NEURO

Question 1

A physical therapist is treating a patient who had a traumatic brain injury 3 weeks ago. The patient is confused and agitated. Physical therapy evaluation found decreased lower extremity coordination and strength. Which of the following would be the MOST appropriate intervention?

1. Participating in biofeedback training for lower extremity muscles with supervision
2. Walking in parallel bars with supervision
3. Participating in an aerobics group exercise class for 30 minutes
4. Performing lower extremity exercises while following a written handout

Answer 1

2. Walking in parallel bars permits the patient to use the bars if balance is lost (p. 448). The closed environment is appropriate secondary to the heightened state of activity of the patient (p. 868).

Question 2

A patient is referred to physical therapy with a history of ulnar nerve entrapment at the level of the hamate. Which of the following would be the MOST specific exercise to improve this patient’s strength deficits?

1. Practice pinching between thumb (1st digit) and the tip of the index finger (2nd digit).
2. Squeeze hand grip with elastic-band resistance.
3. Oppose thumb (1st digit) to the metacarpal phalangeal joint of each finger (2nd through 5th digits).
4. Squeeze therapy putty between the sides of the fingers.

Answer 2

4. This movement isolates the lumbricals and interossei, which are innervated by the ulnar nerve and are affected when entrapment occurs at the tunnel of Guyon (at the level of the hamate)

Question 3

A patient who has meralgia paresthetica has been referred to physical therapy. Which of the following clinical features is MOST likely to be assessed by the physical therapist during the examination?

1. Strength of the adductor longus
2. Strength of the quadriceps femoris
3. Sensation of the superior medial aspect of the thigh
4. Sensation of the lateral aspect of the thigh

Answer 3

4. Meralgia paresthetica is an entrapment or injury to the lateral femoral cutaneous nerve, a purely sensory nerve. Injury affects sensation to the lateral thigh. Sensory testing of this region is the most appropriate assessment.

Question 4

The condition shown for the patient’s left hand in the photograph is MOST likely caused by entrapment of which of the following nerves? (Fingers pinching together)

1. Anterior interosseous nerve
2. Radial nerve
3. Posterior interosseous nerve
4. Ulnar nerve

Answer 4

1. The image shows an anterior interosseous syndrome (Kiloh-Nevin syndrome) in the patient’s left hand. The patient is unable to flex the distal phalanx of the thumb and index fingers (1st and 2nd digits) because the anterior interosseous nerve, which supplies the flexor pollicis longus and the radial half of the flexor digitorum profundus, is entrapped. (p. 411)

Question 5

A patient reports upper extremity numbness and tingling that extends from the neck to the thumb and index finger (1st and 2nd digits). Which of the following shoulder positions would MOST likely exacerbate the patient’s symptoms?

1. Lateral (external) rotation with abduction
2. Medial (internal) rotation with abduction
3. Lateral (external) rotation with adduction
4. Medial (internal) rotation with adduction

Answer 5

1. Numbness and tingling over the thumb and index finger (1st and 2nd digits) involves the median nerve. Shoulder lateral (external) rotation with abduction is used to test the median nerve (upper limb tension test [ULTT 2a]). Shoulder lateral (external) rotation is added to 90° of shoulder abduction combined with shoulder girdle depression to place tension on the median nerve.

Question 6

The asymmetrical position in the photograph is MOST likely due to a lesion in which of the following nerves?

1. Long thoracic
2. Spinal accessory
3. Axillary
4. Dorsal scapular

Answer 6

1. The long thoracic nerve innervates the serratus anterior. Weakness of the serratus anterior results in winging of the scapula, which is the pathological position shown in the photograph. (Magee, p. 281; Drake, pp. 726-727, 744)

Question 7

Initial examination of a patient reveals paresthesia over the hypothenar eminence. The MOST probable cause of this condition is:

1. carpal tunnel syndrome.
2. C8 nerve root involvement.
3. de Quervain tenosynovitis.
4. pronator teres syndrome.

Answer 7

2. The C8 nerve root innervates the hypothenar eminence (Magee, p. 203). Injury to the C8 nerve root will cause paresthesia in the hypothenar eminence (Magee, p. 482).

Question 8

A physical therapist is obtaining the medical history of a patient with amyotrophic lateral sclerosis. Which of the following is MOST important to ask about in order to determine the prognosis for this patient?

1. Swallowing difficulties
2. Cognitive deficits
3. Bowel and bladder function
4. Neck pain

Answer 8

1. Patients with an initial onset of bulbar and respiratory weakness tend to have a more rapid progression to death than patients whose weakness begins in the distal extremities.

