PEAT 1 Flashcards
In splinting or immobilization, the functional position of the hand includes wrist:
A. extension, phalangeal flexion, and thumb abduction
B. extension, phalangeal extension and thumb abduction
C. extension, phalangeal flexion and thumb adduction
D. flexion, phalangeal flexion and thumb adduction
A. The functional position of the wrist and hand describes the position from which the optimal function is most likely to occur. This position is described as a) slight wrist extension, b) slight ulnar deviation, c) fingers flexed at the MCP, PIP & DIP joints and d) thumb slightly abducted.
During pregnancy, which of the following is contraindicated?
A. curl-ups
B. bridging
C. double leg lifts
D. deep breathing with forced expiration
C. During pregnancy and postpartum period, the stretched abdominal muscles are unable to stabilize the lower back, as the legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscle and cause damage to the spinal joints.
A target heart rate is determined for individual entering a training program in order to:
A. regulate exercise intensity
B. estimate energy expenditure
C. control blood pressure and specific heart rate
D. ensure participants exercise at maximal capacity
A. Exercise intensity can be expressed as 02 uptake during activity. HRand 02 uptake have a relatively lower linear relationship.
Therefore, utilizing a target HR will ensure that the
appropriate exercise intensity is being achieved. Estimation of energy expenditure requires measurement of O2 consumption that is then calculated into calories metabolized during the activity. BP cannot be controlled at specific HR. Exercising at maximal capacity does not achieve aerobic training benefits and is unsafe for the majority of patient population.
A herniated nucleus pulposus at the L3-L4 disc produces which of the following clinical findings?
A. Numbness in the back of the calf and dorsiflexor weakness
B. Numbness in the anteromedial thigh and knee and quadriceps weakness
C. Numbness and weakness in the thigh, legs, feet and/or perineum
D. Numbness in the back of the calf and atrophy of gastrocnemius and soleus
B. Pressure on the L3 L4 root causes numbness in the anteromedial thigh and knee and quads weakness. Numbness in the back of the calf and dorsiflexor weakness is indicative of L4, L5 and S1 nerve root involvement. Numbness and weakness in the thighs, legs and feet and perineum is indicative of L2 through S1 nerve root involvement. Numbness in the back of the calf and atrophy of gastrocsoleus is indicative of the S1 nerve root involvement.
The intervention for a patient with limitation of shoulder flexion and medial rotation includes mobilization. Which glide is the most appropriate for mobilizing this shoulder to specifically increase the restricted motion?
A. Posterior
B. Anterior
C. Medial
D. Lateral
A. The most appropriate mobilization technique for increasing both shoulder flexion and medial rotation would be posterior (dorsal) glide. Lateral glide may be used as a general joint distraction technique.
Medial glide would not be appropriate to increase flexion and medial
rotation. Anterior glide is used to increase extension and lateral rotation.
Which of the following techniques is MOST appropriate for a patient with low postural tone?
A. Slow regular rocking while sitting on the treatment bolster
B. Continuous pressure to the skin overlying the back muscle
C. Low frequency vibration to the back muscle
D. Joint approximation applied through the shoulder to the trunk
D.
Options A, B & C are techniques used to decrease postural tone, which is not indicated for this patient. Option D is the most appropriate technique for improving low postural tone.
Which skin change associated with aging has the GREATEST effect on wound healing?
A. Reduction in sensation
B. Decrease elasticity of the skin
C. Decrease epidermal proliferation
D. Change in pigmentation
C. Wounds heal via a complex process involving re-epithelialization. With advanced aging, the rate of epidermal proliferation decreases.
Which of the following techniques is MOST effective in teaching an IDDM patient about foot care?
A. Reassure the patient that no infection will occur if the directions are followed, then demonstrate procedure
B. Tell patient how foot care is performed, then watch patient’s performance
C. Watch patient perform foot inspection and caution him that amputation results from unattended skin problems
D. Have the patient demonstrate a foot inspection, then give feedback on patient’s performance
D. Learning the process of foot care is a psychomotor skill and effective strategies to teach psychomotor skills include repeat demonstration by the patient of the skill followed by feedback from the therapist to highlight what was performed correctly and what areas need improvement.
Reassurance about prevention of infection with proper foot care would primarily be a cognitive skill and does not ensure that the patient can effectively perform proper foot care. Options B &
C do not include feedback that informs the patient about their performance.
For a child with Duchenne muscular dystrophy, the MOST appropriate rehabilitation goal would be:
A. prevention of contractures and determine method of mobility
B. preservation of strength and muscle tone
C. inhibition of abnormal tone and facilitation of normal movement and position reaction
D. facilitation of normal movement and improvement of strength
A. Goals of PT intervention for a child with DMD are to retard the development of contracture and muscle weakness, which could lead to functional limitations and thus disability. The PT would also play a role in determining the appropriate use of assistive devices that could help maintain the child’s mobility such as wheelchairs, walkers and orthoses. Muscle tone changes and decline in strength cannot be prevented since they are results of the disease process.
A patient with complete long thoracic nerve injury would have difficulty in:
A. putting hand in the back pocket.
B. bending toward the involved side.
C. taking a deep breath.
D. reaching forward above head.
D. The long thoracic nerve innervates the serratus anterior muscle. Reaching forward above the head (shoulder flexion) would require the action of serratus anterior, and long thoracic nerve injury would affect the motion. The serratus anterior muscle also works in conjunction with the upper and lower trapezius muscle to upwardly rotate the scapula (abduct) during shoulder flexion. Putting the hand in the back pocket would require scapular adduction. Side bending and deep breathing would not require scapular motion.
Outcomes of prenatal exercise program would not include:
A. improved body mechanics
B. application of relaxation technique
C. improve ligament flexibility
D. strengthen pelvic floor musculature
C. During pregnancy, the ligaments soften due to hormonal influences and allow some degree of separation between joint surfaces. Additional stretching of the ligaments would result in joint instability or injury, and would not be a goal of treatment.
The remaining options are all
appropriate interventions.
Utilization review and peer review are activities that are part of a comprehensive:
A. policy and procedure manual
B. quality improvement program
C. audit cycle
D. performance evaluation
B. According to the Standards of PT Practice, there should be a written plan of continuous improvement of quality of care. This includes ongoing review and evaluation of the PT services provided. Utilization and peer review are two types of review processes.
Which of the following is the BEST documentation exercise of a goal?
A. The therapist will reduce patient’s hip flexion contracture to neutral
B. The patient will ambulate 75 feet independently in 3 weeks
C. The therapist will reduce patient’s pain from 7/10 to 3/10
D. The patient will understand how to increase ADL in 4 weeks
B. A goal should include the following elements: a) Audience; who will exhibit the skill, b) Behavior; what the person will do, c) Condition; under what circumstances (the position, the equipment that must be available for the patient to perform the behavior), d) Degree; how well will the behavior be done, e) Time span; set an anticipated specific time span in which the goal will be achieved, and f) Measurable; the outcome must be measurable.
Option B meets all the
criteria while the other responses do not.
Patient has a limited ankle dorsiflexion following ORIF of distal tibia. Radiographs reveal that the fracture is well healed. Treatment with passive mobilization should include:
A. posterior glide of talus on tibia
B. lateral glide of calcaneus on tibia.
C. posterior glide of tibia on talus
D. anterior glide of talus on tibia.
A. The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly relative to the tibia. To facilitate movement of dorsiflexion, one would need to perform a posterior glide of the talus on the tibia.
A patient who recently and successfully completed a 12 week program of phase III cardiac rehabilitation will MOST likely demonstrate a decrease in:
A. COz elimination in maximal work
B. cardiac output in maximal work
C. stroke volume at a given level of submaximal work
D. heart rate at a given level of submaximal work
D.
Aerobic conditioning that occurs during the 12 weeks of cardiac rehab will result in a decrease HR both at rest and with exercise.
COz elimination and cardiac output would both
increase with maximal work. The stroke volume would increase during submaximal work.
The demographic information on the subject in a research study list a mean age of 32 and median of 35. The difference between the median and mean indicates:
A. the value of standard deviation score
B. the value of the Z score
C. that the distribution is skewed
D. that the two measures should be average
C. A normally distributed sample has a median and mean that are equal in value. In that type of distribution, the median and mean would be at the halfway point. One half of the scores (50%) would be distributed above the median and one half below. If the median and mean are not of equal value, the distribution is skewed. If the median is of a higher value than the mean, the distribution is to the left, if lower, it is skewed to the right. The standard deviation is a measure of variability of the mean. The z score is a standard score with a mean of zero and a standard deviation of 1. Averaging the two measures would not be appropriate or meaningful.
Rocking in quadruped position could be included in physical therapy intervention for a 40 year old patient to increase ROM at the:
A. hip joint, 1 month post total hip replacement
B. distal radioulnar joint, 2 weeks post fracture of the distal radius
C. glenohumeral joint, 2 months post rotator cuff tear
D. hip joint, 1 week post subcapital fracture of the femoral neck
C.
Increasing hip flexion is usually contraindicated for THA at 1 month. The quadruped position would not be allowed for a patient at 2 weeks post distal radius fracture. There are no precautions for the patient 2 months following a rotator cuff tear as the motions in quadruped rocking would be synonymous with the glenohumeral motions that need to be increased and are achieved in a closed chain position.
A therapist is treating a young athlete with gastrocnemius muscle strength of fair plus (3+/5). In the prone position, which of the following exercises is the MOST appropriate to maximize strengthening?
A. Resistive exercises with the knee bent.
B. Resistive exercises with the knee straight.
C. Active exercises with the knee bent
D. Active exercises with the knee straight.
B.
With a muscle grade of fair plus, the patient should not need active assistive exercise.
Resistive exercise against gravity would be most appropriate to strengthen this muscle. Since the gastrocnemius in a shortened position and lesser its ability to produce tension. Therefore, exercising with knee straight put the gastrocnemius on a stretch, increasing its ability to produce tension.
Redness on the inferior aspect of the patella upon removal of a patellar tendon bearing
prosthesis indicates that the residual limb:
A. is not far enough into the prosthesis and fewer socks should be worn
B. is not far enough into the prosthesis and additional socks should be worn
C. has slipped too far into the prosthesis and fewer socks should be worn
D. has slipped too far into the prosthesis and additional socks should be worn
D. The residual limb is pistoning up and down because the socket diameter is too large or the suspension system is inadequate, resulting in skin friction.
The addition of more socks will
enhance fit.
A therapist is evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine.
Which of the following findings would be the BEST indicator that the
symptoms will respond positively to the PT intervention?
A. The pain is referred only to the buttock and not the thigh.
B. The patient prefers standing and walking than sitting.
C. There is a decrease in lumbar lordosis.
D. Repeated backward bending centralizes the pain.
D. The fact that backward bending is centralizing the pain is an indicator that the nucleus of the disc is being moved centrally and the pressure is being taken off the nerve root. Centralization of the pain is also a good indicator for PT intervention.
A therapist evaluates a patient who has lateral epicondylitis. the patient reports a subjective pain of 8/10. The patient also reports pain and shows weakness with resisted wrist extension.
The therapist decides to use ice massage as an intervention.
The MOST appropriate length of
time for the ice massage is:
A. ten minutes
B. until the area turns red and patient reports burning sensation
C. until the patient reports that the area is numb
D. no longer than five minutes
C. Ice massage is usually applied to control pain, edema and inflammation. In this case, the ice would be used for pain relief and to reduce inflammation, if present. The dosage for ice massage is determined by the patient’s response, and usually applied until the patient experiences analgesia or reported numbness over the area of massage.
Although 5 to 10
minutes may be a usual time for the response to occur, the dosage depends on the patient’s response, not the exact time. The patient will usually feel the following sequential sensations during the massage: cold, burning, aching and then finally numbness.
The desired effect is numbness, not aching. The skin may turn white, however, the desired effect is numbness or pain reduction and not skin color.
Following spinal joint mobilization procedure, a patient calls the therapist and reports a minor dull ache in the treated area of the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should:
A. consider a possible neurological lesion in the area
B. refer the patient back to the physician
C. inform the patient that the response is common
D. add strengthening exercises to the home program.
C. Joint mobilization procedures may cause some soreness. The therapist should inform the patient of this response to treatment. The patient should re-evaluate the patient and could alter the treatment by waiting an extra day before the next treatment or by decreasing the dosage.
There would not be a need to refer to the physician. The additional exercises would not alter the response and there would be no indication of neurological involvement with the reported symptom.
In order to conduct an experimental study on pain in postsurgical orthopedic patients, a therapist randomly assigns patients into two groups. One group is treated with TENS, heat and exercises; the second receives heat and exercises only. In this experimental design, TENS is the:
A. continuous variable
B. dependent variable
C. discrete variable
D. independent variable
D.
The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case, the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables.
A 90-year-old patient with chronic congestive heart failure has been non-ambulatory and a nursing home resident in the past year.
The patient was recently admitted to the hospital
following an episode of dehydration. Which of the following plans for prophylactic respiratory care is MOST appropriate?
A. Turning, coughing and deep breathing every 1 to 2 waking hours.
B. Vigorous percussion and vibration 4 times a day
C. Gentle vibration, with the foot of the bed elevated once a day.
D. Segmental postural drainage using standard positions throughout the day.
A. A patient who is bed bound and immobile will be prone to developing atelectasis (partial collapse of lung tissue); which can lead to pneumonia.
Frequent position changes with deep
breathing and coughing will help prevent development of atelectasis. Given that this patient is elderly and does not have diagnosis of secretion retention, vigorous percussion and vibration is not indicated. Vibration with the head down or standard postural drainage positions will not be tolerated in this elderly patient with chronic CHF.
Which diagnostic procedure is LEAST likely to confirm suspected disc herniation in a patient with low back pain?
A. MRI scan
B. CAT scan
C. Radiograph
D. Myelogram
C. Radiographs are in orthopedics to detect bony abnormalities. Soft tissue defects such as disc herniations would not show up on the radiograph. MRI scans are used to assess degenerative diseases, infarction, tumor, hemorrhage and congenital anomalies. Myelography is used to assess bone displacement, disc herniation, cord compression or tumor. Computed tomography (CAT scan) is used to assess the density, displacement of abnormality of the ventricular system and gray and white matter.
To help the students apply newly learned skill to clinical practice, the MOST effective action for the clinical instructor to take is to:
A. point our possible patient situations and discuss how the skill would apply to them.
B. have the students research reference materials and compile a list of the steps required in the acquisition of the skill
C. prepare a list of indications and contraindications for the skill.
D. have the students provide examples of patient situations where the skill would be appropriately applied.
D.
Behavioral objective should be learner centered, outcome oriented, specific, and measurable.
Option D is the only one that is learner (student) oriented and specific to a
situation. Options A & C require action by the clinical instructor, not the student. Option C, which may be a step in the process is not as learner centered or outcome centered as option D.
It is important to perform cool down exercises immediately following a general aerobic program
PRIMARILY in order to prevent:
A. venous pooling
B. cardiac arrhythmia
C. decrease body temperature
D. muscle tightening
A. During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow and the venous system relies on muscular pumping in order to return blood back to the heart.
Without a cool-down period, there would be no muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well, but is less likely in someone without cardiac disease. Cessation of activity by itself would result in gradual decrease in body temperature and specific exercises are not necessary. Muscle tightening may occur as a result of metabolites accumulating in the circulatory system, but this would occur as a result of the venous pooling.
The intervention for a patient who has right sciatic pain caused by piriformis compression would
NOT include:
A. instruction in mild self-stretching in sitting with the right hip and knee flexed and pressure applied in the medial direction to the distal thigh with the left arm.
B. contract-relax exercise to the hip external rotators performed with the patient sidelying and the right hip and knee positioned in 90 degrees of flexion.
C. active resistive strengthening exercise to the piriformis with the patient prone and the knee flexed
D. application of cold to the area of sciatic nerve irritability
C. The piriformis muscle functions as an external rotator of the hip and it is thought that the tight piriformis muscle may compress the sciatic nerve causing pain. Passive internal rotation and resisted external rotation may be painful.
