PEAT 2 Flashcards
A physical therapist examining wrist-joint play finds restriction in the direction indicated by the arrow downward). (The forearm in midposition with the ulnar side resting on the table and the hand at the edge of the table, palm facing you.) The therapist should suspect a decrease in which joint motion?
A. Radial deviation
B. Ulnar deviation
C. Flexion
D. Extension
A.
The therapist is shown performing an ulnar glide which is the same joint motion used for radial deviation. Limited motion in this direction indicates limited ability to perform radial deviation.
The intervention for a patient with limitation of shoulder flexion and medial (internal) rotation includes mobilization. What glide is MOST appropriate for mobilizing this shoulder to specifically increase the restricted motions?
A. Posterior
B. Anterior
C. Medial
D. Lateral
A.
The most appropriate mobilization technique for increasing both shoulder flexion and medial (internal) 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 (internal) rotation. Anterior glide is used to increase extension and lateral (external) rotation.
Which of the following techniques is MOST appropriate for a patient with low postural tone?
A. Slow regular rocking while sitting on a treatment bolster
B. Continuous pressure to the skin overlying the back muscles
C. Low-frequency vibration to the back muscles
D. Joint approximation applied through the shoulders to the trunk
D.
Options A, B and 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.
What skin change associated with aging has the GREATEST effect on wound healing?
A. Reduction in sensation
B. Decreased elasticity of the skin
C. Decreased 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 a patient with insulin-dependent diabetes about foot care?
A. Reassure the patient that no infections will occur if the directions are followed, then demonstrate procedures.
B. Tell the patient how foot care is performed, then watch the patient’s performance.
C. Watch the patient perform a foot inspection and caution him that amputations result from untended skin problems.
D. Have the patient demonstrate a foot inspection, then give feedback on the patient’s performance.
D.
Learning the process of foot care is a psychomotor skill and effective strategies to teach from tner therapist sonidhighe wilatwas-sercined correctiyanta what areas here improvemark.
if any. 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 and C do not include feedback that informs the patient about their performance.
Utilization review and peer review are activities that are a 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 Practice for Physical Therapy there should be a written plan for continuous improvement of quality care. This includes ongoing review and evaluation of the physical therapy services provided. Utilization review and peer review are two types of review processes.
The demographic information of the participants in a research study lists a mean age of 32 and median age of 35. The difference between the median and mean indicates:
A. the value of the standard deviation score.
B. the value of the Z-score.
C. that the distribution is skewed.
D. that the 2 measures should be averaged.
C.
A “normally distributed” sample has a median and a 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 percent) 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 skewed to the left, if lower it is skewed to the right. The standard deviation is a measure of the variability of the mean. The Z-score is a standard score with a mean of zero and a standard deviation of one. Averaging the two measures would not be appropriate or meaningful
A physical 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 MOST appropriate to maximize strengthening?
A. Resistive exercises with the knee bent
B. Resistive exercises with the knee straight
C. Active assistive exercises with the knee bent
D. Active assistive 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 crosses both the knee and ankle, bending the knee would put the gastrocnemius in a shortened position and lessen its ability to produce tension. Therefore, exercising with the knee straight would put the gastrocnemius on stretch, increasing its ability to produce tension.
Following spinal joint mobilization procedures, 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 this 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 therapist 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 addition of exercises would not alter the response and there would be no indication of neurological involvement with the reported symptoms
A 90 year-old patient with chronic congestive heart failure has been non-ambulatory and a nursing home resident for 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/day
C. Gentle vibration with the foot of the bed elevated 1 time/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 then 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 a 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 congestive heart failure.
To help students apply a newly learned skill to clinical practice, the MOST effective action for the clinical instructor to take is to:
A. point out 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 to acquire 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 objectives should be learner centered, outcome oriented, specific, and measurable. Option D is the only one that is learner (student) centered and specific to a situation.
Options A and C require action by the clinical instructor, not the student. Option B, which may be a step in the process, is not as learner centered or outcome centered as Option D.