Question 9

A physical therapist is examining a 4-year-old child with a history of prematurity and developmental delay. To determine if the child has age-appropriate gross motor skills, the therapist’s assessment should include:

1. kicking a rolling ball, catching a small ball, and hopping on one foot.
2. kicking a stationary ball, fast walking, and walking with assistance on stairs.
3. dribbling a basketball, riding a bicycle, and skipping.
4. catching a large ball, riding a tricycle, and running short distances.

Answer 9

1. Kicking a rolling ball, catching a small ball, and hopping on one foot are gross motor tasks that are most age-appropriate for a 4-year-old. Gross motor developmental assessment at age 4 years should include functional tasks. (Palisano, p. 62; Tecklin, p. 64)

Question 10

Which of the following types of practice is MOST appropriate for long-term motor learning for a patient with a cerebrovascular accident?

1. Varied task practice with variable time intervals
2. Task practice of one activity for 15 minutes with 10-minute rest
3. Practice of a variety of related skills in blocks of 5 minutes
4. Partial task practice with patient-preferred time intervals

Answer 10

1. Random practice provides a higher level of contextual interference that requires the individual to retrieve practice from memory stores. Research has shown superior long-term effects for random practice due to the higher cognitive processes required. (Umphred, p. 82; O’Sullivan p. 413)

Question 11

A physical therapist is treating a person who had a cerebrovascular accident and is unable to support full weight on the affected lower extremity. The patient’s primary goal is to return to walking independently. Which of the following is the MOST effective intervention?

1. Upright supported standing in a frame, progressing to independent standing
2. Mobility training emphasizing independence in a wheelchair
3. Treadmill training with a harness and partial body-weight support
4. Walking with an ankle-foot orthosis and standard cane

Answer 11

3. Early upright walking appears to be effective in fostering return of walking in persons following a cerebrovascular accident. Partial body-weight support allows for early upright walking without risk to the patient or therapist. (pp. 696-697)

Question 12

Examination of a patient with balance dysfunction reveals the following:

Romberg test: positive
Gait: wide-based, slow, with decreased trunk rotation
Loss of balance when asked to turn head while walking
No sign of ataxia
Based on these findings, which of the following diagnoses is MOST likely correct?

1. Benign paroxysmal positional vertigo
2. Cerebellar lesion
3. Unilateral vestibular lesion
4. Mononeuropathy of the sural nerve

Answer 12

3. Patients with a unilateral vestibular lesion will experience vertigo, postural instability, oscillopsia, and disequilibrium. The wide-based gait is an attempt to minimize trunk rotation and movement of the head, which can increase sensory conflict and vertigo in the patient with a unilateral vestibular lesion.

Question 13

An 80-year-old patient who has left hemiparesis relies heavily on the right extremities for support. The patient has shoulder pain when the left upper extremity is elevated above 60°. Which of the following positions is BEST to facilitate simultaneous upper and lower extremity weight-bearing for the patient?

1. Modified plantigrade
2. Standing with both hands on a wall
3. Bridging
4. Quadruped

Answer 13

1. Modified plantigrade is an ideal early standing posture in which to develop upper extremity and lower extremity control. Affected extremities are weight-bearing out of synergy patterns. This position is easily tolerated by elderly patients.

Question 14

A patient who has a C5 spinal cord injury (ASIA Impairment Scale A) suddenly reports light-headedness and ringing in the ears while sitting upright in a wheelchair. Which of the following conditions is MOST likely present?

1. Angina pectoris
2. Deep vein thrombosis
3. Orthostatic hypotension
4. Autonomic dysreflexia

Answer 14

3. Orthostatic hypotension is a common complication in patients who have an acute cervical injury. It manifests with dizziness or light-headedness and ringing in the ears when in a vertical position, such as sitting or standing. (pp. 72, 896)

Question 15

On initial evaluation of a patient, a physical therapist finds a weakness in plantar flexion, forefoot inversion, and toe flexion. The therapist should suspect involvement of which of the following peripheral nerves?

1. Medial plantar
2. Tibial
3. Common peroneal
4. Femoral

Answer 15

2. The tibial nerve innervates the muscles that flex the toes and plantar flex and invert the foot (p. 593).

Question 16

A patient with a mild hemiparesis is able to stand and walk independently with a quad cane, but reports difficulty transferring from sitting to standing. A physical therapist is MOST likely to find the cause of the difficulty by testing the patient’s:

1. lower extremity strength.
2. static standing balance.
3. joint position sense.
4. dynamic standing balance.

Answer 16

1. Muscle weakness affects the performance of functional movement. Weakness in the extremities interferes with functional use either in weight-bearing (in this case, sitting to standing) or during movement in space. (pp. 725, 731)

Question 17

A 4-year-old child has maxillary hypoplasia, an elongated mid face, and a short, upturned nose. The child has a short attention span and poor growth. Which of the following interventions would be MOST appropriate for the child?

