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.