NBPTE Exam Review Flashcards
A patient with coronary artery disease has been doing regular aerobic exercise on a treadmill. If the patient fails to comply in taking prescribed beta-blocker medication and continues to exercise, what potential rebound effects could result?
A- increase in BP and decrease in HR
B- decrease in BP and HR
C- increase in BP and HR
D- decrease in BP and increase in HR
C- increase in BP and HR
Explanation: Beta affect the beta-1 adrenergic receptors. Blocking these inhibits the sympathetic response. However, when abruptly terminated, they cause a reflexive opposite response. This patient will demonstrate increased contractility, blood pressure (BP), and heart rate (HR) as a result.
A patient has persistent midfoot pain with weight bearing. The injury occurred during a soccer match when an opposing player stepped on the patient’s right foot when it was planted and cutting to the left. Patient locates the pain where laces are tied. Upon examination there is splaying of the first metatarsal and increased pain when passively stressing the foot with plantarflexion and rotation. What injury should the therapist suspect the patient has sustained?
A-Lisfranc Injury
B-Turf toe
C-Calcaneocuboid joint subluxation
D-Hallux rigidus
A-Lisfranc Injury
Explanation: Lisfranc injury (also known as the Lisfranc fracture, tarsometatarsal injury, or simply midfoot injury) is an injury of the foot in which one or all of the metatarsal bones are displaced from the tarsus. Direct Lisfranc injuries are usually caused by a crush injury, such as when a heavy object falls onto the midfoot, or when landing on the foot after a fall from a significant height. The injury often occurs when an athlete has his or her foot plantar flexed and another player lands on his or her midfoot.
A patient is referred to physical therapy with a 10-year history of rheumatoid arthritis (RA). What are possible extra-articular complications?
A-Disc Degeneration
B-Psoriatic skin and nail changes
C-Vasculitis
D-Conjunctivitis and iritis
C-Vasculitis
Explanation: Rheumatoid arthritis is a progressive autoimmune disease affecting primarily joints and synovial tissue. Extra-articular complications of the disease can include vasculitis.
Incorrect Choices:
The other choices are not expected extra-articular complications in patients with RA. Disc degeneration is seen in degenerative disc disease. Psoriatic skin and nail changes and conjunctivitis and iritis can be seen in psoriatic arthritis.
What would a therapist who is examining the breathing pattern of a patient with a complete (ASIA A) C5 spinal cord injury expect to observe?
A-Asymmetric lateral costal expansion due to ASIA-A Injury
B-An increased subcostal angle due to air trapping from muscle weakness
C-No diaphragmatic motion since the diaphragm is below the level of the lesion
D-Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera
D-Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera
Explanation: The abdominal musculature provides external stability to the abdominal viscera. Without this, the viscera are displaced with respiration.
Incorrect Choices:
With an ASIA A injury, the muscle weakness would be symmetric. The diaphragm is innervated by C3–5 nerve roots, so it will be functioning in this patient. Muscle weakness will cause a restrictive disorder (inability to generate negative pressure), not an obstructive disorder (air trapping).
Men are at risk for development of metabolic syndrome if they exhibit which of the following symptoms?
A-An HDL level lower than 45 mg/dL
B-A waist size greater than 40 in.
C-Triglyceride levels greater than 100 mg/dL
D-Fasting blood glucose less than 100 mg/dL
B-A waist size greater than 40 in.
Explanation: Criteria for diagnosis of metabolic syndrome include abdominal obesity (waist circumference >40 inches in men or >35 inches in women).
Incorrect Choices:
Other criteria include elevated triglycerides (150 mg/dL or higher); low HDL levels (<40 mg/dL in men or <50 mg/dL in women); and a fasting plasma glucose level >110 mg/dL.
An 8-year-old boy is referred to physical therapy with chronic pain in the hip, thigh, and knee without any precipitating trauma or other known cause. The symptoms initially began as soreness and progressively worsened. The physical therapist notes that the patient walks with exaggerated trunk and pelvic movements, and there is significantly limited range of motion with hip abduction and extension. Examination of the knee region is normal. What is theMOST LIKELYdiagnosis?
A- Hip dysplasia
B- Legg-Calve-Perthes disease
C- Growing pains
D- Slipped capital femoral epiphysis
B- Legg-Calve-Perthes disease
Explanation: Legg disease is an idiopathic childhood hip disorder initiated by disruption of blood flow to the femoral head, leading to avascular necrosis. Age of onset is between 2–13 years and is four times more likely in boys than girls. Characteristic clinical examination findings are gradual onset and limited range of motion in abduction and extension (due to collapse of subchondral bone at the femoral neck/head). The gait deviation is called a psoatic limp due to weakness of the psoas major muscle. The patient moves in hip external rotation, flexion, and adduction along with exaggerated trunk and pelvic movements.
Incorrect Choices:
Slipped capital femoral epiphysis (SCFE) is also a common hip disorder observed in adolescents. However, the age of onset in males is usually 10–17 years (average 13 years). Patients with SCFE demonstrate a Trendelenburg gait and limited range of motion in abduction, flexion, and internal rotation. Hip dysplasia is an abnormality in the size, shape, orientation, or organization of the femoral head and/or acetabulum that can result in hip subluxation or dislocation. Hip dysplasia is more common in females than males. Legg-Calvé-Perthes disease is often misdiagnosed as growing pains in early stages. However, children experiencing growing pains typically present with increased pain at night and do not commonly exhibit loss of range of motion or a dysfunctional gait.
To prepare a patient with a cauda equina lesion for ambulation with crutches, what upper quarter muscles would be the most important to strengthen?
A- UTs, Rhomboids, and levator scapulae
B- Deltoid, coracobrachialis, and brachialis
C- MTs, SAs, and triceps
D- LTs, Lats, pec major
D- LTs, Lats, pec major
Explanation: The muscles needed for crutch use include the shoulder depressors and extensors along with elbow extensors.
Incorrect Choices:
All other choices include muscles that enhance shoulder elevation or abduction.
What will a patient with a significant right thoracic structural scoliosis demonstrate on examination?
A- Decreased breath sounds on the right
B- Decreased thoracic rib elevation on the right
C- Increased lateral costal expansion on the right
D- Shortened internal/external intercostal on the right
C- Increased lateral costal expansion on the right
Explanation: With a right thoracic scoliosis, the convex side is on the right. This would allow for increased aeration and mobility on that side.
Incorrect Choices:
The ribs would elevate normally or more on the right side. The remaining choices would be true on the contralateral or shortened side of the scoliosis. The left side would have shortened muscle length and decreased aeration.
A therapist has been treating a patient for several weeks for decreased shoulder elevation and a loss of external rotation. Recovery has been good; however, the patient still complains of being unable to reach the upper shelves of kitchen cabinets and closets. To help the patient achieve this goal, what should be the focus of manual therapy?
A- Superior glide
B- Inferior glide
C- Anterior glide
D- Grade II oscillations
C- Anterior glide
Explanation: Anterior glide would help increase external rotation (ER), which is a component of full elevation. Performing anterior glides to improve ER and late flexion will help increase overhead reach since ER of humerus occurs with flexion.
Incorrect Choices:
Superior glide is not a joint mobilization for any pathology of the shoulder. Inferior glide would help increase shoulder abduction. Grade II mobilization would not improve motion.
Which activity would help break up obligatory lower extremity synergy patterns in a patient with hemiplegia?
A- High kneeling position, ball throwing
B- Standing, alternate marching in place with hip and knee flexion and hip abduction
C- Sitting, alternate toe tapping
D- Sitting, foot slides under the seat
A- High kneeling position, ball throwing
Explanation: Kneeling positions with the hip in extension and the knee flexed to 90 degrees is an out-of-synergy position. Balance training activities (e.g., reaching, ball throwing) enhance postural control while engaging cognitive control on the added activity (ball throwing).
Incorrect Choices:
Marching with hip and knee flexion and hip abduction, toe tapping in sitting, and foot slides using knee flexors in sitting all utilize movement in synergy or a synergy-supported position.
A patient recovering from a partial spinal cord injury reports lack of feeling in the more-affected hand. Monofilament testing reveals lack of ability to tell when the stimulus is being applied (only 1 correct response out of 5 tests). What additional sensory tests should the therapist perform?
A- Test for sharp sensation
B- Test for two-point discrimination
C- Test for vibration
D- Test for joint proprioception (thumb up/thumb down)
A- Test for sharp sensation
Explanation: Testing for perception of sharp sensation can be performed as pain and temperature are carried in a different pathway (anterolateral spinothalamic pathways) from other answer options; monofilament, vibration, and joint proprioception are carried in the dorsal column-lemniscal pathways.
Incorrect Choices:
All other choices test for discriminative sensations (two-point discrimination, vibration, and joint proprioception) and require intact dorsal column–medial lemniscal pathways projecting to the somatic sensory cortex.
A patient seen in an outpatient physical therapy clinic has a primary complaint of paresthesias affecting the lateral half of the right palm. If the result of the special test shown here reproduces these symptoms, which is the BEST intervention for this patient?
A- Thermal US to anterior wrist
B- Neutral-positioned wrist orthosis
C- Laser therapy to the anterior wrist
D- Iontophoresis to the carpal tunnel region
B- Neutral-positioned wrist orthosis
Explanation: The special test shown in this video is Phalen’s test. If the test reproduces the patient’s paresthesias in the right palm (median nerve distribution), it increases the likelihood of a diagnosis of carpal tunnel syndrome (CTS). There is moderative evidence (Grade B) to recommend the use of a wrist orthosis, particularly worn at night, for symptom relief and functional improvement in patients with CTS. See Box 2-4 for the CTS Clinical Practice Guideline.
Incorrect Choices: The Clinical Practice Guideline recommends that each of the other modalities listed as answer choices should NOT be used to treat CTS.
Following a motor vehicle accident, a patient with chest trauma developed atelectasis. Which intervention is ineffective in the immediate management of atelectasis?
A- Pain Reduction Techniques
B- Segmental breathing
C- Incentive spirometry
D- Paced breathing
D- Paced breathing
Explanation: In order to reverse atelectasis, the patient needs a technique to facilitate deep breathing. Paced breathing controls the rate of breathing, not the depth of breathing, and will therefore be ineffective.
Incorrect Choices:
Reducing the patient’s pain associated with the trauma will allow the patient to take deeper breaths, which will decrease atelectasis. Segmental breathing will allow for prolonged inspiration with a breath hold. The long inspiration will facilitate deeper breathing, which can reverse the atelectasis. A breath hold will allow collateral ventilation via the pores of Kohn, which will result in increased pressures to inflate alveoli and therefore reverse atelectasis. Incentive spirometry will cause increased deep breathing with visual feedback, which can reverse atelectasis.
Following a reattachment of the flexor tendons of the fingers, the patient is in a splint. One physical therapy goal is to minimize adhesion formation. What should the physical therapist teach the patient to perform after 72 hours postsurgery?