Intervention would call for stretching of the
piriformis muscle, not strengthening it. Modalities such as ice may also be helpful to decrease the inflammation.
A therapist is assigned in the planning and implementation of services for all members of the community. The therapist’s FIRST step would be to:
A. develop a brochure for distribution to the community.
B. organize a health fair to provide screening for the community.
C. evaluate existing services and community resources.
D. initiate contacts in the medical community to establish prescriptive relationships.
C. The most appropriate first step (pre-planning) would be to evaluate existing services within the community and work out a budget for the project. Options A & B, although important, are things that would most likely be done after the practice is up and running.
Option D may be
done early on in the planning process, but would follow option C.
To prevent contractures in a patient with an above-knee amputation (transfemoral), emphasis should be placed on designing a positioning program that maintains ROM in hip:
A. flexion and abduction
B. extension and adduction
C. adduction and lateral rotation
D. flexion and medial rotation.
B.
Following an above knee amputation (transfemoral), the residual limb has tendency to develop contractures in the hip flexors and abductors.
Therefore, it is particularly important
that the patient be positioned so as to maintain full ROM in hip extension and adduction.
After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right above-knee amputation. For this patient, which of the following is the MOST important factor in establishing long-term goals for functional walking?
A. Status of the wound at the amputation site.
B. ROM of the right hip.
C. Condition of the left lower extremity
D. Ability to maintain upright posture.
C. The left limb must function as the main support limb.
Any treatment strategy for
ambulation must ensure that the remaining limb is optimally functioning and that the limb is healthy. While the other factors are relevant, the integrity of the remaining limb is the greatest concern for this patient establishing long term functional goals.
A patient is referred to physical therapy complaining of severe pain in the right hip and groin area, which increases during walking.
The patient complains of tenderness when the therapist
palpates the area over the right greater trochanter. The MOST likely cause of the patient’s signs and symptoms is:
A. sacroiliac joint derangement
B. a hip fracture
C. a strain of the adductor longus muscle
D. hip bursitis
D. Signs and symptoms of hip bursitis include the following: severe pain over the bursa area, with pain aggravated by active motion including activities such as walking.
Signs and
symptoms of a sacroiliac joint derangement include pain directly over the region of the joint and in the low back, in addition to pain with walking.
Signs and symptoms of hip fracture will
include the following: severe pain in the groin area and tenderness occurs in the area anterior to the femoral neck.
An adductor longus muscle strain would not cause tenderness over the
greater trochanter.
A therapist is conducting a 12-minute walk test with a patient who has COPD and uses 2 L/min of Oz by nasal cannula. The patient’s resting Oz saturation is 91 % and the resting heart rate is 110 bpm. The O2 flow should be increased if the:
A. patient’s CO2 level starts to increase
B. patient starts to complain of shortness of breath.
C. patient’s 02 saturation falls below 87%.
D. patient’s heart rate is greater than 150 bpm.
C. A fall in oxygen saturation below 87% is equivalent to a partial pressure of 55 mg of oxygen in the blood, which is considered to be moderately hypoxemic (low Oz levels). This situation would require increased oxygen levels in order to be rectified.
A rise in carbon
dioxide level would not be alleviated by increased oxygen levels. Complaints of shortness of breath can come from a variety of causes and would not necessarily be alleviated by increased oxygen levels. An increased heart rate to 150 bpm may be a normal response to this activity and would not necessarily require increased oxygen levels.
When working with a neurological patient to ensure that physical therapy services are adequately documented, it is MOST important to record changes in:
A. muscle tone
B. functional abilities
C. cognitive status
D. quality of movement
B. All documentation about physical therapy services should readily translate the physical findings (impairment) into functional abilities/limitations.
A patient has right hemiparesis resulting from TBI. When assessing motor control in the right lower extremity with the patient standing, the therapist finds that the patient cannot extend the hip while flexing the knee or flex the hip while extending the knee.
In which of the following
functional activities will this problem be MOST apparent?
A. Shifting weight while standing.
B. Walking sideways.
C. Walking backward.
D. Moving from sitting position to standing position.
C. Of the four options, backward walking is the only one that requires hip extension with concurrent knee flexion and hip flexion with knee extension.
A patient was injured in a motor vehicle accident two days ago, resulting in quadriplegia at C6 level. When providing PROM to the UE, which of the following is MOST critical in order to optimize long-term hand function?
A. Passive wrist and finger extension exercise to gain maximum stretch of the finger flexors
B. Passive wrist and finger flexion exercise to gain maximum stretch of the finger extensors.
C. Holding the wrist in flexion when passively extending the fingers.
D. Holding the wrist in extension when passively extending the fingers.
C. This patient needs to have functional benefits of tenodesis by allowing the finger flexors to shorten with the wrist extended; therefore, PROM of the finger flexors should be performed with the wrist in non-functional position of flexion.
People with C6-C7 quadriplegia use the
tenodesis grasp.
This allows the fingers to flex with wrist extension and to open with wrist
flexion.
An athlete sustained a severe inversion sprain of the right ankle while playing basketball. To provide strapping support for the ankle, pressure and support should be applied over the
tendons of the:
A. flexor digitorum longus and tibialis posterior
B. gastrocnemius and flexor hallucis longus
C. peroneus longus and brevis
D. tibialis anterior and tibialis posterior.
C. With an inversion injury, the tendons of peroneus longs and brevis can become strained.
Swelling with an inversion strain usually occurs over the anterolateral part of the ankle.
Compression and support is most beneficial by placing tape stirrups on the lateral side of the ankle, over the tendons of the peroneus longus and brevis and pulling the ankle into slight eversion.
In which of the following conditions would a nerve conduction velocity test be MOST important?
A. Carpal tunnel syndrome
B. Cerebrovascular accident
C. Myotonia
D. Duchenne Muscular Dystrophy
A. Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or
Tower motor neuron status.
Therefore, since carpal tunnel syndrome is the only one of the
conditions that directly involves a peripheral nerve, it would be the most appropriate choice. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne muscular dystrophy are primary muscle disorders.
When training a patient to increase muscle activity with the use of MG biofeedback, the therapist should adjust the unit so that sensitivity:
A. starts at low and increases as the patient shows an increase in muscle activity
B. starts high and decreases as the patient shows an increase in muscle activity
C. remains at approximately mid-range during the entire treatment period.
D. is not set, since this is not necessary for this form of biofeedback.
B. Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from muscles. As the sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit (i.e. provide an audio visual cue to the patient).
For use in muscle
re-education, the unit should be most sensitive during the initial treatment so that the patient is able to recruit enough motor units to trigger the unit. As the patient is able to recruit more motor units, the sensitivity is decreased which would require the patient to activate more motor units.
A patient with leukemia has developed thrombocytopenia following a bone marrow transplant.
Which of the following measures are indicative of the status of the thrombocytopenia?
A. T4 lymphocyte count
B. Red blood cell count.
C. Platelet count
D. White blood cell count
C.
Thrombocytopenia is an acute or chronic disease in the number of platelets in the circulation. The T4 lymphocyte count is used to assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of anemia and the white blood cell count would be examined to determine presence of infection or degree of immunosuppression.
During a postural examination, the therapist notes that the patient’s patella both point inward when viewed from the front of the patient. The MOST likely cause of this problem is excessive:
A. femoral anteversion
B. weakness of the vastus medialis
C. genu varum
D. medial tibial torsion
A. The most common cause of inwardly pointing or “squinting patellae” is excessive femoral anteversion. Although there is normally 8-15 degrees of femoral anteversion, an excessive amount leads to squinting patellae and toeing in. The other options would all have a tendency to cause the patella to point outward during standing.
A therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve. During the cranial nerve examination, which of the following would be the MOST significant sign?
A. Inability to close the eyelid
B. Medial strabismus
C. Posis of the eyelid
D. Constricted pupil
C. The oculomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper eyelid and the pupillary constrictor muscle. Therefore, a lesion of the oculomotor nerve would make it difficult, if not impossible for the patient to fully raise the lid (open the eve) and would cause a condition termed posis. In addition, the eye may not react to light and therefore may not show pupillary constriction when light is directed into the eye. Inability to fully close the eye would be seen with a lesion of the facial nerve (Bell’s palsy). Medial strabismus would be caused by damage to the abducens nerve, innervating the lateral rectus causing a medial strabismus.
For a patient with IDDM who is completing a cardiovascular fitness program, what change in diabetic management is MOST likely to be instituted as fitness increase?
A. Switching to oral rather than injected medication.
B. Decreasing caloric intake for 2 to 3 hours following the exercise sessions.
C. Decreasing the amount of insulin taken daily.
D. Increasing the amount of insulin taken daily.
C. Exercise has been shown to increase sensitivity of insulin receptors therefore leading to a decrease in the amount required. Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 - 48 hours after exercise, therefore increasing caloric intake, particularly carbohydrates, would be essential.
An elderly patient presents with a sacral pressure ulcer measuring 6 in. x 6 in.
The wound has
moderate serous fluid drainage and is loosely covered with necrotic and fibrotic tissue, although there are no indications of infection present. The BEST method of debridement would be:
A. daily vigorous scrubbing of the wound.
B. wet-to-dry dressings with normal saline 2 times a day.
C. daily wet-to-dry dressings with 1:1 dilute povidone-iodine (Betadine)
D. whirlpool jet agitation 2 times a day.
B. Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage would require more frequent (i.e., BID) dressing changes. scrubbing of the wound could damage friable tissue.
Betadine can be cytotoxic.
Vigorous
Whirlpool
would not be effective in removing necrotic tissue
A patient is referred to physical therapy for treatment of tenosynovitis. The patient complains of
“pins and needles” sensation on the palmar surface of the first three fingers. The therapist’s examination reveals a positive Tinel’s sign at the wrist and good (4/5) grade thumb opposition.
Based on these findings, the therapist should suspect:
A. median nerve compression at the wrist
B. ulnar nerve compression distal to the elbow
C. tenosynovitis of abductor pollicis longus
D. thoracic outlet syndrome
A. The median nerve supplies sensory innervation to the palmar surface of the thumb, index and middle fingers. A positive Tinel’s sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) and weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory and motor changes in the little and ring fingers, not the thumb. Tenosynovitis of the abductor pollicis longus muscle would most likely reveal a positive Finklestein’s test (stretching of the abductor muscle with pain over the dorsum of the hand. Thoracic outlet syndrome would most likely reveal with special tests that cause alteration of radial pulse.
A patient has disuse atrophy of the anterior compartment muscle following cast removal after a fracture of the tibia. The patient has poor (2/5) strength in the ankle dorsiflexors. Electrical stimulation is to be used to enhance dorsiflexor strength in conjunction with exercise. Initially, which of the following waveform characteristics is MOST appropriate to stimulate the muscles?
A. Monophasic pulse with a frequency of 110 pps and on/off cycle ration of 3:1
B. Biphasic pulse with a frequency of 30 pps and on/off cycle ratio 1:5.
C. Direct current waveform with an on/off ratio of 1:1
D. Interferential waveform with a beat frequency of 1 pps.
B. The most efficient stimulus would be one that causes tetany in the muscle without causing fatigue. The biphasic waveform at 30 ps best fit this stimulus. The 100 ps stimulus rate may cause fatigue, which would be undesirable. The interferential waveform at the frequency of 1 pps is too low and the direct current would not be appropriate because it would not cause tetany.
In addition, an on/off cycle of 1:5 would allow adequate recovery time for the muscles between successive contractions.
A patient is referred to physical therapy with a 20-degree knee flexion contracture following arthroscopic knee surgery a month ago.
All of the following interventions are appropriate
EXCEPT:
A. stretching of the semimembranosus muscle
B. strengthening of vastus medialis.
C. inferior gliding of the patella.
D. mobility of the posterior capsule of the knee joint.
C. A 20 degrees knee flexion contracture means that the knee is unable to complete the last 20 degrees of extension. This limitation of motion can be caused by several factors including tightness of the hamstrings (semimembranosus), restriction in the posterior capsule of the knee, and weakness in the quadriceps femoris muscle (vasts medialis).
Restriction of patellar
movement may also be a factor, however the proper glide technique to increase knee extension would be a superior (not inferior) glide of the patella.
A patient with a complete SCI is sitting in a wheelchair on a custom made cushion. Pressure relief activities should be performed:
A. when the patient shows signs of pressure sores
B. every 15 to 20 minutes
C. every 1 to 2 hours
D. if the patient does not have an appropriate cushion.
B. A patient with thoracic spinal cord level injury is able to perform independent pressure relief strategies and should be complete every 15 to 20 minutes.
During a review, a patient lacks 10 degrees of passive ankle dorsiflexion. The same degree of limitation is present whether the knee is flexed of extended.
The muscle MOST likely
contributing to this restriction is the:
A. gastrocnemius
B. tibialis anterior
C. plantaris
D. soleus
D. The soles originates on the tibia and fibula and inserts onto the calcaneus, crossing only
Therefore, it will have an effect on the ankle whether the knee is flexed or
the ankle joint. extended.
Which of the following assignments is MOST appropriate for the physical therapist to delegate to a volunteer?
A. Restocking treatment booths with linens, US gel, massage lotion.
B. Attending a patient who is on a tilt table while the therapist takes a phone call.
C. Transporting a patient who complains of dizziness back to his room.
D. Transferring a patient from the mat to a wheelchair.
A. The restocking of treatment booths with supplies is the only option which does not involve direct patient contact or care, and thus is the MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with patient care activities (i.e., transporting patients), the patients in the above situations pose a potential risk and would require supervision by someone other than a volunteer.
A patient sustained a severe brain stem injury one week ago and has demonstrated minimal change since the incident. The patient’s cognitive status is MOST likely to include:
A. a decrease level of arousal
B. a decrease level of intelligence
C. an increase level of agitation
D. an increase level of impulsivity
A. A state of alertness to the internal and external environment must be maintained for a motor or mental activity to occur. The brainstem reticular activating system brings about the state of general arousal. To proceed from a state of general arousal to one of selective attention” requires the communication of information to and from the cortex, the thalamus, and the limbic system and its modulation over the brainstem and spinal pattern generators.
The hospital administrator asks members of the rehabilitation department to develop a comprehensive program to help reduce the risk of low back injuries.
Which of the following
would be the FIRST step necessary to develop the program?
A. Include all employees in a lumbar extension exercise class
B. Design a program that meets each department’s functional needs
C. Perform an ergonomic analysis on each workstation
D. Provide pamphlets on proper body mechanics
C. The first step in preparing any education experience is to determine what the needs of the audience are. Since prevention of low back injury is the ultimate goal, assessment of the employee’s workstations is an important first step in planning the education program. Simply instructing all employees in lumbar extension exercises is inappropriate without a thorough evaluation of their physical needs.
Option B cannot be done unless an assessment of the
functional needs has be performed. Providing pamphlets are useful teaching adjunct but would not be the first step to prevent low back pain effectively in this population.
To maximize continuity of patient care, the PT should begin discharge planning when the:
A. physician refers the patient for discharge
B. therapist makes the discharge review of the patient
C. discharge planner requests information pertinent to the patient’s discharge status
D. therapist performs initial review of the patient
D.
The Standards of Practice of Physical Therapy state that the physical therapist is responsible for establishing a plan of care for the patient based on the evaluation of the examination data and patient needs.
The plan of care includes plans for discharge. The
implication is that the long-term goals for the patient (discharge plans) are determined when the therapist first sees the patient. It is anticipated that modifications of the plan of care is to be expected depending on the response of the patient to the intervention.
The PT is positioning a patient for postural drainage. In order to BEST drain the posterior segment of both lower lobes, the patient should be placed in which of the following positions?
A. Prone, head down at 45 degree angle
B. Supine, flat surface
C. Side lying, head elevated 30 degree angle
D. Sitting, leaning forward
A. The best position for the patient, to drain the posterior segment of both lower lobes would be prone lying with the head down and lower extremities and hips elevated about 45 degrees.
A MMT of a patient sustained a gunshot wound just superior to the elbow joint reveals specific muscle weakness from a partial median nerve injury. The PT intervention for this patient would
MOST likely include strengthening activities for wrist flexion and forearm:
A. pronation, finger flexion, thumb adduction
B. pronation, finger flexion, thumb opposition
C. supination, finger abduction, thumb opposition
D. supination, finger abduction, thumb extension
B.
