NPTE Practice Test #1 Flashcards
A patient is referred to a woman’s health clinic with moderate to severe uterine prolapse. What symptoms should the therapist examine for?
Low back pain and perineal discomfort aggravated by prolonged standing.
Low back pain and perineal discomfort aggravated by prolonged standing are common with uterine prolapse.
Incorrect Choices:
Perineal sensation is not decreased; patients typically experience a sensation of heaviness or pulling in the pelvis. Pain is often relieved by lying down (not aggravated). Constipation and painful bowel movement are common.
Type of Reasoning: INFERENTIAL
This question requires one to determine what is most likely to be true based on knowledge of uterine prolapse. Questions of this nature often require inferential reasoning skill. In this case, one should infer that back and perineal pain aggravated by prolonged standing are often associated with uterine prolapse. If answered incorrectly, review signs and symptoms of uterine prolapse.
Absent perineal sensation.
Bowel leakage.
Low back pain and perineal discomfort aggravated by lying down.
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?
Increase in blood pressure and heart rate during exercise.
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.
Incorrect Choices:
This patient’s BP will increase, but the patient’s HR will not decrease with exercise. The HR and BP will increase, not decrease with exercise on a beta-blocker or when it is quickly removed. The BP will increase, not decrease with activity due to the abrupt stopping of the medication.
Type of Reasoning: INFERENTIAL
This question requires one to determine the likely effects of exercise and not taking beta-blocker medication. Questions of this nature, where one must infer what is most likely to be true of a situation, require inferential reasoning skill. For this scenario, one should infer that the patient would have an increase in blood pressure and heart rate with exercise. If answered incorrectly, review information on effects of beta-blockers and exercise.
Increase in blood pressure and decrease in heart rate during exercise.
Decrease in blood pressure and heart rate during exercise.
Decrease in blood pressure and increase in heart rate during exercise.
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?
Lisfranc injury.
The 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.
Incorrect Choices:
Turf toe is a sprain of the MTP joint of the first toe due to hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground. Calcaneocuboid joint subluxation (also known as cuboid syndrome) is defined as a minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint. The disruption of the cuboid’s position irritates the surrounding joint capsule, ligaments, and fibularis longus tendon. Hallux rigidus (stiff big toe) is a degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux. Symptoms include pain and stiffness in the joint at the base of the big toe during use (walking, standing, bending, etc.).
Type of Reasoning: ANALYTICAL
This question requires one to determine a type of injury sustained based on a description of mechanism of injury and symptoms. Questions that necessitate analyzing information to determine a reasonable conclusion often utilize analytical reasoning skill. For this situation, the symptoms are consistent with Lisfranc injury. Review signs and symptoms of Lisfranc injury if answered incorrectly.
Turf toe.
Calcaneocuboid joint subluxation.
Hallux rigidus.
A patient is referred to physical therapy with a 10-year history of rheumatoid arthritis (RA). What are possible extra-articular complications?
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.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must infer or determine what is most likely to be true for a patient with rheumatoid arthritis. This requires inferential reasoning skill. In this case, possible extra-articular complications include vasculitis. Review information on rheumatoid arthritis if answered incorrectly.
Disc degeneration.
Psoriatic skin and nail changes.
Conjunctivitis and iritis.
During an examination, the limitations of ultrasound imaging include which of the following?
Difficulty penetrating bone and therefore visualizing internal structure of bones.
Ultrasound has difficulty penetrating bone. Ultrasound images are typically used to help diagnose tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle; abnormalities of the muscles, such as tears; bleeding or other fluid collections within the muscles, bursae, and joints; benign and malignant soft tissue tumors; early changes of rheumatoid arthritis; fluid in a painful hip joint in children; lumps in the neck muscles of infants; and soft tissue masses (lumps/bumps) in children.
Incorrect Choices:
The other choices are not limitations of diagnostic ultrasound.
Type of Reasoning: DEDUCTIVE
One must recall the limitations of ultrasound in order to arrive at a correct conclusion. This necessitates factual recall of guidelines, which is a deductive reasoning skill. For this scenario, difficulty penetrating bone and visualizing internal structure of bones is a limitation of ultrasound. Review ultrasound guidelines and limitations if answered incorrectly.
Inability to clearly see cartilage in infants.
Disruption of cardiac pacemakers.
Inability to give a clear picture of tendons and therefore diagnose tendon tears.
What will a patient with a significant right thoracic structural scoliosis demonstrate on examination?
Increased lateral costal expansion on the right.
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.
Type of Reasoning: DEDUCTIVE
This question requires the test-taker to recall the structural changes that occur with thoracic scoliosis. This necessitates the recall of facts, which is a deductive reasoning skill. For this case, the therapist should anticipate that the patient will demonstrate an increased lateral costal expansion on the right. Review scoliosis information, especially thoracic scoliosis and structural changes, if answered incorrectly.
Decreased breath sounds on the right.
Decreased thoracic rib elevation on the right.
Shortened internal and external intercostals on the right.
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?
Anterior glide.
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.
Type of Reasoning: INDUCTIVE
One must utilize knowledge of joint mobilization techniques and benefits of specific mobilization approaches in order to arrive at a correct conclusion. This necessitates clinical judgment, which is an inductive reasoning skill. For this situation, the therapist should focus on anterior glides to improve ER and late flexion. Review joint mobilization techniques if answered incorrectly.
Superior glide.
Inferior glide.
Grade II oscillations.
Which activity would help break up obligatory lower extremity synergy patterns in a patient with hemiplegia?
High kneeling position, ball throwing.
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.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must recall out-of-synergy positions and then use that knowledge to determine which described position would be most beneficial for breaking up lower limb synergy. This requires inferential reasoning skill. In this case, having the patient in a high kneeling position with ball throwing will accomplish this. Review out-of-synergy positions if answered incorrectly.
Standing, alternate marching in place with hip and knee flexion and hip abduction.
Sitting, alternate toe tapping.
Sitting, foot slides under the seat.
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?
Test for sharp sensation.
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.
Type of Reasoning: INDUCTIVE
For this question, one must utilize knowledge of sensory testing and sensory pathways in order to determine the test that is best to perform next. This reasoning process requires inductive reasoning skill, where clinical judgment is paramount to arriving at a correct conclusion. For this case, the therapist should test for pain to assist in localized/involvement of the lesion. Review the sensory pathways if answered incorrectly.
Test for two-point discrimination.
Test for vibration.
Test for joint proprioception (thumb up/thumb down).
Following a motor vehicle accident, a patient with chest trauma developed atelectasis. Which intervention is ineffective in the immediate management of atelectasis?
Paced breathing.
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.
Type of Reasoning: INDUCTIVE
This question requires clinical judgment and knowledge of atelectasis in order to determine a best course of action. This necessitates inductive reasoning skill where clinical judgment is used to reach a sound conclusion. In this case, the least effective treatment would be paced breathing. Review atelectasis and treatment approaches if answered incorrectly.
Pain reduction techniques.
Segmental breathing.
Incentive spirometry.
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?
Active extension and passive flexion of the interphalangeal joints.
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.
Type of Reasoning: INDUCTIVE
One must utilize clinical judgment coupled with knowledge of flexor tendon repairs in order to arrive at a correct conclusion. This requires inductive reasoning skill. For this scenario, the therapist should teach the patient to perform active extension and passive flexion of the interphalangeal joints. If answered incorrectly, review treatment approaches for flexor tendon repairs.
Passive extension and active flexion of the interphalangeal joints.
Active extension and flexion of the interphalangeal joints.
Gentle passive extension and flexion of the interphalangeal joints.
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
Which intervention is appropriate for this patient and is associated with the highest level of evidence?
Joint mobilization.
There is moderate strength of evidence (Grade B) to recommend the use of thrust or nonthrust joint mobilization to reduce pain and disability in patients with chronic LBP and radiating leg pain. See Box 2-18 for a synopsis of the LBP Clinical Practice Guideline.
Incorrect Choices: There is Grade C evidence to support the use of dry needling in conjunction with other treatments to reduce pain and disability in patients with chronic LBP, but no recommendation for use of the modality in patients with radiating leg pain. Furthermore, dry needling is not currently being tested on the NPTE. The CPG states that PTs should not use mechanical traction for patients with chronic LBP with leg pain, due to the lack of benefit when added to other interventions. There is no evidence or recommendation in the CPG for the use of ultrasound in those with chronic LBP with leg pain.
Type of Reasoning: Deductive
Dry needling.
Mechanical traction.
Therapeutic ultrasound.
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?
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.
Type of Reasoning: DEDUCTIVE
For this question, one must recall the guidelines for application of iontophoresis and treatment using the acetate ion. This necessitates factual recall of information, which is a deductive reasoning skill. In this case, the therapist should use direct current using the negative pole. Review iontophoresis guidelines if answered incorrectly.
Monophasic twin-peaked pulses using the positive pole.
Monophasic twin-peaked pulses using the negative pole.
Direct current using the positive pole.
A patient in the late stages of Parkinson’s disease exhibits episodes of akinesia while walking. What should the therapist examine?
Triggers that precipitate the freezing episodes.
Freezing of gait (episodes of akinesia) is typically associated with a trigger (e.g., turning, changing direction or speed, doorways). Identification of triggers is helpful in developing the plan of care.