A- Passive extension and active flexion of IP joints
B- Active extension and flexion of the IP joints
C- Active extension and passive flexion of the IP joints
D- Gentle passive extension and flexion of IP joints
C- Active extension and passive flexion of the IP joints
Explanation: Severe edema increases tendon drag and likelihood of rupture. Therefore, wait until 48 to 72 hours postop prior to initiating range of motion (ROM) therapy. This patient is a few days postop and can begin passive finger flexion with caution so as not to disrupt the repair. Begin by blocking the metacarpophalangeal (MCP) in full flexion and actively extend interphalangeal (IP) joints, followed by passive proximal interphalangeal (PIP) flexion and active extension.
Incorrect Choices:
Generally for weeks 1 through 3 there should be no active flexion of the involved digits, as this could damage and/or tear the repair. Passive extension of the fingers should not be done until there is adequate strength of the repair.
Setting: Outpatient
Gender: Male
Age: 48
Presenting Problem/Current Condition: Persistent low back pain for the past 3 months, Radiating pain into right buttock and posterior thigh, Numbness of little toe and lateral side of right foot, Diminished right Achilles tendon reflex, Modified Oswestry Disability Index (ODI) score = 17%
Past Medical History: Chronic low back pain, Hypertension
Other information: Works as office manager (desk job), Rides bicycle for exercise, Enjoys doing yard work and restoring old cars
What is the MOST LIKELY diagnosis for this patient?
A- L5 radiculopathy
B- S1 radiculopathy
C- Spinal instability
D- Lumbar facet dysfunction
B - S1 Radiculopathy
This patient’s complaint of pain and numbness is along the S1 dermatome. Additionally, the diminished Achilles tendon reflex is an S1 reflex. These findings are consistent with compression of the S1 nerve root.
Incorrect Choices: The patient profile and examination findings do not include any items that are suggestive of L5 radiculopathy, spinal instability or lumbar facet dysfunction.
A patient’s plan of care includes use of iontophoresis for the management of calcific bursitis of the shoulder. To administer this treatment using the acetate ion, what current characteristics and polarity should be used?
A- Monophasic twin-peaked pulses using the positive pole
B- Monophasic twin-peaked pulses using the negative pole
C- Direct current using the positive pole
D- Direct current using the negative pole
D- Direct current using the negative pole
The acetate ion has a negative charge, and thus a negative pole will be needed to repel the drug into the tissue. Direct current will continuously drive the acetate into the tissue during the treatment time.
Incorrect Choices: While monophasic, twin-peaked current has polarity, it is a pulsed current and will not be able to continuously drive the acetate into the tissue resulting in less medication being delivered to the site. The positive pole will not repel the acetate ion.
A patient is seen in a physical therapy clinic for a traumatic knee injury. The patient sustained the injury by falling “up the stairs” in their house and striking the proximal tibia directly against the edge of a step. During the examination of the patient, the therapist notes diffuse bruising around the tibial tuberosity. What structure wasMOST LIKELYinjured?
A- ACL
B- PCL
C- medial patellofemoral ligament
D- popliteal artery
B- PCL
The PCL is the primary restraint to posterior displacement of the tibia on the femur. The scenario describes one of the three most common mechanisms of injury of the PCL. This occurs when the knee is flexed, and an object forcefully strikes the proximal anterior tibia and displaces it posteriorly. The most common causes of PCL injury are motor vehicle accidents (dashboard injury) and athletics.
Incorrect Choices:
The usual mechanism of injury for the ACL is noncontact deceleration that produces a valgus twisting injury (e.g., athlete quickly pivoting in the opposite direction). Other mechanisms of injury of the ACL include hyperextension and severe medial tibial rotation.The medial patellofemoral ligament is typically injured during a lateral patellar dislocation. The most common mechanism for a patellar dislocation is a powerful contraction of the quadriceps in combination with sudden flexion and external rotation of the tibia on the femur. This question describes trauma to the tibia, not the patella.Injuries of the popliteal artery are rare and typically result from severe trauma resulting in (1) a dislocation of the tibia on the femur or (2) a fracture of the distal femur with posterior displacement of the short distal fragment.
A physical therapist examines a tall, thin adult patient whose chief complaint is intense mid-back pain that is described as a dull ache and throbbing. The patient is unable to identify any aggravating or easing factors, and the therapist is unable to change the patient’s symptoms with any type of position changes or functional tests. The therapist notices that the patient has an indented sternum (pectus excavatum). In this situation, what action should the therapist take?
A- Treat pt w/ Gr 3-4 thoracic and costovertebral mobs
B- Begin the pt on a strengthening program targeting the chest, back, and core muscles
C- Recommend XR to rule out fx of T-spine and sternum
D- Refuse to treat pt and immediately consult with patient’s primary care provider for further evaluation.
D- Refuse to treat pt and immediately consult with patient’s primary care provider for further evaluation.
This question describes a patient with a possible thoracic aortic aneurysm (TAA). Although less prevalent than abdominal aortic aneurysms, a TAA should still be treated as an emergency situation. Patients often describe the pain of an aneurysm as throbbing or pulsating, and the pain location of a TAA is typically between the shoulder blades or substernal. Risk factors for aortic aneurysms include connective tissue disorders such as Marfan’s syndrome. Patients with Marfan’s syndrome are tall and thin and often have deformities of the sternum.
Incorrect Choices:
There are no indications in this scenario that the patient’s back pain is musculoskeletal in nature. Each of the incorrect choices describe intervention options for a musculoskeletal problem and ignore the fact that what is described is a potential emergency situation. If there had been a fracture of a thoracic vertebra, changes in positions and activities certainly would have provoked the patient’s symptoms.
A patient presents with a chronic restriction of the temporomandibular joint (TMJ). The physical therapist observes the situation seen in the picture during mouth-opening range of motion (ROM) assessment. What is theBESTintervention if the patient has a classic TMJ unilateral capsular restriction?
A- Left TMJ, superior glide manip
B- Left TMJ, inferior glide manip
C- Right TMJ, superior glide manip
D- Right TMJ, inferior glide manip
D- Right TMJ, inferior glide manip
Right TMJ, inferior glide. In the photo, the chin has deviated to the right at terminal opening. The active range of motion (AROM) will be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with a TMJ capsular pattern of restriction.
Incorrect Choices:
The left TMJ incorrectly states the capsular pattern. Additionally, superior glide manipulation on the right would compress the joint, not affording a stretch to the capsule tightness.
A physical therapist is treating a patient with active infectious hepatitis B. In addition to wearing a protective gown when in the patient’s room, what precautions should be taken to avoid transmission of the disease?
A- Avoid direct contact with patient’s blood by wearing gloves
B- Avoid direct contact with any part of patient
C- Have patient wear mask to minimize droplet spread of organisms from coughing.
D- Provide tissues and no-touch receptacles for disposal of tissues
A- Avoid direct contact with patient’s blood by wearing gloves
Hepatitis B is transmitted in blood, body fluids, or body tissues. Precautions should include avoiding direct contact with blood or blood-contaminated equipment.
Incorrect Choices:
This is not an airborne infectious disease. The patient does not need to wear a mask or have specific no-touch tissue receptacles. Contact with body surfaces with no blood droplets or open wounds should also not be an issue.
A college student is seen by a physical therapist 3 weeks after having an open reduction and internal fixation (ORIF) for a talus fracture. There was no known nerve damage associated with the original injury or surgery. After several treatment sessions the therapist notices that the patient’s pain is out of proportion to what is expected at this stage of recovery. The therapist observes that the patient’s ankle and foot are still markedly swollen, and the skin appears mottled (red and white). The injured foot feels sweaty compared to the unaffected side. What condition should the therapist suspect?
A- ankle joint infection
B- CRPS type 1
C- CRPS type 2
D- post-traumatic arthritis
B- CRPS type 1
Complex regional pain syndrome (CRPS) Type I was formerly known as Reflexive Sympathetic Dystrophy. This question describes classic symptoms of CRPS, which include unexplained and hypersensitive pain, temperature changes, skin changes, and swelling of the affected area. In CRPS Type I, there is no known nerve damage, whereas in CRPS Type II (formerly causalgia) there is a known nerve injury, such as a crush injury to a peripheral nerve.
Incorrect Choices:
An infection of the ankle joint would have presented differently than what is described in the question stem. Signs of infection include fever and chills, palpable warmth in the infected area, and pain, redness, and possible purulent drainage at the surgical incision site. Post-traumatic arthritis may develop in the ankle or subtalar joints following a surgical repair of the talus, but it would typically take months to develop. Additionally, the clinical presentation described in this scenario is not consistent with the pain and stiffness patients describe in an arthritic joint.
The therapist is treating a patient with chronic Lyme disease of more than 1 year’s duration. What joints are likely to demonstrate more arthritic changes and therefore should be the focus of physical therapy interventions?
A- Small joints of hands and feet
B- Large joints of body, esp. knee
C- axial joint, esp. lumbosacral spine
D- axial joint, esp. C and T spine
B- Large joints of body, esp. knee
Stage 3 Lyme disease (late or chronic Lyme disease) is characterized by intermittent arthritis with marked pain and swelling, especially in the large joints. Permanent joint damage can occur.
Incorrect Choices:
Other joints may be affected, though not with the same frequency as the large joints.
A patient with type 1 diabetes mellitus has generalized osteoporosis. What is theBESTexercise to include in this patient’s plan of care?
A- B quads presses against resistance in sitting
B- Aquatic exercises
C- Running on treadmill
D- Partial squats in standing
D- Partial squats in standing
Extensor stabilization exercises in weightbearing postures provide the best stimulus to bone (e.g., standing, holding against resistance, standing partial squats).
Incorrect Choices:
High-load, short-duration activities ( jumping, running, weights) provide less stimulus to bone while posing increased risk of muscle strain and injury. The buoyancy of water limits the load on bone during aquatic exercises.
Type of Reasoning: INDUCTIVE
This question requires the test-taker to utilize clinical judgment in order to determine a best course of action. Questions of this nature often require inductive reasoning skill. For this case, the best exercise to include for osteoporosis is partial squats in standing. Review exercise guidelines for osteoporosis if answered incorrectly.
This picture depicts a clinician assessing for Stemmer’s sign. The clinician is examining for what condition?
A- Metatarsalgia
B- Hammer toe
C- Lymphedema
D- Fx of 2nd toe
C- Lymphedema
Stemmer sign is assessed by pulling up on the skin at the base of the second toe or finger, which the clinician is doing in this picture. If the skin is unable to be pulled up, then it is a sign of lymphedema, usually primary but also advanced secondary.
Incorrect Choices:
A bunion is diagnosed by the metacarpophalangeal (MCP) joint angle. A fracture is diagnosed by radiology. A hammer toe is usually diagnosed by visual inspection of the foot.
