Giles Set B Flashcards
A physical therapist performs the Thessaly test to a patient with a suspected meniscal tear. This testing procedure would require the therapist to:
A. Passively medially rotate the patient’s tibia and extend the knee
B. Cup the patient’s heel and allow the knee to extend from a fully flexed position
C. Grasp the patient’s hands in standing to promote balance
D. Passively flex and extend the patient’s knee while feeling for “popping”
Correct Answer: C
The Thessaly test for a meniscal tear occurs in single leg stance by having a patient rotate the femur on the tibia
medially and laterally three times. A positive test is indicated by joint line discomfort, catching or locking in the
knee.
A. The Mcmurray test is performed with the patient positioned in supine. The therapist grasps the distal leg
with one hand and palpates the knee joint line with the other. With the knee fully flexed, the therapist
medially rotates the tibia and extends the knee. The therapist repeats the same procedure while laterally
rotating the tibia. A positive test is indicated by a click or prono itation felt over the joint line and
may be indicative of a posterior meniscal lesion.
B. The bounce home test is performed with the patient position
heel and maximally flexes the knee. The patient’s knee 1s th
indicated by incomplete extension or a rubbery end-feel and
C. The therapist grasp the patient’s hands in standing during the
which allows the patient to perform the necessary medial and lateral rotation
D. Hughston’s plica test 1s performed with the patient positioned in supine. The therapistflexes the knee and
medially rotates the tibia with one hand while the other hand attempts to move ace medially and
palpate the medial femoral condyle. A positive test 1s indicated by a popping sound over the medial plica
while the knee i ively flexed and extended.
A physician orders electromyography for a patient with a brachial plexus injury to objectively determine the extent of pathology. Which of the following responses is MOST indicative of a normal muscle at rest?
A. Electrical silence
B. Spontaneous potentials
C. Polyphasic potentials
D. Occasional motor unit potentials
Correct Answer: A
Electromyography is a test that assesses the health of the muscles and the nerves controlling the muscles. A needle electrode is inserted through the skin into the muscles. The electrical activity is detected by this electrode is displayed on an oscilloscope provides information about the ability of the muscle to respond when the nerves are stimulated.
A. A normally innervated muscle is electrically silent at rest. Once the insertion activity (caused by the trauma of needle insertion) resolves, there should be no action potential on the oscilloscope.
B. Spontaneous electrical potentials. Like fibrillations and positive sharp waves, are seen in an acutely denervated muscle. Fibrillation and positive sharp waves are the result of spontaneous discharge of a single
muscle fiber.
C. Polyphasic potentials are the electrical potentials from a denervated motor unit. A motor unit that exhibits
five or more phases is referred to as polyphasic.
D. Neuropraxia is likely when occasional motor unit potentials occur during minimal effort muscle contractions two to three weeks after injury.
A patient being treated in physical therapy experiences a syncopal event. A review of the patient’s medical
record indicates that the patient has had oth diarrhea and vomiting within the last 24 hours. The MOST
likely cause associated with the syncopal event is:
A. Anemia
B. Dehydration
C. Orthostatic hypotension
D. Pregnancy
Correct Answer: B
Syncope is a sudden and reversible loss of consciousness with an inability to maintain postural tone. The condition is due to a temporary reduction in blood flow which creates a shortage of oxygen to the brain. There
are a variety of potential causes of syncopal events including anemia, dehydration, orthostatic hypotension, and
pregnancy.
A. Anemia refers to a low red blood cell count which can be caused by impaired red blood cell production, increased red blood cell destruction or blood loss. Anemia can cause syncope due to the lack of red blood cells delivering oxygen to the brain.
B. Dehydration refers to a lack of sufficient fluids in the body. The loss of fluids from bodily processes such as diarrhea and vomiting can lead to dehydration and cause syncope. The fact that the patient has experienced diarrhea and vomiting within the last 24 hours makes dehydration the most probable cause.
C. Orthostatic hypotension occurs due to a loss of sympathetic vasoconstriction in combination
with absent or severely reduced muscle tone. When standing, a normal blood pressure cannot be maintained and if blood pressure drops far enough, syncope can result. A variety of conditions can increase the risk of orthostatic hypotension including dehydration & anemia
D. Pregnancy can be associated with syncope due to compression of the inferior vena cava by the enlarged uterus
A physical therapist prepares to treat a patient currently undergoing active treatment for osteosarcoma. Which statement BEST describes this condition?
A. A malignant growth affecting the long bones
B. A malignant growth affecting the flat bones
c. A benign growth affecting the long bones
D. A benign affecting the flat bones
Correct Answer: A
Osteosarcoma is diagnosed slightly more often in boys and typically presents during periods of rapid bone growth in adolescence. Osteosarcoma may develop insidiously, or secondary to radiation treatment received as part of treatment for other malignancies
A. Osteosarcoma is a malignant bone growth (ie tumor) affecting the long bones of the body. It is most commonly diagnosed in the distal femur, followed by the proximal tibia, and the proximal humerus.