To prevent contractures in a patient with a transfemoral amputation, emphasis should be placed on designing a positioning program that maintains range of motion in hip:
A. flexion and abduction.
B. extension and adduction.
C. adduction and lateral (external) rotation.
D. flexion and medial (internal) rotation.
B.
Following an above knee (transfemoral) amputation, the residual limb has a 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 range of motion in hip extension and adduction.
After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right transfemoral amputation. For this patient, which of the following factors is MOST important in establishing long-term goals for functional walking?
A. Status of the wound at the amputation site
B. Range of motion 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 in establishing long term, functional goals.
A physical therapist is conducting a 12-minute walk test with a patient who has chronic obstructive pulmonary disease and uses 2 L/min of oxygen by nasal cannula. The patient’s resting oxygen saturation is 91% and resting heart rate, 110 bpm. The oxygen flow should be increased if the:
A. patient’s carbon dioxide level starts to increase.
B. patient starts to report shortness of breath.
C. patient’s oxygen 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 mm Hg of oxygen in the blood, which is considered to be moderately hypoxemic (low oxygen levels). This situation would require increased oxygen levels in order to be rectified. A rise is 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 increase in HR to 150 bpm may be a normal response to this activity and would not necessarily require increased oxygen levels.
When training a patient to increase muscle activity with the use of electromyographic biofeedback, the physical therapist should adjust the unit so that sensitivity:
A. starts 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 midrange 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 or visual cue to the patient). For use in muscle re-education, the unit should be most sensitive during the initial treatment so 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.
During a posture examination, the physical therapist notes that both of the patient’s patella 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° to 15° 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 physical therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve (Ill). During the cranial nerve examination, which of the following signs would be the MOST significant?
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 eye) and would cause a condition termed ptosis. In addition, the eye may not react to light and therefore would 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.
A patient is referred to physical therapy for treatment of tenosynovitis. The patient reports a “pins and needles” sensation on the palmar surface of the thumb (1st digit), index (2nd digit), and middle (3rd digit) fingers. The physical therapist’s examination reveals a positive Tinel’s sign at the wrist and Good (4/5) grade opposition of the thumb (1st digit). 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 the 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 longs muscle would most likely reveal a positive Finkelstein’s test (stretching of the abductor muscle) with pain over the dorsum of the thumb. Thoracic outlet syndrome would most likely be revealed with special tests that cause alteration of the radial pulse.
A patient with a complete thoracic spinal cord injury 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 a thoracic spinal cord level injury is able to perform independent pressure relief strategies and should be completed every 15 to 20 minutes.
A therapist is measuring passive knee range of motion in a patient. The measurements obtained are shown in photographs A and B. (A - more knee flexion with hip flexed; B - less knee flexion with the hip extended). The MOST likely cause of the difference in knee range of motion is:
A. knee joint capsule restriction.
B. tightness in the rectus femoris.
C. weakness of the hamstrings.
D. tightness in the vasts medialis
B.
Capsular restriction would show up in both measurements. In photograph A, there is more knee flexion present with the hip flexed. In this position the rectus femoris is on slack across the hip joint allowing greater range of knee flexion. In photograph B the rectus femoris is stretched over both the knee joint and the hip joint, so tightness in the rectus femoris would restrict knee flexion. Photograph B also shows hip joint flexion. Hamstring weakness would not affect passive range of motion. Vasts medialis tightness would affect both measurements.
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 steps is the FIRST step necessary to develop this 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 educational 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 been performed. Providing pamphlets are a useful teaching adjunct but would not be the first step to prevent low back pain effectively in this population.
The physical therapist is positioning a patient for postural drainage. 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 a 45° angle
B. Supine, flat surface
C. Sidelying, head elevated at a 30° 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 the lower extremities and hips elevated to about 45°
A patient who has a right piriformis syndrome is referred to physical therapy for evaluation and intervention. The patient’s history includes a total hip arthroplasty on the right side 2 years ago.
Because of the total hip arthroplasty, which of the following interventions require added precautions for this patient?
