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 patient with right hemiplegia is observed during gait training. The patient performs side stepping towards the hemiplegic side. The physical therapist may expect the patient to compensate for weakened abductors by:
A. Hip hiking of the unaffected side
B. Lateral trunk flexion towards the affected side
C. Lateral trunk flexion towards the unaffected side
D. Hip extension of the affected side
Lateral trunk flexion towards the unaffected side
Lateral trunk flexion towards the unaffected (left) side can compensate for weak hip abductors while side stepping. This action unweights the right lower extremity and utilizes momentum along with the abductors to perform side stepping.
A patient reports to a scheduled physical therapy session 25 minutes late. The patient has not been seen previously in physical therapy and was scheduled in a 45 minute block of time. The patient referral indicates the patient is 10 days status post arthroscopic medial meniscectomy. The MOST appropriate therapist action is:
A. Begin the examination
B. Design a home exercise program
C. Consult with the patient’s physician
D. Ask the patient to reschedule
Begin the examination
The physical therapist should have ample time (i.e., 20 minutes) to begin the examination. This may be particularly important in the described scenario because the patient is 10 das status post arthroscopic surgery.
A physical therapist reviews a laboratory report for a 41-year-old male diagnosed with chronic obstructive pulmonary disease. Which of the following would be considered a normal hemoglobin value?
A. 10 gm/dI
B. 15 gm/dL
C. 20 gm/dI
D. 25 gm/dL
15 gm/dL
Although the exact lower and upper values of normal may vary slightly depending on the source, 15 gm/dL is well within the range of normal.
A patient diagnosed with an incomplete spinal cord lesion presents with muscle paralysis on the ipsilateral side of the lesion and a loss of pain, temperature, and sensitivity on the contralateral side of the lesion. This presentation BEST describes:
A. Posterior cord syndrome
B. Central cord syndrome
C. Anterior cord syndrome
D. Brown-sequard’s syndrome
Brown-sequard’s syndrome
Brown-Sequard’s syndrome most commonly occurs from a stab or bullet wound. True hemisection of the cord is rare; most injuries are irregular in nature with a mixture of symptoms.
A physical therapist reviews a phvisician’s examination of a patient scheduled for physical therapy. The examination identifies excessive medial displacement of the elbow during ligamentous testing. Which ligament is typically involved with medial instability of the elbow?
A. Annular
B. Radial collateral
C. Ulnar collateral
D. Volar radioulnar
Ulnar collateral
The ulnar collateral ligament extends from the medial epicondyle to the medial margin of the ulna’s trochlear notch and is assessed for potential instability by applying vagus force to the distal forearm.
A physical therapist performs an examination on a 27-year-old male diagnosed with iliotibial band syndrome. The patient is an avid distance runner who routinely ran between 45-60 miles per week before experiencing pain in his knee. Standing posture reveals a varus position at the knee and a cavus foot. When palpating the lateral portion of the lower, which area would MOST likely exhibit marked tenderness?
A. Lateral femoral condyle
B. Lateral joint line
C. Lateral tibial condyle
D. Fibular head
Lateral femoral condyle
The iliotibial band is a thickened strip of fascia that extends from the iliac crest to the tibial tubercle. In iliotibial band syndrome there is excessive contact between the iliotibial band and the lateral femoral condyle usually when the knee is in approximately 30 degrees of flexion.
The measurement of blood pressure with an aneroid sphygmomanometer is said to have concurrent validity if the pressures measured by the sphygmomanometer are equal to the pressures measured at the same time by:
A. An electrocardiogram
B. A pressure transducer inserted in the artery
C. A physician using a mercury sphygmomanometer
D. A pulse oximeter
A pressure transducer inserted in the artery
For blood pressure measured by an aneroid sphygmomanometer to have concurrent validity, the systolic and diastolic pressures would have to be similar to the pressures measured simultaneously by another instrument considered to be the “gold standard.” A pressure transducer inserted in the patient’s artery provides a direct and precise measurement of blood pressure.
A physical therapist working on an oncology unit reviews the medical chart of a male patient prior to initiating airway clearance techniques. The patient’s cell counts are as follows: hematocrit 44%, white blood cells 8,500/mm’, platelets 30,000/ul, hemoglobin level 15 gm/dL. Which blood test value suggests that chest percussion for airway clearance is contraindicated?
A. Hematocrit
B. White blood cells
C. Platelets
D. Hemoglobin
Platelets
The platelet count is well below the normal range of 165,000-415,000/ul. With a platelet count of 50,000/pl or less, the patient is thrombocytopenie and would be placed on thrombocytopenic precautions until the platelet count returns to normal. These precautions include restricting chest percussion due to the increased risk of bleeding. Alternative chest physical therapy techniques may include coughing, deep breathing exercises, and using an incentive spirometer.
A physical therapist treats a patient with a fractured left hip. The patient is weight bearing as tolerated and uses a large base quad cane for gait activities. Correct use of the quad cane would include:
A. Using the quad cane on the left with the longer legs positioned away from the patient
B. Using the quad cane on the right with the longer legs positioned away from the patient
C. Using the quad cane on the left with the longer legs positioned toward the patient
D. Using the quad cane on the right with the longer legs positioned toward the patient
Using the quad cane on the right with the longer legs positioned away from the patient
The quad cane, positioned in the right hand with the longer legs pointing away from the patient, will allow for proper distribution of the weight during gait and as a result, the patient will be less likely to trip over the longer legs of the cane.
A physical therapist inspects a wound that has large quantities of exudate which requires frequent dressing changes. If the therapist applies a dressing that cannot handle the quantity of exudate present, the MOST likelv outcome is:
A. Maceration
B. Granulation
C. Epithelialization
D. Infection
Maceration
Maceration refers to a softening of connective tissue fibers due to excessive moisture. The result is a loss of pigmentation and a wound that is highly susceptible to breakdown or enlargement.
A phvsical therapist completes an examination on a 36-vear-old female diagnosed with multiple sclerosis.
After completing the examination, the therapist should FIRST:
A. Develop long-term goals
B. Develop short-term goals
C. Develop a problem list
D. Justify the need for physical therapy services
Develop a problem list
Once an examination has been completed, the physical therapist reviews all of the data and generates a problem list. The problem list assists the therapist to determine if physical therapy services are warranted and to develop an effective and individualized plan of care.
An electrical equipment safety committee develops a policy to limit electrical hazards arising from ground faults. Which action would be the MOST appropriate to meet the committee’s objective?
A. Report all equipment defects or failures
B. Manually test each ground fault circuit interrupter on a monthly basis
C. Follow manufacturer recommendations for electrical equipment care and service
D. Mandate an introductory inservice on all new electrical equipment
Manually test each ground fault circuit interrupter on a monthly basis
Ground fault circuit interrupters are designed to identify the presence of ground faults and quickly switch off power to that circuit. The automatic device provides personal protection from electrical shock. Manually testing each ground fault circuit interrupter on a fixed interval allows for proactive monitoring.
A 21-year-old female is examined in physical therapy after sustaining a grade I ankle sprain two days ago in a marching band competition. The patient’s description of the mechanism of injury is consistent with inversion and plantar flexion. Which of the following ligaments would MOST likely be affected?
A. Anterior talofibular ligament
B. Calcaneofibular ligament
C. Anterior tibiofibular ligament
D. Deltoid ligament
Anterior talofibular ligament
The anterior talogibular ligament is a thickening of the anterior joint capsule that extends from the anterior surface of the lateral malleolus to the lateral facet of the talus and the lateral surface of the talar neck. The ligament functions to resist ankle inversion with the foot in plantar flexion. Regardless of the position of the foot, the anterior talofibular ligament is the most likely ligament torn with an inversion injury.
A physical therapist prepares to administer iontophoresis over the anterior surface of a patient’s knee. The therapist would like to keep the current density low in order to avoid skin irritation. Which of the listed parameters would BEST accomplish the therapist’s objective?