Incorrect Choices:
Freezing is most often evident during gait and typically involves the entire body, not individual segments of the body. Associated dyskinesias may be present but do not typically influence freezing episodes.
Type of Reasoning: INDUCTIVE
For this question, one must utilize clinical judgment and knowledge of Parkinson’s disease in order to arrive at a correct conclusion. This requires inductive reasoning skill. For this situation, the therapist should examine triggers that precipitate the freezing episodes. Review Parkinson’s disease, especially examination of akinesia, if answered incorrectly.
Primary involvement of the head and trunk.
Associated dyskinesias.
Primary involvement of the hips and knees.
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?
Complex regional pain syndrome (Type I).
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.
Type of Reasoning: ANALYTICAL
For this question, the test-taker must analyze the presenting symptoms of the patient and determine the likely diagnosis. This requires analytical reasoning skill where pieces of information are analyzed to draw reasonable conclusions. For this situation, the symptoms are consistent with CRPS (Type I). If answered incorrectly, review information on CRPS, especially Type I symptoms.
Infection in the ankle joint.
Complex regional pain syndrome (Type II).
Post-traumatic arthritis.
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?
Large joints of the body, especially the 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.
Type of Reasoning: DEDUCTIVE
This question requires the test-taker to recall the stages of Lyme disease and presenting symptoms in order to arrive at a correct conclusion. This necessitates the recall of facts and guidelines, which is a deductive reasoning skill. For this situation, the patient is likely to show arthritic changes of the large joints of the body, especially the knee. Review Lyme disease stages and symptoms if answered incorrectly.
Small joints of the hands and feet.
Axial joints, especially the lumbrosacral spine.
Axial joints, especially the cervical and thoracic spine.
A patient with type 1 diabetes mellitus has generalized osteoporosis. What is theBESTexercise to include in this patient’s plan of care?
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.
Bilateral quadriceps presses against resistance in sitting.
Aquatic exercises.
Running on a treadmill.
Patients may sustain injuries that cause external or internal bleeding. Which finding is MOST LIKELY to be present in patients with internal bleeding?
Referred pain.
Referred pain is present when visceral structures are impacted by injury, tumors, or abnormal pressure.Patients who suffer blunt trauma may sustain bleeding that creates abnormal pressure on visceral structures that refer to a predictable body region (e.g., liver referred to the right shoulder). Patients with a history of blunt trauma, who present with referred pain, should be emergently referred to a physician for assessment.
Incorrect Choices:
Restlessness and anxiety, decreased levels of consciousness, and skin changes (cool, moist, pale/gray) are symptoms related to shock. Patients may experience any of these symptoms due to hypovolemia or psychogenic reasons. Patients with both external or internal bleeding may experience symptoms of shock. Symptoms of shock are very concerning, and in response, health care providers should place patients in supine, elevate the legs if appropriate, and activate EMS if symptoms are not quickly resolved.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must infer what is likely to be true of a situation, based on clinical symptoms. Questions of this nature often require inferential reasoning skill. For this situation, referred pain is most likely to be present with internal bleeding. If answered incorrectly, review information on internal bleeding and common findings.
Decreased level of consciousness.
Cool, moist skin with a pale or gray appearance.
Restlessness or anxiety.
A new child is moving into a school district and entering 2nd grade. A physical therapy request has been made. In reviewing the chart from the previous school, the therapist notes that the child has cerebral palsy. Using the Gross Motor Classification System (GMFCS) for Cerebral Palsy, the child is reported at a Level V. The reason for the referral is MOST LIKELY for which of the following goals?
Maintain range of motion and skin integrity with use of positioning devices.
A Level V indicates that the child is severely limited even with the use of assistive technology. So the referral is most likely to prevent further impairments and maintain educational goals.
Incorrect Choices:
Jumping, climbing describe a Level I; stair training describes a Level III; manual wheelchair use describes a level III or IV.
Type of Reasoning: INFERENTIAL
One must infer or determine what is most likely to be true of a situation in order to reach a reasonable conclusion. This requires inferential reasoning skill, where the test-taker is tasked with determining the most likely reasoning for the child’s referral to PT. In this case, the referral was MOST LIKELY for maintaining range of motion and skin integrity with use of positioning devices. If answered incorrectly, review the Gross Motor Function Classification System.
Independent in advanced gross motor skills such as jumping, climbing, and riding a bike.
Independent and safe in gait and stair climbing using an assistive device.
Independent in use of manual wheelchair for primary mobility.
A patient is recovering from a mild stroke with trunk weakness and postural instability. The patient complains of severe heartburn. What is theBESTchoice to maximize stroke recovery and improve trunk stabilization while minimizing heartburn?
Perform resisted holding in sitting using rhythmic stabilization.
Heartburn is a common symptom of gastroesophageal reflux disease (GERD) and can be aggravated by positioning in supine, prone, or bridging. Modifying the patient’s position to upright can alleviate the symptoms and demonstrate to the patient the therapist’s concern.
Incorrect Choices:
Semi-Fowler position (supine, head and torso elevated 30 degrees) is not an effective position to work on trunk stabilization. Bridging will aggravate heartburn. Prophylactic use of antacids before therapy is not indicated. With severe heartburn, the patient will likely be on a proton pump inhibitor (PPI) such as Prilosec, Nexium, or Prevacid.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must utilize clinical judgment in order to arrive at a correct conclusion. This necessitates inductive reasoning skill. In this situation, the best choice for a patient with severe heartburn is to perform resisted holding in sitting using rhythmic stabilization. Review information regarding GERD and exercise approaches if answered incorrectly.
Perform trunk stabilization exercises with the patient in the semi-Fowler position.
Begin with bridging exercises progressing to sitting holding.
Instruct the patient to take antacids right before physical therapy.
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?
Discontinuation of NSAIDs prior to the 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.
Type of Reasoning: Deductive
No change in NSAID use before or after the PRP injection.
Decrease in NSAID dosage after the PRP injection.
Increase in NSAID dosage after 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?
Anterior glide of the radial head on the 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.
Type of Reasoning: INDUCTIVE
This question requires the test-taker to recall joint mobilization information and then apply them to a patient who sustained an elbow dislocation with resultant decreased elbow flexion. This requires inductive reasoning skill, where clinical knowledge is applied to therapeutic situations. For this situation, the therapist should select an anterior glide of the radial head on the humerus. If answered incorrectly, review joint mobilization guidelines, especially for the elbow.
Posterior glide of the radial head on the humerus.
Lateral glide of the radial head on the humerus.
Medial glide of the radial head on the humerus.
Which of the following is theMOSTvalid prognostic indicator of early wound healing of a diabetic foot ulceration?
A reduction of the wound surface area in the 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.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must infer what is most likely to be true for the healing of a diabetic foot ulceration. Specifically, the test-taker must review the information presented and determine which is the most reliable prognostic indicator for future healing. This necessitates inferential reasoning skill. For this scenario, a reduction of the wound surface area in the first month is the most reliable indicator for future healing. Review wound healing guidelines, especially diabetic foot ulcers, if answered incorrectly.
Increase in the granulation formation within the first month.
A reduction in the exudate production in the first few weeks.
Epithelialization is present within the first month of care being initiated.
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?
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.
Type of Reasoning: INFERENTIAL
For this question, one must weigh the patient’s symptoms and then infer which disease is most likely to be present. This requires inferential reasoning skill, where the test-taker predicts what is true of a situation. In this case, the symptoms are most likely to be due to IBD. If answered incorrectly, review IBD symptoms.
Colorectal cancer.
Diverticulitis.
Pancreatitis.
A research team compares the effects of exercise mode (concentric and eccentric strengthening) on patients with chronic Achilles’ tendinopathy. Measurements of disability and performance are collected at baseline, after 12 weeks of treatment, and at 1 year post-treatment. Which is the best statistical test to use to determine which exercise mode is best at decreasing disability over time?
Two-way ANOVA with repeated measures on one factor.
The study has two independent variables (exercise mode and time). Exercise mode is a between-subjects (nonrepeated) factor with two levels (concentric and eccentric). Time is a within-subjects (repeated) factor with three levels (baseline, 12 weeks, and 1 year). The two-way ANOVA with repeated measures on one factor (also called a two-way mixed model ANOVA) is used to compare each factor independently (main effects) as well as the effect of one factor on the other (interaction effect).
Incorrect Choices:
The one-way ANOVA is used to compare a single independent variable (between subjects factor) with at least three levels. A repeated measures ANOVA is used to compare a single independent variable (within-subjects factor) with at least three levels. A two-way ANOVA with repeated measures on both factors is used to compare two independent variables that are both within-subjects factors (all participants are exposed to all levels of each independent variable). Each independent variable would have to have at least two levels in this case.
Type of Reasoning: DEDUCTIVE
For this question, the test-taker must recall research guidelines in order to arrive at a correct conclusion. This necessitates deductive reasoning skill, where factual recall of information guides conclusions. For this case, the best statistical test is the two-way ANOVA with repeated measures on one factor. If answered incorrectly, review statistical tests information.
One-way analysis of variance (ANOVA).
Repeated measures ANOVA.
Two-way ANOVA with repeated measures on both factors.
A patient experienced a cerebrovascular accident (right CVA) 2 weeks ago. The patient has motor and sensory impairments primarily in the left lower extremity; the left upper extremity shows only mild impairment. The patient exhibits some confusion and perseveration. Based on these findings, what type of stroke syndrome does this patient present with?