The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2) flexor digitorum superficialis, (3) flexor digitorum profundus (index and middle fingers), three (3) thenar muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis).
Therefore, a lesion of the median nerve would affect those muscles and their
accompanying actions:
forearm pronation, finger flexion and thumb opposition.
Thumb
adduction is accomplished by the adductor pollicis (ulnar nerve).
Finger abduction is
performed by the dorsal interossei (ulnar nerve. Forearm supination is the action of the supinator (radial nerve) and biceps brachii (musculocutaneous nerve).
A patient who has a piriformis syndrome is referred to TP for review and intervention.
The
patient’s history includes THR on the right side 2 years ago. Because of the THR, which of the following should only be used with precaution?
A. TENS
B. Continuous us
C. Hot packs
D. Massage to the right hip
B. The only one of the above interventions that requires precaution because of total hip replacement is continuous ultrasound.
However, that does not mean that ultrasound is
contraindicated for this patient. TENS may be used over metal implants.
Hot packs and
massage would not affect the total hip prosthesis.
A patient presents with adhesive capsulitis of the shoulder joint. The ROM examination reveals restricted external rotation and abduction of the shoulder.
The FIRST mobilization procedure
that should be done for this patient is:
A. posterior glide
B. distraction
C. anterior glide
D. external rotation
B. For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates the joint surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be used in conjunction with the other mobilization techniques listed.
Later, mobilization techniques would most likely
include anterior glide.
A patient sustained a severe TBI 3 months ago. During the exam of passive ROM, the therapist notices decrease passive knee extension and moderate hamstring spasticity. Palpation reveals a firm mass on the lateral aspect of the joint.
The therapist should refer the patient to a
physician for a review of probable:
A. osteogenic sarcoma
B. patellar fracture
C. osteomyelitis
D. heterotopic ossification
D. Heterotopic ossification occurs in 10% to 20% of patients with traumatic brain injury. The abnormal bone formation occurs in the soft tissue surrounding major joints. Patients with spasticity are at increased risk. Loss of ROM is characteristic for this problem. Osteogenic sarcoma is less likely. A patellar fracture would not present as a lateral mass.
A patient complains of anterolateral shoulder pain with insidious onset. Examination shows full passive ROM, pain on passive lateral rotation and pain on resistive internal rotation.
These
signs are consistent with a diagnosis of:
A. bicipital tendonitis
B. supraspinatus tendonitis
C. subscapularis tendonitis
D. infraspinatus tendonitis
C. Pain with resisted medial (internal) rotation and pain with passive lateral (external) rotation is indicative of subscapularis tendonitis. Bicipital tendonitis is suspected if resisted supination is painful when the patient’s arm is at the side and the elbow is flexed to 90 degrees. Painful resisted abduction and resisted lateral (external) rotation is indicative of supraspinatus tendonitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.
A measurable objective for a community education program exercise techniques would be for
participants to:
A. understand the importance of sufficient warm-up period
B. list five stretching techniques that can be used when warming up
C. overcome LE problems and adhere to a regular exercise program
D. appreciate the effects of increasing intensity of exercise on heart rate
B. Objectives must be measurable and the specific behavior expected should be stated.
Understanding, overcoming, and appreciating elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore measurable.
During MMT of the hip flexors in the sitting position, a patient exhibits lateral rotation and abduction of the thigh as resistance is applied.
The PT should suspect substitution by:
A. sartorius
B. tensor fascia late
C. adductor longus
D. semimembranosus
A. The sartorius flexes, externally rotates and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to perform all three actions giving the observed substitution pattern. The tensor fascia late is a medial (internal) rotator flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. The adductor longs would adduct the hip. Substitution by the semimembranosus would cause hip extension.
A PT is treating a patient who has lymphedema in the right LE. The therapist decides to use mechanical, intermittent pneumatic compression as an intervention, using a sleeve that covers the foot, leg and thigh. The therapist measures BP at 135/85 mm Hg. At first treatment session, the MOST appropriate inflation pressure for the sleeve is:
A. 20 mm Hg
B. 60 mm Hg
C. 100 mm Hg
D. 140 mm Hg
B. The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 mmH (higher for the LE than UE). It is also recommended that the pressure be below the diastolic pressure. Pressures below 30 mg are not considered to be effective.
Pressures above diastolic can be used with caution. For the first treatment, it would be most appropriate to use a pressure that is considered effective, yet not so high as to cause a potential problem for the patient. If the patient responds positively to the intervention, the higher pressure could be instituted.
A patient is entering a cardiac rehabilitation program. The PT should FIRST ask the patient to:
A. describe the correct aspect of exercise demonstrated by the therapist
B. list problems associated with nutritional habits
C. identify the harmful effects of smoking with regards to cardiac disease
D. describe the type of angina that the patient experience
D. In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation is necessary to properly form a treatment plan. An important aspect of the examination is ascertaining the type of angina that the patient experience so that the therapist will know how to prevent angina with exercise or recognize if it does occur during the treatment session. The other options provided are all outcomes that would occur after the patient has completed a cardiac rehabilitation program.
A PT receives a telephone call from a woman who identifies herself as a friend of one of the therapist’s patients. She wants to know how the patient is doing and if he will be able to go up and down the stairs, because she wants to take him home for a weekend visit. What should the therapist do?
A. Discuss the patient’s program and functional status with the caller
B. Invite the caller to observe the patient’s next therapy session
C. Refuse to discuss the patient’s status unless the patient’s permission is obtained
D. Refer the caller to the patient’s social worker
C. According to the Guide to PT Practice, “Information relating to therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient’s care without the prior written consent of the patient”. Option C is the only one that fits these criteria.
The parents of a 1-month old child with myelomeningocele report that the child has been increasingly irritable and has changed sleeping patterns over the past three days. The child has also been vomiting. Which of the following is the MOST appropriate action for the therapist to take?
A. Refer to immediate medical follow-up
B. Instruct the parents to monitor head circumference daily
C. Advise the parents to watch the child for worsening symptoms
D. Take the head circumference measurements to compare to subsequent visits
A.
Sixty percent (60 %) of children with myelomeningocele develop hydrocephalus after surgical closure of their lesion. Early warning signs of hydrocephalus include: irritability, changes in sleep patterns, and changes in appetite and weight. 80 - 90 % of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require ongoing follow-up by a physician. Given the seriousness of this child’s symptoms, the child should immediately be referred for medical follow-up.
A therapist is setting up a home program of ES for a patient who has Bell’s palsy. Which of the following muscles should be stimulated as part of the home program?
A. Sternocleidomastoid
B. Masseter
c. Temporalis
D. Frontalis
D.
Bell’s palsy involves the facial nerve.
The frontalis is the only muscle listed that is
innervated by the facial nerve. The sternocleidomastoid is innervated by the spinal accessory nerve, and the masseter and temporalis are innervated by the trigeminal nerve.
A patient is lying supine with his hips and knees extended and hands behind his head. The patient is able to raise his head, shoulder and thorax from the treatment table, but is unable to come to a complete long-sitting position.
The PT should target which muscle for strengthening
program?
A. liopsoas
B. External abdominal oblique
C. Quadratus lumborum
D. Upper rectus abdominis
A. The abdominal muscles are active during sit-ups (with knees extended) up until the spine is completely flexed (head, shoulders, thorax lifted from surface).
In order to come to a
long-sitting position however, the hips must be flexed and the abdominals cannot perform this action because they do not cross the hip joint. Therefore, the hip flexors (iliopsoas among others) would have to complete this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas muscle.
A 14-month old child with spastic diplegia is up on his tiptoes with his toes curled when held in supported standing. This position is characteristic of a:
A. proprioceptive placing reaction
B. moro reflex
C. plantar grasp reflex
D. traction response
C. The plantar grasp reflex is characterized by curling of the toes when the child is held supported in standing.
The reflex is normal up to 9 months of age. Delayed integration of this
reflex can result in delayed, independent ambulation.
A therapist is developing a gait training program for a patient following a THA of the right hip.
The proper instructions and rationale for crutch training utilizing one crutch include holding the crutch in:
A. right hand to decrease activity in the right hip abductors
B. right hand to facilitate action in the right hip abductors
C. left hand to decrease action in the right hip abductors
D. left hand to facilitate action in the right hip abductors
C.
Placing a crutch in the left hand reduces the magnitude of the right hip abductor force needed to prevent the pelvis from dropping on the left side during the stance phase on the right.
Pushing down on the crutch of the right limb reduces the amount of right hip abductor force needed, which is turn reduces the compression force on the right hip joint.
This effect is
desirable in patients who have hip abductor weakness or hip pain.
Following trauma at C5 spinal cord level, a patient was admitted to the hospital. 24 hours later, the patient shows no reflexes, sensation, or voluntary motor activity below the level of injury.
These findings indicate:
A. the presence of spasticity
B. decerebrate rigidity
C. spinal shock
D. a lower motor neuron lesion
C.
Spinal shock occurs as a reaction to spinal cord injury and is characterized by an absence of all reflex activity below the level of the lesion. Depending on the extent of the lesion, the patient may lose all or some of their sensation and motor activity below the level of the lesion.
Spasticity is associated with hyperreflexia and increased muscle tone. Spasticity would be expected to develop following the spinal shock stage. Decerebrate rigidity involves sustained contraction of the UE and LE in extension. With a lower motor neuron lesion, the loss of sensation and motor activity would be confined to a much smaller region (depending on the exact lesion) and would not affect all levels below the lesion.
A right handed woman is being examined by the PT for right sided weakness in her UE and LE.
The muscle tone is hypotonic and she is ataxic during walking.
She has a history of
hypertension and alcoholism. Passive ROM with DTR show hyporefexia.
She has an intention
tremor when she tries to pick up an object from a table, and exhibits difficulty performing the finger to nose test. Where is the MOST probable area of the lesion?
A. Right side, cervical spinal cord
B. Left side, cerebral hemisphere
C. Left side, substantia nigra
D. Right side, cerebellar hemisphere
D. The patient’s signs and symptoms are reflective of a right-sided cerebellar hemisphere lesion.
That is, cerebellar lesions commonly produce hypotonia, hyporeflexia, ataxia and an intention tremor. Cerebellar lesions also produce ipsilateral manifestations in the extremities.
A patient sustained a gunshot wound to the distal posterior thigh that resulted in complete severance of the common peroneal nerve. Which of the following exercise is necessary in the early rehabilitation period to prevent contracture formation?
A. Active plantarflexion, inversion and toe extension
B. Passive dorsiflexion, eversion and toe extension
C. Active dorsiflexion, eversion and toe flexion
D. Passive plantarflexion, eversion and toe flexion
B.
The common peroneal nerve innervates the following muscles: peroneus longus and brevis, tibialis anterior, extensor digitorum longs and brevis, peroneus tertius and extensor hallucis longus. Because of the complete severance, all of those muscles would be affected and would not be able to actively contract until regeneration has taken place.
Therefore, the
patient would completely lose ankle dorsiflexion, version and toe extension. Those motions have to be performed passively in order to maintain ROM.
Option B is the only one that
contains all of the correct actions.
A patient with mild closed head injury and bilateral femur fracture requires instructions in a LE exercise program. In order to plan the most effective teaching methods for this patient, what would be the MOST critical to assess at the initial visit?
(A. Comprehension of written, verbal and demonstrated instructions
B. Short tem memory capacity
C. Hearing and vision
D. Any personality changes compared to the patient’s premorbid status
A. Option A is the best answer. In option B, if the patient does not initially understand the information, then having short-term memory is irrelevant. For option C, hearing and vision are obviously important but the most critical component is comprehension.
A patient with right above-knee prosthesis will be able to maintain the knee in extension while weight bearing if the center of gravity of the body is shifted so that the gravitational line falls:
A. posterior to the axis of the right knee joint
B. lateral to the axis of the right knee joint
C. anterior to the axis of the right knee joint
D. medial to the axis of the right knee joint
C. Static alignment for knee stability is established by positioning of the knee so that lateral
reference line falls anterior to the knee joint.
In order for a patient with bilateral BKA to maximize balance in a wheelchair, the rear wheels should be positioned more:
A. laterally
B. posteriorly
C. anteriorly
D. inferiorly
B. The center of gravity of a person with bilateral above-knee amputation is more posterior that the center of gravity of a person with their E intact. Setting the back wheels more posteriorly will make the patient more stable in the chair.
This adjustment prevents the wheelchair from
tipping backward.
An initial PT evaluation performed on an elderly patient who is 1 day post total hip arthroplasty (non-cemented) using a posterolateral approach.
The patient has no complicating medical
history and was active and independent preoperatively. Which of the following activities is NOT an appropriate goal for the first week of therapy?
A. Active-assistive positioning of the left hip to 60 degrees of flexion
B. Active left hip abduction in right sidelying
C. Independent bed mobility with use of a trapeze
D. Walking with moderate assistance with a standard walker to 25 feet (7.6 meters)
B. Although protocols depend on the surgeon and the approach, it is generally recommended that anti-gravity hip abduction exercises not begin until 5 to 6 weeks post-surgery. Patients are taught to avoid excessive hip flexion, usually beyond 80 degrees. Bed mobility and ambulation would be started 1 to 2 days post-operatively.
A patient with frequent tension headaches has been referred to physical therapy for instruction in a program of progressive relaxation exercises. Which of the following is MOST essential in a program of progressive relaxation to reduce muscle tension?
A. Release of tension by suggestion and persuasion
B. Passive exercise in quiet surrounding to relieve tension
C. General massage using deep stroking and kneading of tense muscle
D. Recognition of the sensation of tension and release
D. Posterior muscle tension is implicated in the development of tension headaches. Positive imagery is recommended as a self-treatment technique, but the awareness of tension and the appreciation of its absence are fundamental. Massage and passive exercise may be relaxing, but the patient must be aware of the sensations of tension to prolong the benefit.
On the fourth day of PT treatment, a patient who has had an ORIF for a hip fracture develops a large ecchymosis over the unaffected hip. The patient has MOST likely developed:
A. a hemangioma
B. a complication of anticoagulant therapy
C. a hematocele
D. deep vein thrombophlebitis
B. Anticoagulation therapy inhibits the synthesis and function of clotting factors and can lead to bruising (ecchymosis) or more severely, hemorrhage. A hemangioma is a benign liver tumor, deep vein thrombosis would result in redness, swelling and warmth in the affected area and most commonly occurs in the calf muscle, not the hip region. A hematocele is a blood cyst.
A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being monitored with electrocardiogram leads. During the exercise, the ST segment becomes depressed by 2 mm. If the cardiologist has given no specific guidelines, the PT should:
A. terminate the session immediately
B. reduce the resistance load
C. instruct the patient to slow down
D. direct the patient to continue as before
A. An ST segment depression of greater than 1 mm is indicative of myocardial ischemia.
Continuing the exercise session could place the patient at serious risk for continued ischemia, which could ultimately lead to myocardial infarction. Therefore, the best response for the therapist would be to stop the exercise session immediately and inform the cardiologist of the patient’s response. All the other options would continue to place the patient at risk.
A patient slips, falls and cuts her arm in the clinic. The cut is bleeding and the patient is alert and well oriented. In performing first aid for the patient, the FIRST action that the PT should take is to:
A. don a pair of gloves
B. clean the cut with an antiseptic
C. check the patient’s BP
D. cover the cut with sterile dressing
A. Infection control requires that the wound not be contaminated further, and that the health care workers protect themselves from disease by avoiding contact with body fluids. In this case, the patient does not appear to be in life threatening danger, and so the wound should be attended to. Therefore, checking the patient’s blood pressure would not be the first ting to do.
Once the gloves are donned, cleaning the wound and covering it with a sterile dressing would be appropriate.
A PT is working with patient who is aware that he is terminally ill. What is the MOST appropriate intervention when the patient wants to talk about his prognosis?