B. A malignancy such as Ewing’s sarcoma may present in both the long bones (eg femur) & flat bones (eg pelvis, scapula) as well as within soft tissue. Ewing’s sarcoma presents most commonly in the spine, pelvis, & long bones of the extremities
C. Osteochondroma is one of the most commonly occurring types of benign bone tumor. Like osteosarcoma, it is most commonly diagnosed near the ends of long bones
D. Although more commonly diagnosed in long bones, a small percentage of benign bone tumors (eg osteochondroma, osteoblastoma, osteoid osteoma) have been reported in flat bones.
A physical therapist treats a patient diagnosed with posterior tibial tendon dysfunction. When observing the
posterior aspect of the patient’s lower leg and ankle in standing, the MOST probable finding is:
A. Forefoot adduction
B. Hindfoot valgus
C. Hypertrophy of the gastrocnemius
D. Swelling in the lateral ankle region
Correct Answer: B
Posterior tibial tendon dysfunction is the primary cause of medial ankle pain in middle-aged patients. This condition occurs due to the inability of the posterior tibial tendon to support the medial longitudinal arch. As a result, the patient tends to exhibit a flat foot and may feel like the ankle tends to roll inward.
a. The forefoot consists of the tarsometatarsal joints, metatarsophalangeal joints, and interphalangeal joints. Posterior tibial tendon dysfunction is most often characterized by forefoot abduction and hindfoot
valgus.
b. The hindfoot consists of the talus and the calcaneus. Posterior tibial tendon dysfunction is most often characterized by a valgus deformity of the hindfoot due to a flattening of the medial longitudinal arch.
c. Hypertrophy of the gastrocnemius would not be associated with posterior tibial tendon dysfunction. Hypertrophy of the gastrocnemius may be caused by selected gait deviations such as toe walking or can also be observed in Duchenne muscular dystrophy.
d. General swelling of the ankle can be present with posterior tibial tendon dysfunction, however. The swelling is most often concentrated in the medial aspect of the ankle due to the muscle descending
posterior to the medial malleolus and inserting on the navicular and medial cuneiform bone.
A physical therapist is informed that a patient was diagnosed with a Lisfranc injury after returning from a physician visit. The patient was originally diagnosed with a minor lateral ankle sprain, however, returned to the physician after falling to make progress. Which bone would T likely to be impacted with this type of injury?
A. Calcaneus
B. Cuboid
C. Second cuneiform
D. Navicular
Correct Answer: A
Lisfranc injuries occur at the midfoot and may include fractures or dislocations often caused by traumatic disruptions of the tarsometatarsal joints. The midfoot includes the cuboid, navicular, and three cuneiforms and their articulations with the bases of the five metatarsal bones. Lisfranc injuries are commonly mistaken for
sprains since the clinical presentation is fairly similar and they are often difficult to detect upon x-ray. Undiagnosed Lisfranc injuries can have serious complications such as joint degeneration or even compartment syndrome.
a. The calcaneus is a quadrangular bone at the back of the tarsus. The bone articulates with the cuboid and the talus. the calcaneus is considered part of the hindfoot.
b. The cuboid is a lateral bone of the distal row of the tarsus. The bone articulates with the calcaneus, lateral cuneiform, & fourth and fifth metatarsals. The cuboid is the midfoot and could potentially be involved in a lisfranc injury
c. The second ¢uneiform is a wedge-shaped bone positioned between the first & third cuneiforms. The cuneiforms are part fo the midfoot & could potentially be involved in a lisfranc injury.
d. The navicular bone is located on the medial side of the foot. The bone articulates with the talus, three cuneiform bones, and cuboid. The navicular is part of the midfoot and could potentially be involved in a Lisfranc injury.
A physical therapist completes a sensory assessment on a 61-year-old female diagnosed with multiple
sclerosis. As part of the assessment, the therapist examines stereognosis, vibration, and two point
discrimination. What type of receptor is primarily responsible for generating the necessary information?
A. Deep sensory receptors
B. Mechanoreceptors
C. Nociceptors
D. Thermoreceptors
Correct Answer: B
Mechanoreceptors generate information related to discriminative sensations. The information is then mediated
through the dorsal column-medial lemniscal system. Examples of mechanoreceptors include free nerve endings,
Merkel’s disks, Ruffini endings, hair follicle endings, Meissner’s corpuscles, and Pacinian corpuscles.
a. Deep sensory receptos are sensory receptors that are located in the muscles, tendons, and joints. Muscle
and joint receptors are both classified as deep sensory receptors and include Golgi tendon organs,
b. Pacinian corpuscles, muscle spindle, Ruffini endings, free nerve endings, and joint receptors. They evaluate position sense, proprioception, muscle tone, and movement.
c. Mechanoreceptors are sensory receptors that respond to mechanical deformation of the area surrounding a receptor. They are responsible for sensations of touch, pressure, itch, tickle, vibration, and discriminative touch.
d. Nociceptors are specialized peripheral free nerve endings that are found throughout different tissues
within the body that respond to noxious stimuli and result in the perception of pain. A painful stimulus
will ascend through the spinal cord via the lateral spinothalamic tract. Several areas of the brain provide
specific responses to the painful stimulus.