Anterior cerebral artery syndrome.
These signs and symptoms are characteristic of anterior cerebral artery (ACA) syndrome, with contralateral hemiplegia and lower extremities more affected than upper extremities.
Incorrect Choices:
Posterior cerebral artery (PCA) syndrome typically presents with visual impairments, pain, and involuntary movements. Contralateral hemiplegia may also be present, but lacks specific findings with regards to greater impact on the upper or lower extremities. Middle cerebral artery (MCA) syndrome results in contralateral hemiplegia with greater involvement of the upper extremities than lower. Internal carotid lesions typically involve a massive infarction in the areas of the brain supplied by the MCA and ACA, producing significant edema with possible uncal herniation, coma, and death.
Type of Reasoning: ANALYTICAL
For this question, the test-taker must analyze the symptoms presented and determine the specific type of stroke syndrome. Questions that require one to determine a diagnosis based on symptoms often necessitate analytical reasoning skill. In this case, the symptoms are consistent with anterior cerebral artery syndrome. Review types of stroke if answered incorrectly.
Posterior cerebral artery stroke.
Internal carotid syndrome.
Middle cerebral artery syndrome.
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?
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.
Type of Reasoning: ANALYTICAL
This question provides pulmonary findings and the test-taker must determine the expected finding on examination. One must weigh the information presented to draw a reasonable conclusion, necessitates analytical reasoning skill. For this case, the MIP and MEP findings indicate ineffective cough for secretion clearance. If answered incorrectly review pulmonary guidelines, especially MIP and MEP if answered incorrectly.
Asymmetrical decreased costal expansion.
Increased inspiration: expiration (I:E) ratio.
Increased subcostal angle.
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.
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.
Type of Reasoning: INDUCTIVE
This question requires the test-taker to utilize clinical judgment in order to determine a best course of action. This requires inductive reasoning skill. In this case, a platelet count of 20,000 would curtail selection of the specific intervention approach. Review indications and contraindications for airway clearance techniques if answered incorrectly.
Dyspnea when in the Trendelenburg position.
SaO2 range of 88% to 94% on room air.
Diagnosis of multilobe pneumonia.
A patient with degenerative joint disease of the right hip complains of pain in the anterior hip and groin, which is aggravated by weight bearing. There is decreased range of motion and capsular restrictions. Right gluteus medius weakness is evident during ambulation, and there is decreased tolerance of functional activities including transfers and lower extremity dressing. In this case, a capsular pattern of joint motion should be evident by which of the following?
Hip flexion, abduction, and internal rotation.
The capsular pattern of the hip is limitation of flexion/internal rotation with some limitation of abduction. Additionally, according to the Hip Pain/Hip Osteoarthritis Clinical Practice Guideline (see Box 2-1), hip IR or flexion that is 15° less than the nonpainful side is strongly associated with hip OA.
Incorrect Choices:
The other patterns are not representative capsular patterns of the hip.
Type of Reasoning: INFERENTIAL
One must recall the capsular patterns of the hip in order to determine what is likely to be true for the patient in this question. This requires inferential reasoning skill, where one utilizes knowledge to determine likely symptoms or presentation of problems. In this case, the patient would likely show limitations in hip flexion, abduction, and internal rotation. Review capsular patterns of the hip if answered incorrectly.
Hip flexion, adduction, and internal rotation.
Hip extension, abduction, and external rotation.
Hip flexion, abduction, and external rotation.
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?
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.
Type of Reasoning: ANALYTICAL
This question provides a group of symptoms and the test-taker must determine the most likely condition. This necessitates analytical reasoning skill, where information is analyzed to determine its meaning and significance, then draw a reasonable conclusion. For this case, the symptoms are consistent with myopathy. If answered incorrectly, review information on myopathy, especially signs and symptoms.
Guillain-Barré syndrome.
Myasthenia gravis.
Amyotrophic lateral sclerosis.
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 devices is MOST LIKELY to provide immediate assistance and maximize the patient’s community ambulation?
Walking poles.
Walking poles would provide immediate bilateral sensory feedback to assist in postural stability. It would also allow the patient to walk with a natural stride and upright posture.
Incorrect Choices: A standard walker and bilateral ankle foot orthoses are too restrictive and would not adapt to unlevel surfaces. A standard cane is an option but would only provide unilateral sensory feedback and not promote upright posture.
Type of Reasoning: Inductive
Standard walker.
Bilateral ankle foot orthoses.
Single point cane.
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?
The most recent pulmonary function test 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.
Type of Reasoning: INDUCTIVE
One must utilize clinical judgment in order to determine the most important information about a patient with asthma. Questions of this nature, where clinical judgment and knowledge are applied to patient cases, often necessitate inductive reasoning skill. For this situation, the most important information is the most recent pulmonary function test results. If answered incorrectly, review pulmonary rehab, including pulmonary testing information.
A current medication list.
A previous history of the disease.
The most recent chest x-ray results.
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?
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.
Type of Reasoning: INFERENTIAL
For this question, one must determine the reason for a specific gait deviation in order to arrive at a correct conclusion. One must apply knowledge of prosthetics in order to infer the most likely reason, which necessitates inferential reasoning skill. For this situation, the most likely cause is increased knee flexion resistance, which will not allow adequate knee flexion during swing phase. Review lower extremity prosthetics information if answered incorrectly.
Unstable knee unit.
Inadequate socket flexion.
High medial wall or abducted hip joint.
Following a hard tackle, a football player exhibits signs of fractured ribs and a pneumothorax. When auscultating during inhalation over the injured area, what would the physical therapist expect to hear?
Decreased or no breath sounds.
The fractured ribs will cause the patient to have pain and therefore not take deep breaths. More importantly, the pneumothorax will cause an increasing positive pressure on the lung, not allowing it to inflate. The result will be minimal air movement and decreased or absent breath sounds.
Incorrect Choices:
Soft, rustling sounds are normal, vesicular breath sounds. These would not be present with these injuries. Crackles would indicate atelectasis or secretions, but it would not be possible to hear these sounds with these injuries because there is minimal air movement. Likewise, wheezes wouldn’t be possible to hear.
Type of Reasoning: DEDUCTIVE
One must recall the auscultation sounds with a pneumothorax in order to arrive at a correct conclusion. This necessitates the recall of factual information, which is a deductive reasoning skill. For this case, one would expect to hear decreased or no breath sounds. Review auscultation guidelines, especially with pneumothorax, if answered incorrectly.
Soft, rustling sounds on inhalation.
Crackles.
Wheezes.
Which common musculoskeletal complication of cystic fibrosis is important to combat with a resistance training program?
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.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must recall the complications of cystic fibrosis and then prioritize which complication is most important to combat with a resistance training program. This necessitates clinical judgment and knowledge, which is an inductive reasoning skill. For this case, decreased bone density is most important. Review information on cystic fibrosis, especially musculoskeletal complications, if answered incorrectly.
Carpal tunnel syndrome.
Polyarthralgia.
Joint contractures.
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?
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.
Type of Reasoning: INFERENTIAL
One must determine what is likely to be true of a situation in order to arrive at a correct conclusion for this question. This necessitates inferential reasoning skill. The test-taker must utilize knowledge of arterial ulcers to determine what is likely to be true. In this case, the typical location of an arterial ulcer is on the lateral malleolus. Review information on arterial ulcers if answered incorrectly.
Medial malleolus.
Posterior tibial area.
Medial distal tibia.
During pregnancy, the presence of the hormone relaxin can lead to abnormal movement and pain. Which joints are typically affected?
Sacroiliac joints.
The sacroiliac (SI) joints are most often affected in pregnancy, resulting in pain.
Incorrect Choices:
The other joints are not typically affected. Low back pain is common in pregnancy, largely resulting from the physical changes (added weight, poor muscle tone, increased lordosis, loose pelvic ligaments).
Type of Reasoning: DEDUCTIVE
For this question, the test-taker must recall the typical joints that are affected by pregnancy and may result in pain in order to arrive at a correct conclusion. This necessitates the recall of factual information, which is a deductive reasoning skill. For this scenario, the sacroiliac joints are typically affected by pregnancy. Review pregnancy and common physical changes if answered incorrectly.
Glenohumeral joints.
Hip joints.
Lumbrosacral joints.
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?
Starting at the proximal portion of the limb and working distally to move the lymph toward the thoracic 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.
Type of Reasoning: ANALYTICAL
For this question, the test-taker must analyze the symptoms presented in order to determine the most likely diagnosis. This requires analytical reasoning skill, where pieces of information are analyzed in order to draw a logical conclusion. In this situation, the symptoms are indicative of secondary lymphedema. Review secondary lymphedema if answered incorrectly.
Starting at the distal portion of the limb and working proximally to move the lymph toward the right lymphatic duct.
Following application of intermittent pneumatic compression to the right lower extremity.
By performing deep tissue friction massage for several minutes on fibrotic areas prior to CDT.
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?
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.
Type of Reasoning: INDUCTIVE
For this question, one must utilize knowledge of wheelchair prescription for patients with obesity in order to arrive at a correct conclusion. Clinical judgment coupled with knowledge of wheelchair prescription guidelines are required, which necessitates inductive reasoning skill. For this case, the therapist should recommend a wheelchair in which the rear axle is displaced forward for more efficient arm push. Review wheelchair prescription guidelines, especially for patient with obesity, if answered incorrectly.