A. Discourage discussion of death or dying
B. Refer the patient for pastoral counseling
C. Relate the therapist’s experiences with other patients
D. Encourage the patient’s statement of feelings
D. Patients should be encouraged to express their feelings. Comparisons to other patients who are dying in an effort to assure the patient is not alone, takes away from this patient’s feelings. Denial of death would not be good for the patient, since he must ultimately cope with the inevitable. Pastoral counseling would be an option, but the therapist should be ready to listen to the patient, encourage statement of feelings and avoid denial.
Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta blocking medication should receive an explanation of the:
A. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic level
B. need to use measures other than heart rate to determine intensity of exercise
C. need for exercise training sessions to be more frequent but of shorter duration
D. need for longer warm-up periods and cool-down periods during an exercise session
B. The patient taking beta-blocking medication will experience a lower heart rate and blood pressure response during exercise as compared to a patient who is not taking this medication.
Since the heart rate is lower than anticipated, using heart rate to monitor exercise intensity may not be as accurate. Another measure, such as the Borg Scale (rating of perceived exertion) would be more beneficial. However, even though heart rate and blood pressure would be lower, the patient actually achieves the same metabolic levels during exercise and therefore altering the frequency or duration of exercise is unnecessary. The time for warm-up and cool-down exercises is not to be altered.
A clean, well granulating stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed with:
A. a non-adherent dressing
B. a packed dressing
C. topical medication only
D. dry-to-dry gauze
A. Anon-adherent dressing is best choice because any adherence of the dressing to the fragile granulating tissue could cause additional trauma. This is superficial wound, so there would be no need to pack the wound.
Since there is some drainage, a covering is preferential to topical
medication only.
A PT examines a patient who complains of foot pain while jogging. The examination sows that the patient has excessive foot pronation and forefoot varus.
The therapist decides to try a
temporary orthotics insert in the patient’s running shoe. Which of the following would be the MOST appropriate orthotics insert?
A. A lateral forefoot post under the fifth metatarsal head
B. A lateral rearfoot post under the calcaneus placing it in everted position
C. A wedge placed under the instep of the medial foot just beneath the head of the talus
D. A medial post just proximal to the first metatarsal head
D. Pronation of the foot can be caused by a variety of factors including calcaneal eversion and forefoot varus. Correction of the pronation by an orthosis could include a medial post (wedge) placed just proximal to the metatarsal heads or a medial post under the calcaneus.
The
approach involves bringing the ground up to meet the foot.
A post under the fifth metatarsal
head would accentuate the problem, as would a rearfoot post placing the calcaneus in an everted position. If the patient has excessive forefoot varus, a wedge may be placed in the instep in addition to the medial wedge proximal to the metatarsal heads to distribute the load, however, a wedge in the instep by itself would not be the best intervention.
A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint range of motion.
Which of the following would be the MOST appropriate to
increase shoulder abduction?
A. Distraction with inferior glide
B. Anterior glide with internal rotation
C. Superior glide with approximation
D. Distraction with posterior glide
A.
Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, treatment to mobilize that portion of the capsule is of primary concern.
Inferior glide
would stretch the inferior portion of the capsule.
An 8-year-old child who has juvenile rheumatoid arthritis is developing bilateral knee flexion contractures. Which of the following would be the LEAST appropriate action?
A. Exercises to increase joint mobility
B. Ultrasound to the hamstring insertions to increase tissue extensibility
C. Progressive weight bearing by walking in a therapeutic pool to increase endurance
D. Exercise to increase quadriceps strength
B. Options A, C and D are acceptable interventions for this patient. The epiphyseal areas (growth areas of bones) in children should not be exposed to ultrasound. The application of ultrasound over the knee joint (hamstring insertion) could expose the epiphyseal areas to the ultrasound.
Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is positioned in 90 degrees or more of flexion because in this position the:
A. condyles of the femur glide posteriorly on the condyles of the tibia
B. hamstrings act as rotating force
C. patella deviates inferiorly
D. tension on the ligaments is decreased
D. When the knee is extended, the medial and lateral collateral ligaments are taut. During knee flexion, the ligaments slacken.
Therefore, there is very little tibial rotation when the knee is extended (close packed position) and approximately 40 degrees of axial rotation with the knee flexed. Although the femoral condyles may glide posteriorly (depending on the direction of rotation) on the tibia and the hamstrings may rotate the tibia, the reason the motion is available is due to laxity in the collateral ligaments. Other ligaments such as the cruciates and the joint capsule may add to the stability in the close packed position.
A PT is screening a young adult patient for a possible right thoracic, left lumbar structural scoliosis. The postural deviation commonly seen with this diagnosis would be:
A. spinous processes of the thoracic spine rotated to the right
B. high left shoulder
C. posteriorly protruding scapula to the right
D. prominent right posterior rib cage
D. Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve defining the vertebral level. In the right thoracic, left lumbar scoliosis, there is a convex curve to the right the thoracic spine and a convex curve to the left in the lumbar spine. In the thoracic spine, the body of the vertebrae rotates to the right (convex side and the spinous process rotate toward the left (concave side).
Along with this transition, the ribs rotate
posteriorly on the convex side causing the scapula to become more prominent on the convex side and causing the shoulder to be elevated on the convex side.
A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis would include all of the following EXCEPT:
A. strengthening of the scapular protractors
B. strengthening the thoracic erector spine muscles
C. lengthening the short suboccipital muscles
D. lengthening the lumbar erector spine muscles
A. With this particular posture, the patient’s scapula would be in a protracted (abducted) position, therefore the scapular protractors are already overactive and would require stretching, not strengthening. The kyphosis suggests that the thoracic erector spine muscles are weak and need strengthening.
The lumbar lordosis indicates shortened lumbar erector spine
muscles. Forward head posture suggests that the cervical spine is flexed and the occiput is extended, therefore stretching of suboccipital muscles would be indicated. A TEST-TAKING HINT. Although EXCEPT questions are rarely used on the NPTE, be alert for this type of question and read the responses so that you select the unrelated response.
A patient in the eighth month of pregnancy presents with numbness and tingling of the left hand except the fifth digit. She demonstrates edema of the hand and fingers, a positive Tinel’s sign at the wrist, and a good (4/5) muscle test grade of the wrist and finger flexors.
The MOST
appropriate intervention would be:
A. a wrist splint to position the wrist in full extension
B. a hot pack followed by tendon gliding exercises
C. resistive exercises for the wrist and finger flexors
D. frequent rest and elevation of the left upper extremity
D.
Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated with the individual being in the eighth month of pregnancy. In this case, rest and elevation would do the most to decrease the edema and relieve the symptoms.
The wrist should not be positioned in full extension. Initial conservative treatment sometimes includes cock-up splinting to hold the wrist in neutral to 10 degrees of extension, but not full extension. Although tendon-gliding exercises may be used, heat would not be indicated since it may increase the edema. Resistive exercises for the wrist and fingers may aggravate the compression in the carpal tunnel.
An exercise program for a patient with Parkinson’s disease would MOST likely include exercise
to:
A. decrease movement of the upper extremities and trunk
B. increase trunk flexor strength
C. improve balance reactions and reciprocation
D. stretch back extensor muscle
C. Patients with Parkinson’s disease are characterized by rigidity, bradykinesia, tremor, lack of associated movements, impaired balance reactions and a flexed posture (kyphosis). Therefore intervention should be directed toward full ROM and correction of kyphotic posture through back extensor strengthening exercises, balance exercise, and exercises that promote reciprocal movement. Option C is the only one that includes appropriate exercises.
If a BK prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:
A. excessive knee flexion in early stance
B. premature knee flexion in late stance
C. insufficient knee flexion in early stance
D. excessive knee flexion in late stance
A. Upon heel contact, the heel section compresses partially absorbing the ground impact and thus permitting a controlled plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too soon and excessively. An excessively firm heel wedge would not be a factor in late stance.
A patient who has COPD is being treated with a regimen that includes pursed lip breathing exercise. The PRIMARY purpose of the pursed lip breathing is to:
A. help prevent collapse of pulmonary airways during exhalation thereby reducing air trapping
B. decrease the removal of CO2 during ventilation
C. increase the residual volume of respiration so that more 02 is available for body metabolism
D. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated
A. A patient with COPD has premature collapse of the airways upon exhalation, which leads to air trapping and ultimately poor gas exchange. Breathing out through pursed-lips slows the airflow and creates a backpressure, which helps to prevent the airways from collapsing while exhaling. By exhaling more fully through pursed-lips, more carbon dioxide is removed. By preventing airway collapse and air trapping in the lungs, the residual volume is actually decreased. Pursed-lipped breathing helps with ventilation, but does not necessarily assist with secretion mobilization.
A patient with a diagnosis of cervical radiculopathy reports numbness of the right little finger.
The therapist would MOST likely find a diminished DR in the:
A. biceps brachii
B. deltoid
C. triceps brachii
D. brachioradialis
C.
The dermatome providing sensation to the little finger is innervated by the C8 nerve root.
The triceps brachi is the only one of the muscles listed that is also innervated by the C8 nerve root.
The biceps brachil, deltoid, and brachioradialis are innervated by the C5, C6 and sometimes C7 nerve roots.
A therapist is planning a patient education program for a group of patients with chronic LBP. To increase the likelihood that the patients will utilize the proper body mechanics at the work site, the therapist should:
A. ask patients to demonstrate the use of proper body mechanics
B. provide a reference list of articles describing body mechanics
C. ask patients to describe actions they do that increase their back pain
D. provide information on the frequency of low back injuries due to improper body mechanics
A. Evaluation of the patient’s retention of information presented in the program can be enhanced by asking the patients questions about the program information, having the patient ask questions about the program, having the patients demonstrate what they have learned and testing the patient about the program material. Option A is the only one that utilizes one of these techniques. The other options do not require active participation by the patients; they do not address specific interventions.
A patient presents with hemiparesis and demonstrate a foot drop during swing phase of gait. It would be MOST appropriate to administer FES to the tibialis anterior and the:
A. gastrocnemius
B. tibialis posterior
C. extensor digitorum longus
D. peroneus longus
C.
During the swing phase of gait, the foot is dorsiflexed to clear the foot. Muscles active during this phase of gait are the tibialis anterior, extensor hallucis longs and extensor digitorum longus. The gastrocnemius, tibialis posterior and peroneus longs are active during the stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longus is the best choice. If only the tibialis anterior was stimulated, the foot would go into inversion and dorsiflexion, which could cause the patient to land on the lateral side of the foot at initial contact causing them injury. Addition of the extensor digitorum longs would bring the foot up into more dorsiflexion and avoid excessive inversion.
A PT is treating a patient with iontophoresis.
If the current is set at 4 mA, the duration at 15
minutes, and the dexamethasone solution at 0.4%, with an electrode area of 4 cm2, how would the therapist record the current dosage?
A. 0.16 mA.mg
B. 16 mA/cm?
C. 0.60 mg/min
D. 60 mA.min
D. The current dosage for iontophoresis is calculated by multiplying the current (4 mA) by the duration (15 minutes). In this case, the calculation would yield a value of 60 mA.min. None of the other options use the correct value.
An elderly patient has diabetic neuropathy. Upon examination he shows marked mediolateral instability of the left ankle while walking.
The patient also has fluctuating edema and
glove-and-stocking sensory loss in both legs. The MOST appropriate orthotics aid would be:
A. a double-upright ankle foot orthosis
B. hip to toe shoes
C. a prefabricated plastic, solid ankle-foot orthosis
D. a spiral ankle foot orthosis
A.
The double-upright metal ankle foot orthosis would provide the best support for mediolateral instability and would allow for changes in leg volume. The plastic solid AFO would not provide as much mediolateral support and because of its conformation of the leg, it would not be advisable for patients who are experiencing changes in leg volume due to edema. High top shoes would not provide enough support.
The spiral AFO would not provide needed
stability to the ankle and the design would not be indicated with a patient has fluctuating edema.
A 25-year-old patient with cystic fibrosis has been experiencing successful mobilization of thickened secretions by standard percussion and postural drainage.
During the current
treatment session, the patient coughs up sputum that has small, brownish streak of blood. The PT should:
A. percuss more vigorously in an attempt to clear out any other blood that is present in the airwavs
B. perform postural drainage in upright positions for this type of patient only
C. continue treatment with little modification unless more blood is noted
D. stop the treatment and send the patient to the emergency room
C. Hemoptysis or the coughing up of blood can be benign or severe and can be a common occurrence in the cystic fibrosis population secondary to the pathophysiological processes in their pulmonary system. In general, a small amount of hemoptysis that occurs occasionally or a non-persistent hemoptysis is benign. The brownish color indicates either venous blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate to continue treatment without modification. If the blood was larger in amount and fresher (denoted by a bright red color), then the treatment should be discontinued. The presence of blood in the sputum should not warrant more vigorous chest percussion, until it is deemed appropriate to continue with the session.
Since this situation is a benign scenario, alteration of drainage
position is not necessary, and there is no need to send the patient to the emergency room.
Which of the following should be recommended for a patient following a medial meniscectomy if the PT plans to exercise the quadriceps femoris against accommodating resistance?
A. Knee bends through half of the range
B. Knee extension with sandbag in the ankle
C. Knee extension on an isokinetic exercise device
D. Straight leg raising with a sling suspension
C. Isokinetic exercise device utilize accommodating resistance throughout the range of motion.
The other exercises are not forms of accommodating resistance.
In a suction socket prosthesis, the primary function of the valve in the lower and medial part of the socket is to permit air to:
A. remain during the stance phase of gait
B. remain during the swing phase of gait
C. escape during the swing phase of gait
D. escape during the stance phase of gait
D. Air is released during the stance phase of gait, which results in a negative pressure inside the socket to provide a suction suspension during swing phase.
A patient with chronic venous insufficiency of the LE would MOST likely exhibit:
A. normal superficial veins, no edema, ulceration and patches of gangrene around the toes
B. dilation of superficial veins, edema, stasis ulceration
C. no edema, cold, hairless LE, faint dorsalis pedis pulse
D. dilation of superficial veins, edema made worse during sitting or leg elevation
B. With venous insufficiency, the limbs would be edematous, the superficial veins would be dilated and if not corrected ulceration could develop. Options A and C are ruled out because they indicate no edema. Option D is not correct because the condition is relieved by sitting or leg elevation.
Following removal of a long leg cast, a patient has limited knee flexion. The MOST appropriate direction of patellar mobilization would be:
A. distal
B. lateral
C. proximal
D. medial
A. In order to improve knee flexion, the therapist needs to address patellar tightness. During flexion at the knee, the posterior motion of the tibia causes the ligamentum patellae to pull the patella distally and posteriorly.
Patellar mobilization in the distal direction would assist with increasing knee flexion.
Which lower extremity PNF pattern is MOST appropriate for a patient who needs strengthening of the tibialis posterior?
A. Hip extension, abduction and medial rotation with ankle plantarflexion and eversion
B. Hip flexion, adduction and lateral rotation with ankle dorsiflexion and inversion
C. Hip extension, adduction and lateral rotation with ankle plantarflexion and inversion
D. Hip flexion, abduction and medial rotation with ankle dorsiflexion and eversion
C. The tibialis posterior plantarflexes and inverts the foot. This pattern requires the specific action of that muscle. The other patterns do not.
A patient is referred to PT with a diagnosis of low back pain. Radiographic studies, including MRI, have rules out the presence of disc pathology. The patient complains of continuous back pain that radiates towards the thorax and anteriorly into the abdominal region. The therapist should consider which of the following areas as a potential source of discomfort?
A. Dura mater
B. Diaphragm
C. Kidney
D. Urinary bladder
C. Pain that is experienced in the thoracic spine can be caused by a variety of pathologic conditions. Low back pain can be either mechanical or non-mechanical in nature. Pathology in the kidney may refer pain to the lumbar spine (ipsilateral flank), or upper abdomen.
Pathology in the urinary bladder refers to the subpubic or thoracolumbar region.
The
diaphragm is innervated by C3, C4 and C5 with the pain normally confused to the C4 dermatome.
The negative MRI has ruled out possible involvement of the dura mater.
An adult patient who was involved in a motor vehicle accident has sustained multiple traumas, including fractured ribs on the right side.