1. Gait training with a rolling walker
2. Sensory desensitization activities
3. Activities to inhibit spasticity
4. Dynamic balance activities

Answer 17

4. The stem describes characteristics of a child with fetal alcohol syndrome. Fine motor dysfunction, visuomotor deficits, balance problems, and weak grasp are characteristics of children with fetal alcohol syndrome. Balance activities would benefit the child. (Palisano, p. 426)

Question 18

Which of the following cranial nerves is tested by resisting the patient’s ability to keep the eyes tightly shut?

1. Oculomotor (CN III)
2. Trochlear (CN IV)
3. Trigeminal (CN V)
4. Facial (CN VII)

Answer 18

4. Closing the eye tightly is controlled by the facial nerve (CN VII). Therefore, applying resistance to eye closure tests the function of this nerve. (pp. 338-339)

Question 19

A patient who has global aphasia is being discharged to home. Which of the following strategies is MOST appropriate for educating the caregivers about the patient’s care?

1. Have the caregivers practice appropriate care techniques with the physical therapist role-playing the patient.
2. Give the patient written instructions regarding care and ask the patient to discuss the instructions with caregivers.
3. Have the patient and caregivers view an educational video about the patient’s condition.
4. Provide organized treatment sessions during which the caregivers practice caring for the patient.

Answer 19

4. Practice is important for the caregiver. In general, the more the practice, the greater the learning. As learning progresses, the environment should be varied and should incorporate more variable features consistent with real-world, open environments. Allowing the caregiver to practice caring for the patient allows the caregiver to learn to manage the nuances of real life.

Question 20

A physical therapist is evaluating a patient who reports difficulty descending stairs and trouble reading when a book is held in the lap. The patient denies blindness in either eye. When a light is shone into the eyes, each pupil constricts as expected. When the patient looks straight ahead, each eyeball is centered. Which cranial nerve is MOST likely involved?

1. Optic (CN II)
2. Oculomotor (CN III)
3. Trochlear (CN IV)
4. Abducent (CN VI)

Answer 20

3. Trochlear nerve (CN IV) involvement results in a deficit in looking inferomedially, which would contribute to impairment in reading and descending stairs as reported by the patient (p. 116).

Question 21

A patient sustained a cervical hyperextension injury that caused bleeding into the central gray matter of the lower cervical spinal cord. Which of the following descriptions BEST reflects the highest level of function the patient is likely to achieve?

1. Inability to transfer without assistance and use of a motorized wheelchair required for mobility
2. Ability to propel a standard wheelchair independently with upper extremities but inability to walk
3. Independence in bed mobility and self-care activities but use of a sliding board required for transfers
4. Ability to walk but difficulty with distal upper extremity and hand function

Answer 21

4. This is a description of central cord syndrome. Because the spinal tracts for the lower extremities are positioned more laterally in the spinal cord, upper extremities are more affected than lower extremities. Patients with central cord syndrome typically recover the ability to ambulate with some remaining distal arm weakness. Seventy-seven percent of patients with central cord syndrome will attain ambulatory function, and 42% will attain hand function.

Question 22

After a 30-day backpacking trip, a patient has pain over the lateral aspect of the shoulder. Upon examination of the patient, the physical therapist notes weakness of elbow flexion and shoulder abduction on the same side as the pain. A lesion at which of the following sites is MOST likely the source of these symptoms?

1. Axillary nerve
2. Upper trunk of the brachial plexus
3. Long thoracic nerve
4. Musculocutaneous nerve

Answer 22

2. The symptoms are consistent with damage to the C5 and C6 nerve roots.

Question 23

Which of the following procedures should be used to assess a patient’s equilibrium?

1. Marching in place
2. Rebound test
3. Heel on shin
4. Finger to therapist’s finger

Answer 23

1. Equilibrium is a dynamic reaction essential for upright posture and smooth transitional movements. Equilibrium is assessed by testing the body’s ability to respond to a change in body position or surface support to maintain body alignment. Of the options, only marching in place requires a displacement of the center of gravity and a places a demand on the body to maintain upright posture. (Umphred, p. 393)

Question 24

An 18-month-old child with developmental delay collapses into a rounded “C”-shaped posture of forward flexion when placed in a sitting position. Which of the following techniques is most appropriate INITIALLY to improve the child’s posture?

1. Seat the child in a chair with an abduction wedge.
2. Apply approximation through the spinal joints.
3. Present toys from above so that the child must look up.
4. Provide postural correction at the pelvis.

Answer 24

4. This technique will address the posterior pelvic tilt associated with “C”-shaped posture.