Move the small front casters closer to the drive wheels to increase stability.
Add friction rims to increase handgrip function.
Add an antitipping device to prevent falls going up curbs.
What is an acceptable modified position to drain the posterior basal segment of the left lower lobe in a patient with pulmonary infiltrate?
Prone, with a pillow under the hips and the 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.
Type of Reasoning: DEDUCTIVE
One must recall the proper positions for posterior basal segment drainage of the left lower lobe in order to arrive at a correct conclusion. This requires recall of facts and guidelines, which is a deductive reasoning skill. In this case, the therapist should position the patient in prone, with a pillow under the hips and the bed flat. Review postural drainage techniques if answered incorrectly.
Side-lying on the right, with a pillow under the right hip and the bed flat.
Side-lying on the right, with a pillow between the legs and the foot of the bed elevated 18 inches.
Prone, with a pillow under the hips and the head of the bed elevated 18 inches.
What are the different stages of pressure/decubitus ulcers
- Stage I: skin is intact but red
- Stage II: blister
- Stage III: can see muscle
- Stage IV: can see bone and tendons
A physical therapist examines a patient who sustained a noncontact injury of the knee. During the examination, the therapist performs the pivot shift test. What is the pivot shift test used to examine?
Anterolateral rotary instability or ALRI.
The pivot shift test is used to determine the presence of a rotary component to anterior knee instability. The Lachman’s test and anterior drawer test measure straight plane anterior instability. The pivot shift test provides additional information about the lateral stabilizers of the knee, such as the capsule and anterolateral ligament. The Slocum test is also used to identify ALRI. There is a modified pivot shift test used for the examination of suspected meniscal tears. See Box 2-5 for the Knee Ligament Sprains Clinical Practice Guideline.
Incorrect Choices:
A patellar tendon rupture is determined by observation and palpation of a defect in the tendon between the patella and tibial tuberosity. The mechanism of injury is a sudden eccentric loading contraction of the quadriceps femoris muscle, such as when landing from a jump or fall. Special tests used to assess the PCL or posterior instability of the knee include the posterior drawer and quad active test. Hyperextension or a dashboard injury are common mechanisms of injury for the PCL.
Type of Reasoning: DEDUCTIVE
This question requires the test-taker to recall the utility of the pivot shift test. This necessitates the recall of factual guidelines, which is a deductive reasoning skill. For this case, the test is used to determine the presence of anterolateral rotary instability or ALRI. If answered incorrectly, review the pivot shift test.
Patellar tendon rupture.
Posterior instability.
Anteromedial instability or AMRI.
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?
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.
Type of Reasoning: DEDUCTIVE
For this question, one must recall the translatory joint play motion of the CMC joint of the thumb in order to arrive at a correct conclusion. This necessitates the recall of facts, which is a deductive reasoning skill. For this case, the expected motion is dorsal translation of the metacarpal on the trapezium. Review joint play of the CMC joint of the thumb if answered incorrectly.
Palmar translation of the metacarpal on the trapezium.
Ulnar translation of the metacarpal on the trapezium.
Radial translation of the metacarpal on the trapezium.
Damage as a result of a Salter-Harris type IV supracondylar humeral epiphyseal fracture willMOST LIKELYresult in what consequence?
Arrested growth.
Supracondylar fractures are the most common pediatric elbow fracture, occurring most commonly between 3 and 10 years of age. Extension fractures account for about 95% of supracondylar fractures. The mechanism of injury is a fall on an outstretched hand with elbow hyperextended.Type IV is a fracture through all three elements of the bone: the growth plate, metaphysis, and epiphysis (10% incidence). Type IV growth plate fractures start above the growth plate, cross the growth plate, and exit through the joint cartilage. These injuries can affect the joint cartilage and may impair normal growth. See Table 2-31 for a review of Salter-Harris fracture classifications.
Incorrect Choices:
Nonunion of pediatric fractures is a rare complication. However, in one study of nonunion fractures, 47% were about the elbow, with most of the nonunions at the lateral condyle. Refractures of the forearm have an incidence of about 5%. Overall, the incidence of supracondylar-associated neurovascular injury is 12% and increases with displacement to between 19% and 49%. Excessive swelling and ecchymosis are a significant risk factor for compartment syndrome, and a thorough neurovascular exam should be performed and should focus on the brachial artery as well as the median and radial nerves.
Type of Reasoning: INFERENTIAL
This question requires the test-taker to determine the most likely consequence of a Salter-Harris type IV supracondylar humeral epiphyseal fracture. This requires knowledge of the Salter-Harris classification system in order to determine the most likely outcome. For this scenario, the most likely outcome is arrested growth. Review Salter-Harris fractures if answered incorrectly.
Refracture at a future time.
Nonunion.
Severing of the radial nerve.
What interventionBESTillustrates selective stretching when working with a patient with a spinal cord injury (C6 complete)?
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.
Type of Reasoning: INDUCTIVE
One must utilize knowledge of spinal cord injury and selective stretching techniques in order to arrive at a correct conclusion. This necessitates clinical judgment, which is an inductive reasoning skill. In this case, the intervention that best demonstrates this is when the hamstrings are fully ranged to 110 degrees in supine. Review stretching techniques for spinal cord injury if answered incorrectly.
Long finger flexors are fully ranged into extension with wrist extension.
Low back extensors are fully ranged in longsitting.
Hamstrings are fully ranged in longsitting.
A patient who is well known to the physical therapy clinic for treatment of chronic neck pain now presents with a new complaint of acute mid-back pain. Current symptoms also include abdominal pain and distension, which, along with the mid-back pain, intensify soon after meals. The patient also reports having a recent episode of chronic neck pain that resolved after taking 4,000 mg of acetaminophen daily for 2 weeks. What action should the therapist take?
Refer the patient to their primary care physician with possible pancreatitis.
This question describes a patient with acute pancreatitis, likely due to taking excessive amounts of acetaminophen. The maximum daily dosage of acetaminophen is 3,000 mg. Drug toxicity can bring on an acute attack of pancreatitis. In addition to those described in the question stem, common clinical findings include epigastric pain radiating to the back; nausea, vomiting, and diarrhea; fever and sweating; tachycardia; malaise; bluish discoloration of the abdomen or flanks (called Cullen’s sign); and jaundice.
Incorrect Choices:
Nephrolithiasis, or kidney stones, have a different clinical presentation than what is described here. Pain typically occurs in the low back or under the lower ribs and radiates into the abdomen and groin. Painful urination, a persistent need to urinate, and cloudy or foul-smelling urine are all common symptoms of a kidney stone. Cryotherapy is an intervention that would be appropriate if the patient had back pain due to some type of musculoskeletal injury or dysfunction. Choice 4 fails to consider the patient’s gastrointestinal symptoms and the possibility that the excessive dosage of acetaminophen might have contributed to the current complaints.
Type of Reasoning: EVALUATIVE
For this question, one must determine a best course of action based on presenting patient symptoms. This necessitates evaluative reasoning skill, where information is weighed to determine the significance. For this situation, the therapist should refer the patient to their primary care physician for possible pancreatitis. If answered incorrectly, review signs and symptoms of pancreatitis.
Refer the patient to their primary care physician with possible nephrolithiasis.
Treat the patient with cryotherapy for pain relief and instruct the patient in a core strengthening program.
Instruct the patient to rest and continue to take acetaminophen as needed for their pain.
A patient with post–traumatic brain injury (Rancho Los Amigos Levels of Cognitive Functioning Scale level III) has evidence of retained secretions on auscultation and chest films. What is theBESTmode of airway clearance for this patient?
Use of high-frequency chest wall oscillation.
High chest wall oscillations (HFCWO) via a device such as the Vest Airway Clearance System allow for control of inspiratory and expiratory flow rates. The device can be used in any position regardless of the patient’s cognitive status.
Incorrect Choices:
The first two choices require a patient to consistently follow commands and potentially complete the activity alone, which would be difficult for a patient in this cognitive stage of recovery. Oscillatory positive expiratory pressure (PEP) using a FLUTTER device requires a patient to breathe through a mouthpiece with inspiration unimpeded and long exhalation against a back pressure, also impossible for this patient.
Type of Reasoning: INDUCTIVE
For this question, one must determine a best course of action for airway clearance, based on knowledge of effective airway clearance approaches. This necessitates inductive reasoning skill, where clinical judgment is paramount to arriving at a correct conclusion. For this situation, the best mode of airway clearance is high-frequency chest wall oscillation. Review airway clearance approaches if answered incorrectly.
Active cycle of breathing.
Autogenic drainage.
Use of the FLUTTER device.
A physical therapist examines an elderly patient whose chief complaint is deep, boring pain in the pelvis and thighs. The patient also complains of weakness, fatigue, and headaches. Paget’s disease is suspected. Which clinical examination finding may corroborate the diagnosis of Paget’s disease?
Increased skin temperature over long bones.
Increased skin temperature over affected long bones is a common finding in individuals with Paget’s disease, a focal inflammatory condition that produces disordered bone remodeling. There is increased vascularity associated with the bone remodeling, leading to the increased skin temperature in affected areas. The bones that are most commonly involved are the pelvis, skull, femur, tibia, spine, shoulders, and ribs.