A. Current amplitude of 4 mA; electrode with an area of 12cm2
B. Current amplitude of 4 mA; electrode with an area of 4 cm2
C. Current amplitude of 3 mA; electrode with an area of 6 cm2
D. Current amplitude of 3 mA; electrode with an area of 4 cm2
Current amplitude of 4 mA; electrode with an area of 12cm2
Current density = 4 mA / 12 cm2 = .33 mA/em2
A 66-year-old female is referred to physical therapy with rheumatoid arthritis. During the examination the physical therapist notes increased flexion at the proximal interphalangeal joints and hyperextension at the metacarpophalangeal and distal interphalangeal joints. This deformity is MOST representative of:
A. Boutonniere deformity
B. Mallet finger
C. Swan neck deformitv
D. Ulnar drift
Boutonniere deformity
Boutonniere deformity is characterized by extension of the metacarpophalangeal and distal interphalangeal joints and flexion of the proximal interphalangeal joint. The deformity is caused by a rupture of the central tendinous slip of the extensor hood.
Which combination of orthoses and assistive device would be the MOST appropriate for energy efficient ambulation in a seven-year-old child with L1 to L3 level spina bifida?
A. Ankle-foot orthoses (AFO) and rolling walker
B. Ankle-foot orthoses (AFO) and standard walker
C. Reciprocating gait orthosis (RGO) and rolling walker
D. Reciprocating gait orthosis (RGO) and standard walker
Reciprocating gait orthosis (RGO) and rolling walker
RGOs assist with hip flexion and hip extension during ambulation, which is typically necessary for children with LI-L3 level spina bifida due to insufficient strength. Since the cables of the RGO assist with hip flexion and hip extension, the child uses less energy compared to traditional hip-knee-ankle-foot orthoses.
Using a rolling walker is more efficient than a standard walker.
A physical therapist adjusts the on:off time on an electrical stimulation unit prior to beginning treatment.
When using the unit for muscle re-education the MOST appropriate on:off ratio is:
A. 5:1
B. 15:1
C. 1:5
D. 1:15
1:5
The initial on off ratio should be 1:5 in order to minimize muscle fatigue. As the patient gets stronger, the on:off ratio may be altered to 1:4 or 1:3.
A physical therapist is scheduled to administer a whirlpool treatment to a patient that is HIV positive. The therapist is concerned about her ability to complete the treatment since she sustained a small paper cut on her fourth digit approximately three hours ago. The MOST appropriate therapist action is:
A. Refuse to treat the patient and document the rationale in the medical record
B. Treat the patient using appropriate medical asepsis
C. Ask the patient to reschedule their appointment
D. Select another appropriate treatment procedure
Treat the patient using appropriate medical asepsis
A physical therapist should treat a patient that is HIV positive using established medical asepsis techniques to prevent the possible transmission of blood or body fluids.
A physical therapist examines a patient referred to physical therapy diagnosed with anterior compartment syndrome. The patient presents with an inability to dorsiflex the foot and a mild sensory disturbance between the first and second toes. The nerve MOST likelv involved is the:
A. deep peroneal nerve
C. tibial nerve
B. medial plantar nerve
D. lateral plantar nerve
deep peroneal nerve
The deep peroneal nerve innervates the tibialis anterior, extensor hallucis longus and brevis, lumbricals, interossei, extensor digitorum brevis, and peroneus tertius muscles.
A 35-year-old-female is admitted to the hospital following a recent illness. Laboratory testing reveals a markedly high platelet count. This finding is typical with:
A. Emphvsema
B. Metabolic acidosis
C. Renal failure
D. Malignancy
Malignancy
Malignancy is defined as cells that have the ability to spread, invade, and destroy tissue. A tumor that is malignant may or may not respond to treatment or may return after removal. Blood values vary based on type, degree, and location of the malignancy, however, are often increased as a manifestation of an occult neoplasm such as lung cancer.
A patient is positioned in supine with the hips flexed to 90 degrees and the knees extended. As the patient slowly lowers her extended leg toward the horizontal, there is an increase in lordosis of the low back.
This finding is indicative of weakness of the:
A. Hip flexors
C. Hip extensors
B. Back extensors
D. Abdominals
Abdominals
The supplied description of the resistive test in the question is a standard method to assess the strength of the lower abdominal muscles. Failure to maintain the low back flat on the surface of the table as the legs are lowered is indicative of muscle weakness.
In a clinical trial, patient height is measured in centimeters and weight is measured in kilograms. What inference can the physical therapist make about the scale of measurement for height and weight?
A. Height and weight are measurements in the ratio scale
B. Height and weight are measurements on the ordinal scale
C. Height and weight are measurements on the nominal scale
D. Height and weight are measurements on the interval scale
Height and weight are measurements in the ratio scale
Measurements on the ratio scale have an absolute zero point, meaning a score of 0 represents a total absence of the property being measured. Length in centimeters and mass in kilograms are examples of ratio scale measurements because the numbers represent the actual amount of the attributes being measured.
A physical therapist attempts to select an appropriate intervention to treat a patient with a 10 degree
limitation in knee extension. Which of the following mobilization techniques would be indicated?
A. Lateral glide of the patella
B. Caudal glide of the patella
C. Posterior glide of the tibia
D. Anterior glide of the tibia
Anterior glide of the tibia
An anterior glide of the tibia on the femur would be used to improve knee extension range of motion.
A patient with a right radial head fracture is
examined in physical therapy. The patient’s involved elbow range of motion begins at 15 degrees of flexion and ends at 90 degrees of flexion. The physical therapist should record the patient’s elbow range of motion as:
A. 0-15-90
B. 15-0-90
C. 15-90
D. 0-90
15-90
The recording depicts a patient who begins in 15 degrees of elbow flexion and ends in 90 degrees of elbow flexion. The total available degrees of movement would be 75 degrees.
A physical therapist attempts to improve a
patient’s lower extremity strength. Which proprioceptive neuromuscular facilitation technique would be the MOST appropriate to achieve the therapist’s goals?
A. contract-relax
B. repeated contractions
C. rhythmic stabilization
D. hold-relax
repeated contractions
Repeated contractions are used to initiate movement and sustain a contraction through the range of motion. The therapist provides a quick stretch followed by isometric or isotonic contractions. Providing resistance at the point of weakness can enhance the effectiveness of repeated contractions.
When performing range of motion exercises with a patient that sustained a head injury, a physical therapist notes that the patient lacks full elbow extension and classifies the end-feel as hard. The MOST likely cause is:
A. heterotopic ossification
B. spasticity of the biceps
C. anterior capsular tightness
D. triceps weakness
heterotopic ossification
The presence of abnormal bone growth in tissue (i.e., heterotopic ossification) could result in an end-feel that is classified as hard due to the bon contact.
A physical therapist conducts a patient history for a female patient diagnosed with adhesive capsulitis of the shoulder. Given the capsular pattern of the shoulder, which functional limitation would the patient
MOST likely have difficulty with?
A. reaching across her body
B. reaching into her back hip pocket
C. performing a push-up
D. combing her hair
combing her hair
Combing the hair is a functional activity that involves shoulder abduction and external rotation. These two motions are the most limited in patients with adhesive capsulitis of the shoulder.
A patient recently diagnosed with end-stage renal disease begins hemodialysis treatments at an outpatient dialvsis center. Which frequency and duration of dialvsis Is MOST tvpical?
A. one time a week for five hours
B. two times a week for three hours
C. three times a week for four hours
D. five times a week for two hours
three times a week for four hours
Three times a week for four hours is the most common schedule for hemodialysis. This type of schedule allows hemodialysis to accomplish the necessary therapeutic objectives without being excessively burdensome for the patient.
A physical therapist orders a wheelchair for a patient with C4 tetraplegia. Which wheelchair would be the MOST appropriate for the patient?
A. manual wheelchair with friction surface handrims
B. manual wheelchair with handrim projections
C. power wheelchair with sip and puff controls
D. power wheelchair with joystick controls
power wheelchair with sip and puff controls
A patient with C4 tetraplegia will have innervation of the face and neck, diaphragm, and trapezius muscles.
The patient should be able to verbally direct all aspects of wheelchair management and would be a candidate for a power wheelchair with head or mouth controls.
