control would have some level of sensory function preserved below the neurological level. However, they would not have any motor function preserved below the neurological level. This patient would be classified as B using the ASIA Impairment Scale.
A physical therapist discusses the plan of care for a 61-year old-male diagnosed with spinal stenosis with the referring physician. During the discussion the physician shows the therapist a picture of the patient’s spine obtained through computed tomography. What color would vertebrae appear when using this imaging technique?
A. Black
B. Light gray
C. Dark gray
D. White
White
Vertebrae are composed of extremely dense bone and therefore appear to be white.
A physical therapist identifies a number of substances that influence circulation. Which of the following substances is stimulated by decreased arterial pressure and acts as a vasoconstrictor?
A. Angiotensin
B. Histamine
C. Epinephrine
D. Norepinephrine
Angiotensin
Angiotensin is a polypeptide in the blood that causes vasoconstriction, increased blood pressure, and the release of aldosterone from the adrenal cortex. Release of angiotensin is stimulated by decreased arterial pressure.
A physical therapist attempts to auscultate over the aortic valve. Which of the following areas is the MOST appropriate to isolate the desired valve?
A. Second left intercostals space at the left sterna border
B. Second right intercostals space at the right sterna border
C. Fourth left intercostals space along the lower left sterna border
D. Fifth left intercostals space at the midclavicular line
Second right intercostals space at the right sterna border
The second right intercostals space at the right sterna border denotes the aortic area and is best for auscultating the aortic valve.
A physical therapist attempts to estimate the energy expenditure in calories for a patient performing a selected activity for 15 minutes. Assuming the therapist has a metabolic equivalent value for the activity, what other variables are necessary in order to obtain an estimate of the patient’s energy expenditure?
A. Patient’s height
B. Patient’s body weight
C. Patient’s stroke volume
D. Patient’s residual volume
Patient’s body weight
A metabolic equivalent (MET) is a measure of oxygen consumption, 1 MET = 3.5 mL O2 per kg of body weight per minute. Therefore, the caloric expenditure of any activity can be estimated using the number of METs for the activity, the body weight (kg). and the duration of the activity.
A Physical therapist completes a cranial nerve assessment on a patient with a suspected neurological injury by using a tongue depressor. Which cranial nerves are MOST commonly assessed with this type of equipment?
A. VII, IX
B. IX, X
C. X. XI
D. XI. XII
IX, X
Cranial nerve IX-glossopharyngeal is assessed by distinguishing objects by taste or by assessing the gag reflex with a tongue depressor Cranial nerve X-vagus is assessed by assessing the gag reflex with a tongue depressor
A physical therapist critically analyzes the methodology used in a published research study. Which type of sampling procedure would result in the GREATEST degree of sampling error?
A. Simple random sample
B. Systematic sample
C. Cluster sample
D. Stratified random sample
Cluster sample
A cluster sample is a probability sample in which large subgroups (clusters) are randomly selected first, and then smaller units are selected from the clusters. Because the technique requires two or more samples to be drawn, each sample is subject to sampling error, potentially compounding the accuracy of the final sample.
A patient with known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self-administers a nitroglycerin tablet to control the angina. Nitroglycerin helps to control this symptom by:
A. Decreasing heart rate
B. Inhibiting vasospasm of the coronary arteries
C. Dilating peripheral arteries and veins
D. Decreasing platelet aggregation
Dilating peripheral arteries and veins
Nitroglycerin acts in three different ways to decrease myocardial oxygen demand: dilation of veins to decrease venous return (i.e., preload), dilation of arteries to decrease afterload, and relaxation of coronary artery smooth muscle to increase coronary blood supply.
A physical therapist works with a patient who has sustained a lesion to the long thoracic nerve. What objective finding would this patient MOST likely demonstrate?
A. Decreased sensation on the lateral forearm
B. Atrophy of the deltoid muscle
C. Inability to elevate the arm overhead
D. Fair strength with shoulder extension
Inability to elevate the arm overhead
Injury to the long thoracic nerve results in weakness of the serratus anterior muscle. The serratus anterior works in combination with the trapezius muscle to upwardly rotate the scapula during elevation of the arm Weakness of the serratus anterior muscle would make it difficult for a patient to elevate their arm overhead.
A physical therapist reads in the medical record that a patient with suspected cardiovascular disease had a positive graded exercise test. Which place of data would have been the MOST influential when concluding that the test was positive?
A. Angina symptoms
B. Ventricular dysrhythmias
C. ST segment changes
D. Supraventricular dysrhythmias
ST segment changes
The ST segment is the portion of the electrocardiograph tracing from the end of the S wave to the beginning of the T wave. It represents the intiation of ventricular repolarization and is a sensitive indicator of ischemia of the ventricles. The standard criterion for a positive graded exercise test is greater than or equal to Imm of horizontal or downsloping ST segment depression.