The patient is unconscious, intubated and on a
mechanical ventilator in the ICU. Chest radiographs show the development of an infiltrate in the lower lobe during the past two days. Rales and ronchi are heard over the right lower lung fields.
Which chest program is MOST appropriate?
A. Manual hyperventilation and suctioning while positioned on the left side
B. Positioning supine for suctioning, followed by manual hyperventilation while positioned on the left side
C. Suctioning, percussion and vibration while positioned on the right side
D. Positioning on the left side for deep breathing exercises only
A.
In order to optimally clear the congestion that has developed in the right lower lobe, the patient would need to be positioned on the left side to allow gravity to help drain the secretions to the proximal airways.
This patient is also unconscious and intubated so in addition to
drainage, manual hyperinflation is necessary to provide increased ventilation which would help mobilize secretions followed by suctioning to clear out secretions.
Suctioning first then
hyperventilating while in left sidelying less effective than the order suggested in option A.
Positioning on the right side would not drain the right lower lobe, and also since the patient is lying on the right side, the only place to percuss and vibrate would be on the left side, which has no pathology. Finally, positioning on the left side with deep breathing will no be effective in mobilizing secretions, especially since the patient is unconscious and unable to actively perform breathing exercises
A patient who has RA comes to PT with signs of muscle atrophy, ecchymosis, puffy cheeks and a diagnosis of osteoporosis. This patient is MOST likely receiving a high dosage of:
A. penicillin
B. prednisone
C. aspirin
D. gold salts
B. Prednisone is a glucocorticoid that exhibits these side effects. The primary side effect of penicillin is an allergic reaction such as skin rashes and difficulty breathing. The primar side effect of aspirin is gastritis. The primary side effect of gold therapy is diarrhea, irritation of oral mucosa and skin rashes.
A PTis examining a patient who has difficulty making a fist. The muscle test show the following: flexors of the 2nd to 5th digits at the PIP are normal (5/5); flexors of the 2nd and 3rd digits at the DIP are normal (5/5); flexors of the 4m and 5t digits at the DIP are poor (2/5). These findings are consistent with a lesion of the
A. median nerve C8-T
B. median nerve C5-C6
C. ulnar nerve C5-C6
D. ulnar nerve C8-T1
D. The weakness in the flexors of the 4th and 5th digits at the DIP joint (2/5). The other fingers show normal strength (5/5). This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints are involved. The FDP is innervated by both median and ulnar nerves. The median nerve innervates the FDP muscles flexing the index and middle fingers.
The ulnar nerve innervates the FDP muscles flexing the ring and little fingers. Therefore, since the ring and little fingers are involved, the lesion would have to be involving the ulnar nerve.
The FDP to the 4th and 5th fingers is innervated by the ulnar nerve roots C8 and T1.
An elderly man who lives alone fell in his home, sustaining a hip fracture, which necessitated a THR. The patient was previously able to perform all ADLs independently. He has been admitted to a skilled nursing facility for rehabilitation.
The patient’s goal is to return home. His
family believes he should be admitted to a long-term care facility for his own safety once acute rehabilitation is completed. The therapist’s MOST appropriate action is to:
A. advise the family that the patient should determine his own discharge environment
B. recommend a team conference with the patient and his family to discuss discharge plans
C. schedule a home visit to determine if home modifications are needed before discharge
D. implement a treatment plan with a long term goal of discharge to home
B.
The best answer would be for the therapist to recommend a team conference. That conference would bring together members of the health care team as well as the patient and family members, to arrive at joint decision as to the placement of this patient. The best time for such meeting would be prior to discharge, because after discharge, it is difficult to arrange such meetings. Allowing the patient to determine his own discharge environment may be fine if there is no safety concern, however a decision whether or not the patient is competent to make the decision must be made first. Scheduling a home visit or the implementation of a treatment plan for home care would be premature until a decision on placement has been made.
During LE exercise, a patient with incomplete C6 quadriparesis reports a new onset of tingling and numbness in both hands. MMT reveals that overall strength has decreased by one grade.
In this situation, the therapist’s MOST appropriate course of action is:
A. modify the exercise program to accommodate change in strength
B. apply an ice massage prior to exercise
C. continue LE therapeutic exercise and use facilitation techniques to stimulate more activity
D. discontinue all exercises and notify the physician
D. Sudden tingling of the hands and weakness of muscle groups are alarming signs of cord compression. The concern is that the spinal cord sustaining further injury. The exercise may be exacerbating or causing these signs.
This is considered a medical emergency and the
physician should be immediately advised.
In early management of a patient with partial peripheral nerve injury, the goal of the PT intervention will MOSTlikely be to prevent:
A. nerve degeneration
B. spasticity and increase muscle tone
C. muscle atrophy
D. contractures and adhesions
D. The primary physical therapy goal in this case would be joint protection and prevention of contractures and adhesions, usually through splinting. There is no evidence to suggest that physical therapy can prevent nerve degeneration and muscle atrophy, as they are the normal effects of a peripheral lesion. Spasticity would not be present in lower motor neuron injury.
A PTis developing an educational program for individuals with LE peripheral neuropathies due to diabetes. Which of the following is the MOST important information for the PT to recommend for the prevention of injury to the foot?
A. Orthosis to support the extremity
B. Use of proper footwear
C. Moisturizing the skin to prevent dryness
D. Exercise parameter
B. While all of the above would help prevent injury to a diabetic foot, the most important information to provide is about proper footwear. Ensuring properly fitting footwear would alleviate risk of skin breakdown as well as providing appropriate cushioning to the articular cartilage of the foot joints that are prone to injury from repetitive trauma and compression.
Orthoses may not be necessary for all patients.
Despite moisturizing the skin, if there is improper protection, skin breakdown can still occur. Exercising within appropriate parameters will not be beneficial if the patient’s footwear is not supportive or properly fitting.
Elevating a patient’s LE for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive hyperemia in a dependent position.
These signs are indicative of:
A. an intact circulatory system
B. arterial insufficiency
C. venous insufficiency
D. acute arterial occlusion
B. An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with arterial insufficiency may not be able to sustain adequate blood flow against gravity. The vasodilatation, caused by local mechanisms, occurs in response to ischemia. An acute arterial occlusion creates pallor, but because blood flow is blocked, the reactive hyperemia is impaired.
While ascending stairs, an elderly patient leans forward with increased hip flexion. Which of the following muscles are being used to the BEST advantage with this forward posture?
A. Rectus femoris
B. Tensor fascia lata
C. Gluteus maximus
D. Lumbar paraspinal
C. The gluteus maximus is a hip extensor that is more active during resisted motions or when the hip is in flexion, especially in functional activities such as stair climbing. In this case, the patient flexes the hip placing the gluteus maximus in stretch increasing its ability to produce tension.
Therefore, the patient is leaning forward to maximize the ability of the gluteus
maximus to extend the hip during the stair climbing activity. The other muscles listed would not benefit as much from the increased hip flexion.
A therapist is treating a patient with moderately well controlled type I diabetes. One of the goals is to help regulate her insulin dosage through therapeutic exercise. In establishing an exercise program, the therapist should be aware that regular exercise will generally:
(A. lower blood glucose levels and decrease amount of insulin required
B. lower blood glucose levels and increase amount of insulin required
C. raise blood glucose levels and decrease amount of insulin required
D. raise blood glucose levels and increase amount of insulin required.
A. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of
24 to 48 hours after exercise. Exercise has been shown to increase sensitivity of the insulin receptors therefore leading to a decrease in the amount of insulin required.
A PT recognizes that departmental education materials are written on a reading level that is too difficult for some of the patients.
The PT can help the patients better understand the materials
by:
A. including illustrations and a larger print
B. including illustrations and a simpler sentence structure
C. reducing the number of syllables and lengthening the sentences.
D. using a larger print format to present specific medical terminology
B. A larger print will not simplify the meaning, nor will lengthening the sentences. Only option
B, the choice and illustrations and a simpler sentence structure is correct.
An inpatient PT department has only one PT and one PTA on duty due to staff illness. A patient with which of the following is MOST appropriate for the therapist to delegate to the assistant?
A. Ataxia, who is undergoing a trial to determine an appropriate assistive device
B. Hemiparesis, whose initial review has not been completed
C. Multiple sclerosis, so is receiving gait training with a rolling walker
D. Alzheimer’s disease, who is easily agitated during the initial gait training
C.
A physical therapist would be required to perform the initial evaluation, plan of care, re-evaluations, modifications to the plan of care and discharge plan for the patient. The patient who is stable and on an existing program would be most appropriate patient to be delegated to the assistant. Therefore, the patient who has multiple sclerosis who is on an established gait training program would be the most appropriate.
The other three patients are receiving their
initial treatments.
During inspiration, a patient demonstrates increased upper chest expansion with retraction of the epigastric area. The PT should suspect weakness of the:
A. scalene muscle
B. diaphragm
C. rectus abdominis
D. intercostal muscles
B. Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents with a resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension and may result in a compensatory increase in upper chest expansion to improve ventilation. The scalene muscles act to elevate or stabilize the clavicle during inspiration. The rectus abdominis is a stabilizer during inspiration and assists with forced expiration.
The intercostal muscles act to stabilize the thoracic cage during
ventilation.
The brother of a patient who was recently discharged from the hospital’s outpatient PT department telephones on the patient’s behalf to request a copy of the patient’s medical record.
The therapist should explain to the patient’s brother that the medical record is the property of the:
A. patient’s family and can be released to the bother upon request
B. patient’s insurer now and that the request for a copy must be made in writing to the insurer
C. hospital and the patient can be released only with written authorization from the patient
D. hospital and can be released only with written authorization from the patient’s physician
C.
The medical record is owned by the hospital subject to the patient’s interest in the information it contains. Unless restricted by state or federal law or regulation, a hospital shall furnish to a patient, or a patient’s representative parts of the hospital record upon request in writing by the patient or their representative. Option C is the only correct answer in this case, since it specifies that the patient must authorize the release of information.
A PT is examining a patient for a possible LE weakness. PROM is within normal limits. The patient is seated. When the patient tries to dorsiflex and invert his right foot, he is unable to move it through the full ROM and is unable to take any resistance applied by the therapist.
During the subsequent gait examination, the therapist would MOST likely expect the patient to display which of the following?
A. Normal gait, with no deviations
B. Increased right hip flexion during swing phase
C. Throwing the trunk backward, on the right side, shortly after the initial contact
D. Lateral bending toward the right side during midstance
B. The anterior tibialis shows poor (2/5) grade strength during the examination. Because this muscle is active during swing phase of gait and shortly after initial contact, one would expect to see gait deviation showing up at those times.
Specifically, the anterior tibialis maintains
dorsiflexion of the foot during swing phase and controls plantarflexion after initial contact.
During swing phase, weakness of the anterior tibialis would cause the patient to increase the amount of hip and knee flexion to prevent toe drag. With weak hip abduction, this patient would be expected to have excessive pelvic rotation. To compensate, the patient would laterally bend toward the weak (right) side during midstance to help prevent the excessive hip drop. Throwing the trunk backward after initial contact may be due to weakness of hip extensors (gluteus maximus.
A patient is referred for PT with a diagnosis of chondromalacia patella. The PT decides to include quads setting and SLR as part of the home exercise program because:
A. the vasts medialis muscle is primarily responsible for terminal knee extension
B. quads setting and SLR help improve patellar tracking
C. Patellofemoral compression forces are increased when the knee is extended
D. the vastus medialis muscle is preferentially activated during SLR.
B.
The patient’s symptoms would be aggravated by exercises that cause increases in patellofemoral joint reaction force. One of the goals of treatment would be to promote proper patellar tracking. Isometric exercises such as quadriceps setting and SR are most often used for strengthening with a diagnosis of chondromalacia patella because they produce smaller patellofemoral joint reaction forces than some other forms of quadriceps exercises, and thus are less painful. The vasts medialis is one of the muscles active during quads setting. This muscle tends to pull the patella mediall during contraction and thus acts as a dvnamic medial stabilizer, which promotes proper patellar tracking.
The vasts medialis is not preferentially
recruited during a straight leg raising, nor it is the only muscle responsible for terminal knee extension. Patellofemoral compression forces are generally less during SLR than when doing extension exercises with the knee bent.
A patient with low back pain has been undergoing treatment for two sessions. The patient tells the therapist that today the pain is centralizing with the extension exercises, but is intense as it was at the first treatment session. The patient is frustrated by this reaction. The therapist’s most appropriate response would be:
A. continue with the present program
B. eliminate the extension exercises
C. consult the patient’s physician about the situation
D. progress to trunk flexion exercises
A. With an extension exercise program, centralization indicate that the patient is improving, even through the pain may be just as intense as it was. Even though the patient may feel frustrated, he is actually improving, and therefore the therapist should continue with the extension exercise program.
There is no need to call the physician at this point, since the
centralization is perfectly normal. Although trunk flexion may be used later in the intervention, it would not be indicated at this point because extension is working.
Which of the following statements does NOT document patient outcome?
A. The patient propelled his wheelchair independently after 4 weeks
B. The patient demonstrated independent performance of home program after 2 weeks
C. The patient walks 100 feet with minimal assistance after one week
D. The patient attended PT sessions 3x a week for 2 weeks
D. An outcome measure documents a desired performance or change in the patient’s condition over time. This may include a description of the patient’s function before, during and after intervention. Option D does not indicate a change or function, but is focused on attendance.
Which of the following is the MOST likely cause of reduced vital capacity in a patient who has quadriplegia at C5-C6 level?
A. Decreased anterolateral chest expansion resulting from paralysis of the external intercostals
B. Inability of the patient to generate a negative intrapleural pressure secondary to a enervated diaphragm
C. A relatively high resting position of the diaphragm resulting from paralysis of abdominal
muscles
D. Reduced rib cage elevation due to paralysis of the anterior scalene and sternocleidomastoid muscles
A. The rib cage would not be able to expand normally during inspiration due to weakness of the intercostal muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the C5-C6 level, the diaphragm would still receive innervation from the phrenic nerve (C4). The anterior scalene (C4-C6) would be partially innervated and the sternocleidomastoid (C2-C3) would be fully innervated. The abdominal muscles would not be innervated since they receive their innervation from thoracic nerve segments. Paralysis of the abdominal muscles would cause the diaphragm to assume a low resting position.
An attorney calls the PT department seeking information on the status of his client, a patient who is undergoing rehabilitation following total knee surgery.
The patient’s physical therapist
should:
A. refer the attorney to the patient’s insurance carrier
B. describe the patient’s current status
C. require written authorization from the patient to release information
D. obtain verbal permission from the patient to release information
C.
“Information relating the therapist-patient relationship is confidential and may not be communicated to a third party not involved in that patient’s care without the prior written consent of the patient”. Option C is the only one that fits these criteria.
Involving interdisciplinary team members in making decisions about continuity of patient care has all of the following benefits EXCEPT:
A. promoting each individual’s commitment to, and responsibility for, the decisions that have been made by the group
B. discouraging one or two members from being in control and having all the authority
C. enabling decisions regarding quality of care to be made quickly
D. promoting quality of care by including several aspects of the patient’s care
C. Inclusion of all members of the health care team into decision-making is important for the patient and provides for continuity of care for the patient. However, the team approach has some pitfalls such as arranging meetings between team members, which may be a time consuming process. The team concept would also assume that the team reaches a consensus that require more time than relying on individual decisions that can be made quickly. Therefore, option C is the best answer to the question. The other three options are advantages of the team concept.
Instruction in energy conservation and joint protection should be provided to the patient with rheumatoid arthritis because:
A. the joints may be predisposed to damage by overuse
B. fatigue often masks joint pain
C. phagocytes remove more pannus in resting joint
D. activity of the antigen-antibody complex is diminished with rest
A. Rheumatoid arthritis is a chronic inflammatory disease that affects many body systems including the joint space. Destruction and subluxation of joints can occur over time secondary to the inflammation that occurs in the synovium. Fatigue is a common symptom that accompanies RA. Therefore, the patient must get enough rest to avoid excessive fatigue and to protect the joints from overuse damage. Therefore, education on energy conservation and joint protection is essential to minimize joint deformity. However, the patient must realize that some activity is good for them to prevent contractures and maintain strength and endurance. Fatigue and joint pain can and often do co-exist in patients with RA. The pannus in the joints is actually increased with rest.