A young adult who is comatose (Glasgow Coma Scale score of 3) is transferred to a long-term care facility for custodial care. On initial examination, the therapist determines the patient is demonstrating decerebrate posturing. Which limb or body position is indicative of this?
A- The UEs in flexion and LEs in extension
B- Extreme hyperext of neck and spine w/ BLEs flexed and heels touching buttocks
C- All 4 limbs in extension
D- All 4 limbs in flexion
C- All 4 limbs in extension
With decerebrate posturing (decerebrate rigidity), the upper and lower extremities are held rigidly in extension.
Incorrect Choices:
In decorticate posture, the upper extremities are held rigidly in flexion while the lower extremities are extended. With opisthotonos, extreme hyperextension of the neck and spine is evident, with both lower extremities flexed and the heels touching the buttocks. All limbs flexed is not typically found in the comatose patient.
A physical therapist is educating a patient with diabetic polyneuropathy. What is the BEST foot care precaution information to share with this patient?
A- Apply moisturizing cream daily in-between toes and on heels
B- It is best to shop for new shoes at beginning of day
C- Keep feet warm at night w/ heating pad or hot water bottle
D- Use pumice stone to gently remove calluses
D- Use pumice stone to gently remove calluses
Foot care precaution for patients with diabetic polyneuropathy should include the use of a pumice stone to gently file calluses. Other advice includes examining footwear for proper fit to prevent callus and corn development. Additionally, patients should never use anything sharp or chemicals to debride corns or calluses.
Incorrect Choices:
It is important to moisturize but not between the toes as it contributes to skin maceration. It is best to buy shoes at the end of the day when the feet are larger. Buying shoes at the beginning of the day could result in an improper fit. Finally, heating pads and hot water bottles are contraindicated in someone with polyneuropathy. If the patient’s feet are cold, it is recommended they wear socks.
A therapist wishes to examine the balance of an elderly patient with a history of falls. The Berg Balance Test is selected. Which area isNOTexamined using this test?
A- STS transitions
B- Functional reach in standing
C- Turning head while walking
D- Tandem standing
C- Turning head while walking
The Berg Balance Test (BBT) is a test of static and dynamic balance in sitting and standing. It includes transitional items of sit-to-stand and stand-to-sit. It does not include items on gait. Turning while walking is an item on both the Tinetti Performance-Oriented Mobility Assessment and the Dynamic Gait Index.
Incorrect Choices:
All other choices are items on the BBT.
Pursed lip breathing as part of the treatment regimen would beMOSTappropriate for a patient with which condition?
A- Circumferential thoracic burns
B- Asbestosis
C- Rib fracture
D- Emphysema
D- Emphysema
Pursed lip breathing gives increased resistance to the airways on exhalation. The resistance causes increased pressure, which helps to prevent airway collapse (likely sequelae given the pathophysiology of emphysema). This occurs via collateral ventilation through pores of Kohn and canals of Lambert.
Incorrect Choices:
Circumferential thoracic burn is a restrictive disorder, and pursed lip breathing will not have any effect on this. Asbestosis is an interstitial lung disease where there are fibrotic changes within the lung tissue. Pursed lip breathing will have no effect on this patient’s breathing pattern. Rib fractures are also a restrictive disorder. In order to improve the breathing pattern, it would be most beneficial to control pain. Pursed lip breathing will have little effect.
A physical therapist examines a patient with knee pain in an outpatient clinical setting. The patient reports they are scheduled for a platelet rich plasma (PRP) injection. Which statement MOST accurately reflects an expected adjustment in the patient’s use of NSAIDs?
A- No change in NSAID use before or after PRP injection
B- Decrease in NSAID dosage after PRP injection
C- Increase in NSAID dosage after PRP injection
D- Discontinuation of NSAID prior to PRP injection
D- Discontinuation of NSAID prior to PRP injection
Patients are typically advised to suspend the use of NSAIDS prior to a PRP injection because of the potential for NSAIDs to diminish the effects of the injection. Aspirin, acetaminophen and some NSAIDs tend to decrease platelet count. Patients can continue to take COX-2-selective NSAIDs prior to a PRP injection as studies show that COX-2 NSAIDs do not significantly decrease platelet counts or aggregation.
Incorrect Choices: The mechanism of action which makes NSAIDs effective pain relievers also inhibits platelet aggregation via the cyclooxygenase-arachidonic acid pathway. Therefore, any dose (decrease, same, or increase) of NSAIDs would likely interfere with the therapeutic potential of the PRP injection.
An adult patient sustained an elbow dislocation while completing a military obstacle course eight weeks ago and continues to have limited elbow flexion. Which joint mobilization technique is BEST to improve elbow flexion?
A- Posterior glide of radial head on humerus
B- Anterior glide of radial head on humerus
C- Lateral glide of radial head on humerus
D- Medial glide of radial head on humerus
B- Anterior glide of radial head on humerus
An anterior glide of the radius on the humerus would be used to increase elbow flexion. In this case, and according to the concave-convex rule, a concave surface is moving on a convex surface, so the anterior glide will occur in the same direction as the osteokinematic motion of flexion. See Table 2-1 for a review of the concave-convex rule application to peripheral joints.
Incorrect Choices:
Medial and lateral glides may be used to augment overall mobility but are not the best choice to improve elbow joint flexion. Posterior glide of the radial head would be used to increase elbow extension.
A patient with a complete tetraplegia (ASIA A) at the C6 level is initially instructed to transfer using a transfer board. With shoulders externally rotated, how should the remaining upper extremity (UE) joints be positioned?
A- Forearms pronated with wrists and fingers extended
B- Forearms supinated with wrists extended and fingers flexed
C- Forearms pronated with wrists and fingers flexed
D- Forearms supinated with wrists and fingers extended
B- Forearms supinated with wrists extended and fingers flexed
The patient with tetraplegia at the C6 level does not have triceps to assist in transfers. Independent transfers can be achieved using muscle substitution and positioning to lock the elbow. The hands are positioned anterior to the hips; the shoulders are externally rotated with the elbows and wrists extended, forearms supinated, and fingers flexed. Strong contraction of the anterior deltoid, shoulder external rotators, and clavicular portion of the pectoralis major flexes and adducts the humerus, causing the elbow to extend.
Incorrect Choices:
Fingers are always flexed (not extended) to preserve tenodesis grasp. Forearms are supinated (not pronated) and the wrist is extended (not flexed).
Which of the following is theMOSTvalid prognostic indicator of early wound healing of a diabetic foot ulceration?
A- Increase in granulation formation within first month
B- Reduction of wound surface area in first month
C- Reduction in exudate production in first few weeks
D- Epithelialization is present within first month of care being initiated
B- Reduction of wound surface area in first month
A significant decrease in wound area during the first month is the most significant prognostic indicator of full wound closure for diabetic foot ulcerations. Significant reduction of wound area in the first few weeks is also a predictor of complete wound healing in venous and pressure ulcerations.
Incorrect Choices:
Although the other options are important for wound healing and contribute to a reduction in wound surface area, individually they represent an earlier stage of wound healing and are not as predictive of complete wound healing.
A patient is referred to physical therapy with a chief complaint of pain involving their hips, low back, and shoulders.The patient is unable to identify any precipitating event or trauma that led to their symptoms.During the physical examination of these regions, the therapist is unable to reproduce the patient’s symptoms.The patient also reports experiencing recent bouts of diarrhea, abdominal pain, and skin rashes.The therapist suspects that a systemic disorder may account for all of the patient ‘s complaints.Which disease is the most likely explanation for this patient ‘s clinical presentation?
A- Colorectal cancer
B- Inflammatory bowel disease
C- Diverticulitis
D- Pancreatitis
B- Inflammatory bowel disease
Inflammatory bowel disease (IBD) refers to two inflammatory conditions: Crohn’s disease and ulcerative colitis. The etiology of these two disorders is unknown but thought to be due to genetic or immunologic influences on the gastrointestinal (GI) tract. Both diseases cause inflammation inside the intestine as well as significant problems in other parts of the body including polyarthritis and migratory arthralgias. Diarrhea, constipation, abdominal pain, fever, rectal bleeding, night sweats, skin rashes and uveitis are other clinical signs and symptoms of IBD. IBD is a different clinical entity than IBS–irritable bowel syndrome.
Incorrect Choices:
Common signs and symptoms of colorectal cancer include rectal bleeding; hemorrhoids; abdominal, pelvic, back, and sacral pain; diarrhea, nausea and vomiting; constipation; and unexplained weight loss. Diverticulitis involves inflamed pouches of intestine that can also lead to abdominal pain and nausea. Left lower quadrant pain is another common symptom of diverticulitis, along with flatulence, bloody stools, and constipation. Patients with pancreatitis typically complain of epigastric pain that radiates to the mid back; nausea, vomiting and diarrhea; abdominal distention; and malaise. They may also exhibit jaundice and in severe cases may exhibit a bluish discoloration of the abdomen (Cullen’s sign) or discoloration of the flanks (Grey Turner’s sign) due to hemorrhage.
A patient with Guillain-Barré syndrome was just weaned from a ventilator. The patient has a maximal inspiratory pressure (MIP) of −35cmH2O and maximal expiratory pressure (MEP) of 40cmH2O. Which of the following is an expected finding on examination?
A- Asymmetrical decreased costal expansion
B- Increased inspiration:expiration (I:E) ratio
C- Increased subcostal angle
D- Ineffective cough for secretion clearance
D- Ineffective cough for secretion clearance
Both the MIP and MEP findings indicate significant ventilator muscle weakness. The patient will have difficulty drawing air in and forcefully expelling it, which are two phases of an effective cough. Therefore, the patient will have difficulty clearing their secretions. See Tables 5-1 and 5-2 for normal values of MIP and MEP.
Incorrect Choices:
A patient with Guillain-Barré syndrome will present as if they have a restrictive lung disease. The patient will have decreased costal expansion, but it will be symmetrical. Both increased I:E ratio and subcostal angle are findings consistent with someone with obstructive lung disease and lung hyperinflation, not restrictive lung disease.
A therapist is planning to use percussion and shaking for assisting airway clearance with a patient diagnosed with chronic obstructive pulmonary disease (COPD). What major precaution might curtail selection of this form of intervention?
A- Platelet count of 20,000
B- Dyspnea when in Trendelenburg position
C- SaO2 range of 88-94% on room air
D- Diagnosis of multilobe pneumonia
A- Platelet count of 20,000
A patient with a platelet count of 20,000 is at increased risk for bleeding. Percussion may cause microtraumas and increased bleeding risk.
Incorrect Choices:
While dyspnea in Trendelenburg is uncomfortable, the position could be modified so that percussion and vibration can be completed. While an SaO2 range of 88% to 94% on room air is a consideration, it would not preclude this intervention. This should be monitored closely while considered positions maximize ventilation and perfusion. While this patient will require assistance for positioning, it doesn’t eliminate this treatment intervention. Pneumonia is an indication for manual airway clearance techniques. The therapist will need to complete the techniques in multiple postural drainage positions to optimize efficiency.