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 physical therapist works with a patient status post stroke on a mat program. The therapist assists the patient in lateral weight shifting activities while positioned in prone on elbows. Which therapeutic exercise technique would allow the patient to improve dvnamic stability with this activity?
A. alternating isometrics
B. approximation
C. rhythmic initiation
D. timing for emphasis
approximation
Approximation is a therapeutic exercise technique designed to facilitate contraction and stability through joint compression. The compression force is most often applied to joints through gravity acting on body weight, manual contacts or weight belts.
A patient with a recent stroke affecting the right hemisphere displays signs consistent with pusher syndrome. While practicing seated balance reactions, this patient would MOST likely lean:
A. forward
B. backward
C. to the right
D. to the left
to the left
A patient with pusher syndrome would lean laterally to the hemiparetic side. A patient with a stroke affecting the right hemisphere would have left hemiparesis and would lean to the left side. The patient would also resist attempts to passively correct their posture to midline.
A physical therapist identifies a limitation in movement after performing a straight leg raise test on a patient in supine. The therapist then passively flexes the patient’s knee on the test leg, but is unable to gain any additional hip flexion range of motion. The MOST likely diagnosis iS:
A. gluteal bursitis
B. hamstrings strain
C. sciatic nerve pathology
D. trochanteric bursitis
gluteal bursitis
Gluteal bursitis is an example of a condition that would result in buttock pathology and a positive sign of the buttock test. Other conditions that may also vield a positive test include an abscess, tightness of the gluteus maximus and tightness of the posterior capsule.
A phvsical therapist examines a 30-vear-old patient that complains of a fullness of the left lower extremity, sensation of tightening skin, and overall aching of the leg. As part of the examination, the therapist attempts to pinch and pick up a fold of skin at the base of the left second toe, but is unable to do so.
This type of objective finding is BEST termed:
A. Stemmer’s sign
B. Froment’s sign
C. tripod sign
D. Homan’s sign
Stemmer’s sign
A positive Stemmer’s sign is characterized by the inability to squeeze and pick up a skinfold at the base of the second toe. This test is typically used to determine the presence of primary lymphedema. If the therapist was able to pinch a skinfold, the test would be negative.
A physical therapist observes that a patient has difficulty controlling the affected lower extremity during the loading response. This phase is characterized by
A. increased quadriceps activity and increased hamstrings activity
B. increased quadriceps activity and decreased hamstrings activity
C. decreased quadriceps activity and increased hamstrings
D. decreased quadriceps activity and decreased hamstrings
increased quadriceps activity and decreased hamstrings activity
The loading response phase requires increased quadriceps activity to limit the rate of knee flexion. Hamstrings activity particularly of the semimembranosus and semitendinosus, is decreased since the muscles are no longer needed to prevent knee hyperextension.
A patient has weakness of the quadriceps secondary to a femoral nerve Injury. When examining the patient’s gait from heel strike to foot flat, the physical therapist would MOST likely observe the patient compensate for their injury by:
A. using excessive dorsiflexion
B. leaning the trunk forward
C. using excessive knee flexion
D. vaulting on the contralateral limb
leaning the trunk forward
A patient with quadriceps weakness may use a forward trunk lean to compensate for their impairment. A forward trunk lean reduces the flexion moment at the knee and helps compensate for the quadriceps weakness.
A physician analyzes the results of a magnetic resonance imaging study to determine the extent of a patient’s lung cancer. When staging the patient’s cancer using the TNM system, which of the following factors would NOT be considered?
A. size of the tumor
B. involvement of the Imphatic svstem
C. rate of growth of the cancer cells
D. presence of metastasis
rate of growth of the cancer cells
The rate of growth of cancer cells is highly variable depending on the actual type of cancer. This variable is determined by examining cancer cells using a microscope. The rate of growth of cancer cells, although extremely relevant, is not considered when using the TNM system to stage a patient’s cancer.
A physical therapist administers the Functional Reach Test to a patient rehabilitating from a neurological disorder. Which bony landmark would be the MOST appropriate to utilize when formally measuring the distance the patient reached during each trial?
A. distal tip of the third digit
B. third metacarpal
C. radial styloid process
D. ulnar styloid process
third metacarpal
The Functional Reach Test requires the therapist to measure the position of the patient’s third metacarpal on the yardstick after making a fist.
A 22-year-old male rehabilitating from a motor vehicle accident is referred to physical therapy for galt training. The patient sustained multiple injuries including a fractured tibia and a traction Injury to the brachial plexus. The patient is partial weight bearing and has good upper extremity strength. The MOST appropriate assistive device is:
A. axillary crutches
B. Lofstrand crutches
C. walker with platform attachment
D. cane
Lofstrand crutches
Lofstrand or forearm crutches avoid transmitting pressure to the brachial plexus area and accommodate for the weight bearing status of the involved lower extremity. The patient’s age and upper extremity strength make Lofstrand crutches the most appropriate device.
A patient informs a physical therapist how frustrated she feels after being examined by her physician.
The patient explains that she becomes so nervous, she cannot ask any questions during scheduled office visits. The therapist’s MOST appropriate response is to:
A. offer to go with the patient to her next scheduled physician visit
B. offer to call the physician and ask an relevant questions
C. suggest that the patient write down questions for the physician and bring them with her to the next scheduled visit
D. tell the patient it is a very normal response to be nervous in the presence of a physician
suggest that the patient write down questions for the physician and bring them with her to the next scheduled visit
Writing down questions allows the patient to reflect on the information she would like to gather in advance and provides the structure necessary to reduce the influence of the patient’s anxiety during office visits.
A physical therapist reviewing a patient’s medical record identifies that the patient was recently placed on a corticosteroid medication. Which condition would MOST warrant the use of this tvpe of pharmacological agent?
A. Dermatitis
B. Folliculitis
C. Melanoma
D. rosacea
Dermatitis
Dermatitis is a broad term covering many different disorders characterized by a rash accompanied by pruritus and erythema. Patients with dermatitis are often treated with corticosteroids, antihistamines or immunomoduiators. Actions to avoid dermatitis include wearing loose fitting natural fiber clothing, avoiding wearing plated jewelry, and lubricating the skin after bathing.
An athlete is forced to contemplate knee surgery after spraining the anterior cruciate ligament (ACL) while plaving soccer. Which situation would provide the MOST direct support for an anterior cruciate ligament reconstruction?
A. grade III ACL sprain with a grade I posterior cruciate ligament (PCL) sprain
B. grade III ACL sprain with a lateral meniscus tear
C. grade II ACL sprain with a medial meniscus tear
D. functional instability
functional instability
Many individuals are able to continue to function at high levels despite a variety of ligamentous and meniscal injuries, therefore functional instability provides the most direct support for an anterior cruciate ligament reconstruction.
A physical therapist employed in a long-term care setting attempts to identify a screening tool that examines a patient’s ability to perform a varlety of activitles of daily living independently. The therapist would like to readminister the tool to assess patient progress. The MOST appropriate screening tool is the:
A. Barthel Index
B. Berg Balance Scale
C. Functional Reach Test
D. Tinetti Performance Oriented Mobility Assessment
Barthel Index
The Barthel Index consists of ten activities of daily living and is often used as a screening tool in rehabilitation, long- term care settings, and home care. Scoring ranges from 0-100 in increments of 5. A score of 100 indicates that the patient is independent.
A physical therapist uses the rule of nines on a three-vear-old child to determine the approximate percentage of the body affected by a burn. When using this assessment tool, which area of the child’s body would be given a higher percentage value compared to an adult?
A. the head
B. the trunk
C. the legs
D. the genitalia
the head
The head of an infant makes up a larger percentage of the total surface area as compared to an adult. For an adult, the front and the back of the head each comprise 4.5% of the total surface area.
A physical therapist completes a respiratory assessment on a patient with T2 paraplegia. As a component of the assessment, the therapist measures the amount of chest excursion during inspiration. The MOST appropriate patient position to conduct the measurement is
A. Sitting
B. Supine
C. Prone
D. sidelying
Supine
The supine position creates support and resistance to the diaphragm. There is a direct correlation between the amount of chest expansion and intercostal strength.