Rest does not appear to change the activity of the antigen-antibody
complex.
In which of the following is independence the MOST realistic long-term goal for a patient with a complete spinal cord lesion at C8?
A. Effective cough technique
B. Rolling from side to side
C. Transfer from bed to wheelchair
D. Ambulation with forearm crutches
C. This patient would have functional use of the triceps and finger flexors and would therefore, be independent for all wheelchair transfers to all surfaces. Coughing would not be limited and would not be a goal. Rolling would be easily achievable as a short-term goal. Ambulation with forearm crutches would not be a reasonable expectation for this patient.
A physical therapist examines a patient with multiple sclerosis who is in the period of exacerbation. The patient is independent with bed mobility, can sit unassisted at the edge of the bed, and requires physical assistance to stand with a walker. Which of the following ADL activities is the MOST important for the initial intervention?
A. Wheelchair propulsion up a 10 foot ramp
B. Wheelchair transfers
C. Walking with an assistive device
D. Tub transfers
B. Physical therapy intervention should focus on helping the patient obtain maximal functional independence. Wheelchair transfers are the means to enable the patient to be independently mobile and will be a requirement before more difficult tasks are performed such as ascending a
10-foot ramp. The patient is presumably too weak to walk at this point in time. Tub transfer is important, but the wheelchair will be the best means to get the patient to the tub. Therefore, for the initial intervention session, wheelchair transfers would be the most important.
When examining a patient who had a baby 3 days ago by vaginal delivery, the physical therapist notices that the patient has a 2-cm. diastasis of the rectus abdominis. To address this problem, the patient should:
A. perform partial sit-ups, supporting her abdominal muscles with her hands while lifting her head in the supine position
B. not perform exercises until the diastasis heals spontaneously
C. perform sit-ups with knees bent and arms behind the head
D. perform partial sit-ups with the legs straight and arms in front
A. Raising just the head activates only the recti muscles, and supporting the abdominal muscle with the hands provides external support to the stretched abdominal muscles.
This is the
optimal position to initiate strengthening following delivery for a patient with diastasis rectus abdominis.
Doing exercise would not be appropriate.
With no support of the abdominal
muscles, option C and D would be too aggressive at this time.
To minimize skin irritation during functional electrical nerve stimulation, the physical therapist should use:
A. lower intensity, larger inter-electrode distance and larger electrodes
B. lower intensity, larger inter-electrode distance and smaller electrodes
C. higher intensity, smaller inter-electrode distance and smaller electrodes
D. lower intensity, smaller inter-electrode distance and larger electrodes
A. Several things can be done to decrease the current density and the possibility of skin irritation.
These include decreasing the intensity of the stimulation, increasing the
inter-electrode distance and the use of larger electrodes.
A patient is doing active and resistive exercises on a mat table in the physical therapy department.
After 15 minutes, the patient becomes short of breath, begins coughing and expectorates pink, frothy sputum. At this point, the physical therapist should first stop the treatment, then:
A. assess vital signs, let the patient rest a few minutes with the feet elevated, and ten resume with a less vigorous program
B. sit the patient up, assess vital signs and call a nurse or physician for further instructions
C. lay the patient supine, transfer the patient to stretcher and return the patient to the nursing unit
D. lay the patient down flat, call for assistance and begin cardiopulmonary resuscitation
B. The presence of Dyspnea and the pink, frothy sputum would suggest the presence of CHF and resultant pulmonary edema. CHF can occur from poor cardiac muscle function as a result of myocardial infarction. Pulmonary edema occurs from the backflow of blood from the heart into the pulmonary vessels, increasing pulmonary capillary pressure.
The increase in
pulmonary capillary pressure increases fluid movement into the alveoli, which are normally dry.
These leads to the presence of pink, frothy sputum that can be expectorated along the shortness of breath (dyspnea). Positions that increase blood flow to the heart, such as lying flat, will increase the signs and symptoms. Therefore, the patient should be positioned with the head up or as in this problem; the patient should be placed in a sitting position to help alleviate the symptoms. Laying the patient down flat, supine or with the legs elevated would exacerbate the patient’s problems.
When evaluating a wheelchair positioning of a child with cerebral palsy, the therapist should
FIRST examine the position of the child’s:
A. pelvis
B. legs
C. head
D. spine
A. The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. The orientation and range of mobility of the pelvis in all three planes will in turn determine the alignment and support needed at the trunk, head and extremities.
A patient who sustained a mild CVA 3 weeks ago is being prepared by the physical therapist for discharge to home and an adult day program. To facilitate the discharge plan, the MOST appropriate health professional for the therapist to consult with is the:
A. skilled nursing coordinator
B. occupational therapist
C. medical social worker
D. primary physician
C. Medical social services deal with home situations, financial supports and acts, as a resource director on behalf of the patient. Social services would be the most appropriate choice to help arrange and coordinate rehabilitative services for this patient while they are at home. Although nurses, occupational therapists, physical therapists and physicians may all be involved with direct patient care, they would not be the most appropriate for this level of discharge planning.
For a patient with a right middle lobe pneumonia, the proper bronchial drainage position is supine with the bodv:
A. one-quarter turned to the left and foot of the bed raised 14 inches
B. one-quarter turned to the right and bed flat
C. three-quarters turned to the left and head of the bed raised 14 inches
D. three-quarters turned to the right and foot of the bed raised 14 inches
A. In order to place the right middle lobe in an optimal position to drain secretions, a patient would need to be positioned as stated in option A. Another way this position may be stated is
“left sidelying with quarter turn towards supine”.
The other positions do not optimally drain
this lobe.
To avoid the appearance of increased motion, which movement must be prevented during goniometric measurement of shoulder abduction?
A. Upward rotation of the scapula
B. Medial rotation of the shoulder
C. Lateral rotation of the shoulder
D. Lateral flexion of the trunk to the opposite side
D. During measurement of shoulder abduction, the spine should be kept straight. If the patient is allowed to laterally flex the trunk, it will give the appearance of increased shoulder abduction, but the motion would be occurring the spine and not in the shoulder. Upward rotation of the scapula and lateral rotation of the shoulder would normally accompany the motion of shoulder abduction.
Medial rotation of the shoulder would decrease the available
abduction.
A patient who receive organ transplantation 4 years ago demonstrates progressive weakness and is referred to physical therapy for strengthening exercises. In reviewing the medical history, the therapist learns that the patient takes prednisone and immunosuppressive drugs. Which of the following would the therapist MOST likely need to consider?
A. Isokinetic strengthening will be preferable for this patient
B. The patient may have limited ROM from increased bone mass
C. The patient will need to be treated in an isolation room
D. Muscle strengthening may be limited in this patient
D. An adverse side effect of prolonged prednisone use, in this case for 4 years, is muscle degeneration and therefore achieving increases in muscle strength may be limited.
Since
muscle strengthening may be limited, then isokinetic exercise would not necessarily be more beneficial. Prednisone may lead to a decrease in bone density, not an increase. Four years after transplantation, the patient will have been out in the community and the need for an isolation room is unnecessary.
A therapist examines a high school athlete in the training room. After removing the adhesive strapping from the athlete’s ankle, the therapist discovers that the athlete has developed an open weepy rash on the instep of the foot. The therapist should FIRST:
A. apply moist heat to the foot
B. send the patient to the hospital emergency room
C. use more pre-wrap with the next joint taping
D. refer the patient to the team physician
D. The open weeping rash may be infected. Skin infections are easily spread in training from environment, and if not attended to correctly may infect more people. If an infection were suspected, the precise diagnosis would be made by means of a culture.
There the most
appropriate action would be to refer the patient to the team physician. Moist heat increases the infection by increasing blood flow. An emergency room visit would not be indicated at this time.
Occluding the wound with more pre-wrap creates an environment ideal for infection.
A patient who sustained a left below-knee amputation 3 weeks ago is being evaluated for possible ambulation with prosthesis. Which of the following factors is MOST relevant?
A. Size of the right residual limb scar
B. Length of the right residual limb
C. Proficiency in previous prosthetic use
D. Severity of phantom pain
C. The previously amputated left limb must function as the main support limb. Any treatment strategy for ambulation must ensure that the left limb is functioning optimally. While the other factors are relevant, the previous ability of the patient to ambulate is the greatest concern.
The results of a developmental screening of a 4-month old infant indicate a possible right hip
The presence of which of the following are the MOST consistent with this
dislocation. diagnosis?
A. Pelvic obliquity, apparent pain on movement of the right hip, and decreased hip abduction on the left side
B. Asymmetrical gluteal folds, femoral telescoping and limited hip abduction on the right side
C. Decreased active movement of the right hip, increased femoral neck retroversion, and atrophy of the gluteus maximus on the right side
D. Hip flexion contracture on the right side, apparent leg length discrepancy, and inability to tolerate supported sitting
B. Physical findings of congenital hip dislocation include asymmetric skin folds of the buttocks and adductor region; limitation of passive hip abduction; leg length inequality; and telescoping of the flexed and adducted thigh on the pelvis.
A 14-month old child with brachial nerve palsy has motor and sensory loss in the right upper extremity in the areas innervated by C5 & C6. Which of the following activities is MOST difficult to accomplish with the affected upper extremity?
A. Pushing a wagon
B. Carrying a teddy bear in the crook of the arm
C. Holding a raisin in the palm of the hand
D. Grasping a cup
B. The C5 and C6 myotomes include the biceps brachi, brachialis, brachioradialis and deltoid muscles. The elbow flexors and supinators (C5-C6) are used to carry a teddy bear in the crook of the arm. Pushing a wagon requires the use of the triceps (C7-C8). Holding a raisin requires the presence of wrist flexors (C6-C8). Grasping a cup requires finger, thumb and wrist muscles (C6-C8, T1).
A therapist is treating a patient who has been diagnosed with a nerve root impingement on his right side due to narrowing of the intervertebral foramen between L4 & L5. The therapist decides to use mechanical, lumbar traction an intervention. Which of the following positions, on a traction table, would be the MOST appropriate to relieve pressure on the nerve root?
A. Supine, hips & knees flexed
B. Supine, with hips and knees straight and laterally shifted to the right
C. Prone, hips and knees straight
D. Sidelying on the right with a bolster between the table and the patient
A. In order to open up the intervertebral foramen, it would be best to flex or at least flatten the lumbar spine prior to applying the traction. Of the above options, positioning the patient supine with the hips and knees flexed would be the best way to do this. Laterally bending the trunk to the left would also open up the foramen, but this is not one of the options. Supine with hips and knees straight and then laterally shifted to the right would tend to close down the intervertebral foramen. Prone would also close the foramen.
Sidelying with bolster under the right lumbar
spine also tends to close the foramen.
A prone standing board has been recommended for a 5-year old child with severe hypotonia.
The PRIMARY purpose for the use of a prone stander is to:
A. promote weight bearing
B. reinforce an exaggerated positive support reflex
C. prevent hip dislocation
D. increase hip and knee ROM
A.
Prone standers are used frequently for children who cannot achieve or maintain upright standing. The benefits from the physiologic changes associated with weight bearing and from the social and perceptual opportunity to see the environment from an upright position.
A patient who is transported to the physical therapy department in a wheelchair complains of severe, bilateral lower extremity pain. A purple discoloration of both feet is observed. The pain is relieved when the patient’s feet are raised just above the horizontal plane. These signs are
MOST indicative of:
A. arterial insufficiency
B. intermittent claudication
C. venous insufficiency
D. a psychosomatic episode
C. With arterial insufficiency, elevation increases ischemia and therefore pain. Intermittent claudication is a phenomenon associated with metabolic demands exceeding the capability of the vascular system to supply adequate blood flow. Placing the limb in a dependent position increases swelling and therefore possibly pain with venous insufficiency. An objective sign such as purple discoloration rules out a psychosomatic episode.
A patient who completes a Phase I cardiac rehabilitation program should be expected to achieve:
A. independence in self-monitored walking
B. increased aerobic capacity to physical activity
C. modification of risk factors
D. increased blood pressure at a given workload
A. The primary physical therapy goal of phase I cardiac rehabilitation is to achieve a safe and independent level of activity that can be carried out at home. Increasing aerobic capacity cannot happen until phase Ill, when cardiac tissue has healed fully. Modification of risk factors is a life-long process and will not be achieved during a short in-patient stay. Systolic BP, when exercising, during the inpatient stay should only rise approximately 20 mmH above resting.
A therapist has been working with a patient who has a spinal cord injury. To document that the patient has been educated about skin care, the therapist should record that the patient:
A. is unable to tolerate more than 1 hour in a wheelchair
B. has good strength of the scapular depressors and elbow extensors
C. is able to state 3 causes of skin breakdown
D. is able to perform 10 push-ups in the wheelchair
C. Option C is the only one stated clearly in education terms. The other options are objectives based on observation.
A patient has difficulty palpating the carotid pulse during exercise. The patient should be
instructed in alternate methods of self-monitoring, because repeated palpation is likely to result in:
A. increasing the heart rate
B. decreasing the heart rate
C. an irregular heart rhythm
D. increasing systolic BP
B. Pressure receptor (baroreceptors) are present in the carotid sinus and these receptors respond to changes in BP. An increase in blood pressure that is sensed by these receptors will stimulate the parasympathetic system to decrease the rate and force of contraction of the heart in order to help lower the pressure. Repeated palpation in the carotid sinus area may stimulate an increase in BP and cause this reaction. Therefore increased heart rate and blood pressure are incorrect. Irregular heart rhythms generally result from electrolyte imbalance and/or ischemia to the conduction system of the heart.
A patient complains of pain lateral to the coracoid process. When palpating the shoulder to assess the possible cause of the pain, starting at the coracoid process and moving laterally, the therapist would expect to find the following sequence of structures:
A. lesser tuberosity, biceps tendon, greater tuberosity
B. greater tuberosity, biceps tendon, lesser tuberosity
C. lesser tuberosity, coracobrachialis tendon, greater tuberosity
D. greater tuberosity, coracobrachialis tendon, lesser tuberosity
A. Starting at the coracoid process and moving laterally, one would palpate the following structures: (1) lesser tuberosity, (2) biceps tendon and (3) greater tuberosity.
Any other order of
structure palpation would be incorrect.
A factor that MUST be considered in designing an exercise program for a patient with angina pectoris is that when the arms are exercised:
A. angina occurs at a lower heart rate than when exercising the legs
B. heart rate and BP rise more steeply in relation to workload than when exercising the legs
C. pulmonary ventilation increases less rapidly than when exercising the legs
D. angina occurs at higher workloads than when exercising the legs
B. Heart rate and systolic blood pressure responses are higher for any given workload when performed with the upper extremity as compared to the lower extremity. Angina is determined by a certain myocardial workload that is represented by the product of heart rate and systolic blood pressure. Therefore option A cannot be a conclusive statement. Pulmonary ventilation has less definitive responses but in general would be similar in that upper extremity exercise would cause a greater ventilatory response than lower extremity exercise would. Since heart rate and blood pressure would be higher at any given workload with upper extremity exercise, then angina would most likely occur at a lower workload.
A patient spilled boiling water on the right arm when reaching for a pan on the stove.
The
forearm, elbow and lower half of the upper arm appear blistered and red, with some subcutaneous swelling and pain on touch. To facilitate optimal function, the therapist should
PRIMARILY emphasize:
A. ROM exercises to the right hand, wrist and elbow
B. application of compression dressings
C. sterile whirlpool to the right upper extremity
D. splinting of the right arm in full elbow extension
A. The patient will be reluctant to move the limb because it is painful. ROM is essential to regain and maintain a functional ROM. In this case, the physical therapist’s primary goal is to restore function with ROM exercises.
Compression dressings, whirlpool and splinting are all
acceptable aspects of care that help in restoration of ROM. However, functional ROM would be the primary goal.
A therapist wishes to study the effect of cold compression on PROM in a group of 10 patients.