A physical therapist attempts to identify an appropriately sized wheelchair for a patient recently referred to a rehabilitation hospital. The physical therapist determines that the patient’s hip width in sitting and the measurement from the back of the buttocks to the popliteal space are each 16 inches. Given these measurements, which of the following wheelchair specifications would BEST fit this patient?
A. Seat width 16 inches, seat depth 14 inches
B. Seat width 18 inches, seat depth 18 inches
C. Seat width 16 inches, seat depth 18 inches
D. Seat width 18 inches, seat depth 14 inches
Seat width 18 inches, seat depth 14 inches
A seat width of 18 inches and a seat depth of 14 inches are consistent with the presented formula based on the obtained measurements.
A physical therapist employed in an acute care hospital conducts an initial interview with a patient referred to physical therapy. During the interview, the therapist asks the patient if he feels dependent on coffee, tea or soft drinks. Which clinical scenario would MOST appropriatelv warrant this tvpe of question?
A. A 27-vear-old female status post arthroscopic medial meniscectomy
B. A 42-year-old male with premature ventricular contractions
C. A 37-year-old female with restrictive pulmonary disease
D. A 57-year-old male witt respiratory alkalosis
A 42-year-old male with premature ventricular contractions
It would be important to know if a patient known to have PVCs has a dependence on coffee, tea, and soft drinks since these drinks may contain caffeine, a stimulant that can precipitate PVCs. The physical therapist should inform the patient about the possible connection between these drinks and the occurrence of PVCs.
A patient diagnosed with C5 tetraplegia receives physical therapy services in a rehabilitation hospital. The patient has made good progress in therapy and is schedules for discharge in one week. During a treatment session, the patient informs the physical therapist that one day in the future he will walk again. The MOST appropriate therapist response is:
A. Your level of injury makes walking unrealistic.
B. Future advances in spinal cord research may make your goal a reality.
C. You can have a rewarding life even if confined to a wheelchair.
D. Completing your exercises on a regular basis will help you to walk.
Future advances in spinal cord research may make your goal a reality.
Responding in this manner leaves open the possibility that the patient may one day walk, without providing the patient with a sense of false hope.
A physical therapist performs several surface palpations on a patient diagnosed with an acromioclavicular injury, Which anatomical landmark is MOST consistent with the location of the therapist’s finger?
A. Manubrium
B. Sternoclavicular joint
C. Suprasternal notch
D. Xiphoid process
Suprasternal notch
The anatomical landmark consistent with the therapist’s finger is the suprasternal notch. The suprasternal notch refers to the “V” shaped notch at the top of the sternum.
A physical therapist discusses the plan of care for a patient rehabilitating from total hip arthroplasty surgery (posterolateral approach) with the patient’s surgeon. During the discussion the surgeon indicates that he would like the patient to continue to wear a knee immobilizer in order to help prevent hip dislocation. The PRIMARY rationale for this action is:
A. The knee immobilizer serves as a constant reminder to the patient that the hip is susceptible to injury.
B. The knee immobilizer reduces hip flexion by maintaining knee extension.
C. The knee immobilizer facilitates quadriceps contraction during weight bearing activities.
D. The knee immobilizer limits post-operative edema and as a result, promotes lower extremity stability.
The knee immobilizer reduces hip flexion by maintaining knee extension.
A knee immobilizer limits hip flexion by maintaining the knee in an extended position. The immobilizer can be particularly helpful in patients who are unable to maintain posterior hip precautions independently.
A 46-year-old male rehabilitating form a radial head fracture misses this third consecutive physical therapy treatment session. The therapist called the patient after the second missed appointment, but did not receive a return phone call. The MOST appropriate physical therapist action is:
A. Contact the patient’s insurance provider
B. Design a home exercise program for the patient
C. Schedule the patient with another physical therapist
D. Discharge the patient from physical therapy
Discharge the patient from physical therapy
Multiple missed appointments without a response to a phone call warrants discharging the patient from physical therapy. Failure to act in this manner limits the availability of physical therapy services for other patients.
A physical therapist treats a patient with a decubitus ulcer using whirlpool. After treating the wound for 10 treatment sessions, the wound still shows little evidence of granulation. The MOST appropriate action is:
A. Begin aggressive debridement
B. Recommend a wound culture
C. Apply aseptic ointment to the wound
D. Discontinue whirlpool treatments
Discontinue whirlpool treatments
Physical therapist have an obligation to discontinue ineffective interventions. If the selected intervention was beneficial it is likely that 10 treatment sessions would have been adequate to generate supporting evidence such as signs of healing (e.g., presence of granulation tissue).