A physical therapist working in an outpatient physical therapy clinic guards a patient descending a step with axillary crutches. Based on the image, the MOST likely patient scenario IS:
A. partial weight bearing secondary to a left lateral ankle sprain
B. partial weight bearing secondary to a right lateral ankle sprain
C. toe touch weight bearing secondary to a left lateral ankle sprain
D. toe touch weight bearing secondary to a right lateral ankle sprain
partial weight bearing secondary to a left lateral ankle sprain
The patient should use the upper extremities and the uninvolved lower extremity to slowly lower the body when descending a step. As a result, the patient’s left ankle would be the involved ankle. Partial weight bearing occurs when a patient is allowed to put a particular amount of weight through the involved extremity
A physical therapist works with a 71-vear-old female patient who is status post reverse total shoulder arthroplasty. What is the MOST likely reason the patient had this surgical procedure as opposed to a total shoulder arthroplasty?
A. fracture of the humerus
B. glenohumeral osteoarthritis
C. significant deltoid weakness
D. Irreparable supraspinatus tear
Irreparable supraspinatus tear
In cases where a rotator cuff tear cannot be repaired, a reverse total shoulder replacement is indicated. The inverted alignment of the joint surface components allows for greater congruency and stability of the joint surfaces decreased translation of the humeral component, and an increased deltoid moment arm. These features allow the patient to elevate their arm in the presence of an insufficient rotator cuff.
A physical therapist assesses a patient’s sensation of light touch in the lower extremities. The therapist documents that the patient has impaired sensation of the entire right leg, yet normal sensation of the left leg.
Which injury is MOST likely present?
A. compression of a lower extremity peripheral nerve
B. compression of a lumbar nerve root
C. spinal cord transection
D. left hemisphere stroke
left hemisphere stroke
Patients status post stroke often have impairments of superficial and/or deep sensations. The type of impairment found is related to the location of the vascular lesion. A patient with a left hemisphere lesion will have sensory impairments on the right side of the body and can involve the face, upper extremity, and lower extremity.
An athlete is referred to physical therapy after being diagnosed with apophysitis of the ischial tuberosity.
Which mechanism of injurv is MOST consistent with this condition?
A. a soccer plaver kicking a soccer ball
B. a runner competing in the hurdles
C. a tennis player rapidly changing direction
D. a sprinter coming out of the starting blocks
a runner competing in the hurdles
A runner competing in the hurdles would be the mechanism of injur most commonlv associated with apophysitis of the ischial tuberosity. This occurs due to the origin of the hamstrings on the ischial tuberosity and the traction force that accompanies hurdling when the hip is flexed and the knee is extended.
A physical therapist treats a patient in a hospital setting with a pressure ulcer over the left ischial tuberosity. The patient’s stage Ill pressure ulcer has healed over time and currently shows characteristics of a stage I pressure ulcer. What ulcer stage should be assigned to the wound?
A. stage I ulcer
B. modified stage I ulcer
C. stage III ulcer
D. modified stage Ill ulcer
stage III ulcer
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.
A physical therapist examines several superficial reflexes on a patient diagnosed with an upper motor neuron lesion. When assessing the cremasteric reflex the MOST appropriate stimulus is:
A. stroke the skin beneath the costal margins and above the inguinal ligament
B. stroke the skin of the superior and medial thigh
C. prick the skin of the perianal region
D. prick the skin of the glans penis
stroke the skin of the superior and medial thigh
Stroking of the skin of the superior and medial thigh will elicit the cremasteric reflex. Upper and lower motor neuron disorders as well as a spinal injury at the LI-L2 level can cause the reflex to be absent.
A patient is unable to take in an adequate supply of nutrients by mouth due to the side effects of radiation therapy. As a result, the patient’s physician orders the implementation of tube feeding. What type of tube is MOST commonly used for short-term feeding?
A. Endobronchial
B. Nasogastric
C. Endotracheal
D. tracheostomy
nasogastric
a nasogastric tube is a plastic tube inserted through a nostril that extends into the stomach . this device is commonly used for liquid feeding, medication administration, or removing gas from the stomach. a gastric tube is inserted directly into the stomach for long term feeding.
A physical therapist emploved in an acute care hospital prepares to work on standing balance with a patient rehabilitating from abdominal surgery. The patient has been on extended bed rest following the surgical procedure and has only been out of bed a few times with the assistance of the nursing staff. The MOST important objective measure to assess after assisting the patient from supine to sitting is:
A. systolic blood pressure
B. diastolic blood pressure
C. perceived exertion
D. oxygen saturation rate
systolic blood pressure
During bed rest, when the leg muscles are not used regularly blood pools in the leg veins and is not pumped back to the heart. This results in diminished blood volume which serves to reduce blood pressure. Systolic blood pressure is the maximum arterial pressure during svstole or contraction of the left ventricle. It is the most important measure to assess after prolonged bed rest due to the risk of orthostatic hypotension. A decrease in systolic blood pressure of 20 mm Hg or greater with vertical positioning or a decrease in diastolic blood pressure greater than 10 mm Hg is indicative of orthostatio hypotension.
A patient with diabetes mellitus is scheduled to walk approximately one half mile as part of a community fitness Initiative. The therapist checks the patient’s blood glucose level before initiating the activity and finds it is 100 mg/dL. This finding indicates that:
A. the patient is safe to perform the activity
B. the patient should Increase food intake with a fruit or bread exchange
C. the patient should increase food intake with a half sandwich with fruit or milk
D. the patient should not exercise until the blood glucose is under better control
the patient is safe to perform the activity
The patient is safe to perform the activity (low intensity exercise) if the blood glucose is 100 mg/dL. If the blood glucose value was less than 100 mg/dL, the patient would increase food intake prior to performing the activity. Supplementing additional carbohydrates is not needed for this intensity of exercise.
A physical therapist attempts to palpate the lunate by moving their finger immediately distal to Lister’s tubercle. Which wrist motion will allow the therapist to facilitate palpation of the lunate?
A. Extension
B. Flexion
C. radial deviation
D. ulnar deviation
Flexion
The lunate is palpable just distal to the radial tubercle. Flexion of the wrist facilitates palpation of the lunate.
A physician indicates that a patient rehabilitating from a cerebrovascular accident has significant perceptual deficits. Which anatomical region would MOST likely be affected by the stroke?
A. primary motor cortex
B. somatosensory cortex
C. basal ganglia
D. cerebellum
somatosensory cortex
The somatosensory cortex occupies the postcentral gyrus which is directly behind the central sulcus. The structure is responsible for complex processing of sensory information and damage can cause severely impaired perception. The somatosensory cortex receives information regarding touch, temperature, pain, and discriminative senses including stereognosis and position sense.
While examining a patient diagnosed with Achilles tendonitis, a physical therapist notes that the foot and ankle appear to be pronated. Which motions combine to create pronation in a non- weight bearing foot?
A. abduction, dorsiflexion, eversion
B. adduction, dorsiflexion, inversion
C. abduction, plantar flexion, eversion
D. adduction, plantar flexion, inversion
abduction, dorsiflexion, eversion
Pronation of the foot consists of abduction of the forefoot, dorsiflexion of the subtalar and midtarsal joints, and eversion and inward rotation of the heel.
A physical therapist reviews the results of a pulmonary function test for a 58-year-old male patient recently admitted to the hospital. The therapist notes that the patient’s total lung capacity is significantly increased when compared to established norms. Which medical condition would MOST likely produce this tvpe of result?
A. chronic bronchitis
B. emphysema
C. spinal cord injury
D. pulmonarv fibrosis
emphysema
As a result of the pathologic changes to the lung tissue in emphysema, the lungs become hyperinflated. Due to the loss of elastic recoil, obstruction to airflow is seen as an increase in total lung capacity, residual volume, and functional residual capacity.
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 instructs a patient to squeeze a piece of paper between the index and middle fingers while the therapist attempts to pull it away. This tpe of testing would be the MOST appropriate to assess the:
A. C6 mvotome
B. C7 mvotome
C. C8 mvotome
D. T1 myotome
T1 myotome
Involvement of the TI myotome would most likely result in weakness of finger abduction and adduction.