A physical therapist and physical therapist assistant are conducting a cardiac rehabilitation session for 20 patients. The therapist is suddenly called out of the room. The physical therapist assistant should do which of the following?
A- Terminate exercises and have patients monitor their pulses until the therapist returns
B- Have patients continue with same exercises until therapist returns
C- Have patients switch to less intense exercise until therapist returns
D- Continue with outlined exercise program for that session
D- Continue with outlined exercise program for that session
The physical therapist provided an exercise program, and it is appropriate for the PTA to continue to follow it.
Incorrect Choices:
There is no need to terminate exercise since the patients have an established exercise program. It is within a PTA’s scope of practice to progress a program, so there is no need to maintain the same intensity of exercise. There is no need to reduce the intensity of the program, as the PTA can monitor and progress a program.
A patient reports progressive fatigue, muscle weakness, and soreness in the bilateral shoulder and pelvic girdle muscles for the past 4 months. The patient’s past medical history is unremarkable with the exception of a 10-year history of high cholesterol and hypertension. Neuromuscular screening of the bilateral upper and lower extremities revealed weakness (4-/5 manual muscle testing) of various shoulder/scapular and pelvic muscles bilaterally. Cranial nerve, sensory, and reflex (to include Babinski/Clonus) testing are normal. Which of the following health conditions is most consistent with the patient’s signs and symptoms?
A- GBS
B- Myopathy
C- Myasthenia gravis
D- Amyotrophic lateral sclerosis
B- Myopathy
Myopathy typically impacts proximal muscles to a greater extent than distal muscles. Cholesterol lowering drugs (statins) are a risk factor for the development of myopathy.
Incorrect Choices:
Guillain-Barré syndrome (GBS) typically follows a respiratory illness or vaccination and causes rapid demyelination of multiple peripheral nerves resulting in rapid and acute proximal to distal weakness. Although myasthenia gravis causes fatigue and ultimately weakness in multiple muscles in the bilateral upper and lower extremities, it also presents with mild ptosis and involvement of ocular and/or oropharyngeal muscles. Amyotrophic lateral sclerosis may also cause fatigue/weakness, but it typically presents with asymmetric weakness and is defined by both lower and upper motor neuron involvement.
Setting: Outpatient
Gender: Female
Age: 44
Presenting Problem/Current Condition: Intense brief radiating electric pain in the spine and bilateral lower extremities when looking down over the past 6 months, Numbness in the bilateral lower extremities distal to the bilateral knees, Periodic blurry vision, Fatigue that is increased with hot weather, She denies trauma, neck pain, or radiating pain, numbness/tingling, or weakness in the face or bilateral upper extremities, Ataxic gait on unlevel surfaces with 3 near falls in the past 6 months, Decreased fine touch(monofilament) and vibration in the bilateral lower extremities distal to the knees, Normal manual muscle testing, reflexes (to include Babinski and ankle clonus), and pinprick sensation in the bilateral upper and lower extremities
Past Medical/Surgical History: Unremarkable
Other information: Marketing executive, Married with two children
Goal: Be able to safely walk and hike.
Which of the following examination items is BEST to assess the patient’s primary impairments and their influence on postural instability?
A- Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)
B- Semi-Tandem St. EO
C- Functional Reach Test (FRT)
D- TUG
A- Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)
The mCTSIB is ideally suited to assess the influence of the patient’s diverse sensory impairments(vestibular, somatosensory, vision) on postural stability.
Incorrect Choices: Options #2-4 do not directly assess the patient’s sensory impairments and are specifically intended to measure static stability, functional stability limits, and mobility, respectively.
A patient is seen in physical therapy with a complaint of ring finger pain and weakness after an injury sustained while playing football. The patient describes grabbing an opponent’s uniform and feeling a painful pop in the finger during an attempted tackle. During the physical examination, the therapist observes swelling of the distal and middle phalanges of the ring finger, tenderness to palpation of the distal interphalangeal (DIP) joint region, and inability to produce flexion at the DIP joint. What is theMOST LIKELYdiagnosis?
A- Boutonniere deformity
B- Mallet finger
C- Swan neck deformity
D- Jersey finger
D- Jersey finger
Jersey finger is the eponym for a rupture or avulsion fracture of the flexor digitorum profundus (FDP) tendon at its insertion on the distal phalanx. The ring finger is involved in 75% of cases of jersey finger because it is more prominent than the other digits during grip. The mechanism of injury is forceful extension of the DIP joint during maximal contraction of the FDP. The key physical examination finding is an inability to actively flex the DIP joint in isolation.
Incorrect Choices:
A boutonniere deformity results from rupture of the central tendinous slip of the extensor tendon mechanism. With boutonniere deformities, the PIP is in a position of flexion and between the two lateral bands of the extensor mechanism. A swan neck deformity results from injury to the volar plate or transverse retinacular ligament, producing a deformity of flexion of the MCP and DIP joints with relative hyperextension of the PIP. Boutonniere and swan neck deformities may result from trauma but are often seen in patients with rheumatoid arthritis. A mallet finger results from rupture or avulsion of the terminal tendon of the extensor mechanism at the insertion on the distal phalanx. The mechanism of injury is usually traumatic forced flexion of the DIP joint and results in a deformity of flexion of the DIP with an inability to produce active extension.
A patient with chronic asthma has been admitted to the hospital for an acute exacerbation. What is theMOSTimportant information the therapist needs in order to determine the patient’s prognosis with physical therapy?
A- Current medication list
B- Previous hx of disease
C- most recent chest XR results
D- most recent PFT results
D- most recent PFT results
Recent pulmonary function test results will give the therapist information regarding the severity of the lung disease. This information will assist in determining how much the patient will progress.
Incorrect Choices:
While the current medication list will help determine how the patient is currently being managed, it doesn’t give any information about his or her function. The previous history of the disease will not translate well into what the patient’s function has been. It is possible that he or she has been quite functional despite terrible disease such that an acute exacerbation with little reserve will leave him or her quite limited. An acute asthma exacerbation will likely not appear on a chest x-ray, nor would chronic disease.
A therapist is examining the gait of a patient with a transfemoral prosthesis. The patient circumducts the prosthetic limb during swing. The therapist needs to identify the cause of the gait deviation. What is theMOSTlikely prosthetic cause?
A- Unstable knee unit
B- Inadequate socket flexion
C- High medial wall or abducted hip joint
D- Increased knee flexion resistance
D- Increased knee flexion resistance
Prosthetic causes of circumduction include a long prosthesis, locked knee unit, inadequate knee flexion, inadequate suspension, small or loose socket, and plantar flexed foot.
Incorrect Choices:
An unstable knee unit will cause forward flexion during stance. Inadequate socket flexion will result in lordosis during stance. A high medial wall or abducted hip joint will result in an abducted gait.
A middle-aged adult experienced a mild traumatic brain injury 1 month ago and has been undergoing rehabilitation. The patient initially had intermittent headaches, dizziness, and difficulty with dynamic balance, but now reports resolution of all symptoms. The dizziness handicap inventory score on the last visit was 1/100 at baseline and 3/100 after walking 10 minutes. The Mini-Balance Evaluation System Test (Mini-BEST) on the last visit was 26/28. The patient would like to go back to their previous active lifestyle, to include running. Which of the following examination items would provide the most complete assessment for safe return to work and recreation?
A- FGA
B- Four square step test (FSST)
C- Functional Independence Measure (FIM)
D- Community Balance and Mobility Scale (CBMT)
D- Community Balance and Mobility Scale (CBMT)
The patient’s performance on the dizziness handicap inventory and Mini-BEST reinforce their symptoms (both at rest and exertion) have improved and fall risk is very low. The CBMT is the correct answer as it includes higher level balance and mobility items, to include running short distances. It is also a reliable and valid tool for patients who have experienced a TBI (see Table 3-16).
Incorrect Choices:
The FGA and FIM do not assess higher level balance and mobility items. The FSST requires dynamic mobility and balance in multiple planes but does not specifically address running or other higher level community tasks.
Which common musculoskeletal complication of cystic fibrosis is important to combat with a resistance training program?
A- Carpal tunnel syndrome
B- Polyarthralgia
C- Decreased bone density
D- Joint contractures
C- Decreased bone density
In addition to production of a thick and sticky mucus that blocks the airways, patients with CF also produce a thick mucus that can block the common bile duct leading to malabsorption of nutrients and resulting in decreased bone density. A resisted exercise program can assist with reversing the effects of the disease process.
Incorrect Choices:
CF primarily affects the respiratory and digestive systems. There is no evidence that carpal tunnel syndrome or other peripheral neuropathies are a common complication of cystic fibrosis. Patients with cystic fibrosis may present with polyarthralgias (joint swelling and stiffness) and joint contractures, but a strength training program would not be the best intervention to address these impairments.
A therapist is examining a patient with an ulcer in the lower leg/ankle and suspects it is an arterial rather than a venous ulcer. One of the factors the therapist uses to determine this is based on the location of the ulcer. What is the typical location of an arterial ulcer?
A- Medial malleolus
B- Posterior tibial area
C- Lateral malleolus
D- Medial distal tibia
C- Lateral malleolus
The typical location of an arterial ulcer is the distal lower leg (toes, foot), the lateral malleolus, or the anterior tibial area.
Incorrect Choices:
The typical location of a venous ulcer is the distal lower leg and the medial malleolus.
A client with Stage I lymphedema of the right lower extremity is referred for physical therapy. The therapist considers a program of complete decongestive therapy (CDT). An important component of CDT is manual lymphatic drainage. How should the therapistBESTperform this procedure?
A- Starting at distal portion of limb and working proximally to move lymph toward right lymphatic duct
B- Starting at proximal portion of limb and working distally to move lymph toward right lymphatic duct
C- Following application of intermittent pneumatic compression to RLE
D- By performing deep tissue friction massage for several minutes on fibrotic areas prior to CDT
B- Starting at proximal portion of limb and working distally to move lymph toward right lymphatic duct
Manual lymphatic drainage is a component of a CDT plan for patients with lymphedema. Because of the very low forces present in the lymph system, lymph load in proximal areas must be relieved prior to progressing to areas where lymphedema is present. This proximal to distal approach maximizes any benefits that may occur from this treatment technique. Additionally, the anatomy of the lymph system requires movement of lower extremity lymph toward the thoracic duct. Only right upper quarter lymph would be directed toward the right lymphatic duct.
Incorrect Choices:
Intermittent pneumatic compression may be a treatment alternative when care is utilized to avoid damaging the lymph system by using low pressure, sequential compression. Additionally, the practice is limited to use in the upper extremity due to the unacceptable risk of causing genital lymphedema if performed in the lower extremity. Deep tissue friction massage is not indicated in patients with lymphedema. Aggressive manipulation of the integument may cause damage to lymphatic structures.