Incorrect Choices:
Pain, redness and swelling of the 1st metatarsal joint is a hallmark finding of gout. The combination of tachycardia, hyperreflexia, and decreased muscle strength is characteristic of Graves’ disease or hyperthyroidism. Kyphosis and easy bruising are common findings in Cushing’s syndrome, along with the telltale “moon face” and buffalo hump appearance of individuals with the disorder.
Type of Reasoning: INFERENTIAL
For this question, a diagnosis is provided and the test-taker must determine the likely symptoms consistent with this diagnosis. This requires inferential reasoning skill, where one infers or determines what is likely to be true of a situation. For this case, symptoms of increased skin temperature over long bones would corroborate a diagnosis of Paget’s disease. If answered incorrectly, review symptoms of Paget’s disease.
Pain, redness and swelling of the 1st metatarsal joint.
Tachycardia, hyperreflexia and decreased muscle strength.
Kyphosis and easy bruising.
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?
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.
Type of Reasoning: ANALYTICAL
For this case, the test-taker must evaluate the symptoms presented and determine the special test that will rule in a diagnosis. This necessitates analytical reasoning skill, where symptoms are analyzed to draw reasonable conclusions. For this scenario, the therapist should conduct a crossed straight leg raise to rule in lumbosacral radiculopathy. If answered incorrectly, review information on special testing for lumbosacral radiculopathy.
Straight leg raise.
Prone instability test.
Femoral nerve traction test.
What is the most effective form of diagnostic imaging for patients with multiple sclerosis (MS) to help determine level of disease activity?
Magnetic resonance imaging (MRI).
MRI is highly sensitive for detecting MS plaques in the white matter of the brain and spinal cord. Lesions are seen as areas of increased signal intensity (bright spots). Contrast-enhanced scans are used for more long-term disease activity.
Incorrect Choices:
All other choices of diagnostic imaging techniques do not offer the same sensitivity and specificity for detecting plaques.
Type of Reasoning: DEDUCTIVE
One must recall the most effective diagnostic tool for MS in order to arrive at a correct conclusion. This requires the recall of factual information, which is a deductive reasoning skill. For this scenario, the most effective test is magnetic resonance imaging (MRI). Review diagnostic imaging techniques, especially for MS, if answered incorrectly.
Positron emission tomography (PET).
Computed tomography (CT).
Transcranial sonography.
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?
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.
Type of Reasoning: INDUCTIVE
One must utilize knowledge of accessory muscles of respiration in order to arrive at a correct conclusion. Based on this knowledge, one can determine the best muscles to focus on for intervention, which is an inductive reasoning skill. In this case, the scalenes should be the focus. Review accessory muscles for respiration if answered incorrectly.
Tranversus abdominis.
Internal obliques.
External obliques.
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?
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.
Type of Reasoning: INDUCTIVE
One must utilize clinical judgment in order to determine the best intervention approach for this client. This necessitates inductive reasoning skill. For this scenario, the therapist should choose rhythmic stabilization during holding in kneeling to improve stability. Review intervention approaches for stability, especially rhythmic stabilization, if answered incorrectly.
Lower extremity splinting and light touch-down hand support.
Perturbed balance activities while standing on carpet.
Stabilizing reversals during holding in side-lying.
A physician requests that a physical therapist perform interferential current for pain management over the left shoulder of a patient with adhesive capsulitis. The therapist discovers that the patient has a pacemaker. In this case, what should the therapist do?
Do not perform the treatment since it is contraindicated.
All applications of electrical stimulation are contraindicated in the presence of a pacemaker. Consultation with the referring physician is necessary.
Incorrect Choices:
All other options resulting in the administration of electrical stimulation near or through a pacemaker are contraindicated.
Type of Reasoning: EVALUATIVE
This question requires the test-taker to weigh the potential courses of action and determine which response will have the most beneficial outcome. This necessitates evaluative reasoning skill. For this scenario, the therapist should not perform the electrical stimulation and should instead consult with the physician about alternative forms of therapy. Review contraindications for electrical stimulation if answered incorrectly.
Perform the treatment since there is no contraindication.
Refer the patient to another physical therapist who has greater expertise in using electrical modalities for patients with pacemakers.
Administer the treatment with a waveform that does not penetrate as deep as interferential current.
An elderly patient with diabetic peripheral neuropathy and retinopathy is having difficulty with balance when ambulating at home. The patient has fallen three times in the last month. What is the first priority of the home physical therapist’s plan of care?
Gait training with a cane to ensure safety.
The first priority of the home physical therapist should be gait training with a cane to ensure safety. This compensatory strategy is necessary as this patient is demonstrating complications of diabetes, which are chronic and progressive.
Incorrect Choices:
Color-coding steps and installing nightlights may also be necessary compensatory strategies to modify the home environment. However, they are not the first priority. Ambulation practice without a cane will not ensure the safety of this patient.
Type of Reasoning: INDUCTIVE
This question requires clinical judgment in order to determine a best course of action for an elderly patient with a history of falls. This necessitates inductive reasoning skill coupled with knowledge of effective approaches for home safety and fall prevention. For this scenario, the therapist should focus on gait training with a cane to ensure safety. Review fall prevention and home safety guidelines if answered incorrectly.
Color-coding raised surfaces, such as steps, with a sharp color contrast.
Ambulation practice on changing floor to carpet surfaces in the home.
Installing nightlights in strategic areas throughout the house and keeping them lit continuously.
A patient recovering from a total hip arthroplasty is seen by the physical therapist for early mobilization out of bed. While sitting on the edge of the bed, the patient experiences rapid onset of dyspnea, sudden chest pain, and cyanosis. What action should the therapist take?
Stabilize the patient and contact medical services immediately.
This patient is exhibiting signs and symptoms of pulmonary embolism. This is an emergency medical situation and a cause of death in a substantial number of patients.
Incorrect Choices:
All other choices do not address the life-threatening and emergency nature of this situation.
Type of Reasoning: EVALUATIVE
For this question, one must determine the best course of action by weighing the options presented. This requires analysis of the symptoms in order to determine the severity of the situation to reach a sound conclusion, which is an evaluative reasoning skill. In this case, the therapist should stabilize the patient and contact medical services immediately. Review emergency procedures for pulmonary embolism if answered incorrectly.
Return the patient to supine and monitor vital signs for the next 5 minutes.
Allow the patient to rest for a few minutes and continue with the therapy session.
Return the patient to supine and reschedule the therapy session for later in the afternoon.
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?
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.
Type of Reasoning: ANALYTICAL
For this question, the test-taker must analyze the examination requirements presented and determine which formalized examination best meets these parameters. This requires analytical reasoning skill. For this case, the Coma Recovery Scale-Revised provides the needed measures of consciousness and formalized examination of brainstem reflexes. Review assessments for TBI, especially coma recovery and the Coma Recovery Scale-Revised, if answered incorrectly.
Glasgow Coma Scale.
Rancho Los Amigos Levels of Cognitive Functioning.
Glasgow Outcome Scale-Extended.
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?
The Mini-BEST (Balance Evaluation System Test).
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.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must utilize knowledge of examination approaches for patients with Parkinson’s disease in order to arrive at a correct conclusion. This requires clinical judgment, which is an inductive reasoning skill. For this case, the Mini-BEST would best assess the patient’s current balance and fall risk. If answered incorrectly, review balance and fall risk assessments, especially the Mini-BEST.
Berg Balance Scale (BBS).
Functional Gait Assessment (FGA).
Timed Up & Go with Cognitive Task (TUG-Cog).
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?
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.
Type of Reasoning: INFERENTIAL
This question requires one to recall slowly absorbed carbohydrates in order to arrive at a correct conclusion. This necessitates the recall of factual information, which is a deductive reasoning skill. For this situation, crackers or bread should be chosen to prevent delayed-onset hypoglycemia after exercise. Review dietary recommendations to prevent hypoglycemia if answered incorrectly.
Fruit juice or candy.
Beef jerky and string cheese.
Carrot sticks and cherry tomatoes.
A patient with complete C7 spinal cord injury is receiving physical therapy to maintain joint mobility in an inpatient rehabilitation setting. What intervention is likely to produce theGREATESTrisk of heterotopic ossification (HO)?
Forceful passive range of motion (PROM), especially if spasticity is present.
Forceful PROM in the presence of spasticity increases the risk of developing HO (osteogenesis typically occurring in the soft tissues adjacent to large joints).
Incorrect Choices:
Joint mobility can usually be successfully maintained with all other choices.
Type of Reasoning: INFERENTIAL
For this question, the test-taker is provided with a condition and must determine the greatest risk factor associated with the condition. This requires one to determine what is likely to be true of a situation, which necessitates inferential reasoning skill. For this scenario, forceful passive range of motion (PROM), especially with spasticity present, presents the greatest risk for developing HO. Review risk factors for development of HO if answered incorrectly.
Prolonged positioning with resting splints.
Prolonged stretching using tilt table standing.
Joint mobilization with PROM.
A patient sustained a trimalleolar ankle fracture on the right and a fracture of the left distal radius. For partial weight bearing, it isBESTif the therapist has the patient use which device?
Platform crutches.
Platform crutches allow weightbearing on the forearms and are used for patients who are unable to bear weight through their hands, as in this case.
Incorrect Choices:
All other choices allow weightbearing through the hands, placing stress on the distal radius.