A physical therapist works with a patient who is in the initial stages of recovery after a traumatic brain injury. Based on the typical pattern of spasticity experienced with upper motor neuron disorders, which muscle would be MOST likelv affected?
A. Flexor carpi radialis
B. Supinator
C. Triceps
D. Extensor digitorum
Flexor carpi radialis
The pattern of spasticity for the upper extremity includes flexion of the wrist. The flexor carpi radialis is one of the muscles affected by spasticity and serves to maintain the wrist in a flexed position.
A physical therapist prepares to administer rescue breathing to a 45-year-old male that is unresponsive. The MOST appropriate method to administer rescue breathing is:
A. Mouth to mouth ventilation
B. Mouth to nose ventilation
C. Mouth to mouth and nose ventilation
D. Mouth to mask ventilation
Mouth to mask ventilation
Mouth to mask ventilation allows the physical therapist to provide ventilations without having to experience direct skin to skin contact. Face masks are typically made of durable plastic with a one-way valve and filter.
Although several of the other options are appropriate methods to administer rescue breathing, the ability of the mask to serve as a barrier makes this option the most desirable.
A physical therapist instructs a patient rehabilitating from a low back injury in a series of five pelvic stabilization exercises. The patient indicates he understands the exercises, however, frequently becomes confused and is unable to perform them correctly. The MOST appropriate therapist action is:
A. Repeat the exercise instructions
B. Reduce the number of exercises in the series
C. Select a different treatment option
D. Conclude the patient is not a candidate for physical therapy
Reduce the number of exercises in the series
Reducing the number of exercises in the series serves to simplify the program. Five pelvic stabilization exercises is a significant number for the patient to learn, and as a result, it is reasonable to hypothesize that the number of exercises may be the primary reason for the patient’s difficulty.
A physical therapist employed in a rehabilitation hospital prepares to perform a stand pivot transfer with a
42-year-old male rehabilitating from a motor vehicle accident. Prior to initiating the transfer, the therapist notices that the patient is wearing only a pair of hospital issued non-skid socks on his feet. The MOST appropriate therapist action is to:
A. Ask another therapist for assistance and complete a dependent transfer
B. Have the patient complete a sliding board transfer
C. Perform the stand pivot transfer without socks
D. Perform the stand pivot transfer with the patient wearing the hospital-issued socks
Perform the stand pivot transfer with the patient wearing the hospital-issued socks
The hospital-issued socks are appropriate for transfers since the non-skid surface incorporates rubberized material that significantly improves traction when compared to traditional socks.
A physical therapist treats a patient diagnosed with chronic arterial disease. The patient exhibits cool skin, decreased sensitivity to temperature changes, and intermittent claudication with activity. The primary treatment goal is to increase the patient’s ambulation distance. The MOST appropriate ambulation parameters to facilitate achievement of the goal are:
A. Short duration, frequent intervals
B. Short duration, infrequent intervals
C. Long duration. Frequent intervals
D. Long duration, infrequent intervals
Short duration, frequent intervals
Treadmill and track walking are the most effective modes of exercise to reduce claudication/ The initial workloads are set to elicit claudication symptoms within three to five minutes. This is followed by a period of standing or sitting to allow symptoms to resolve. The exercise-rest-exercise pattern is repeated throughout the exercise session. Due to the short duration of each bout of exercise before the onset of symptoms, more frequent exercise bouts are indicated
A patient rehabilitating from a bone marrow transplant is referred to physical therapy for instruction in an exercise program. The physical therapist plans to use oxygen saturation measurements to gain additional objective date related to the patient’s exercise tolerance. Assuming the patient’s oxygen saturation was measured as 95% at rest, which of the following guidelines would be the MOST appropriate?
A. Discontinue exercise when the patient’s oxygen saturation is below 95%
B. Discontinue exercise when the patient’s oxygen saturation is below 90%
C. Discontinue exercise when the patient’s oxygen saturation is below 85%
D. Discontinue exercise when the patient’s oxygen saturation is below 80%
Discontinue exercise when the patient’s oxygen saturation is below 90%
When oxygen saturation falls below 90% exercise should be discontinued and the patient should rest. This corresponds to a partial pressure of oxygen (Pa02) of approximately 60 mm Hg, which represents a state of arterial hypoxemia. This is the most common indication for supplemental oxygen therapy.
A 52-year-old female is restricted from physical therapy for two days following surfical insertion of a urinary catheter. This type of procedure is MOST commonly performed with a
A. Condom catheter
B. Foley catheter
C. Suprapubic catheter
D. Swan-Ganz catheter
Suprapubic catheter
A suprapubic catheter is an indwelling urinary catheter that is surfically inserted directly into the patient’s bladder. Insertion of a suprapubic catheter is performed under general anesthesia.