A physical therapist assesses an infant by performing a pull-to-sit maneuver. During the maneuver the therapist notes that the infant has learned to lead with their head as soon as the stimulus of being pulled to sitting occurs. Which muscle group would be LEAST instrumental in performing the described activity?
A. Abdominals
B. cervical flexors
C. hip flexors
D. scapular stabilizers
scapular stabilizers
The scapular stabilizers are not as critical as the other listed muscles when performing the pull-to-sit maneuver since the therapist applies the force necessary to move the infant by pulling the infant’s upper extremities at the wrists. In addition, the scapular stabilizers are not necessary to overcome the force of gravity or to generate the flexion moment required at the neck, trunk or lower extremities during the pull-to-sit maneuver.
A physical therapist treats a female patient with multiple sclerosis for impaired balance and coordination. The patient reports that since being diagnosed four years ago, her symptoms have gradually gotten worse without any plateau or lessening in severity. Which terminology would MOST accurately describe the patient’s disease course?
A. relapsing-remitting multiple sclerosis
B. primary-progressive multiple sclerosis
C. secondary-progressive multiple sclerosis
D. progressive-relapsing multiple sclerosis
primary-progressive multiple sclerosis
Primary-progressive multiple sclerosis is characterized by a continuous worsening of symptoms from the onset without distinct relapses or remissions.
A patient diagnosed with piriformis syndrome is referred to physical therapy for one visit for Instruction in a home exercise program. After examining the patient, the physical therapist feels the patient’s rehabilitation potential is excellent, but is concerned that one visit will not be sufficient to meet the patient’s needs. The MOST appropriate action is to:
A. schedule the patient for treatment sessions as warranted by the results of the examination
B. explain to the patient that recent health care reforms have drastically reduced the frequency of physical therapy visits covered by third party payers
C. explain to the patient that she can continue with physical therapy beyond the initial session, but will be liable for all expenses not covered b her insurance
D. contact the referring physician and request approval for additional physical therapy visits
contact the referring physician and request approval for additional physical therapy visits
The physical therapist will need to seek physician approval for the additional visits in order to be working under a physician referral. Although this does not guarantee that the visits will be approved by the physician or that the visits will be covered by the third party payer, it provides the therapist with the opportunity to act in the patient’s best Interest.
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 patient diagnosed with Guillain-Barre syndrome works on weight shifting activities while standing in the parallel bars. The PRIMARY objective of this activity is to improve:
A. Mobility
B. Stability
C. controlled mobility
D. skill
controlled mobility
Controlled mobility, the third stage of motor control, refers to the ability to move within a weight bearing position or rotate around a long axis.
A physical therapist asks a physical therapist assistant to complete a lower extremity isokinetic test on a patient. The physical therapist assistant is willing to complete the test, however, indicates it has been quite some time since they have set up the isokinetic device. The MOST appropriate physical therapist action is:
A. provide verbal cueing for the physical therapist assistant prior to beginning the set up
B. instruct the phvsical therapist assistant to refer to the owner’s manual
C. observe the physical therapist assistant complete the set up
D. ask another physical therapist assistant to complete the set up
observe the physical therapist assistant complete the set up
Observing the physical therapist assistant complete the set up allows the physical therapist to assist the physical therapist assistant as needed and at the same time ensures the device is set up correctly. Direct involvement of the physical therapist is collaborative and may assist the physical therapist assistant to complete the set up independently in the future.
A physical therapist administers ultrasound over a patient’s anterior thigh. After one minute of treatment, the patient reports feeling a slight burning sensation under the soundhead. The therapist’s MOST appropriate action is to:
A. explain to the patient that what she feels is not out of the ordinary when using ultrasound
B. temporarily discontinue treatment and examine the amount of coupling agent utilized
C. discontinue treatment and contact the referring physician
D. continue with treatment utilizing the current parameters
temporarily discontinue treatment and examine the amount of coupling agent utilized
The complaint of a slight burning sensation may indicate improper coupling, By temporarily discontinuing the treatment and examining the amount of coupling agent used, the physical therapist may be able to continue with treatment. If the physical therapist adds coupling agent and the patient reports a similar sensation, the intervention should be discontinued and the ultrasound unit should be formally inspected by a qualified technician.
A physical therapist uses a manual wheelchair during a training session with a patient with C5 quadriplegia. Which wheelchair would be the MOST appropriate based on the patient’s level of injury?
A. manual wheelchair with sip and puff controls
B. manual wheelchair with handrim projections
C. manual wheelchair with friction surface handrims
D. manual wheelchair with standard handrims
manual wheelchair with handrim projections
A manual wheelchair with handrim projections would be appropriate to use during a training session for a patient with C5 quadriplegia, however, may not be used as the primary mode of mobility due to the limited upper extremity muscle innervation and the associated endurance issues.
A physical therapist works with a patient that sustained burns to the left axilla and shoulder. The therapist would MOST likely fabricate a splint for the patient in order to avoid a:
A. shoulder abduction contracture and webbing of the axillary folds
B. shoulder adduction contracture and webbing of the axillary folds
C. shoulder flexion and medial rotation contracture
D. thoracic kyphosis secondary to flexion forces
shoulder adduction contracture and webbing of the axillary folds
A burn involving the shoulder and axilla may result in a shoulder adduction contracture and webbing of the axillary folds if the joint is not splinted properly. Ideally, the splint would conform to the entire arm from the wrist, through the axillary area, and down the trunk to the waist in order to provide the necessary support. The splint should be molded to the patient and secured with wraps, pads, and other strapping.
A six-year-old female is currently taking Neurontin for the treatment of seizures. Based on the prescribed medication, the patient may have the MOST difficulty when performing interventions that attempt to improve:
A. Coordination
B. verbal comprehension
C. strength
D. flexibility
Coordination
Ataxia is a common side effect of Neurontin. Ataxia is a cerebellar deficit that may Impair the patient’s ability to perform coordinated movements and participate in functional activities. Physical therapists should include coordination activities in the plan of care if ataxia is present.
A physical therapist examines a patient with a dorsal scapular nerve injury. Which muscles would you expect to be MOST affected by this condition?
A. serratus anterior, pectoralis minor
B. levator scapulae, rhomboids
C. latissimus dorsi, teres major
D. supraspinatus, infraspinatus
levator scapulae, rhomboids
The levator scapulae and rhomboids are innervated by the dorsal scapular nerve
A physical therapist treats a patient with mechanical lumbar traction by positioning the patient in supine with the hips and knees flexed and the lower legs resting on a stool. This position would be MOST appropriate to treat a patient diagnosed with:
A. spinal stenosis
B. herniated disk
C. osteoporosis
D. spondylolisthesis
spinal stenosis
Spinal stenosis is a condition in which the spinal canal narrows and compresses the spinal cord and nerves. The condition is best treated with the patient positioned in flexion since the position maximizes opening of the intervertebral foramen.
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 physical therapist instructs a patient to make a fist. The patient can make a fist, but is unable to flex the distal phalanx of the ring finger. This clinical finding can BEST be explained by:
A. a ruptured flexor carpi radialis tendon
B. a ruptured flexor digitorum superficialis tendon
C. a ruptured flexor digitorum profundus tendon
D. a ruptured extensor digitorum communis tendon
a ruptured flexor digitorum profundus tendon
The flexor digitorum profundus muscle acts to flex the distal interphalangeal joints of the index, middle, ring, and little fingers, and assists in flexion of the proximal interphalangeal and metacarpophalangeal joints.
A ruptured flexor digitorum profundus tendon would therefore make it impossible to flex the distal phalanx.
A physical therapist implements an aquatic program for a patient rehabilitating from a lower extremity injury. The program requires the patient to run in place using a flotation device while tethered to the side of the pool using an elastic cord, Which action would be the MOST appropriate to increase resistance?