Type of Reasoning: INDUCTIVE
For this question, one must determine the best assistive device for a patient with a trimalleolar ankle fracture on the right and a fracture of the left distal radius. This necessitates clinical judgment, which is an inductive reasoning skill. Based on the patient’s injuries, platform crutches are the best choice. Review indications for platform crutches if answered incorrectly.
Axillary crutches.
Forearm crutches.
Lofstrand crutches.
A teenager is admitted to a skilled nursing facility with a severe traumatic brain injury and marked spasticity. Cognitive function is documented at Rancho Los Amigos Levels of Cognitive Functioning Scale level IV. Family members visit on a daily basis. In this situation, it would be BEST if passive range of motion (PROM) exercises are implemented in which way?
Taught to family members in order for them to participate in the care of the patient.
Passive range of motion (PROM) exercises can be taught to family members in order for them to participate in the care of the patient.
Incorrect Choices:
Other rehab staff, not only PTs or PTAs (e.g., rehabilitation aides, nursing assistants), can also be taught PROM techniques to maintain the joint mobility of the patient with marked spasticity. The RN is not typically engaged in this type of care of the patient.
Type of Reasoning: EVALUATIVE
This question requires one to weigh the potential courses of action in order to determine which action will have the best therapeutic outcomes. This requires evaluative reasoning skill. For this situation, the therapist should teach family members PROM exercises so they can participate in the care of the patient. Review traumatic brain injury information and participation of family in the plan of care.
Performed only by the physical therapist since the patient is unable to follow verbal commands.
Performed only by the physical therapist (PT) or physical therapist assistant (PTA) to minimize the possibility of pathological fractures.
Taught to all registered nurses (RNs) who might participate in the care for the patient.
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?
Go up stairs 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.
Type of Reasoning: DEDUCTIVE
One must recall motor skill development in toddlers in order to arrive at a sound conclusion for this question. This necessitates the recall of factual information, which is a deductive reasoning skill. For this situation, going up stairs foot-over-foot is a normal developmental milestone for a 2-year-old child. Review motor skill milestones, especially stair negotiation, if answered incorrectly.
Hop on one foot.
Stand on tiptoes.
Jump with two feet.
Which high-intensity interval training program would be best for a patient with compensated New York Heart Association Class III heart failure?
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.
Type of Reasoning: INDUCTIVE
This question requires one to determine through clinical judgment the best high-intensity interval training program for a patient with compensated Class III heart failure. This requires knowledge of cardiac rehabilitation guidelines, which is an inductive reasoning skill. For this situation, the best program would be >35 minutes; intensity: 90%–95% of peak VO2 with a frequency 2–3 times/week and a duration of 8–12 weeks. If answered incorrectly, review high-intensity interval training programs, especially for compensated Class III heart failure.
Time: 5–10 minutes; Intensity: 40%–50% of peak VO2; Frequency: 2–3 times/week; Duration: 4–6 weeks
Time: 5–10 minutes; Intensity: 90%–95% of peak VO2; Frequency: 5–7 times/week; Duration: 4–6 weeks.
Time: >35 minutes; Intensity: 40%–50% of peak VO2; Frequency: 5–7 times/week; Duration: 8–12 weeks.
An independent community dwelling adult with multiple sclerosis is referred to physical therapy secondary to a recent exacerbation that has resulted in a significant increase in fatigue with activities of daily living and their work as an accountant. Which of the following examination items are BEST to serve as initial outcome measures for this patient?
Visual Analog Scale (Fatigue) and 2-minute walk test.
The visual analog scale (Fatigue) measures self-report of fatigue for daily life, grooming, and household/occupational activities. Normative values for the 2-minute walk test have also been established for patients with multiple sclerosis.
Incorrect Choices:
None of the other options, except for the Fatigue Scale of Motor/Cognitive Function, directly measure the patient’s primary impairment of fatigue. Additionally, secondary to the recent exacerbation it is important that the patient is not overexerted with more demanding (e.g., running) and increased duration activities (e.g., 6-minute walk test). Please see Table 3-18 for the APTA Neurology Section Multiple Sclerosis EDGE Task Force recommended examination items.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must utilize clinical judgment to determine the best examination item for a patient with multiple sclerosis. This necessitates inductive reasoning skill. In this case, one must be familiar with the examinations presented in order to choose the examination that will best assess the patient’s symptoms. For this scenario, the Visual Analog Scale (Fatigue) and 2-minute walk test are best. If answered incorrectly, review information on assessments for multiple sclerosis, especially the Visual Analog Scale (Fatigue) and the 2-minute walk test.
12-item Multiple Sclerosis Walking Scale and Dynamic Gait Index.
Multiple Sclerosis Quality of Life Measure and Timed Up & Go.
Fatigue Scale of Motor/Cognitive Function and 6-minute walk test.
A therapist is working with a patient with early myasthenia gravis with a focus on improving endurance, strength, and community participation. Which of the following signs are most consistent with exacerbation of myasthenia gravis and a need to stop or modify an exercise session?
Double or blurred vision, decreased voice projection, and difficulty with repetitive sit to stand.
Patients with myasthenia gravis (MG) typically have involvement of bulbar (extraocular, facial, and muscles of mastication) and proximal limb-girdle muscles. If overworked, patients will exhibit visual changes and difficulty with prolonged speaking, eating, or reading. They will also have weakness with repetitive testing of exercise of proximal limb muscles.
Incorrect Choices:
Shortness of breath, syncope, and cold distal extremities are more consistent with cardiovascular and respiratory conditions and not typically associated with MG unless it is severe (e.g., myasthenic crisis). Hyperreflexia and muscle spasm are more closely associated with upper motor neuron lesions and CNS involvement. Joint and muscle pain, inability to sleep, and irritability are more consistent with an active arthritic process or fibromyalgia.
Type of Reasoning: INFERENTIAL
This question requires the test-taker to infer or determine what is likely to be true for symptoms that are consistent with exacerbation of myasthenia gravis. This necessitates inferential reasoning skill. For this situation, double or blurred vision, decreased voice projection, and difficulty with repetitive sit to stand would indicate an exacerbation of myasthenia gravis. Review information on myasthenia gravis, especially response to exercise, if answered incorrectly.
Dyspnea, syncope, and cold hands and feet.
Hyperreflexia, muscle spasms, and an inability to stand on one foot with eyes open.
Increased muscle and joint pain, inability to sleep, and irritability.
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?
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.
Type of Reasoning: DEDUCTIVE
For this question, one must recall the protocol for range of motion after extensor tendon repair. This requires the recall of protocol guidelines, which is factual information and necessitates a deductive reasoning skill. For this scenario, the therapist should instruct the patient to passively extend the wrist and actively flex the MCP joints. Review extensor tendon repair range of motion guidelines if answered incorrectly.
Actively extend the wrist and passively flex the MCP joints.
Actively extend the wrist and MCP joints.
Passively extend the wrist and MCP joints.
What is one of the most common early signs of right ventricular failure?
Dependent edema.
If the right ventricle fails, the increased fluid will back up. Traveling backward from the right ventricle, the edema goes into the right atrium and then the periphery. This causes dependent edema.
Incorrect Choices:
An inability to lie flat occurs when there is edema in the lungs (paroxysmal noctural dyspnea). This doesn’t occur in isolated right ventricular failure. Exertional dyspnea occurs in right ventricular failure as a result of deconditioning after a period of time. It is not an early indication. Pulmonary edema results from increased intravascular pulmonary pressures. This doesn’t occur in right ventricular failure because there is a reduction in forward flow, and therefore there are lower pulmonary arterial pressures.
Type of Reasoning: DEDUCTIVE
For this question, one must recall the early signs of right ventricular failure in order to arrive at a correct conclusion. This requires the recall of factual information, which is a deductive reasoning skill. In this case, an early sign is dependent edema. Review signs and symptoms of right ventricular failure if answered incorrectly.
Paroxysmal nocturnal dyspnea.
Exertional dyspnea.
Pulmonary edema.
An ectomorphic adolescent patient presents at a physical therapy practice with a 6-month history of pain in both hands. Subjective complaints consist of pain that is worse in the morning but gradually improves throughout the day and overall fatigue. The only significant objective data from examination was mild edema and pain at end ranges of motion. What should the physical therapist do next in order to try to establish a diagnosis?
Refer the patient to a physician.
This case represents the typical presentation for juvenile rheumatoid arthritis (JRA). The following are common symptoms of JRA: swollen, stiff, painful joints usually worse in the morning; fatigue; fever; swollen lymph nodes; and poor weight gain/slow growth. Additionally, the physical therapist was unable to identify specific impairments that would be potentially contributing to the patient’s complaints, warranting referral to physician for additional testing.
Incorrect Choices:
The other choices do not address the findings of swollen, painful joints. The FIM evaluates functional performance (eating, dressing, grooming). Clubbing is seen with hypertrophic osteoarthropathy. Dupuytren’s contracture involves flexion contractures of the fourth and fifth digits of the hand, MP, and proximal interphalangeal (PIP) joints.
Type of Reasoning: EVALUATIVE
For this question, one must weigh the potential courses of action and determine which decision will best aid in establishing a diagnosis. This necessitates evaluative reasoning skill where one weighs the merits of each potential course of action to seek resolution. For this situation, the therapist should refer the patient to a physician. Review diagnostic approaches for JRA if answered incorrectly.