A patient has a body mass index (BMI) of 32 kg/m2with excessive tissue mass in the hip area. What accommodations are needed to the wheelchair prescription for this patient?
A- Move the small front casters closer to drive wheels to increase stability
B- Add friction rims to increase handgrip function
C- Add antitipping device to prevent falls going up curbs
D- Displace the rear axle forward for more efficient arm push
D- Displace the rear axle forward for more efficient arm push
This patient is obese. A bariatric wheelchair with heavy-duty, extra-wide wheels is necessary. The rear axle is displaced forward compared to the standard wheelchair to allow for more efficient arm push.
Incorrect Choices:
Moving the front casters closer to the drive wheels would decrease stability (not increase). Friction rims and antitipping devices are adjustments that may be necessary for the patient with a spinal cord injury.
A male athlete sees a physical therapist with a complaint of “right groin strain.” Examination of the musculoskeletal system in the groin is inconclusive; however, the therapist does detect swollen inguinal lymph nodes on the right side only. What should the therapist do next?
A- Refer the athlete to a primary care physician to rule out systemic disease
B- Examine lymph nodes of the neck which may be swollen if mononucleosis is suspected
C- Ask the patient questions relating to possible STD as many symptoms are mistaken for other conditions
D- Examine the right foot, leg, and hip for injury or infection
D- Examine the right foot, leg, and hip for injury or infection
The most common cause of unilateral inguinal lymph node swelling is injury or infection involving the distal foot, leg, thigh, or hip. Abrasions in these areas, fairly routine for many athletes, are potential sources. Insect bites are another possible cause. The therapist should perform a thorough examination and treat any injuries or wounds appropriately.
Incorrect Choices:
Although mononucleosis (Epstein-Barr virus) is prevalent in young males, there were no complaints of sore throat or fatigue. The only swollen lymph nodes detected were in the right inguinal area. It is unlikely that mononucleosis is the source. Asking the patient about STDs at this point in the examination is also premature. STDs can result in swollen lymph nodes (chlamydia, gonorrhea, etc.) and not necessarily present with other symptoms; but, is this the next step in the PT examination? If the swollen lymph nodes were more extensive and had remained so for 2 or 3 weeks, then referral to a physician would be in order.
What is an acceptable modified position to drain the posterior basal segment of the left lower lobe in a patient with pulmonary infiltrate?
A- S/L on R, w/ pillow under R hip and bed flat
B- Prone, w/ pillow under hips and bed flat
C- S/L on R, w/ pillow b/w legs and foot of bed elevated 18 inches
D- Prone, with a pillow under hip and head of bed elevated 18 inches
B- Prone, w/ pillow under hips and bed flat
Prone with a pillow under the hips and the bed flat will raise the posterior basal segments up to facilitate drainage. This is an acceptable modified position for drainage of the posterior basal segment of the left lower lobe.
Incorrect Choices: The side-lying position with the bed flat will drain the lingula more than the posterior basal segments. With the bed elevated in side-lying, the pillow position is just for comfort but will not facilitate drainage. Raising the bed up will cause drainage to go toward the base of the lungs, which would not be effective. If the head of the bed is elevated up in prone, drainage will also be more difficult.
An adult patient is seen in a physical therapy clinic one day after sustaining an ankle inversion injury. The lateral aspect of the ankle is swollen. The patient is having difficulty bearing weight on the involved lower extremity. The therapist is concerned about the possibility of a fracture. What other physical exam finding would indicate a need for ankle radiographs?
A- TTP at distal lateral malleolus
B- Inability to fully DF ankle
C- (+) Anterior drawer test
D- Weak/painful resisted eversion
A- TTP at distal lateral malleolus
The Ottawa Ankle Rules (see Box 2-10) were developed to provide clinicians with guidelines for determining when to order an x-ray following an acute ankle injury. Palpation tenderness of either malleoli is one of the criteria. The Ottawa Ankle Rules are highly sensitive and accurately rule out a fracture following an acute ankle injury.
Incorrect Choices: The other choices are each common and important examination findings in patients after ankle sprain, but none of them is a component of the Ottawa Ankle Rules.
A patient complains of excessive upper and lower extremity muscle aching, cramping, and right upper quadrant pain when exercising. The patient has a history of chronic alcoholism and was placed on atorvastatin (a statin drug) 2 months ago. The therapist should refer the patient to the primary care physician for which reason?
A- For an exercise test to determine the right intensity for exercises
B- To rule out cirrhosis of liver
C- To rule out liver and muscle dysfunction from statin
D- To rule out gallstones that may be obstructing bile duct
C- To rule out liver and muscle dysfunction from statin
A small percentage of patients (<5%) who take statins (atorvastatin such as Lipitor, or others) can experience myalgia, cramps, stiffness, spasm, or weakness affecting exercise tolerance. The patient needs to see the primary care physician to have the dose or medication changed.
Incorrect Choices:
Determining the appropriate exercise intensity is within the scope of a physical therapist’s practice. A physical therapist (PT) is the appropriate professional in this case, so no referral is needed. These signs and symptoms are not consistent with cirrhosis or gallbladder disorders. Exercise would not worsen this condition.
A therapist is treating a child with spastic diplegia. What intervention can be used to promote relaxation?
A- Rhythmic stabilization
B- Slow rocking on therapy ball
C- Spinning in hammock
D- Rolling/spinning on scooter board
B- Slow rocking on therapy ball
Relaxation can be achieved using slow rocking (slow vestibular stimulation).
Incorrect Choices:
Rhythmic stabilization is a proprioceptive neuromuscular facilitation (PNF) technique used to improve postural stability. Spinning and rolling on a scooter board are interventions used to increase mobility based on fast vestibular stimulation.
A patient presents to physical therapy with a complaint of anterior knee pain. There was no history of trauma associated with the onset of the pain. The patient interview and physical examination are consistent with patellofemoral pain syndrome (PFPS). Which of the following is the BEST intervention for most patients with PFPS?
A- Running gait retraining
B- Patellar taping
C- PF knee orthoses
D- Exercises targeting hip/knee muscles
D- Exercises targeting hip/knee muscles
According to the Patellofemoral Pain Clinical Practice Guidelines (CPG; see Box 2-8), there is strong evidence to support the prescription of therapeutic exercises that target both the hip and knee musculature. Hip exercises should focus on the gluteal muscles. Knee exercises may include both weightbearing and non-weightbearing exercises targeting the quadriceps and hamstring muscles.
Incorrect Choices: According to the Patellofemoral Pain CPG, there is only moderate evidence for the use of the other three answer choices. Running gait retraining, patellar taping, and patellofemoral knee orthoses are all interventions that physical therapists may consider in patients with patellofemoral pain. Running gait retraining may include multiple sessions of cuing to adopt a non-rearfoot strike pattern, cuing to increase cadence, and cuing to reduce peak hip adduction.
A research team is interested in determining if video taken on a smartphone is as accurate as a three-dimensional motion capture system at estimating step length, step width, and gait velocity. Which type of validity is the research team trying to establish?
A- Face validity
B- Content validity
C- Predictive validity
D- Concurrent validity
D- Concurrent validity
Concurrent validity is a type of criterion validity. It is used when comparing two measures at the same time to determine if the experimental measure (in this case the smartphone video) can be used as a substitute for the reference measure/gold standard (three-dimensional motion capture).
Incorrect Choices: Face validity indicates that a measure appears to measure what it is intended to measure. It is the weakest form of validity. Content validity is used to determine if the items that make up an instrument represent all possible content that defines the variable of interest. Predictive validity is a type of criterion validity and is used to determine if an experimental measure can predict a future outcome.
When using continuous ultrasound in treating the hip of an obese patient, theGREATESTbenefit might occur if the ultrasound frequency and dosage (intensity) are set at which parameters?
A- 1 MHz and 1.5 watts/cm2.
B- 1 MHz and 0.5 watts/cm2.
C- 3 MHz and 1.5 watts/cm2.
D- 3 MHz and 0.5 watts/cm2.
A- 1 MHz and 1.5 watts/cm2.
1 MHz MHz frequency is recommended for target tissue deeper than 2 cm, and 1.5 watts/cm² would increase the rate of heating, allowing it to be treated in a reasonable time frame.
Incorrect Choices: The frequency 3 MHz does not penetrate past 2 cm and would not be effective at the hip. A rate of heating of 0.5 watts/cm² intensity is very slow and would result in a prolonged treatment time.
A patient presents with a stage III pressure ulcer with a moist, necrotic wound. A hydrocolloidal dressing is being used. During the dressing change, the therapist detects a strong odor, and the wound drainage has a yellow color. What is the therapist’sBESTcourse of action?
A- Reapply a new gauze dressing instead of hydrocolloid and report the findings to the physician.
B- Speak to the nurse about changing to a hydrogel dressing.
C- Leave the dressing off the wound and report the findings immediately to the physician.
D- Reapply a new hydrocolloid dressing and record the findings in the chart.
D- Reapply a new hydrocolloid dressing and record the findings in the chart.
Hydrocolloidal dressings are typically changed every 3 to 5 days or when drainage leaks out. An odor and yellowish color is to be expected as the dressing material melts.
Incorrect Choices:
The decision about what type of dressing to apply to a wound is the physician’s in collaboration with the wound care team. This is not an emergency situation.
During examination of a patient with degenerative osteoarthritic changes in the carpometacarpal (CMC) joint of the right thumb, the physical therapist notes a 20-degree loss of thumb palmar abduction. What translatory joint play motion (based on the traditional concave/convex rules of motion) is associated with thumb palmar abduction and should be examined?
A- Dorsal translation of the metacarpal on the trapezium.
B- Palmar translation of the metacarpal on the trapezium.
C- Ulnar translation of the metacarpal on the trapezium.
D- Radial translation of the metacarpal on the trapezium.
A- Dorsal translation of the metacarpal on the trapezium.
The carpometacarpal joint of the thumb is considered a saddle joint in which the articular surface geometry is generally concave in one plane and convex in a plane perpendicular to the other. The proximal joint surface of the first metacarpal is generally convex in the palmar to dorsal direction and concave in the medial to lateral direction. The articular surface of the base of the first metacarpal typically presents as the convex member of this joint when movement occurs in palmar abduction. Thumb palmar abduction thus involves a convex metacarpal surface moving on the concave surface of the trapezium. Following the traditional concave/convex rules of motion, one would expect a combination of palmar roll and dorsal translatory motion of the metacarpal on the trapezium during palmar abduction. In this case, a therapist would be sure to evaluate dorsal glide of the metacarpal on the trapezium.
Incorrect Choices:
The other examples of joint play motion are not congruent with palmar abduction of the thumb.
What is theBESTway to monitor the intensity of exercise for a patient limited mostly by claudication?
A- Assessing ankle-brachial index (ABI) during exercise.