A. increase the water temperature
B. Increase the speed of movement
C. increase the depth of the water
D. remove the flotation device
Increase the speed of movement
The viscosity of water provides resistance to a body in motion. Viscosity refers to the thickness or resistance to the flow of a liquid. The faster the relative speed of the body the greater the magnitude of resistance.
A physical therapist reads a recentlv published case report. Which statement describes the MOST important contribution case reports make to evidence-based practice in physical therapy?
A. A case report demonstrates a causal relationship between treatment and outcome in a single patient
B. A case report provides information that can be used to generate inductive hypotheses for future studies.
C. A case report provides data on the natural history of disease states.
D. A case report uses triangulation to test a hypothesis with more than one source of data.
A case report provides information that can be used to generate inductive hypotheses for future studies.
Case reports are important for generating and testing theory and for providing information that may be used to generate inductive hypotheses that can be tested by exploratory or experimental methods.
A patient’s pulmonary function tests reveal that the patient has a forced vital capacity (FVC) of 4.0 liters and a forced expiratory volume in 1 second (FEV) of 3.5 liters. These results would be MOST anticipated with a diagnosis of:
A. cvstic fibrosis
B. idiopathic pulmonary fibrosis
C. chronic bronchitis
D. emphysema
idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis is a condition characterized by inflammation within the alveolar walls and the subsequent fibrosis of those structures. The change in lung structure affects the lung’s ability to expand, thus lung volumes and capacities are reduced. The airflow rates remain normal however. The patient in the above scenario has a restrictive lung disease since the FEVFVC ratio is normal (3.5/4.0= 87.5%).
A physical therapist treats a patient with a wound impacting the epidermis of the skin. Which structure would be MOST affected based on the described wound?
A. arrector pili muscles
B. Meissner’s corpuscles
C. Melanocytes
D. sebaceous glands
Melanocytes
Melanocytes, located at the base of the epidermis, produce a dark pigment called melanin, which contributes to skin color and provides protection from ultraviolet light.
A physical therapist discusses pain management for a patient following total hip arthroplasty with the patient’s nurse. Which objective finding would make the use of patient-controlled analgesia MOST unrealistic?
A. altered cognitive status
B. elevated respiratory rate
C. advanced age
D. history of substance abuse
altered cognitive status
Altered cognitive status would make it problematic for the patient to understand the rationale for the use of
PCA and to follow the supplied Instructions. PCA is an ineffective form of pain management for patients with altered cognition.
A physical therapist treats an infant diagnosed with torticollis with marked lateral flexion of the neck to the right. As part of the infant’s plan of care the therapist performs passive stretching activities to improve the patient’s range of motion. The MOST appropriate stretch for the patient is:
A. lateral flexion to the right and rotation to the right
B. lateral flexion to the left and rotation to the left
C. lateral flexion to the right and rotation to the left
D. lateral flexion to the left and rotation to the right
lateral flexion to the left and rotation to the right
Stretching the patient in lateral flexion to the left and rotation to the right is the correct answer since it is opposite of the patient’s current contracture (i.e., marked lateral flexion of the neck to the right and rotation to the left).
A physical therapist instructs a patient to close her eyes and hold out her hand. The therapist places a series of different weights in the patient’s hand one at a time. The patient is then asked to identify the comparative weight of the objects. This method of sensory testing is used to examine:
A. Barognosis
B. Graphesthesia
C. recognition of texture
D. stereognosis
Barognosis
Barognosis refers to the ability of a patient to identify the comparative weight of objects in a series. This can be done by placing a series of different weights in the same hand or by placing different weights in each hand simultaneousIv.
A physical therapist instructs a patient rehabilitating from a serious motor vehicle accident to ambulate with a platform walker. The patient has poor balance and is presently partial weight bearing. Which description would MOST warrant the use of the platform attachment?
A. upper extremity spasticity
B. generalized upper extremity muscle weakness
C. flexion contracture of the elbow
D. impaired upper extremitv sensation
flexion contracture of the elbow
A patient with an elbow flexion contracture would be unable to straighten their arm to use a standard walker
A physical therapist employed in a rehabilitation hospital utilizes the services of a physical therapy aide.
Which variable BEST determines the extent to which physical therapy aides are involved in patient care
activities?
A. the number of years of experience
B. the scope of formal training
C. the discretion of the physical therapist
D. the quantity of continuing education courses
the discretion of the physical therapist
The determination of what tasks are appropriately directed to the aide must be made by the physical therapist or, where allowable by law or regulations, the physical therapist assistant.
A physical therapist prepares to treat a patient with cystic fibrosis using postural drainage. The MOST appropriate patient position when treating the superior segments of the lower lobes is:
A. sitting, leaning back at a 30-40 degree angle
B. head down on left side, 1/4 turn backward
C. supine with two pillows under the knees
D. prone with two pillows under the hips
prone with two pillows under the hips
Prone with two pillows under the hips describes the postural drainage position for the superior segments of the left and right lower lobes.
A physical therapist treating a child with cerebral palsy would like to utilize a reverse walker to help with the child’s gait impairments. The PRIMARY rationale for prescribing a reverse walker instead of a traditional walker is because the child:
A. displays a Trendelenburg gait pattern
B. exhibits excessive upper extremity weakness
C. displays a forward trunk lean with gait
D. demonstrates excessive extensor tone
displays a forward trunk lean with gait
Patients with cerebral palsy may demonstrate a crouched gait pattern where they walk with a forward trunk lean and the lower extremity Joints are held in flexion. A reverse walker would potentially be effective for a patient with cerebral palsy to help Increase thoracic extension and therefore improve upright posture.
A physical therapist elects to use mechanical lumbar traction for a patient rehabilitating from a back injury. The therapeutic goals of the session include decreasing the patient’s muscle spasm. The MOST appropriate force based on the stated objective would be:
A. 10% of body weight
B. 15% of body weight
C. 25% of body weight
D. 50% of body weight
25% of body weight
Twenty-five percent of the patient’s body weight is generally recommended when the goal of treatment is to decrease muscle spasm or stretch soft tissue in the lumbar spine.
A physical therapist reviews a physician referral form that includes only the patient’s name and the referring physician’s signature. During the examination the patient indicates that she had knee surgery two weeks ago, however, is unable to provide more specific information. The therapist attempts to call the physician’s office, but is unable to reach anyone. The MOST appropriate therapist action is:
A. initiate treatment based on the results of the examination
B. initiate treatment based on an established protocol following knee surgery
C. initiate treatment, however, avoid resistive exercises and high-level functional activities
D. delay treatment until orders are received from the referring physician
delay treatment until orders are received from the referring physician
Delaying treatment until orders are received from the referring physician ensures that the physical therapist has all of the relevant information prior to developing a plan of care. This action allows the therapist to be fully informed about relevant contraindications and precautions and allows the therapist to develop a plan of care based on the anticipated outcomes.
A physical therapist employed in an acute care hospital reviews the results of recent laboratory testing for one of their patients. A note in the medical record Indicates that the patient was dehydrated at the time the blood sample was taken. Which finding would be MOST likely based on the patient’s hydration status?
A. Increased coagulation time
B. decreased hematocrit level
C. increased blood urea nitrogen level
D. decreased hemoglobin level
increased blood urea nitrogen level
A blood urea nitrogen test is performed to assess kidney function. An increased blood urea nitrogen level can be indicative of dehvdration, renal failure or heart failure. Normal blood urea nitrogen levels for adults are 10-20 mg
A patient four davs status post transtibial amputation is transported to phsical therapv for a scheduled treatment session. Assuming an uncomplicated recovery, the MOST appropriate patient transfer to utilize from a wheelchair to a mat table is:
A. two-person lift
B. hydraulic lift
C. stand pivot
D. sliding board
stand pivot
A stand pivot transfer is used when a patient is able to stand and bear weight through one or both of the lower extremities. The patient must possess functional balance and the ability to pivot.
A patient reports experiencing pain with active shoulder range of motion testing. The therapist hypothesizes that the pain may be associated with anterior glenohumeral instability. Which portion of the shoulder range of motion would the therapist expect the pain to be MOST pronounced:
A. 70-80 degrees of lateral rotation
B. 80-90 degrees of lateral rotation
C. 60-70 degrees of medial rotation
D. 70-80 degrees of medial rotation
80-90 degrees of lateral rotation
80-90 degrees of lateral rotation places the greatest amount of pressure on the anterior structures, therefore, any level of inflammation, irritation or structural damage may be likely to produce pain with active motion.