Administer the Functional Independence Measure (FIM).
Examine for clubbing at the distal interphalangeal joints.
Examine for Dupuytren’s contracture.
A patient presents to outpatient cardiac rehabilitation. Their intake form states they had new onset atrial fibrillation 3 months ago, and their physician started a beta-blocker and placed a permanent pacemaker (dual sensing, demand pacemaker). Which statement BEST describes the anticipated patient findings or response to exercise?
The pacemaker will sense a lack of depolarization and initiate a contraction if the heart rate drops too low.
A dual sensing pacemaker is implanted to assess depolarization of the atrium or the ventricle. If the depolarization does not occur within the set time limits of the device, the pacemaker will initiate depolarization, which results in a ventricular contraction.
Incorrect Choices:
The pacemaker has no effect on the heart rhythm in this case. The beta-blocker may lead to the patient converting to normal sinus rhythm, or more likely, the patient will remain in atrial fibrillation and the medication works to maintain the heart rate within a normal range (60–100 beats per minute). There is not any increased risk associated with exercise and a pacemaker. The hemodynamic response should be the same as any patient on a beta-blocker.
Type of Reasoning: INFERENTIAL
For this question, one must determine what is likely to be true for a patient with atrial fibrillation and a permanent pacemaker in place. This requires inferential reasoning skill, where one must predict outcomes based on information presented. For this situation, the patient’s pacemaker will sense a lack of depolarization and initiate a contraction if the heart rate drops too low. Review pacemaker guidelines if answered incorrectly.
The pacemaker placement will have eliminated the atrial fibrillation, and the patient will have a regular heart rate.
The patient could experience sudden cardiac death if they exercise.
The patient’s hemodynamic response will be an unreliable measure of exercise tolerance and should not be measured.
Which of the following symptoms/signs are MOST consistent with a gastric ulcer?
Vomit that looks like coffee grounds.
Gastric ulcers cause a mixture of dried and new blood that often looks like coffee grounds. Symptoms of gastric ulcers include epigastric pain that is often described as gnawing or burning.
Incorrect Choices: Esophageal dysfunction (e.g. gastroesophageal reflux disease) may present as atypical head, neck, and chest pain that mimics a heart attack. Diffuse right shoulder pain is associated with liver or gall bladder dysfunction. Visible blood in the feces occurs with disorders of the descending colon and rectum (e.g., colon cancer, diverticulitis, hemorrhoids).
Type of Reasoning: Inferential
Atypical head, neck, and chest pain.
Diffuse right shoulder pain.
Visible blood in the feces.
Which of the following is a risk factor for the development of primary lymphedema?
Positive family history of the disorder.
Lymphedema is divided into two broad categories: primary (congenital or hereditary) and secondary (acquired) lymphedema. Primary lymphedema occurs due to a genetic condition that affects the development of lymph nodes and vessels.
Incorrect Choices: Secondary lymphedema occurs “secondary” to an obstruction of the lymphatic system from surgery, infection, trauma, or radiation. Secondary lymphedema often develops after surgery to remove lymph nodes in patients with cancer. Burns that cover large portions of the body, including the extremities, can impede lymph flow. Filariasis is a parasitic infection spread via mosquitoes and is the leading cause of lymphedema worldwide.
Type of Reasoning: Deductive
Surgical removal of axillary lymph nodes.
Burns covering over 60% of the body.
Recent diagnosis of filariasis.
Which of the following devices is BEST for community ambulation for a patient with a complete spinal cord injury (ASIA A-L3 neurologic level)?
Manual wheelchair.
Bilateral L3 neurologic levels would allow a patient to have partial function of the quadriceps and hip adductors but would result in complete paralysis and sensory loss below the knees. The most realistic device for community ambulation would be a wheelchair. Most patients with a complete L3 neurologic level would be able to ambulate short distances with the assistance of bilateral KAFO and a walker or forearm crutches.
Incorrect Choices: An AFO would be unrealistic for this patient for community ambulation, as the patient lacks any sensation or strength distal to the knees. Standard crutches are also not recommended for long-term use as forearm crutches in a trained patient provide similar stability and less pressure on the shoulders over time.
Type of Reasoning: Deductive
Loftstrand (forearm) crutches and ankle foot orthoses.
Standard walker and ankle foot orthoses (AFO).
Standard crutches with knee/ankle foot orthoses (KAFO).
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? !
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.
Type of Reasoning: Analytical
Eczema
Fungal infection
Scleroderma
An elderly patient with hypothyroidism is recovering from a fall and is referred to physical therapy to increase exercise tolerance and safety. The patient denies numbness but reports significant muscle pain in both lower extremities. What additional musculoskeletal effects should the therapist examine for?
Proximal muscle weakness.
Hypothyroidism can have numerous musculoskeletal effects, including myalgia (muscle pain) and proximal muscle weakness.
Incorrect Choices:
Additional musculoskeletal effects include stiffness (not joint laxity) and delayed relaxation (decreased) deep tendon reflexes.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must determine what is most likely to be true based on knowledge of hypothyroidism. Questions of this nature, where one must infer information, require inferential reasoning skill. In this case, one should infer that proximal muscle weakness is most likely to be present. If answered incorrectly, review information on hypothyroidism.
Distal muscle weakness.
Joint laxity.
Increased deep tendon reflexes.
A child experienced a superficial partial-thickness burn from a scalding pot of water affecting 26% of the thorax and neck. On what should the therapist’sINITIALplan of care focus?
Chest wall mobility and prevention of scar contracture.
Prevention of scar contracture and preservation of chest wall mobility and normal neck range of motion (ROM) are the initial major goals to focus on with this patient.
Incorrect Choices:
Return to preburn function and ADLs is an important treatment goal but is not the initial focus. Pain and infection management are important goals of the medical team and are typically managed by the medical team.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must use clinical judgment to determine a best course of action, which necessitates inductive reasoning skill. Knowledge of effective treatment approaches for burns is paramount to arriving at a correct conclusion. In this case, chest wall mobility and prevention of scar contracture should be the initial focus of the therapist. Review treatment approaches for burns, especially in children, if answered incorrectly.
Return to preburn function and activities of daily living.
Pain management.
Infection management.
A physical therapist is instructing an elderly patient how to perform bed mobility following a total hip replacement. The therapist should carefully consider the effects of aging that relate to skin. What is one such effect?
Impaired sensory integrity.
Changes in skin composition associated with aging include decreased sensitivity to touch, decreased perception of pain and temperature, and increased risk of injury.
Incorrect Choices:
Perception of pain is decreased (not increased). The dermis thins, and elasticity is decreased (not increased). The elderly often exhibit low-grade inflammation; acute inflammatory responses are commonly caused by tissue injury or infections.
Type of Reasoning: INFERENTIAL
For this question, the test-taker must recall the effects of aging and then determine the most likely effect that relates to the skin. This requires inferential reasoning skill. For this situation, the most likely skin effect is impaired sensory integrity. Review effects of the aging process, especially those that affect the skin, if answered incorrectly.
Increased perception of pain.
Increased skin elasticity.
Increased acute inflammatory response.
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?
Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera.
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).
Type of Reasoning: INFERENTIAL
One must determine what is most likely to be true for patients with cervical spinal cord injury in order to arrive at a correct conclusion. Questions that ask one to predict possible outcomes often necessitate inferential reasoning skill. For this case, the therapist should anticipate rising of the abdomen due to no abdominal muscle tone on the abdominal viscera. Review cervical spinal cord injury effects on respiration if answered incorrectly.
Asymmetric lateral costal expansion due to ASIA A injury.
An increased subcostal angle due to air trapping from muscle weakness.
No diaphragmatic motion since the diaphragm is below the level of the lesion.
Men are at risk for development of metabolic syndrome if they exhibit which of the following symptoms?
A waist size greater than 40 inches.
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.
Type of Reasoning: DEDUCTIVE
This question requires the test-taker to recall the guidelines for risk of developing metabolic syndrome. This is factual information, which is a deductive reasoning skill. For this situation, a waist size greater than 40 inches would be a risk factor. Review metabolic syndrome guidelines if answered incorrectly.
An HDL level lower than 45 mg/dL.
Triglyceride levels greater than 100 mg/dL.
Fasting blood glucose less than 100 mg/dL.
A patient with a body mass index (BMI) of 37 is referred to physical therapy for exercise conditioning. What are additional clinical manifestations associated with the BMI that this patient might exhibit?
Hypertension and hyperinsulinemia.
Obesity is associated with hypertension, dyslipidemia, hyperinsulinemia (type 2 diabetes), and hyperglycemia. The presence of these comorbidities increases risk, resulting in the need for additional medical screening before exercise testing.
Incorrect Choices:
Hyperpituitarism, hormone-related cancer, and hypotension are not associated with obesity.
Type of Reasoning: DEDUCTIVE
For this question, the test-taker must recall the clinical manifestations associated with a high BMI (obesity). This is factual information, which necessitates deductive reasoning skill. In this case, the clinical manifestations include hypertension and hyperinsulinism. Review obesity guidelines if answered incorrectly.
Hyperpnea and hyperpituitarism.
Hormone-related cancer.
Hypolipoproteinemia and hypotension.
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?
Legg-Calvé-Perthes disease.
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.