B- Maintaining heart rate (HR) between 60% and 70% of age-predicted HRmax during exercise.
C- Sustaining pain levels of at least 2 out of 4 on the claudication scale during exercise.
D- Upholding rate of perceived exertion (RPE) levels of 11 to 13 out of 20 during exercise.
C- Sustaining pain levels of at least 2 out of 4 on the claudication scale during exercise.
It has been established that in order to generate collateral circulation in patients with ischemia (i.e., claudication), patients need to exercise with at least moderate claudication pain. This level of blood and oxygen deprivation over time initiates the generation of collateral circulation. This correlates to 2 out of 4 on the claudication scale.
Incorrect Choices:
The ABI is not practical to assess during exercise because the patient cannot be moving during this test. While the RPE and HRmax are at moderate levels, this may not be at an intensity that elicits claudication symptoms.
What interventionBESTillustrates selective stretching when working with a patient with a spinal cord injury (C6 complete)?
A- Long finger flexors are fully ranged into extension with wrist extension.
B- Hamstrings are fully ranged to 110 degrees in supine.
C- Low back extensors are fully ranged in longsitting.
D- Hamstrings are fully ranged in longsitting.
B- Hamstrings are fully ranged to 110 degrees in supine.
Hamstrings need to be fully ranged to 110 degrees in the supine position. This allows for function in the longsitting position (e.g., dressing, leg management during transfers).
Incorrect Choices: Ranging the hamstrings or low back extensors in long sitting will result in overstretched low back extensors (needed for stability in sitting). The long finger flexors are ranged into full extension with wrist flexion (not wrist extension). This allows the hand to be used functionally for tenodesis grasp.
Strengthening of the lateral pterygoid, anterior head of the digastric muscle, and suprahyoid muscles would be theMOST BENEFICIALintervention to improve which of the following?
A- Mouth closing
B- Mouth opening
C- Mouth protrusion
D- Mouth retrustion
B- Mouth opening
The muscles involved in opening include the lateral pterygoid, anterior head of the digastric muscle, and suprahyoid muscles.
Incorrect Choices: The muscles that assist with mouth closing are the masseter, temporalis, medial pterygoid, and lateral pterygoid. The muscles that assist with protrusion are the temporalis, medial pterygoid, and lateral pterygoid. The muscles that assist with retrusion are the temporalis and suprahyoid muscles.
A patient with suspected right cubital tunnel syndrome presents with sensory loss (light touch and sharp/dull) and radiating pain in the medial arm, medial forearm, medial hand, and little and ring fingers. The patient also has 4/5 muscle testing in all C8-T1 muscles in the right upper extremity with the exception of C8 muscles innervated by the right radial nerve. The patient has no neck pain and Spurling’s and cervical quadrant testing are negative. Past medical history includes breast cancer (treated with surgery/radiation and chemotherapy) that has been in remission for 2 years. Past social history includes a 35-year history of smoking. Which of the following health conditions is most consistent with the patient’s signs and symptoms?
A- Cubital tunnel syndrome
B- Ulanr/median neuropathy at the axilla
C- Medial cord brachial plexopathy
D- C8-T1 radiculopathy
C- Medial cord brachial plexopathy
The patient’s history and physical examination findings are most consistent with medial cord brachial plexopathy. This can occur secondary to a Pancoast tumor (tumor of the upper lobe of the lung). Smoking and a past history of cancer are risk factors for this type of tumor.
Incorrect Choices:
Isolated ulnar nerve involvement does not explain the patient’s weakness in other C8-T1 muscles that are not innervated by the ulnar nerves. It also does not explain the patient’s more proximal medial arm and forearm sensory loss. Medial and ulnar compression at the axilla are also not consistent with the patient’s symptoms, and specifically the involvement of the median nerve would result in weakness in forearm flexors and pronator teres (non C8-T1 muscles), as well as sensory loss of the right palmar hand, thumb, index, long and ring fingers. C8-T1 radiculopathy would explain the majority of the patient’s findings, but if these nerve roots were involved the patient would also have weakness of radial-C8 innervated muscles.
What is theBESTevidence to determine orthotic intervention to prevent inversion ankle sprains?
A- Systemic review and meta-analysis of cohort studies
B- Systemic review and meta-analysis of RCTs
C- Meta-analyses of multiple case studies
D- Randomized double-blind controlled trials
B- Systemic review and meta-analysis of RCTs
Systematic review including meta-analysis of randomized controlled trials (RCTs) provides the best research evidence of effectiveness of an intervention.
Incorrect Choices:
Meta-analysis is not applied to cohort studies or multiple case studies. While an RCT can provide strong evidence of the effectiveness of an intervention, evidence derived from a meta-analysis that combines multiple RCTs is stronger.
A patient with a 7-year history of Parkinson’s disease is hospitalized. The patient is ambulatory but requires close supervision to prevent falls. What should be the focus of the physical therapist’s plan of care?
A- Manual balance perturbation training.
B- Transfer and wheelchair training.
C- Caregiver training for contact guarding during level walking and stairs.
D- Locomotor training using a rolling walker.
C- Caregiver training for contact guarding during level walking and stairs.
Caregiver training with safety instruction in contact guarding during level walking and stairs is the best choice to keep this patient functional in the home environment.
Incorrect Choices: Manual balance perturbation training will likely result in a rigid response, decreasing use of normal synergistic movements. This patient should be kept safe and ambulatory for as long as possible and not be relegated to a wheelchair. A rolling walker is contraindicated for patients with a forward, flexed posture (typical in patients with Parkinson’s disease).
A patient is referred to physical therapy with a diagnosis of congestive heart failure. During the initial session, the physical therapist examines the skin for suspected changes. What appearance can be expected?
A- Pale, washed-out color.
B- Yellowish discoloration.
C- Slightly bluish, slate-colored discoloration.
D- Cherry-red discoloration.
C- Slightly bluish, slate-colored discoloration.
Slightly bluish, grayish, slate-colored discoloration of the skin along with clubbing of the nails is characteristic of chronic hypoxia.
Incorrect Choices:
Pallor (lack of skin color, paleness) is indicative of anemia, internal hemorrhage, or lack of sunlight exposure. Yellowish discoloration of the skin is indicative of jaundice (liver disease). Cherry-red discoloration of the skin is indicative of carbon monoxide poisoning.
A patient with a 10-year history of discoid lupus erythematosus presents with multiple discoid skin lesions that are raised and red and contain scaling plaques with central atrophy on the lower extremities. Topical corticosteroid creams are being used. What should be the focus of the therapist’s initial plan of care?
A- Range of motion (ROM) exercises and prevention of deformity.
B- Lightweight splints to provide joint protection.
C- Aerobic training using a treadmill.
D- Resistive training using weights at 60% to 80%, one repetition maximum.
A- Range of motion (ROM) exercises and prevention of deformity.
Range of motion (ROM) exercises and prevention of deformity are important elements of the plan of care.
Incorrect Choices: Lightweight splints are not an initial priority and can contribute to contracture development if worn too long. Furthermore, there are no reports of arthralgia in this case. Regular exercise is important but should not be aggressive (resistive training). Also, long-term use of corticosteroids puts this patient at risk for osteoporosis. Aerobic (treadmill) training might be indicated but is not an initial priority. Splints to provide joint protection are also not an initial priority.
A physical therapist is starting a neuromuscular screen on a patient with numbness, tingling, and weakness in the bilateral legs and feet for one year. How should the therapist interpret the findings shown in the video? (shows repeated muscle contractions of tib ant)
A- Muscle spasticity with potential upper motor neuron (central nervous system) involvement.
B- Fasciculations with potential lower motor neuron (peripheral nervous system) involvement.
C- Myotonia with potential myopathy.
D- Benign fibrillations with no concern of neuromuscular pathology.
B- Fasciculations with potential lower motor neuron (peripheral nervous system) involvement.
The patient is having pronounced fasciculations in multiple muscles in the anterior, lateral, and posterior compartment of the leg, consistent with peripheral nervous system involvement. These findings should be correlated with lower extremity reflex, strength, and sensory testing to determine the most likely cause of peripheral nervous system pathology (e.g., radiculopathy, polyneuropathy, mononeuropathy, motor neuron disease).
Incorrect Choices: Muscle spasticity would be velocity dependent and occur with movement (e.g., clonus, Hoffman’s sign, hyperreflexia) and less likely to be seen at rest. Myotonia is caused by dysfunction in the muscle membrane and is often associated with inherited myopathic disorders. Individuals with myotonia have difficultly relaxing the muscle (e.g., releasing their grip on objects). Fibrillations are not visible and can only be seen on needle EMG examination. Fibrillations are pathologic and consistent with peripheral nervous system damage to motor axons and/or the anterior horn cell.
A physical therapist is working with a patient who exhibits fluent aphasia. What is a typical characteristic of this form of aphasia?
A- Impaired auditory comprehension.
B- Slow, hesitant speech.
C- Good comprehension.
D- Impaired articulation.
A- Impaired auditory comprehension.
Fluent aphasia is characterized by impaired auditory comprehension and fluent speech that is of normal rate and melody (e.g., Wernicke’s aphasia).
Incorrect Choices:
Nonfluent aphasia is characterized by speech that is slow, hesitant, awkward, interrupted, and produced with effort (e.g., Broca’s aphasia). Patients tend to have good awareness of their deficit and comprehension. Impaired articulation characterizes the patient with dysarthria (a motor speech disorder).
A physical therapist evaluates a patient with low back pain and radiating pain and paresthesias into the right buttock, posterior thigh, lateral leg, and lateral foot. An S1 radiculopathy is suspected. Which special test isBESTfor rulingINa lumbosacral radiculopathy?
A- Straight leg raise.
B- Crossed straight leg raise.
C- Prone instability test.
D- Femoral N traction test.
B- Crossed straight leg raise.
This question requires knowledge of lumbar spine musculoskeletal special tests along with the application of their established sensitivity and specificity values. The crossed straight leg raise (SLR) is considered to be a highly specific test, which when positive helps to rule in the diagnosis of a herniated nucleus pulposus or lumbosacral radiculopathy. See Table 2-21 for a summary of the diagnostic accuracy of lumbar spine and pelvis special tests.
Incorrect Choices: The SLR (Lasegue’s) test is a highly sensitive test and is therefore helpful in ruling out a lumbosacral radiculopathy when negative. The SLR test is an integral part of a comprehensive physical examination of a patient with LBP, but given its poor specificity, it is not helpful for ruling in a lumbar radiculopathy. The prone instability test is clinically useful for assessing lumbar spine instability. The femoral nerve traction test is helpful for assessing neurological dysfunction involving the femoral nerve and/or lumbar nerve roots L2–L4.