A physical therapist examines the abdomen of a patient with suspected referred shoulder pain from the viscera. Which component should be assessed FIRST?
A. superficial palpation
B. deep palpation
C. percussion
D. auscultation
auscultation
Auscultation of the abdomen allows the physical therapist to hear clicks, rumblings, and gurgling sounds throughout the abdomen. Auscultation occurs using the diaphragm of the stethoscope applied directly to the abdominal wall with firm, but gentle pressure. Auscultation should occur prior to palpation and percussion since the act of palpating or percussing may alter the frequency and Intensity of bowel sounds.
A physician prescribes a spinal brace for a patient with chronic low back pain. Which brace would be the MOST appropriate if the objective is to allow spinal motion while increasing intra-abdominal pressure?
A. Tavlor brace
B. Milwaukee brace
C. Jewett brace
D. Corset brace
Corset brace
A corset brace is a non-rigid spinal orthosis that is made of fabric and contains pouches for the optional addition of flexible vertical stays. Because of this, it will not restrict spinal motion like rigid braces will.
However, because corset braces fit more snugly to the body, they are more effective at increasing intra-abdominal pressure than are rigid orthoses.
A physical therapist positions a patient in supine prior to performing a manual muscle test of the supinator. To isolate the supinator and minimize the action of the biceps, the therapist should position the patient’s elbow in:
A. 30 degrees of elbow flexion
B. 60 degrees of elbow flexion
C. 90 degrees of elbow flexion
D. terminal elbow flexion
terminal elbow flexion
Placing the biceps in a maximally shortened position significantly limits the muscle’s ability to function as a supinator. Physical therapists should avoid maximum pressure in this position since the shortened position of the biceps can result in significant cramping.
A patient rehabilitating from cardiac surgery is monitored using an arterial line. The PRIMARY purpose of an arterial line is to:
A. measure right atrial pressure
B. measure heart rate and oxygen saturation
C. measure pulmonary artery pressure
D. measure blood pressure
measure blood pressure
An arterial line is a monitoring device consisting of a catheter that is inserted into an artery and attached to an electronic monitoring system. The device is considered to be more accurate than traditional measures of blood pressure and does not require repeated needle punctures.
A patient in the intensive care unit rehabilitating from a serious infection is connected to a series of lines and tubes. Which lower extremity intravenous infusion site would be the MOST appropriate to administer an intravenous line?
A. median cubital vein
B. basilic vein
C. cephalic vein
D. saphenous vein
saphenous vein
The saphenous vein is a superficial vein that extends from the foot to the saphenous opening. The vein is the only listed option that is located in the lower extremity.
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 examines the foot of a 17-year-old female referred to physical therapy with lower leg pain. After placing the foot in subtalar neutral, the therapist determines that the medial border of the foot along the first metatarsal is higher than the lateral border of the foot along the fifth metatarsal. This position would MOST appropriately be documented as:
A. forefoot varus
B. forefoot valgus
C. rearfoot varus
D. rearfoot valgus
forefoot varus
Forefoot varus refers to an inverted position of the forefoot in relationship to the rearfoot with the subtalar joint in a neutral position. Patients with low arches in weight bearing often exhibit forefoot varus with the subtalar joint in a neutral position.
A phsical therapist reviews the medical record of a patient recentlv admitted to an inpatient rehabilitation hospital. The patient sustained a traumatic head injury in a motor vehicle accident five weeks ago. The medical record indicates that the patient is often disoriented and can frequently become agitated with little provocation. The MOST appropriate location for the therapist to make initial contact with the patient is:
A. in the patient’s room
B. in the physical therapy gym
C. in a private treatment room
D. in the physical therapy waiting room
in the patient’s room
The patient’s room is the most appropriate first meeting place since the patient will be familiar with the surroundings and may therefore be less distractible. The patient may tend to become agitated in the gym due to overstimulation from other patients and the overall level of activitv.
A patient with limited elbow and forearm range of motion is referred to physical therapy. When mobilizing the humeroradial articulation, the treatment plane is considered to be:
A. in the concave radial head, parallel to the long axis of the radius
B. in the concave radial head, perpendicular to the long axis of the radius
C. in the convex radial head, parallel to the long axis of the radius
D. in the convex radial head, perpendicular to the long axis of the radius
in the concave radial head, perpendicular to the long axis of the radius
The radial head is the concave partner and the treatment plane is perpendicular to the long axis of the radius.
A physical therapist conducts an inservice on exercise guidelines for a group of senior citizens. As part of the inservice, the therapist discusses the benefits of improving cardiovascular status through a low intensity activity such as a walking program. What frequency of exercise would be the MOST desirable to achieve the stated objective?
A. twice per dav
B. one time per week
C. three times per week
D. five times per week
five times per week
Since walking is a low intensity activity, more frequent exercise sessions are needed to improve cardiovascular status. Five times per week is the most desirable option.
A physical therapist emploved in an acute care hospital reviews the medical record of a patient diagnosed with congestive heart failure. The therapist would like to implement a formal exercise program but is concerned about the patient’s exercise tolerance. Which condition is MOST responsible for the patient’s limited exercise tolerance?
A. diminished lung volumes
B. arterial oxygen desaturation
C. insufficient stroke volume during ventricular systole
D. excessive rise in blood pressure
insufficient stroke volume during ventricular systole
Congestive heart failure may be due to a diminished pumping ability of the ventricles due to muscle weakening (systolic dysfunction) or to stiffening of the heart muscle that impairs the ventricles’ capacity to relax and fill (diastolic dysfunction). With systolic dysfunction, the weak heart pumps a smaller volume of blood for each contraction of the ventricles (stroke volume), reducing cardiac output. The resultant decrease in the delivery of oxygenated blood to the active tissues limits the patient’s ability to exercise.
A physical therapist measures a patient for a wheelchair. When measuring back height, which method is
MOST accurate?
A. measure from the seat of the chair to the base of the axilla and subtract two inches
B. measure from the seat of the chair to the base of the axilla and subtract four inches
C. measure from the seat of the chair to the acromion process and subtract two inches
D. measure from the seat of the chair to the acromion process and subtract four inches
measure from the seat of the chair to the base of the axilla and subtract four inches
Back height should be determined by measuring from the seat of the chair to the base of the axilla and subtracting four inches. This method will allow the back height to fall below the inferior angle of the scapula. The height of the seat cushion used, if applicable, must be added to the obtained measurement.
A physical therapist plans to perform a sensory examination on a patient with a suspected neurological lesion. Which sensation should the therapist assess FIRST?
A. Vibration
B. two-point discrimination
C. temperature
D. Kinesthesia
temperature
Temperature is a superficial sensation and should therefore be assessed prior to the other options. Other superficial sensations include pain, crude touch, and pressure
A patient has recently been diagnosed with end-stage renal disease. Which comorbidity is MOST likely to have caused this condition?
A. chronic hypotension
B. diabetes
C. peripheral arterial disease
D. congestive heart failure
diabetes
Diabetes is the primary cause of ESRD, accounting for 40% of newly diagnosed cases. High blood glucose levels overwork the kidneys by causing them to filter excessive volumes of blood, eventually leading to breakdown of the kidneys (i.e., diabetic nephropathy). When not treated early, this condition can lead to ESRD.
A physical therapist is concerned that a 77-year-old female taking diazepam for anxiety may be a significant fall risk. Which side effect of the medication is MOST responsible for this increased risk?
A. Ataxia
B. Hemorrhage
C. Sedation
D. postural hypotension
Sedation
Sedation is a side effect commonly associated with diazepam. Diazepam remains active in the body for many hours and as a result drowsiness may last into the next day. Other side effects associated with diazepam that can contribute to an increased fall risk include impaired balance decreased neuromuscular function, and decreased central processing. Diazepam has a high potential for dependence and addiction.
