PEAT 1 Flashcards

Question

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

Answer 1

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.

Answer 2

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.

Answer 3

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.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

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.

Answer 10

B. All documentation about physical therapy services should readily translate the physical findings (impairment) into functional abilities/limitations.

Answer 11

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.

Answer 12

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.

Answer 13

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.

Answer 14

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.

Answer 15

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.

Answer 16

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.

Answer 17

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.

Answer 18

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.

Answer 19

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.

Answer 20

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

Answer 21

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.

Answer 22

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.

Answer 23

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.

Answer 24

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.

Answer 25

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.

Answer 26

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.

Answer 27

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.

Answer 28

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.

Answer 29

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.

Answer 30

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.

Answer 31

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).

Answer 32

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.

Answer 33

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.

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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.

Answer 38

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.

Answer 39

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.

Answer 40

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.

Answer 41

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.

Answer 42

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.

Answer 43

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.

Answer 44

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.

Answer 45

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.

Answer 46

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.

Answer 47

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.

Answer 48

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.

Answer 49

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.

Answer 50

C. Static alignment for knee stability is established by positioning of the knee so that lateral reference line falls anterior to the knee joint.

Answer 51

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.

Answer 52

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.

Answer 53

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.

Answer 54

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.

Answer 55

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.

Answer 56

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.

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

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.

Answer 61

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.

Answer 62

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.

Answer 63

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.

Answer 64

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.

Answer 65

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.

Answer 66

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.

Answer 67

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.

Answer 68

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.

Answer 69

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.

Answer 70

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.

Answer 71

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.

Answer 72

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.

Answer 73

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.

Answer 74

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.

Answer 75

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.

Answer 76

C. Isokinetic exercise device utilize accommodating resistance throughout the range of motion. The other exercises are not forms of accommodating resistance.

Answer 77

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.

Answer 78

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.

Answer 79

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.

Answer 80

C. The tibialis posterior plantarflexes and inverts the foot. This pattern requires the specific action of that muscle. The other patterns do not.

Answer 81

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.

Answer 82

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

Answer 83

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.

Answer 84

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.

Answer 85

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.

Answer 86

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.

Answer 87

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.

Answer 88

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.

Answer 89

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.

Answer 90

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.

Answer 91

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.

Answer 92

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.

Answer 93

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.

Answer 94

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.

Answer 95

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.

Answer 96

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.

Answer 97

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.

Answer 98

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.

Answer 99

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.

Answer 100

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.

Answer 101

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.

Answer 102

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.

Answer 103

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.

Answer 104

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.

Answer 105

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.

Answer 106

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.

Answer 107

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.

Answer 108

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.

Answer 109

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.

Answer 110

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.

Answer 111

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.

Answer 112

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.

Answer 113

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.

Answer 114

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.

Answer 115

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.

Answer 116

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.

Answer 117

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).

Answer 118

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.

Answer 119

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.

Answer 120

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.

Answer 121

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.

Answer 122

C. Option C is the only one stated clearly in education terms. The other options are objectives based on observation.

Answer 123

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.

Answer 124

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.

Answer 125

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.

Answer 126

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.

Answer 127

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.

Answer 128

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.

Answer 129

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.

Answer 130

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.

Answer 131

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.

Answer 132

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.

Answer 133

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.

Answer 134

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.

Answer 135

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.

Answer 136

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.

Answer 137

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.

Answer 138

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.

Answer 139

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.

Answer 140

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.

Answer 141

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.

Answer 142

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.

Answer 143

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.

Answer 144

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.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

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.

Answer 150

B. Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and prevent maceration.

Answer 151

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.

Answer 152

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.

Answer 153

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.

Answer 154

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.

Answer 155

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.

Answer 156

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.

Answer 157

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.

Answer 158

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.

Answer 159

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.

Answer 160

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.

Answer 161

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.

Answer 162

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.

Answer 163

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.

Answer 164

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.

Answer 165

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.

Answer 166

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.

Answer 167

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.

Answer 168

C. All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.

Answer 169

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.

Answer 170

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.

Answer 171

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.

Answer 172

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.

Answer 173

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.

Answer 174

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.

Answer 175

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.

Answer 176

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.