Type of Reasoning: ANALYTICAL
This question requires the test-taker to analyze pieces of information in order to draw a reasonable conclusion. This type of reasoning process is analytical, where the test-taker weighs the individual symptoms to determine a likely diagnosis. The symptoms presented in this situation are most likely consistent with Legg-Calvé-Perthes disease. Review information on Legg-Calvé-Perthes disease if answered incorrectly.
Hip dysplasia.
Growing pains.
Slipped capital femoral epiphysis.
To prepare a patient with a cauda equina lesion for ambulation with crutches, what upper quarter muscles would be the most important to strengthen?
Lower trapezius, latissimus dorsi, and pectoralis major.
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.
Type of Reasoning: INDUCTIVE
For this question, one must utilize clinical judgment to determine the most important muscles to strengthen for crutch use. This requires inductive reasoning skill. For this scenario, the therapist should focus on strengthening the lower trapezius, latissimus dorsi, and pectoralis major. Review muscles needed for crutch use if answered incorrectly.
Upper trapezius, rhomboids, and levator scapulae.
Deltoid, coracobrachialis, and brachialis.
Middle trapezius, serratus anterior, and triceps.
A basketball player is referred to a physical therapist with a diagnosis of a quadriceps muscle contusion. The injury occurred 24 hours earlier when the player was struck in the thigh by an opponent’s knee. Which intervention is contraindicated at this time?
Aggressive quadriceps femoris stretching.
Aggressively stretching a muscle following direct trauma that results in formation of a hematoma may induce myositis ossificans, which is a painful condition of abnormal calcification within a muscle belly. The quadriceps, brachialis, and biceps brachii muscles are the most frequent locations for myositis ossificans. While flexibility exercises in a pain-free range are appropriate, aggressive stretching exercises into the painful range should be avoided.
Incorrect Choices:
Quadriceps setting exercises, gentle knee and hip range of motion exercises, and ice baths are all appropriate choices of interventions after a muscle contusion that do not increase the risk of developing myositis ossificans.
Type of Reasoning: INDUCTIVE
For this question, the test-taker must recall intervention approaches that should be avoided after muscle contusion. This requires inductive reasoning skill, where one utilizes clinical judgment and knowledge of intervention guidelines to arrive at a correct conclusion. For this case, the therapist should avoid aggressive quadriceps femoris stretching in order to avoid inducing myositis ossificans. If answered incorrectly, review intervention guidelines for patients with muscle contusions.
Isometric quadriceps femoris exercises.
Knee and hip range of motion in a pain-free range.
Ice baths.
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?
*shows Phalen’s test
Neutral-positioned wrist orthosis.
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.
Type of Reasoning: Inductive
Thermal ultrasound to the anterior wrist.
Laser therapy to the anterior wrist.
Iontophoresis to the carpal tunnel region.
A patient with a long history of cigarette smoking has been admitted to the hospital and presents with tachycardia, signs of lung infection, abnormal breath sounds in both lower lobes, and dullness to percussion. What should the therapist’sINITIALintervention focus on with this patient?
Airway clearance and secretion removal.
The patient has signs and symptoms consistent with pneumonia. It is most important to assist with secretions clearance to assist with recovery from the infection and to improve gas exchange.
Incorrect Choices:
Quitting smoking is an appropriate goal for this patient but would be best timed after the acute period has passed. It isn’t stated that the patient’s breathing pattern is impaired and therefore it is not imperative to address it at this time. If there is an increased work of breathing, it will be rectified by clearing the secretions. Patients with a history of chronic obstructive pulmonary disease (COPD), which is presumed in this case due to the long history of tobacco use, do benefit from inspiratory muscle training (IMT). However, this is best timed after the acute infection has resolved.
Type of Reasoning: INDUCTIVE
This question requires one to utilize clinical judgment to consider a best course of action for a patient with pneumonia. Knowledge of effective intervention approaches for pneumonia is paramount to arriving at a correct conclusion and requires inductive reasoning skill. For this case, the therapist should focus on airway clearance and secretion removal initially. Review intervention approaches for pneumonia if answered incorrectly.
Getting the patient to quit smoking.
Breathing reeducation to increase efficiency of ventilation.
Graded inspiratory muscle training.
A patient presents to a physical therapy clinic after a traumatic anterior glenohumeral joint dislocation. The patient complains of numbness in the lateral part of the upper arm. During the physical examination, the therapist confirms that there is numbness in the deltoid region, in addition to painful limited range of motion and weakness with shoulder abduction and external rotation. Which neurological diagnosis is consistent with the findings in this patient?
Axillary nerve injury.
Injury to the axillary nerve is a well-documented complication of glenohumeral dislocation, reported in as many as 40% of cases. The incidence of concomitant axillary nerve injuries increases with age. Patients with this injury typically present with numbness or paresthesias in the lateral shoulder region and weakness with shoulder abduction.
Incorrect Choices:
Thoracic outlet syndrome occurs with compression of neurovascular structures in the region of the scalene triangle, between the clavicle and 1st rib, or between the pectoralis minor and thoracic wall. Pain and paresthesias may be present and are typically reported in the medial forearm and hand. A radiculopathy that involves the C7 and C8 nerve roots would primarily affect forearm and intrinsic hand muscles and the patient would present with pain and paresthesias along the C7 and C8 dermatomes. Radial tunnel syndrome is an entrapment neuropathy of the lateral elbow region causing pain and paresthesia in the posterolateral forearm and dorsum of the hand.
Type of Reasoning: ANALYTICAL
This question requires the test-taker to analyze the presenting symptoms and determine the likely diagnosis that is consistent with the findings. This requires analytical reasoning skill where pieces of information are weighed for their significance and flowing from that, a reasonable conclusion of what the information means. In this case, the findings are consistent with axillary nerve injury. Review information on axillary nerve injury if answered incorrectly.
Thoracic outlet syndrome.
C7–C8 radiculopathy.
Radial tunnel syndrome.
While performing an evaluation for a 17-year-old patient for neck pain, the patient expresses the need for housing assistance after being laid off recently due to budget cuts. As a result, the therapist helps the patient coordinate an appointment with a social worker. According to the Health Insurance Portability and Accountability Act (HIPAA), which of the following pieces of information is MOST likely inappropriate to share with the social worker?
The patient has neck pain.
Health care providers can communicate information relevant to mutual patients, but not communicate information that is irrelevant to another provider’s care. In this example, the patient’s neck pain is most likely to be irrelevant information to the social worker relative to the other items.
Incorrect Choices:
The information regarding being laid off, need for housing assistance, and the patient’s age are valuable background information for the social worker. This information is sensitive but must be shared to allow the social worker to have a basic understanding of why assistance is needed.
Type of Reasoning: EVALUATIVE For this question, the test-taker must weigh the information presented and then apply knowledge of the HIPAA to arrive at a correct conclusion. This requires weighing the information for its merits, which is an evaluative reasoning skill. For this case, it would be most likely inappropriate to share that the patient has neck pain. If answered incorrectly, review HIPAA guidelines.
The patient was laid off.
The patient needs housing assistance.
The patient is 17 years old.
A patient in the ICU is two days post-CABG. What is the primary purpose of the tubing inserted into this patient?
To evacuate air and/or blood from the intrapleural space.
A chest tube has been inserted into the intrapleural space. It would be attached to a vacuum line with a water seal interspersed. Air, blood, or other fluid is evacuated from the pleural space following a pneumothorax, cardiothoracic surgery, pleural effusion, or other condition to allow the lung to fully expand. The water seal prevents any air from back flowing into the thoracic cavity. Chest physical therapy is permitted in this area.
Incorrect Choices:
Supplemental O2 is provided by use of a nasal cannula, mask, or manual resuscitator bag. Mechanical ventilation is a means to replace spontaneous breathing. Moistened and heated O2 is administered via endotracheal, nasotracheal, or tracheal means. A chest tube is not applicable for these purposes.A Swan-Ganz catheter, also known as a pulmonary catheter, is a thin tube inserted directly into the pulmonary artery. It can measure pulmonary artery pressure, cardiac output, and oxyhemoglobin saturation.
Type of Reasoning: ANALYTICAL
For this question, the test-taker must analyze the information in the picture in order to make a determination of the primary purpose of the tubing inserted into the patient. This requires analytical reasoning skill, where determining a correct answer through the review of pictures, charts, and graphs is utilized. For this case, the tubing is placed to evacuate air and/or blood from the intrapleural space. Review ICU guidelines, especially types of drainage tubes, if answered incorrectly.
To provide moistened room air directly to the patient.
To provide heated and moistened pure O2 directly to the patient.
To measure pulmonary artery pressure and cardiac output via a Swan-Ganz catheter.
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
Which is the MOST LIKELY diagnosis for this patient?
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.
Type of Reasoning: Analytical
L5 radiculopathy.
Spinal instability.
Lumbar facet dysfunction.
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
Given the sensation complaints and diminished Achilles reflex, manual muscle test results might demonstrate weakness in which muscle?
Gastrocnemius.
The gastrocnemius muscle is innervated by the S1-2 spinal nerve root levels. This is the only S1-innervated muscle listed in the answer choices.
Incorrect Choices: The nerve root innervation levels for the other answer choices are iliopsoas (L2-3), quadriceps femoris (L3-4) and tibialis anterior (L4-5).
Type of Reasoning: Inferential
Iliopsoas
Quadriceps femoris.
Tibialis anterior.