A physical therapist examines an infant in the neonatal intensive care unit. Which information from the medical chart provides the MOST compelling evidence that the child is at high risk for cerebral palsy?
A. Birth weight of 2000 grams
B. Apgar score of 8 at 1 minute
C. Periventricular leukomalacia
D. Premature birth at 34 weeks
Periventricular leukomalacia
Periventricular leukomalacia is an ischemic disturbance around the brain ventricles causing white matter damage. This condition is the most common ischemic pathology resulting in cerebral palsy. Any type of disturbance resulting in brain pathology can be predictive of cerebral palsy.
A physical therapist notices that a patient with a transfemoral amputation consistently takes a longer step with the prosthetic limb than the contralateral limb. The MOST likelv cause of the deviation is:
A. Weak abdominal muscles
B. Hip flexion contracture
C. Weak residual limb
D. Fear and insecurity
Hip flexion contracture
A hip flexion contracture would cause decreased hip extension during late stance on the prosthetic side allowing for a shorter step on the uninvolved side and a longer step with the prosthetic limb.
A physical therapist prepares to perform manual vibration as a means of airway clearance with a patient diagnosed with chronic obstructive pulmonary disease. When performing vibration the MOST appropriate form of manual contact over the affected lung segment is:
A. Contact with a cupped hand
B. Contact with the entire palmar surface of the hand
C. Contact with the ulnar border of the hand
D. Contact with the distal phalanx of the middle finger
Contact with the entire palmar surface of the hand
Vibration requires the palmar aspect of the physical therapist hands to be in full contact with the affected lung segment. The therapist may elect to partially or full overlap the hands during manual vibration. Vibration is applied at the end of a deep inspiration and is maintained through the end of expiration.
A physical therapist works with a patient with a moderate disk protrusion on an extension progression. Which position would have immediately preceded the pictured position?
A. prone press-up
B. prone Iving with a pillow under the waist
C. standing extension
D. prone lying
prone lying
A prone position refers to a patient lying on their stomach. This position requires the spine to be in a slightly extended position.
A patient rehabilitating from an upper extremity injury affecting the left shoulder performs a resistive exercise as shown. Which muscle would be primarily emphasized when performing the pictured exercise?
A. pectoralis major
B. supraspinatus
C. teres major
D. teres minor
supraspinatus
The supraspinatus originates on the middle two-thirds of the supraspinous fossa of the scapula and inserts on the greater tubercle of the humerus. The muscle acts to abduct the shoulder and stabilize the head of the humerus in the glenoid fossa.
A physical therapist observing a patient complete a leg curl exercise notices two prominent tendons visible on the posterior surface of the patient’s left knee. The visible medial and lateral tendons are MOST likely associated with the:
A. Semimembranosus and semitendinosus muscles
B. semitendinosus and biceps femoris muscles
C. popliteus and semitendinosus muscles
D. semimembranosus and biceps femoris muscles
semitendinosus and biceps femoris muscles
The semitendinosus and biceps femoris are hamstrings muscles whose tendons become prominent when performing a leg curl. The biceps femoris is the lateral tendon, while the semitendinosus is the medial tendon.
A physical therapist instructs a patient diagnosed with restricted shoulder mobility in a self-mobilization exercise. The therapist instructs the patient to attempt to lean in between their fixed arms (i.e., direct their upper thorax toward the mat surface). The PRIMARY objective of this activity is to improve:
A. glenohumeral abduction
B. glenohumeral external rotation
C. glenohumeral internal rotation
D. glenohumeral flexion
glenohumeral external rotation
The image depicts the recommended technique for administering a ventral glide of the humerus. A ventral glide of the humerus can be used to increase range of motion into glenohumeral external rotation, extension, and horizontal abduction.
A phvsical therapist administers a neural tension test to a patient being treated in physical therapy with low back pain. Assuming the current testing procedure has been unable to reproduce the patient’s symptoms, the MOST appropriate modification is to:
A. apply passive overpressure to cervical flexion
B. apply passive overpressure to left ankle dorsiflexion
C. passively extend the right knee
D. ask the patient to activelv extend the right knee
apply passive overpressure to left ankle dorsiflexion
Although the patient’s left ankle appears to be dorsiflexed, applying passive overpressure to left ankle dorsiflexion would increase the amount of neural tension.
A physical therapist instructs a patient positioned in supine to bring her left leg toward her chest and maintain the position. Assuming the therapist observes the reaction shown in the image what muscle would MOST likely have insufficient length?
A. Iliopsoas
B. quadratus lumborum
C. rectus femoris
D. sartorius
rectus femoris
Extension of the right knee is an indication that the patient has tightness in the two-joint rectus femoris muscle. A patient without tightness in the rectus femoris would typically present with the knee in 90 degrees of flexion while maintaining the position.