Setting: Outpatient
Gender: Male
Age: 65
Presenting Problem/Current Condition: Right shoulder pain and weakness. Onset after a fall 4 days ago. X-rays taken soon after the injury were negative for fracture. No complaints of neck pain or neurologic symptoms. Full passive ROM of the right shoulder. Resisted shoulder external rotation is weak and painless
Past Medical History: Long history of chronic shoulder pain. Hypertension. Hyperlipidemia. Prostate cancer.
Other information: Retired carpenter, Enjoys playing tennis, Right hand dominant
Based on the history and physical examination findings, which diagnosis should the therapist suspect?
A- Adhesive capsulitis.
B- Shld instability.
C- Full-thickness infraspinatus tear.
D- Full-thickness subscapularis tear.
C- Full-thickness infraspinatus tear
The finding of weak and pain-free resisted motion during the examination is suggestive of a complete muscle or tendon tear. The fact that this finding occurs with resisted external rotation indicates that the infraspinatus, a shoulder external rotator, is involved. The subscapularis is a shoulder internal rotator.
Incorrect Choices: A key characteristic of adhesive capsulitis is that active and passive motions of the joint are both limited in the same directions. In this scenario, the patient had full passive shoulder external rotation, which is the motion that tends to be most significantly limited in patients with adhesive capsulitis. Other than the fall, none of the findings listed in the question stem are suggestive of shoulder instability.
Setting: Outpatient
Gender: Male
Age: 65
Presenting Problem/Current Condition: Right shoulder pain and weakness. Onset after a fall 4 days ago. X-rays taken soon after the injury were negative for fracture. No complaints of neck pain or neurologic symptoms. Full passive ROM of the right shoulder. Resisted shoulder external rotation is weak and painless
Past Medical History: Long history of chronic shoulder pain. Hypertension. Hyperlipidemia. Prostate cancer.
Other information: Retired carpenter, Enjoys playing tennis, Right hand dominant
A- Jobe test.
B- External rotation lag sign.
C- Full can test.
D- Hawkins-Kennedy test.
B- External rotation lag sign.
The external rotation lag sign is a good test to rule in full-thickness infraspinatus tears with an associated +LR of 7.2. This test is recommended with a moderate strength of evidence in the Rotator Cuff Disorders Clinical Practice Guidelines (see Box 2-2). The examination finding of weak and pain-free resisted external rotation is also suggestive of a complete tear.
Incorrect Choices: The Jobe and full can tests are useful for ruling in a diagnosis of a full-thickness supraspinatus tear. The Hawkins-Kennedy test is a screening test that can be used to rule out a partial rotator cuff tear or rotator cuff tendinopathy.
The left phrenic nerve of a patient was accidentally severed during thoracic surgery. Which muscles should the physical therapist strengthen in order to provide substitute function?
A- TA
B- Scalenes
C- IOs
D- EOs
B- Scalenes
The phrenic nerve arises from the neck (C3–5) and innervates the diaphragm. The diaphragm is responsible for 45% of the air that enters the lungs during quiet breathing. During quiet breathing, the predominant muscle of respiration is the diaphragm. As it contracts, pleural pressure drops, which lowers the alveolar pressure and draws in air down the pressure gradient from mouth to alveoli. Expiration during quiet breathing is predominantly a passive phenomenon; as the respiratory muscles relax, the elastic lung and chest wall return passively to their resting volume. With paralysis of the diaphragm, the accessory muscles of respiration should be strengthened. These include the scalenes and sternocleidomastoid.
Incorrect Choices: During active expiration, the most important muscles are those of the abdominal wall (including the rectus abdominis, internal and external obliques, and transversus abdominis), which drive intra-abdominal pressure up when they contract and thus push up the diaphragm, raising pleural pressure, which raises alveolar pressure, which in turn drives air out. These muscles do not substitute for diaphragmatic function.
A patient recovering from surgery to remove a cerebellar tumor presents with pronounced ataxia and problems with standing balance and postural stability. To help improve this situation, what would be theBESTapproach to incorporate in the intervention?
A- LE spinting and light touch-down hand support.
B- Rhythmic stabilization during holding in kneeling.
C- Perturbed balance activities while standing on carpet.
D- Stabilizing reversals during holding in side-lying.
B- Rhythmic stabilization during holding in kneeling.
Rhythmic stabilization is a proprioceptive neuromuscular facilitation (PNF) technique designed to improve stability. The high kneeling position is a good choice to begin with for the patient with pronounced ataxia. The posture is upright; while the center of mass (COM) is lowered, the degrees of freedom are reduced by kneeling (foot and ankle control not required), and the base of support (BOS) is increased over standing.
Incorrect Choices: Splinting and touch-down support are compensatory interventions not likely to improve recovery. Perturbed balance activities are contraindicated for the patient with poor postural stability and pronounced ataxia. Stabilizing reversals in side-lying are also not indicated, as the side-lying position does not require upright control.
Which special test of the knee region may assist in the classification of patellofemoral pain syndrome (PFPS)?
A- Patellar apprehension
B- Thessaly
C- Patellar tilt
D- Noble compression
C- Patellar tilt
The patellar tilt test is a nonprovocative test used to identify reduced patellar mobility (positive test), which prompts a moderate change in the likelihood of patellofemoral pain being present. Specifically, the test is used to determine the structural tightness of the lateral patellar retinaculum. The test also assists in classifying patients into the category of patellofemoral pain with mobility impairments. See Box 2-8 for the Patellofemoral Pain Clinical Practice Guidelines.
Incorrect Choices: The Thessaly test is a pain provocation test for meniscal injuries. The patellar apprehension test is utilized to determine if patellar instability is present. The Noble compression test is a provocative test for iliotibial band friction syndrome.
Six weeks following the conclusion of the football season, a therapist examines a player whose chief complaint is right thigh pain and decreased knee range of motion. Radiographic imaging of the area is shown in the picture. Intervention for this pt should be based on which dx?
A- Femoral stress fracture.
B- Neoplasm.
C- Quad hematoma.
D- Myositis ossificans.
D- Myositis ossificans.
Soft tissues that were injured in a traumatic event initially develop a hematoma and subsequently can develop into myositis ossificans. Myositis ossificans is a benign, ossifying soft-tissue lesion typically occurring within skeletal muscle, usually in adolescents and young adults. The most frequent symptoms and signs are pain and tenderness with a soft tissue mass. Approximately 80% of cases arise in the large muscles of the proximal extremities.
Incorrect Choices: A stress fracture is an overuse injury. Bone is constantly attempting to remodel and repair itself, especially when extraordinary stress is applied. When enough stress is placed on the bone, it causes an imbalance between osteoclastic and osteoblastic activity, and a stress fracture may appear. Insidious onset of pain and swelling over the affected region is the most important complaint, initially during the activity. Neoplasms, or cancer of bone, change the appearance of bone on an x-ray. Bone may look ragged or may appear to have a hole in it. Hematomas look very different from tumors or bones on an x-ray because they are mostly fluid, and tumors and bones are solid.
What are some common adverse effects that patients taking nitrates, diuretics, beta-blockers, or calcium antagonists might experience?
A- Hypotension and dizziness.
B- Arrhythmia and unstable blood pressure.
C- Extreme fatigue and arrhythmias.
D- Hypotension and decreased electrolytes.
A- Hypotension and dizziness.
All of these medications lower blood pressure. If the dosage is too great for patients, they will be hypotensive and likely feel dizzy.
Incorrect Choices:
Beta-blockers and calcium antagonists control arrhythmias. All medications stabilize blood pressure. If the dose of all these medications is too great, then the patient might experience extreme fatigue.
A physical therapist examines an elderly patient whose chief complaint is a sudden onset of muscle pain around the neck, shoulders, and hips. The patient also complains of fatigue, temporal headaches, and vision changes. The referring physician suspects polymyalgia rheumatica. Which laboratory test would help establish the diagnosis of this disease?
A- Myelin basic protein.
B- Serum uric acid.
C- Creatine kinase.
D- Erythrocyte sedimentation rate.
D- Erythrocyte sedimentation rate.
Polymyalgia rheumatica is a systemic inflammatory disorder that primarily affects proximal muscles in the shoulder and pelvic girdles, and muscular arteries such as the temporal artery. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests are general markers of inflammation and are markedly elevated in patients with the disorder. In addition to those described in the question stem, common clinical findings include weakness, malaise, low grade fever, sweats, weight loss, and depression.
Incorrect Choices: Myelin basic protein levels are determined following a lumbar puncture with aspiration of cerebrospinal fluid. Elevated myelin basic protein levels are suggestive of demyelinating diseases such as multiple sclerosis. Elevated serum acid levels are seen in patients with gout and may be seen in patients with other conditions such as diabetes, hypothyroidism, and obesity. Creatine kinase levels are used to help diagnose conditions associated with muscle damage such as rhabdomyolysis and myocardial infarction.
A physical therapist is examining a patient recently admitted to inpatient rehabilitation following a severe traumatic brain injury (TBI). Which of the following examination items provides the most complete assessment of consciousness, including formalized examination of brain stem reflexes?
A- Glasgow Coma Scale.
B- Rancho Los Amigos Levels of Cognitive Functioning.
C- Coma Recovery Scale-Revised.
D- Glasgow Outcome Scale-Extended.
C- Coma Recovery Scale-Revised.
The Coma Recovery Scale-Revised examines multiple domains (auditory, visual, motor, verbal, communication, and arousal) of consciousness and function to include brain stem reflexes (pupillary light reflex, corneal reflex, spontaneous eye movements, oculocephalic reflex, and postural responses). It is recommended for use in multiple settings (acute care, inpatient/outpatient rehabilitation, long-term acute care/skilled nursing) and patients with various health conditions (TBI, stroke, brain tumor) that result in altered levels of consciousness.
Incorrect Choices:
The Glasgow Coma Scale (GCS) is typically used to assess acute concussions/TBIs, but is limited to assessing eye, verbal, and motor responses (see Table 3-14). The Rancho Los Amigos Levels of Cognitive Functioning (LOCF) is recommended for various settings and is used to delineate eight levels of cognitive and behavioral function in patients recovering from with moderate to severe TBI (See Table 3-15). Although commonly used, the GCS and Rancho Los Amigos LOCF do not specifically include assessment of brain stem reflexes. The Glasgow Outcome Scale-Extended is a structured interview that does not include physical examination items. It is most often used in research studies to classify global functional outcome states (death, vegetative, moderate/severe disability) for patients who have experienced a TBI.
An older adult with a 3-year history of Parkinson ‘s disease is referred secondary to initial and mild difficulties with balance. The patient has had two near falls in the past 3 months with both occurring after he was accidently bumped in the community. Which of the following examination items is BEST to assess the patient ‘s current balance and fall risk?
A- BBS
B- Mini-BEST
C- FGA
D- TUG-Cog
B- Mini-BEST
The patient’s past falls are a result of delayed reactive postural control (the ability to recover balance after an external perturbation). The Mini-BEST has strong psychometric properties and measures various domains of balance to include reactive postural control (see Table 3-9). The Mini-Best is also recommended by the APTA Neurology Section Parkinson’s Disease EDGE Task Force (see Table 3-19).