Thermoreceptors are sensory receptors that respond to changes in temperature. Stimulation of the cold or warm receptors will ascend through the spinal cord via the lateral spinothalamic tract.
A physical therapist completes a developmental assessment on an infant. At what age should an infant begin
to sit with hand support for an extended period of time?
A. 6-7 months
B. 8-9 months
C. 10-11 months
D. 12-15 months
Correct Answer: A
Infants typically develop the stability to sit with hand support in the sixth to seventh month
a. sitting for a prolonged period of time with UE support usually occurs at 6-7 months of age. The infant will also bring objects to the midline, hold a bottle with 2 hands, & roll to prone.
b. When an infant is 8-9 months of age, they will typically manipulate toys in sitting, raise themselves from supine to sit, pull to stand with support and transfer objects with a controlled release.
c. When an infant is 10-11 months, they will typically stand briefly without support, transition form supine to sitting or quadruped, pull to stand through half kneel, & use pincer grasp.
d. When an infant is 12-15 months of age, they will typically stand up through quadruped, use a wide array of sitting positions, walk without support, creep up stairs, throw a ball in sitting, & mark paper with crayons.
A patient rehabilitating from congestive heart failure is examined in physical therapy. During the examination, the patient begins to complain of pain. The MOST immediate physical therapist action is to:
a. notify the nursing staff to administer pain medication
b. Contact the referring physician
c. Discontinue the treatment session
d. Ask the patient to describe the location & severity of the pain
Correct Answer: D
Congestive heart failure is characterized by the inability of the heart to maintain adequate cardiac output. before the physical therapist can adequately respond to the patient’s report of pain, it is essential to gather additional information.
a. Administering pain medication is premature until more information is known about the pain. Once additional information is collected, the nursing staff will be able to make a more informed decision.
b. Contacting the physician is premature until more information is known about the location and severity of the pain. This type of detailed information is necessary to provide the physician with a better sense of what the patient is currently experiencing.
c. Discontinuing the treatment session based on a subjective report of pain is a viable option, particularly given the patient’s diagnosis, however, the physical therapist would need to gather additional information about the pain prior to making a definitive decision
d. Having the patient describe the location & severity of the pain is the most immediate action the physical therapist should take. The information can be collected in a timely manner & may be useful to determine the relative seriousness of the patient’s subjective report of pain.
A patient demonstrates a significant loss of strength when trying to grasp a cup. However, the patient has much less difficulty when holding onto a pencil. This type of clinical scenario is consistent with pathology affective the:
a. median nerve
b. suprascapular nerve
c. musculocutaneous nerve
d. ulnar nerve
Correct Answer: D
Power grips (eg spherical, cylinder) require the use of both the radial & ulnar sides of the hand, typically involving the thumb, to grasp larger objects. Precision grips (eg lateral prehension, digital prehension) require the use of the radial side of the hand with the thumb to hold onto smaller objects. Grasping a cup would be an example of a power grip while utilizing a pencil would be an example of a precision grip.
a. The median nerve controls flexion of the radial digits and would therefore be involved in both power & precision grips. A patient with the pathology of the median nerve would have difficulty grasping both a cup & a pencil.
b. the suprascapular nerve innervates the supraspinatus & infraspinatus muscles. These muscles do not play a direct role in grasping objects
c. The musculocutaneous nerve innervates the coracobrachialis, biceps brachii, & brachialis muscles. these muscles do not play a direct role in grasping objects
d. The ulnar nerve controls flexion of the ulnar digits & would therefore be involved primarily in power grips. The ulnar nerve innervates some muscles of the thumb, therefore it would have a small effect on precision grips, though this effect would be limited in comparison to power grips which rely on the ulnar side of the hand
A patient presents with ape hand deformity secondary to a peripheral nerve injury. Which of the following findings would MOST likely be noted on examination?
a. Dec strength with thumb opposition
b. Fixed flexion of the MCP joints
c. Fixed hyperextension of the MCP joints
d. Wasting of the hypothenar eminence
Correct Answer: A
It is important for physical therapists to recognize impairments commonly associated with specific wrist & hand deformities. APe hand deformity is a hand deformity caused by median nerve palsy. The condition also known as simian hand, is characterised by an individual being unable to move the thumb away from the rest of the hand.
a. Ape hand deformity is characterized by wasting of the thenar eminence, which results in weakness with thumb flexion, & opposition. The patient’s thumb may fall back in line with the other digits since the pull of the thumb extensors is stronger than the thumb flexors.
b. DUpuytrens’ contracture is a hand deformity that is caused by contracture of the palmar fascia. The shortening of the fascia results in a fixed flexion deformity of the metacarpophalangeal & proximal interphalangeal joints.
c. Claw finger deformity is a hand deformity that is caused by a loss of strength in the hand intrinsics (often secondary to nerve injury). The loss of intrinsic strength results in a fixed deformity with the MCP joint in hyperextension & IP joints in flexion.
d. Bishop’s hand (or benediction hand) deformity is a hand deformity that is caused by ulnar nerve pathology. This condition results in the wasting of the hypothenar eminence.