The plan is to apply this compress to the hamstring muscles once a day for 5 days. Which of the following experimental designs is the MOST appropriate for this type of study?
A. For both the experimental and control groups, gather data from the patient record
B. For both the experimental and control groups, measure ROM of both groups on day 5
C. For both the experimental and control groups, measure ROM on days 1 and 5
D. For the experimental groups, measure ROM everyday. For the control group, measure ROM on days 1 and 5.
C. The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same time, but only the experimental group receives treatment. Gathering information from patient records may not provide the same accuracy as if the researcher had performed all the measurements directly. Measuring ROM only on day 5 would not account for any pretest differences between groups.
During an examination of elbow strength using MMT, the patient supinates the forearm when attempting elbow flexion. Which of the following muscles is MOSTlikely doing the major part of the work?
A. Biceps brachii
B. Brachialis
C. Supinator
D. Brachioradialis
A. The biceps brachi is both an elbow flexor and supinator, and it is most effective as a supinator with the elbow flexed to about 90 degrees approximately the muscle resting position).
The brachialis does not cause supination (only flexion). The supinator does not flex the elbow.
The brachioradialis would move the forearm to midposition rather than fully supinating it.
Therefore, when the elbow both flexes and supinates, the biceps brachi would be the most likely muscle causing this action.
A therapist is treating a patient for limitation of motion following knee surgery several weeks ago.
The patient’s passive knee extension is lacking 15 degrees from full extension, and knee flexion is limited to 95 degrees. Both movements have capsular end feel. Which of the following mobilization techniques is the MOST appropriate for increasing knee flexion?
A. Anterior glide of the tibia on the femur
B. Posterior glide of the tibia on the femur
C. Superior glide of the patella
D. Posterior glide of the femur on the tibia
B. During normal knee extension, the tibia moves posterior relative to the femur. Therefore, posterior gliding of the tibia would promote knee flexion. Superior glide of the patella could be used to increase knee extension.
Posterior glide of the femur on the tibia would be used to
increase knee extension.
A patient has pain, swelling and tenderness in the medial border of the hand. The patient also shows changes in the color and temperature of the skin, hyperhidrosis and progressive joint stiffness in the wrist and hand. The MOST likely cause of the patient’s signs and symptoms is:
A. cervical disc disease
B. raynaud’s phenomenon
C. reflex sympathetic dystrophy
D. carpal tunnel syndrome
С.
All of these manifestations are indicative of reflex sympathetic dystrophy syndrome.
Cervical disc disease does not produce swelling in the hand, color and temperature changes or hyperhidrosis.
Raynaud’s phenomenon results in pain, pallor and coolness, but no
hyperhidrosis. Although carpal tunnel syndrome can also show sympathetic nervous system abnormalities, compression of the median nerve would refer symptoms to the lateral border of the hand (thumb area).
With carpal tunnel syndrome, the patient may also display thenar
muscle weakness.
When considering a special test for orthopedic assessment of a client, the validity of the test is important because the:
A. results of the test can be standardized
B. test measures what it is supposed to measure
C. results of the test are reproducible
D. test can be accurately performed by someone else
B. Option B is the definition of validity. Options C and D for reliability measures. Results can be standardized even though they are not valid.
A patient sustained a Colle’s fracture 8 weeks ago and has been in a cast since that time.
Immediately after cast removal, the physical therapy intervention for the wrist and hand should
MOST appropriately include:
A. passive and active assistive ROM exercises
B. progressive resistive exercises
C. grade 4 mobilization techniques
D. return to pre-fracture level of activity
A. The primary physical therapy goal at this time is to restore ROM. Therefore, the most appropriate intervention for that goal is passive and active assistive ROM exercises. Although gentle joint mobilization techniques may be indicated, grade 4 techniques at this time would not be appropriate. Progressive resistive exercises would come later in the plan of care. Although the long-term goal would be to return to normal activities, the short-term goal would not.
A patient with TBI is receiving outpatient physical therapy. The therapist notices that the patient becomes agitated during therapy sessions. To which of the following professionals should the patient be referred for assessment and diagnosis?
A. Occupational therapist
B. Neuropsychologist
C. Vocation counselor
D. Speech-language pathologist
B. Because the problem is a behavioral disorder, the most appropriate person to assess this patient would be a Neuropsychologist. The Neuropsychologist is trained to assess intellectual, emotional and coping functions of the patient as well as levels of depression and anxiety. They could also provide consultation to the rehabilitation team members as to how to deal with the problem.
While a patient is walking in the parallel bars, the therapist observes that the pelvis drops down on the side opposite the stance extremity. This gait deviation is an indication of weakness of the hip:
A. abductors of the swing extremity
B. adductors of the swing extremity
C. abductors of the stance extremity
D. adductors of the stance extremity
C.
The abductors are particularly active during the midstance phase (single limb support) of gait to prevent the contralateral pelvis from excessive lateral tilting.
Weakness of the hip
abductors, particularly the gluteus medius, causes the hip to drop down on the side opposite the weakness. For example, weakness in the right gluteus medius would show up during stance phase on the right by excessive downward movement (lateral tilt) of the left pelvis. The hip adductors are active during terminal stance and through midswing and would not play a role in controlling the lateral rotation of the pelvis.
The hip abductors show little activity during swing
phase.
A client on a weight loss program has been walking 3 days a week for 15 minutes for the past 3 weeks. To progress the exercise program, which of the following will MOST likely accomplish the weight loss goal?
A. Maintain the current walking speed and increase the duration to 30 minutes
B. Increase the walking speed and keep the duration to 15 minutes
C. Walk 4 days a week and decrease the duration to 10 minutes.
D. Changing from walking 3 days to jogging 1 day a week for 20 minutes
A. The optimal exercise duration for achieving weight loss with a walking program is 40 to 60 minutes of continuous aerobic activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to increase the duration while maintaining the same intensity or walking speed. Increasing walking speed should only be performed once the patient can consistently tolerate 20 to 30 minutes of exercise. Decreasing the duration while increasing the frequency of exercise would not accomplish the goal of 40 to 60 minutes of continuous exercise. A patient who has been walking for only 15 minutes 3 times/week would not be ready to begin jogging and jogging one time per week would be too low of an exercise frequency in general to achieve by training benefit.
When treating a patient with ankylosing spondylitis, the muscle requiring the MOST emphasis for strengthening exercises are the:
A. pectorals
B. hip flexors
C. back extensors
D. abdominals
C.
Trunk ROM exercises and strengthening to minimize thoracic kyphosis are essential.
Persons with ankylosing spondylitis tend to assume flexed postures.
Disproportionately
strong pectorals, hip flexors, or abdominals could worsen the kyphosis.
A 3-month old child has motor and sensory loss in the right upper extremity in the areas innervated by the C5 and C6 spinal nerves. The cause of this birth injury MOST likely is:
A. hemiplegia
B. Erb-Duchenne paralysis
C. Spinal Cord Injury
D. Klumpke’s paralysis
B. A brachial plexus injury that affects the C5 and C6 nerve roots is termed Erb-Duchenne paralysis. A lesion affecting the C8 and T1 roots is termed Klumpke’s paralysis. Hemiplegia and spinal cord injury would be caused by trauma to the CNS and would not normally affect just the C5 and C6 nerve roots.
During examination of the jaw opening pattern of the patient with TMJ problem, the therapist notes early protrusion of the mandible.
Which of the following mandibular movements MOST
likely caused the protrusion?
A. Condylar translation
B. Mandibular depression
C. Condylar rotation
D. Lateral glide
A. The protrusion component involves the arthrokinematic movement of anterior condylar translation. Mandibular depression (jaw opening) involves both condylar rotation and anterior translation. However, this question is asking only about the protrusion component. Lateral glide involves anterior translation on the contralateral side and spin on the ipsilateral side.
A patient with multiple sclerosis is referred for physical therapy at home. Before going home, the patient requires training in bathing, dressing and eating. Adaptive devices maybe needed to accomplish this. The therapist should recommend that the patient be seen by:
A. a social worker
B. an orthotist
C. an occupational therapist
D. a home health nurse
C. The occupational therapist would be the most appropriate member of the health care team to teach the patient the needed self-care skills.
The occupational therapist would also be able to
provide the patient with information regarding modifications to the home environment that would increase the patient’s independence. The occupational therapist could teach the patient how to use adaptive devices and help with the fabrication of splints or self-care aides.
A child who has cerebral palsy has been receiving physical therapy once a week for the past month. During the 4th visit, the therapist instructs the parents in a daily exercise program for the child, including stretching techniques. The BEST method to ensure correct implementation and carry over of the program is for the therapist to:
A. reassess the patient’s ROM one month after instructing the parents
B. review the parent’s written notes on the child’s progress
C. demonstrate the exercises for the parents and ask them to return for a program check in one week
D. ask the parents to demonstrate the exercises and to return for a program check in one week
D. The therapist should observe the parents performing the program as instructed to ensure correct implementation. The parents should return in one week for another demonstration to determine if they can correctly repeat the program as previously instructed.
An otherwise healthy inpatient is referred to physical therapy following total hip arthroplasty.
The patient reports persistent low energy levels. What medical record information will prove the GREATEST clarification of the complaint?
A. CO2 value
B. Hematocrit value
C. Creatinine level
D. Blood urea nitrogen (BUN) level
B. The hematocrit value provides the percentage of red blood cells in plasma. A decrease in the number of red blood cells (anemia) would lead to a decreased oxygen carrying capacity in the blood and therefore less oxygen to the tissues would lead to fatigue. The carbon dioxide value would be examined to assess a patient’s respiratory status while creatinine and BUN levels are examined in relation to kidney function.
Excessive upward rotation of the right scapula is noted when the patient attempts to perform shoulder flexion.
Which of the following exercises is MOST appropriate to help correct the
excessive scapular rotation?
A. Right scapular protraction against resistance with the right arm at 90 degrees of flexion
B. Bilateral scapular elevation with the upper extremity at 180 degrees of flexion
C. Wall push-ups with an isometric hold at the end range with the elbows extended
D. Bilateral scapular adduction with the arms medially rotated and adducted across the back
D.
Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi (downward rotators).
The scapular adduction with medial rotation and
adduction of the arm would require action by those muscles. Option A would help strengthen the serratus anterior, an upward rotator of the scapula. Option B would activate the upper trapezius as well as the rhomboids and since the upper trapezius is also an upward rotator the scapula, this would not be the best exercise to use. Option C also helps strengthen the serratus anterior, which would tend to aggravate the problem.
A patient with Parkinson’s disease has just been admitted to the rehabilitation unit. The patient is dependent in all transfers and requires moderate assistance of one person to walk 30 feet with standard walker. In order to facilitate good carry over for activities, instruction of the family in transfers should occur:
A. during a home visit after the patient is discharged
B. just prior to discharging the patient
C. early in the rehabilitation program
D. when the family feels ready to take the patient home
C. The family should be involved in all stages of planning and treatment. Family involvement can shorten the rehabilitation process and patient’s return to the community. It is important to have the family involved early in the rehabilitation process rather than wait until the patient is ready to be discharged.
A patient had final approval and checkout of a permanent prosthesis 2 weeks ago. The patient now complains to the therapist that the prosthesis is too heavy. The patient will benefit MOST from:
A. an evaluation of socket fit by the prosthetist
B. a prescription from the physician for lighter weight prosthesis
C. reevaluation of hip strength by the therapist
D. adding a fork strap attachment to the prosthesis
C. A complaint of heaviness likely reflects weakness. The complaint is not the fit or comfort of the prosthesis. So option A is incorrect. The expense of obtaining a lighter prosthesis is not justified without determining if the solution is strengthening of the muscle groups, which controls the prosthesis. A fork strap attachment will assist with suspension, but will not reduce the weight of the prosthesis.
A patient with left hemiparesis is being discharged from the rehabilitation center. The therapist has been unsuccessful in getting the family’s cooperation to instruct them in transfers, bed mobility, and safety precautions. The MOST appropriate action for the therapist to take is to:
A. educate the patient so she can tell others how to assist her
B. contact social services and arrange for a team and family meeting
C. refer the patient for home care and document appropriate interventions
D. write a home program and give it to the family
B.
Of the options above, a social worker (social services) would be the most appropriate person to intervene in this case. The social worker is trained to help resolve family issues that arise and would be the best person to lead a team of caregivers and family members in deciding the appropriate action in this case. Educating the patient would only put more burden on them without guaranteeing results. A referral for home care may be appropriate, but the social worker would be the best person to make such contact. Writing a home program for the family would not address the need to instruct family members in person.
A patient has a history of neck pain that is aggravated by long periods of sitting. The pain becomes progressively worse by evening. ROM and strength of the neck and shoulder are within normal limits. Sensation and reflexes are intact in both UE. The patient has a forward head and excessive thoracic kyphosis. The MOST appropriate exercise program would include:
A. stretching of the neck flexors and pectoral strengthening
B. upper traps strengthening and pectoral stretching
C. pectoral strengthening and rhomboid stretching
D. rhomboid strengthening and axial neck extension
D.
The history suggests that prolonged improper positioning of the cervical spine resulted in neck pain. A chronic forward head and kyphosis results in hyperextension in the upper cervical spine and excessive flexion in the upper thoracic spine.
Further muscle length adaptation
occurs with tight anterior muscles and stretched posterior muscles. Treatment should include correction of muscle weakness or imbalance.
Rhomboid strengthening and axial neck
extension are the only options that are both correct.
A patient is being examined for medial epicondylitis. With this diagnosis, the therapist would
MOST likely expect to find pain over the:
A. origin of flexor digitorum profundus with resisted finger flexion
B. origin of pronator teres muscle with active pronation
C. medial epicondyle with passive wrist flexion
D. insertion of the triceps brachi with passive elbow extension
B. The lesion is most likely a tendonitis involving a muscle or muscles that originate from the medial epicondyle of the humerus (i.e., pronator teres, palmaris longus, flexor carpi radialis and ulnaris, and flexor digitorum superficialis). Pain would be elicited with active contraction of the involved muscle (or muscles) or when the muscle/s is/are passively stretched. Resisted wrist flexion and pronation would cause pain over the origin of the pronator teres. Options A, C and D do not meet the criteria for eliciting pain.
In treating a patient who has had recurrent anterior shoulder dislocation, the therapist should
AVOID which of the following extreme shoulder motions?
A. adduction and external rotation
B. abduction and external rotation
C. hyperextension and internal rotation
D. abduction and internal rotation
B. The mechanism that creates an anterior dislocation of the shoulder is forced abduction and lateral (external) rotation of the shoulder. This frequently results in a tear of the anterior portion of the capsule.
Abduction and external rotation may subject the patient to recurrent
subluxations and/or dislocations and should therefore by avoided.
During the examination of a patient with carpal tunnel syndrome, the therapist will MOST likely find:
A. paresthesia of the medial palmar surface of the hand
B. weakness of finger extension of the lateral three digits
C. paresthesia of the lateral three digits
D. weakness in wrist flexion and ulnar deviation
C. In carpal tunnel syndrome there is pain and paresthesias in the median nerve distribution of the hand, which includes the lateral three digits.
There is weakness of the abductor pollicis
brevis, but not of the wrist flexors or finger extensors.
Upon removal of a wet-to-dry dressing from a draining wound, the therapist observes that the skin immediately surrounding the wound is macerated. What should the therapist recommend for future wound care?
A. Continue using current dressing type
B. Make the dressing more absorbent
C. Leave the dressing on longer between dressing changes
D. Change to a pressure type dressing
B. Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and prevent maceration.
A patient’s severe knee sprain resulted from medial rotation of the femur on the tibia with simultaneous application of a valgus force while the foot was placed on the ground. Which structures are MOST likely to be involved?
A. Medial collateral ligament, medial meniscus and anterior cruciate ligament
B. Medial collateral ligament, lateral collateral ligament and posterior cruciate ligament
C. Lateral collateral ligament, medial meniscus and anterior cruciate ligament
D. Medial collateral ligament, lateral meniscus and posterior cruciate ligament
A. A combination of valgus, flexion and external rotation forces applied to the knee while the foot is planted on the ground results in damage to the anterior cruciate ligament, medial collateral ligament and medial meniscus.