Incorrect Choices:
The BBS, FGA, and TUG-Cog do not directly assess reactive postural control.
A patient with insulin-dependent diabetes is participating in an aerobic exercise class. The therapist recognizes that important dietary recommendations to prevent delayed-onset hypoglycemia after exercise include intake of which of the following?
A- Fruit juice or candy.
B- Crackers or bread.
C- Beef jerky and string cheese.
D- Carrot sticks and cherry tomatoes.
B- Crackers or bread.
Slowly absorbed carbohydrates (crackers, bread, or pasta) can help prevent delayed-onset hypoglycemia.
Incorrect Choices:
Rapidly absorbed carbohydrates (e.g., fruit juice, candy, honey) are given during exercise to help prevent hypoglycemia. Foods with saturated fats (beef jerky, string cheese) should be limited. Carrot sticks and cherry tomatoes do not have major effects in preventing hypoglycemia.
After gait training a patient with a transtibial prosthesis, a therapist notices redness along the patellar tendon and medial tibial flare. What would this finding indicate?
A- The socket is too small and the residual limb is not seated properly.
B- The socket is too large and pistoning is occurring.
C- There is improper weight distribution during stance.
D- Pressure-tolerant weight bearing is occurring.
D- Pressure-tolerant weight bearing is occurring.
Pressure areas of the typical transtibial residual limb include the patellar tendon, the medial tibial plateau, the tibial and fibular shafts, and the distal end.
Incorrect Choices:
These are expected areas of redness. All other choices would not result in that pattern of redness.
During the examination of a 2-year-old child with mild cerebral palsy, the therapist is encouraged because the normal developmental milestones for a child of this age have been achieved. This was demonstrated by the child’s ability to perform which activity?
A- Hop on one foot.
B- Stand on tippy-toes.
C- Go upstairs foot-over-foot
D- Jump with two feet
C- Go upstairs foot-over-foot
Going up stairs foot-over-foot (reciprocal stair climbing) is a developmental skill normally achieved by 2 years.
Incorrect Choices: The ability to hop on one foot and stand on tiptoes is normally achieved by 4 years. The ability to jump with two feet is normally achieved by 3 years.
A therapist sees a patient in the intensive care unit with multiple trauma and severe traumatic brain injury. A chest tube is in place and it exits from the right thorax. The patient is in need of airway clearance. What action should be taken in this case?
A- Percussion and shaking are contraindicated due to the traumatic brain injury.
B- Percussion and shaking can be done only in the right side-lying position.
C- Percussion and shaking can be done in the area surrounding the chest tube.
D- Percussion and shaking can be done only when the chest tube is removed.
C- Percussion and shaking can be done in the area surrounding the chest tube.
It is possible to complete manual techniques in the area of the chest tube. It is often the area in most need of airway clearance. It is important to consider pain management when doing this intervention.
Incorrect Choices: Percussion and shaking are not contraindicated, but it is important to consider that this may be agitating to patients with a severe brain injury. Also, placing the patient in Trendelenburg should be avoided in the acute period to eliminate increases in intracranial pressure. Percussion and shaking can be completed bilaterally and with the chest tube in place. It is important to attend to patient comfort and chest tube positioning when in right side-lying.
To promote upright posture and higher walking speeds in a child with spastic diplegia, which ambulatory aid isMOSTbeneficial?
A- A reciprocating gait orthosis.
B- An anterior rolling walker.
C- A posterior rolling walker.
D- Loftstrand (forearm) crutches.
C- A posterior rolling walker.
A posterior rolling walker is used to promote an upright posture (eliminates the forward lean seen in use of the standard anterior walker). The addition of wheels improves walking speed and reduces energy expenditure.
Incorrect Choices: All other choices do not achieve these same goals.
A patient is seen in an outpatient physical therapy clinic 3 days after a medial meniscus repair. What type of exercise should be avoided for the first 6–8 postoperative weeks to protect the repair?
A- Ankle pumps
B- quad isometrics
C- OKC resisted knee ext
D- OKC resisted knee flex
The attachments of the medial meniscus include the semimembranosus tendon, MCL and fibrous capsule, and medial meniscopatellar ligament. During open chain resisted knee flexion, the semimembranosus tendon will pull on the posterior aspect of the medial meniscus and in doing so may tear the surgical repair. Resisted knee flexion should be avoided for several weeks postoperatively until the repair site is stable.
Incorrect Choices: Ankle pumps do not produce any adverse forces on the healing meniscus and are beneficial development postsurgically and during periods of immobilization for prevention of DVT. Isometric quad sets produce little tibiofemoral joint motion. Resisted knee extension produces some anterior meniscal motion via the medial meniscopatellar ligament, but the amount of translation is minimal and not harmful to the repair.
Which high-intensity interval training program would be best for a patient with compensated New York Heart Association Class III heart failure?
A- Time: 5–10 minutes; Intensity: 40%–50% of peak VO2; Frequency: 2–3 times/week; Duration: 4–6 weeks.
B- Time: 5–10 minutes; Intensity: 90%–95% of peak VO2; Frequency: 5–7 times/week; Duration: 4–6 weeks.
C- Time: >35 minutes; Intensity: 90%–95% of peak VO2; Frequency: 2–3 times/week; Duration: 8–12 weeks.
D- Time: >35 minutes; Intensity: 40%–50% of peak VO2; Frequency: 5–7 times/week; Duration: 8–12 weeks.
C- Time: >35 minutes; Intensity: 90%–95% of peak VO2; Frequency: 2–3 times/week; Duration: 8–12 weeks.
Choice 3 incorporates all parameters suggested by the Clinical Practice Guideline for the Management of the Patient with Heart Failure (see Table 4-18).
Incorrect Choices: A training period of 5–10 minutes is too short and 40%–50% of peak VO2 is not a sufficient intensity. A frequency of 5–7 times/week is too often and increases risk for injury. A duration of 4–6 weeks is too short to improve aerobic fitness.
A human bite injury resulted in laceration of the extensor tendons over the metacarpophalangeal (MCP) joints. Following surgical repair, the patient was placed in a dorsal dynamic extension splint (as pictured). Therapy is initiated in the first 24 to 48 hours, with the therapist instructing the patient to move in which way?
A- Actively extend the wrist and passively flex the MCP joints.
B- Actively extend the wrist and MCP joints.
C- Passively extend the wrist and MCP joints.
D- Passively extend the wrist and actively flex the MCP joints.
D- Passively extend the wrist and actively flex the MCP joints.
Goals during the first few weeks include preventing tendon rupture and promoting tendon healing as well as edema and pain control. For scar management, perform active range of motion (AROM) flexion, isolated joint and tendon gliding (hook and straight fist). Perform passive extension via elastic recoil of the dynamic splint, 10 to 20 reps hourly. Begin active MP flexion to 30 to 40 degrees (via flexion block on dynamic splint). Progress MP flexion as tolerated. Perform wrist and digit passive range of motion (PROM) in extension and tenodesis out of splint 10 repetitions hourly. Avoid making a full fist as this may place too much stress on the repair. The wrist is splinted in 40 to 45 degrees extension with 0 to 20 degrees of MP flexion and 0 degrees of IP flexion.
Incorrect Choices: One would not want any active extension as this could disrupt the repair. There are many different protocols, but many avoid any active extension until 4 weeks postop. Passively extending the wrist and MCP joints would be safe but would not help with preventing contractures of the repaired extensor tendons.
A patient is referred to physical therapy secondary to pain in multiple joints in the upper and lower extremities. He also has itchy and dry skin lesions as observed in the image at the bilateral elbows and knees. Which of the following skin conditions is MOST consistent with the patient’s findings?
A- Eczema
B- Fungal infection
C- Scleroderma
D- Psoriasis
D- Psoriasis
The image depicts psoriasis, an autoimmune disease characterized by erythematous plaques covered silver scales. Psoriasis causes dry and itchy skin as is commonly seen at the ears, scalp, knees, elbows, and genitalia.
Incorrect Choices: Eczema, also known as dermatitis, results in itchy skin, but is not associated with silver plaques or joint pain. Fungal infections are characterized by a white coating (fungal spores) over the skin that causes erythema, itching, and pain. Scleroderma is a diffuse autoimmune disease that causes the skin and connective tissue throughout the body to be tight, firm, and inflamed. It is commonly seen in the fingers and toes and is also associated with Raynaud’s phenomenon.
As part of the chart review, the physical therapist views the patient’s most current chest film.Based on this film, what is theMOSTlikely examination finding?
A- Increased lateral costal expansion.
B- Increased subcostal angle.
C- Decreased inspiration:expiration (I:E) ratio.
D- Decreased mediate percussion.
B- Increased subcostal angle.
This film demonstrates a patient with hyperinflated lungs as evidenced by the flattened diaphragm, blunted costophrenic angle, and increased amount of air. This will cause the subcostal angle to increase significantly.
Incorrect Choices: Hyperinflated lungs are indicative of obstructive disease. The I:E ratio will increase in this case as the patient has difficulty getting air out. There is no evidence of secretions in this film, which would alter the resonance of mediate percussion, so it can be assumed that this finding would be normal. Lateral costal expansion would be decreased in this patient due to the hyperinflated lungs.
The image is MOST consistent with which of the following skin conditions?
A- Mole (cherry angioma).
B- Basal cell cancer.
C- Squamous cell cancer.
D- Melanoma.
A- Mole (cherry angioma).
The image depicts a mole (cherry angioma), and it is a benign collection of capillaries. They are common and occur in almost half of all adults over 30 years of age.
Incorrect Choices: Unlike a mole, skin cancer (basal cell, squamous cell, or melanoma) typical has a combination of Asymmetry, irregular Border, multiple Colors, increased Diameter (>6 mm), and/or is Evolving (A, B, C, D, Es of skin examination).
A patient with a primary complaint of neck pain and headaches is seen in an outpatient physical therapy clinic. The therapist performs the special test shown here. If the test result is positive, what should the therapist do next?
A- Initiate treatment utilizing intermittent cervical traction.
B- Discontinue the examination and place the patient in a cervical collar.
C- Continue the examination with graded mobilizations of the upper cervical spine.
D- Continue the examination by performing the craniocervical flexion test.
B- Discontinue the examination and place the patient in a cervical collar.
The procedure shown here is the modified Sharp-Purser test. It is a test for upper cervical spine instability and includes assessing the integrity of the transverse ligament. If the test is positive, the physical examination should be terminated, and no interventions should be attempted other than stabilizing the patient’s spine with a cervical collar. Causes of upper cervical spine instability include trauma, RA, Down syndrome, ankylosing spondylitis, long-term corticosteroid use and connective tissue disorders such as Ehlers-Danlos syndrome.
Incorrect Choices: Each of the other choices place the patient at risk for serious injury and possibly even death.