A patient diagnosed with infrapatellar tendonitis completes a series of functional activities. After completing the activities the physical therapist instructs the patient to use ice massage over the anterior surface of the knee. The MOST appropriate treatment time is:
A. 3-5 minutes
B. 5-10 minutes
C. 10-15 minutes
D. 15-20 minutes
5-10 minutes
Ice massage requires a treatment time of 5-10 minutes due to the intensity of the cooling.
A physical therapist works with a six-vear-old boy with hip pathology. Which condition would be
MOST likely based on the child’s age?
A. Apophysits
B. Legg-Calve-Perthes disease
C. rheumatoid arthritis
D. slipped capital femoral epiphsis
Legg-Calve-Perthes disease
Legg-Calve-Perthes disease is characterized by degeneration of the femoral head due to a disturbance in the blood supply (i.e., avascular necrosis). Peak incidence of Legg-Calve-Perthes disease is between five and seven years of age. The condition is more common in boys than girls.
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.
A 16-year-old female accompanied by her mother receives exercise instructions. During the treatment session, the mother makes several comments to her daughter that appear to be extremely upsetting and result in the daughter losing concentration. The MOST appropriate physical therapist action is to:
A. document the mother’s comments in the medical record
B. ask the patient if her mother is verbally abusive
C. ask the mother to return to the waiting area
D. discontinue the treatment session
ask the mother to return to the waiting area
The therapist increases the likelihood that the child will be able to concentrate on the exercise instructions by asking the mother to return to the waiting area. The question provides ample information to hypothesize that the mother’s actions may be the reason the child is upset.
The goals for a patient status post total knee arthroplasty include general conditioning and independent household mobility. Which component of the patient’s treatment would be the MOST appropriate to delegate to a physical therapy aide?
A. stair training
B. progressive gait training with a straight cane
C. patient education regarding the surgical procedure
D. ambulation with a walker for endurance
ambulation with a walker for endurance
A physical therapist, and in some jurisdictions a physical therapist assistant, may delegate ambulation activities to an aide if the physical therapist feels the aide’s training is adequate to complete the activity. This decision would be heavily influenced by the patient’s current status and competence with ambulation.
Ambulation for endurance implies that the patient already possesses basic competence with the activity.
A 64-year-old female patient is admitted to the hospital with a stage III decubitus ulcer over her right ischial tuberosity. The patient’s past medical history Includes severe chronic obstructive pulmonary disease.
The MOST appropriate position for the patient is:
A. supine with pillows under the knees
B. prone with pillows under the knees
C. left sidelying with pillows between the knees
D. right sidelying with pillows between the knees
left sidelying with pillows between the knees
Left sidelying does not compromise respiration and avoids placing stress on the right ischial tuberosity.
A patient in an acute care hospital has a catheter inserted into the internal jugular vein. The catheter travels through the superior vena cava and into the right atrium. The device permits removal of blood samples, administration of medication, and monitoring of central venous pressure. The device is BEST termed
A. arterial line
B. central venous pressure catheter
C. Hickman catheter
D. Swan-Ganz catheter
Hickman catheter
A Hickman catheter (indwelling right atrial catheter) inserts into the right atrium of the heart. The catheter permits removal of blood samples, administration of medication and monitoring of central venous pressure.
Potential complications associated with the use of a Hickman catheter include sepsis and blood clots.
A 13-year-old patient diagnosed with juvenile rheumatoid arthritis experiences a severe acute exacerbation of her condition. The physical therapist recommends a custom splint in order to prevent a knee flexion contracture. Which type of splint is MOST appropriate to support this goal?
A. functional splint
B. dynamic splint
C. resting splint
D. serial splint
resting splint
A resting splint is typically utilized to maintain a joint in an appropriate position during an acute exacerbation of symptoms, allowing the joint to rest while limiting the risk of contracture development.
A physical therapist consults with an orthotist regarding the need for an ankle-foot orthosis for a patient status post CVA. The patient has difficulty moving from sitting to standing when wearing a prefabricated plastic ankle-foot orthosis (AFO). The therapist indicates the patient has poor strength at the ankle, intact sensation and does not have any edema or tonal influence. The MOST appropriate type of AFO for the patient would incorporate:
A. an articulation at the ankle joint
B. tone reducing features
C. metal uprights
D. dorsiflexion assist
an articulation at the ankle joint
An articulation at the ankle joint would allow the tibia to advance forward over the fixed foot. This would assist the patient with weight shifting during the sit to stand transfer as well as during ambulation.
A physical therapist recommends a wheelchair for a patient rehabilitating from a CVA with the goal of independent mobility. The left upper and lower extremitles are flaccid and present with edema. There is normal strength on the right, however, the patient’s trunk is hypotonic. The patient is cognitively intact. The MOST appropriate wheelchair for the patient is:
A. solid seat, solid back, elevating legrests, and anti-tippers
B. sling seat, sling back, arm board, and elevating legrests
C. light weight, solid seat, solid back, arm board, and elevating legrests
D. light weight, solid seat, solid back, arm board, and standard footrests
light weight, solid seat, solid back, arm board, and elevating legrests
Independent propulsion is facilitated by the use of a lightweight wheelchair, while a solid seating system assists with posture and activities. An arm board allows the flaccid upper extremity to be supported and an elevating legrest will assist to decrease dependent edema.
A physical therapist participates in a formal gait analysis using three-dimensional analysis software for an 11-year-old child with cerebral palsy. Which piece of objective data would LEAST likely be obtained through this process?
A. decreased swing phase
B. decreased walking velocity
C. decreased quadriceps strength
D. decreased knee extension range of motion
decreased quadriceps strength
Muscle weakness cannot be measured directly with gait analvsis. Although gait analvsis may include electromvography, this measure would not provide specific information on muscle strength. A thorough knowledge of muscle function and normal gait combined with the results of manual muscle testing provides the therapist with the necessary information to assess muscle weakness.
A patient’s medical chart indicates that a patient has a lesion in the posterior portion of the spinal cord.
Which of the following impairments would MOST likely be observed?
A. inability to determine joint position
B. inability to distinguish between hot and cold
C. inability to distinguish between sharp and dull
D. inabilitv to feel light touch
inability to determine joint position
Proprioception is the sense of static joint position. Proprioceptive information is transmitted to the brain via the dorsal column-medial lemniscus tract.
A physical therapist hypothesizes that a patient’s clinical presentation may be associated with cubital tunnel syndrome. Which finding would be MOST useful when distinguishing this condition from other common conditions affecting the elbow?
A. visible edema in the posterior elbow
B. medial-sided elbow pain
C. paresthesias in the fourth and fifth fingers
D. increased pain with weight bearing on the elbow
paresthesias in the fourth and fifth fingers
Cubital tunnel syndrome often produces paresthesias in the ring and little finger since the area is innervated by the ulnar nerve. Temporary paresthesias can be facilitated by sleeping with the hand in a flexed position or repeated leaning on a hard surface.
A physical therapist inspects a ramp that conforms to the exact specifications of the Americans with Disabilities Act’s minimum requirements for slope. The ramp has two 24 foot sections connected by a landing area. The MOST likely total height of the ramp is:
A. 12 inches
B. 24 inches
C. 36 inches
D. 48 Inches
48 Inches
A ramp that is designed to accommodate for 48 inches of total height would be 48 feet in length if the ramp conformed to the exact specifications of the Americans with Disabilities Act. Any height greater than 48 inches would require more than 48 feet of horizontal run in order to complv with the Americans with Disabilities Act’s minimum specifications.
A physical therapist examines a 26-year-old female whose subjective complaints include morning stiffness of her hands and visible swelling. The patient indicates that the stiffness seems to diminish with activitv. This description BEST describes:
A. carpal tunnel syndrome
B. osteoporosis
C. rheumatoid arthritis
D. osteoarthritis
rheumatoid arthritis
Symptoms of rheumatoid arthritis include morning stiffness limited range of motion, effusion, pain with movement, and low grade fever. Smaller peripheral joints are initially affected, however, symptoms may progress to larger synovial joints.