A patient with Guillain-Barre syndrome experiencing progressive paralysis is admitted to the ICU.
As a member of the interdisciplinary team managing this patient’s care, the MOST appropriate physical therapy intervention would be to:
A. alter the patient’s mechanical ventilation settings
B. develop patient’s medication schedule
C. perform airway clearance techniques
D. discuss the patient’s medical prognosis with the family
C. The key phrase in the question is “interdisciplinary”. Of all the options provided, only airway clearance is within the scope of practice for physical therapists.
Patients with Guillain-Barre syndrome may experience respiratory muscle fatigue or paralysis and are susceptible to pulmonary infection.
Pulmonary hygiene is a critical role in their care.
A patient is performing a phase I cardiac rehabilitation exercise session.
terminate low level activity in which of the following value changes from resting level?
A. The diastolic BP increases to 120 mmHg
B. The respiratory rate increases to 20 breaths per minute
C. The systolic BP increases by 20 mmHg
D. The heart rate increases by 20 beats per minute
A. During phase I (in-patient) cardiac rehabilitation, vital sign parameters with activity that warrant termination are: diastolic blood pressure of 110 mmH or greater, systolic blood pressure above 210 mmg or an increase greater than 20 mmH from resting and a heart rate that increases beyond 20 beats per minute above resting. The normal resting respiratory rate can range between 12 to 20 breaths per minute in adults, so an increase to 20 breaths per minute with low-level activity would not be a reason to terminate the activity.
A therapist is preparing to teach a patient who has Guillain-Barre syndrome to transfer from wheelchair to a mat table. The patient weighs 150 Ibs., she has poor (2/5) grade in both of her lower extremities and fair (4/5) grade in her left upper extremity; her right upper extremity has normal (5/5) strength. Which of the following would be the MOST appropriate assisted transfer for the initial session of this patient?
A. Two person lift on her right side
B. Sliding board transfer to her right side
C. A hydraulic lift from her wheelchair to the mat
D. Full, standing pivot transfer to her right side
B. Because this patient has significant weakness in both lower extremities, a standing pivot transfer would not be safe. However, since the patient does have fair to normal upper extremity strength, and is not totally dependent, a hydraulic lift or two person lift would not be appropriate because it would not be enhancing the patient’s functional skills. The most appropriate transfer method would be for the patient to use a sliding board transfer to her strongest right side.
A patient with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While on the tilt table, the patient begins to complain of a pounding headache, with flushing and profuse sweating. The therapist should FIRST:
A. lower the tilt table to a flat position
B. remove the patient from tilt table and return to room
C. check the patient’s catheter
D. check the patient’s BP
C. These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated bladder. The FIRST step is to remove the noxious stimulus.
In physical therapy program planning for geriatric patients, an important age-related change that should be taken into consideration is:
A. the inability to learn new motor tasks
B. decrease pain sensation
C. decrease motivation
D. the inability to select alternative movement strategies
B. Neurological changes that are age-related include decreased pain and vibratory sensation.
The other changes listed do not normally occur with aging in the absence of pathology.
To achieve maximum reaction of lymphedema following a mastectomy in the upper extremity by means of a massage, it is MOST important that:
A. local heat be applied before the massage
B. the upper arm be massaged before the forearm
C. the hand be massaged before the forearm
D. the massage strokes occur in a centrifugal direction
B. Massaging the upper arm before the forearm helps reduce the proximal resistance of lymphatic flow, which will optimize the flow of fluid or edema from the distal areas. This has been referred to as the “uncorking effect”. Local heat would cause vasodilation and may increase edema. Massaging the forearm would not allow the “uncorking effect” to occur. The massage strokes should be from distal to proximal (centripetal) direction.
A 6-year-old child with spastic diplegia is walking in the parallel bars. The child walks with increased trunk and hip flexion. What would be the MOST appropriate assistive device?
A. Standard walker
B. Forearm crutches
C. Posterior rolling walker
D. Bilateral quad canes
C. The use of posterior walker has been found to encourage a more upright posture during gait and to promote better gait characteristics than does the use of an anterior walker. A standard walker, forearm crutches and bilateral quad canes all emphasize trunk and hip flexion, which is already increased for this child.
A physical therapist is teaching a patient with T12 paraplegia to fall.
The patient walks with
bilateral KAFO and bilateral forearm crutches using swing to gait.
The MOST appropriate
method to use to prevent injury would be to:
A. have the patient wear a helmet and practice on a soft padded surface
B. give the patient written instructions and illustrations on falling
C. demonstrate and guide the patient through the correct process of falling
D. demonstrate the correct method of falling
C. If patients are skilled in falling, they are less likely to become injured during a fall. The patient demonstrating or performing the task best understanding of a skill. To accomplish this, the patient should be given a demonstration of proper falling technique and then the patient should be allowed to practice while being guided and guarded by the therapist. Without first demonstration and then allowing the patient to practice, the patient could be place at risk for injury. Therefore, options A, B & D are not adequate to ensure patient safety.
A patient with a diagnosis of complete SCI at C4-C5 demonstrates a weak cough mechanism.
Which of the following techniques would MOST effectively augment coughing?
A. Manual pushing against the upper abdomen
B. Positioning the patient in prone
C. Pursed-lip breathing
D. Interrupting the expiratory air stream
A. In order to cough effectively, the abdominal muscles must contract to expel air forcefully.
This patient does not have this ability; therefore manual force against the abdomen would mimic the action of the abdominal muscles.
The prone position would not assist the cough
mechanism in this patient. Both pursed-lipped breathing and interrupting the expiratory air stream would decrease the force of exhalation and decrease cough effectiveness.
A patient is referred for recommendation regarding purchase of a wheelchair.
The
measurements of the patient while sitting are 16 inches across the widest point of the hips and 18 inches from the rear of the buttocks to the popliteal crease. Which of the following wheelchair dimensions are BEST suited for this patient’s needs?
A. Seat width and seat depth of 18 inches
B. Seat width of 18 inches and seat depth of 16 inches
C. Seat width and seat depth of 16 inches
D. Seat width of 16 inches and seat depth of 18 inches
B. The seat width should be slightly wider than the width of the widest body part and depth should come to within 1 inch of the popliteal fossa.
A physical therapist is designing an exercise program for a healthy, elderly individual. Which of the following types of exercise is MOST stressful to the cardiovascular system?
A. Upper limb ergometry
B. Spinal ROM exercise
C. Quadriceps setting exercise
D. Lower limb diagonal PNF patterns
A. Heart rate and systolic blood pressure responses are higher for any given workload when performed with the UE as compared to the LE. Spinal motion does not create much stress on the cardiovascular system. The quadriceps setting and diagonal patterns are performed with the LE and would produce less cardiovascular stress.
Which of the following techniques is MOST important prior to discharge for a patient who has had myocardial infarction?
A. Ascend a flight of stairs before discharge
B. Perform prescribed exercises without angina
C. Return to normal daily activity level
D. Take a radial pulse reliably before discharge
D. There is normal, linear relationship between heart rate and exercise intensity in patients who are not on beta blocker medication or who are on non-rate responsive pacemakers. Therefore, teaching patients to take their pulse reliably before discharge is important learning objective to ensure safety with exercise upon discharge. Ascending a flight of stairs before discharge is only appropriate if the patient needs to negotiate stairs at home, but not as important as pulse monitoring.
Performing exercises without angina can be achieved by monitoring HR with
exercise; therefore, taking a pulse is necessary. Returning to normal daily activity immediately after a myocardial infarction is an unreasonable objective, as it will take 6 to 8 weeks for the myocardium to heal; therefore, activity levels will need to be tempered in order to protect the heart while it is healing.
A therapist is evaluating a patient for a wheelchair prescription. The patient, who lives alone in a small apartment, has bilateral lower extremity weakness and is unable to stand to transfer.
Trunk strength and upper extremity strength are normal and the patient can transfer independently with a sliding board.
The MOST appropriate prescription for this patient is a
wheelchair with:
A. fixed, adjustable-height arm rests and detachable foot rests
B. removable arm rests and detachable swing-away leg rests
C. fixed arm rests and removable leg rests
D. desk-style removable arm rests and fixed elevating leg rests
B. In order to facilitate transfers utilizing a sliding board, the patient will need both removable arm rests and detachable swing-away leg rests. Fixed arm rests make sliding board transfers extremely difficult and unsafe.
Any other options would not be optimal for this particular
patient’s needs.
A patient is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced QRS complexes on the ECG represents:
A. ventricular depolarization
B. premature ventricular contractions
C. atrial fibrillation
D. atrial repolarization
B. The QRS complex represents ventricular contraction. Atrial contraction is represented by the P wave. When an area of the ventricle becomes irritable and develops an ectopic foci, the ventricle will depolarize prematurely before the normal conduction sequence (e.g., prior to SA node firing in the atria) and presents a wide, irregularly shaped QRS complex. In normal ventricular depolarization, the QRS would be narrow and regularly spaced and atrial fibrillation would appear as the P wave changes. Atrial repolarization occurs within the QRS complex and is not normally visible on EKG.
A patient who is on bed rest exhibits orthostatic hypotension upon standing will MOST likely experience:
A. increase venous tone in the lower extremity
B. inadequate ventricular filling during diastole
C. decrease hydrostatic pressure in the capillary beds
D. parasympathetic stimulation of the heart
B. Orthostatic hypotension from bed rest occurs as a result of decreased venous tone, which will lead to a pooling of blood in the LE upon standing. The pooling of blood in the LE will reduce the amount of blood returning to the heart decreasing ventricular filling and ultimately decreasing cardiac output. This results in drop in BP with resultant dizziness. With pooling of blood in the LE, the hydrostatic pressure would increase. To compensate for the decrease in cardiac output, the sympathetic system (not the parasympathetic) would stimulate the heart.
Treatment of a patient with hemophilia who has a subacute hemarthrosis of the knee will initially
include:
A. active assistive ROM exercise to the knee
B. instruction of the patient for weight bearing to tolerance
C. gentle resistive ROM exercise to the knee
D. continuous immobilization of the knee in an extension splint
A. The stage of hemarthrosis will mean that there is still some bleeding into the joint space, but not as extensively, therefore the patient will benefit from ROM exercise to prevent contracture.
The patient may need active-assist, as there may still be pain or edema in the joint that prevents independent performance of ROM. The mechanical trauma of weight bearing to tolerance at this stage may impinge and damage the pathologic synovium within the joint. Resistive ROM is more appropriate when pain and swelling have subsided and no bleeding is occurring.
Continuous immobilization in the extended position will promote contracture in edematous knee.
Which of the following is the MOST appropriate intervention for a patient with juvenile rheumatoid arthritis who is experiencing painful swelling of both knees?
A. Resistive exercises
B. Stretching to prevent contractures
C. Gentle active exercises
D. Walking program
C. All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.
Which of the following is the MOST appropriate home program for a patient with chronic lateral epicondylitis?
A. Using a forearm cuff to increase loading on the extensor tendons
B. Performing exercises for wrist strength and stretching
C. Administering iontophoresis with dexamethasone and xylocaine
D. Doing friction massage of the brachioradialis tendon
B. Lateral epicondylitis is caused by overuse of wrist extensors that originate on the lateral epicondyle of the humerus, especially the ECRB. If the lateral epicondylitis is at a chronic stage, conditioning of the extensor muscles and sustained grip activities will be most effective in long-term management. A forearm cuff is thought the muscle loading. lontophoresis would not be appropriate for a home program. Friction massage of the brachioradialis would not be appropriate since the CRB muscle is usually the one affected.
A therapist who works in a home health agency is treating a patient with diabetes mellitus. The patient tells the therapist that he is no longer taking his insulin. The therapist’s FIRST course of action should be to:
A. instruct the patient in proper technique for injecting insulin
B. contact the patient’s home health nurse
C. tell the patient’s family to report this information to the physician
D. have the patient perform a urine glucose test while the therapist is in the home
B. Contacting the patient’s home nurse is the appropriate first course of action because of the possible safety risk associated with the patient not taking their insulin. Injections and glucose testing would go beyond the scope of practice of physical therapy. Placing the responsibility on the family would not be appropriate because of the gravity of the situation.
Which of the following methods is appropriate for handling a 1-year-old child with cerebral palsy who exhibits strong extensor tone in the trunk and extremities?
A. Carrying the child in a sitting position
B. Carrying the child over one’s shoulder
C. Keeping contact with the back of the child’s head
D. Picking the child up under the arms
A. The sitting position promotes visual attending, use of the UE and social interaction. A child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees flexed.
A patient with left hemiparesis exhibits shoulder subluxation on the affected side. The patient has a demand-type cardiac pacemaker. Which of the following interventions should be used only with extreme caution?
A. Manual resistive exercise on the non-affected side
B. Active exercise on the affected upper extremity
C. Functional electrical stimulation to the affected side
D. Biofeedback to the affected side
C. Electrical stimulation for patients with demand-type pacemakers is often listed as contraindication. However, even though it is often listed as contraindication in textbooks, research studies apparently have not substantiated the suspected risks. Nonetheless, it should only be applied with caution and close supervision in these patients.
Exercise, unless very
strenuous, would be indicated in this patient. Biofeedback introduces no electrical signals into the body and therefore would not be contraindicated.
A 5-year-old patient with a closed head injury is exhibiting behavior consistent with the confused agitated level of cognitive function. During physical therapy intervention, the patient becomes combative. Which of the following techniques would be MOST effective in calming the patient?
A. Providing brief moving touch to the face and turning on the patient’s favorite musical tape
B. Maintaining touch to the shoulders and brightening the room by opening curtains
C. Removing the patient from the current treatment environment and placing the patient in a quiet setting
D. Wrapping the patient in a blanket and rocking the patient rapidly
C. Sensory inputs such as intermittent music and touching the face, rocking the patient rapidly and brightening the room elicit arousal. When a child becomes agitated and confused, it is appropriate to reduce the general amount of environment stimulation.
Decreasing auditory and
visual activity in the room may help the child focus.
The MOST appropriate therapeutic exercise to stretch the neck muscles for the patient with an acute right sided torticollis is:
A. right rotation and right lateral flexion
B. left rotation and right lateral flexion
C. left rotation and left lateral flexion
D. right rotation and left lateral flexion
D. Isolated contraction of the right sternocleidomastoid muscle would cause the head to rotate the left and side bend (lateral flexion) to the right. To stretch the muscle, the opposite actions would be performed on the patient by the therapist; rotation of the head to the right and lateral flexion to the left.
A therapist evaluates a 65-year-old patient with psoriasis for treatment with ultraviolet radiation.
The patient’s history includes the following: total hip arthroplasty 1 year ago; penicillin allergy: calcium supplements since menopause; daily tetracycline use for the past 2 weeks for a urinary tract infection.
Which of these factors should alert the therapist to use extra caution when
applying ultraviolet light?
A. Arthroplasty with a metal implant
B. Daily tetracycline use
C. Penicillin allergy
D. Long-standing calcium supplement use
B.
Caution should be used in patients who are taking tetracycline, because the drug will enhance the effects of ultraviolet radiation. Ultraviolet is not contraindicated in these patients, however the dosage of the ultraviolet would probably have to be adjusted to some lower level.
The penicillin allergy, calcium supplements and metal implants would not be affected by the ultraviolet light. It should be noted that although UV radiation therapy is not common in today’s practice of physical therapy, therapists should nonetheless be aware of the precautions; and be able to advise patients who may be using UV radiation at home.
Which of the following instructions is MOST appropriate for teaching a patient with C6 quadriplegia to transfer from a wheelchair to a mat?
A. “Keep your fingers extended, to give a broader base of support”
B. “Rotate your head and shoulders in the same direction to the desired hip motion”
C. “Rotate your head and shoulders in the direction opposite to the desired motion”
D. “Keep both hands next to your knees to lock your elbows”
C. The position described creates the necessary force to move the lower body in this transfer given the level of SCI. Finger extension against resistance would be difficult for a patient with C6 quadriplegia. The patient’s hands would be kept near the thigh or hips with one hand on the mat and one on the wheelchair.