A. Transcutaneous electrical nerve stimulation
B. Continuous ultrasound
C. Hot packs
D. Massage to the right hip
B. The only one of the above interventions that requires precaution because of the total hip replacement is continuous ultrasound. However, that does not mean that ultrasound is contraindicated for this patient. Transcutaneous electrical nerve stimulation 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 range of motion examination reveals restricted lateral (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. lateral (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, traumatic brain injury 3 months ago. During the examination of passive range of motion, the physical therapist notices decreased passive knee extension and moderate hamstring spasticity. Palpation of the knee reveals a firm mass on the lateral aspect of the joint. The therapist should refer the patient to a physician for an evaluation of probable:
A. osteogenic sarcoma
B. patellar fracture
C. osteomyelitis
D. heterotopic ossification
D. Heterotopic ossification occurs in 10 percent to 20 percent of patients with traumatic brain injuries. The abnormal bone formation occurs in the soft tissue surrounding major joints.
Patients with spasticity are at increased risk. Loss of range of motion is characteristic for this problem. Osteogenic sarcoma is less likely. A patellar fracture would not present as a lateral mass
A patient reports anterolateral shoulder pain with an insidious onset. Examination shows full passive range of motion pain on passive lateral (external) rotation and pain on resistive medial (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°. Painful resisted abduction and resisted lateral (external) rotation is indicative of supraspinatus tendinitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.
During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the:
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 and flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. The adductor longus would adduct the hip. Substitution by the semimembranosus would cause hip extension.
A patient is entering a cardiac rehabilitation program. The physical therapist should FIRST ask the patient to:
A. describe the correct aspects of exercise demonstrated by the therapist.
B. list problems associated with poor nutritional habits.
C. identify the harmful effects of smoking with regards to cardiac disease.
D. describe the type of angina that the patient experiences.
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 experiences so that the therapist will know how to prevent angina with exercise or recognize it 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 physical therapist is setting up a home program of electrical stimulation 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 frontals 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 hips and knees extended and hands behind the head. The patient is able to raise the head, shoulders, and thorax from the treatment table, but is unable to come to a complete long-sitting position. What muscle should the physical therapist target for a strengthening program?
A. liopsoas
B. External abdominal oblique
C. Quadratus lumborum
D. Upper rectus abdominis
A.
The abdominal muscles are active during a sit-up (with the 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 the tiptoes with the 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 a 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.
Following trauma at the C5 spinal cord level, a patient was admitted to the hospital. Twenty-four 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 a sustained contraction of the upper and lower extremities 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 patient with a right transfemoral 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 the lateral reference line falls anterior to the knee joint.
An initial physical therapy evaluation is performed on an elderly patient who is 1 day post total left hip arthroplasty (non-cemented) using a posterior-lateral 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° 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 ft (7.6 m)
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°. Bed mobility and ambulation would be started 1 or 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 surroundings to relieve tension
C. General massage using deep stroking and kneading of tense muscles
D. Recognition of the sensations 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 foundational. Massage and passive exercise may be relaxing, but the patient must be aware of the sensations of tension to prolong the benefit.
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 physical therapist should take is to:
A. don a pair of gloves.
B. clean the cut with an antiseptic.
C. check the patient’s blood pressure.
D. cover the cut with a 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 blood pressure would not be the first thing to do. Once the gloves are donned, cleaning the wound and covering it with a sterile dressing would be appropriate.
A physical therapist is working with a patient who is aware of being terminally ill. What is the MOST appropriate intervention when the patient wants to talk about the 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 expression 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 he 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 expression of feelings and avoid denial.
A physical therapist examines a patient who reports foot pain while jogging. The examination shows that the patient has excessive foot pronation and forefoot varus. The therapist decides to try a temporary orthotic insert in the patient’s running shoe. Which of the following is the MOST appropriate orthotic insert?
A. A lateral forefoot post under the 5th metatarsal head
B. A lateral rearfoot post under the calcaneus placed in an 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 1st 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. This 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.
Although knee motion occurs primarily in 1 plane, tibial rotation is possible when the knee is positioned in 90° 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 a 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 (closed packed position) and approximately 40° 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 closed packed position.
A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis should include all of the following EXCEPT:
A. strengthening the scapular protractors.
B. strengthening the thoracic erector spine muscles.
C. lengthening the short suboccipital muscles.
D. lengthening the lumbar erector spinae 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.
The forward head posture suggests that the cervical spine is flexed and the occiput is extended, therefore stretching of the suboccipital muscles would be indicated. A TEST-TAKING HINT:
Although EXCEPT questions are rarely used on the NPE, be alert for this type of question and read the responses so that vou select the unrelated response.
A patient in the eighth month of pregnancy presents with numbness and tingling of the left hand, except for the little finger (5th 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 is:
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 eight 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° 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.
A patient who has chronic obstructive pulmonary disease is being treated with a regimen that includes pursed-lipped breathing exercises. The PRIMARY purpose of the pursed-lipped breathing is to:
A. help prevent the collapse of pulmonary airways during exhalation thereby reducing air trapping.
B. decrease the removal of carbon dioxide during ventilation.
C. increase the residual volume of respiration so that more oxygen 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 back pressure 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 (5th digit). The physical therapist will MOST likely find a diminished tendon reflex in the:
A. biceps brachi
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 brachii is the only one of the muscles listed that is also innervated by the C8 nerve root. The biceps brachi, deltoid and brachioradialis are innervated by the C5, C6, and sometimes
C7 nerve roots
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 the swing phase.
A patient with chronic venous insufficiency of the lower extremities is MOST likely to exhibit:
A. normal superficial veins, no edema, ulceration, and patches of gangrene around the toes.
B. dilation of superficial veins, edema, and stasis ulceration.
C. no edema, cold, hairless extremities, and faint dorsalis pedis pulse.
D. dilation of superficial veins and edema made worse during sitting or elevation of the lower extremities.
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 is:
A. distal
B. lateral
C. proximal
D. medial
A. In order to improve knee flexion, the physical therapist needs to address patella 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 proprioceptive neuromuscular facilitation pattern is MOST appropriate for a patient who needs strengthening of the tibialis posterior?
A. Hip extension, abduction, and medial (internal) rotation, with ankle plantarflexion and eversion
B. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and inversion
C. Hip extension, adduction, and lateral (external) rotation, with ankle plantarflexion and inversion
D. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and version
C. The tibialis posterior plantar flexes and inverts the foot. This pattern requires the specific action of that muscle. The other patterns do not.
A patient is referred to physical therapy with a diagnosis of low back pain. Radiographic studies, including magnetic resonance imaging, have ruled out the presence of disc pathology. The patient reports continuous back pain that radiates upward toward the thorax and anteriorly into the abdominal region. The physical therapist should consider which of the following areas as a potential source of the 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 suprapubic or thoracolumbar region. The diaphragm is innervated by C3, C4, and C5 with the pain normally confined 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 intensive care unit. Chest radiographs show the development of an infiltrate in the right lower lobe during the past 2 days. Rales and rhonchi are heard over the right lower lung fields. Which of the following chest physical therapy programs 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 his 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 to mobilize secretions followed by suctioning to clear the secretions. Suctioning first then hyperventilating while in left-sidelying is 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 laying on the right side, the only place to percuss and vibrate would be the left side, which has no pathology. Finally positioning on the left side with deep breathing exercises will not be effective in mobilizing secretions, especially since the patient is unconscious and unable to actively perform deep breathing exercises.
A physical therapist reads an article on a muscle physiology study. The results of the study are shown in the graph (length-tension curve). The therapist can BEST use the results of the study to explain the underlying rationale for which of the following interventions?
A. The use of prolonged passive stretching to lengthen shortened connective tissue
B. The use of plyometrics to enhance muscle power
C. The use of closed chain versus open chain exercises to enhance co-contraction of muscles
D. The use of hold-relax techniques for muscle stretching
B. Prolonged stretching does not depend on the length tension curve, but on the stress relaxation curve and Golgi tendon organ. Plyometrics is a form of exercise designed to enhance muscle speed and power. The theory behind plyometrics relies on the stretch reflex (active contraction of a muscle or active tension) and the natural elastic components of skeletal muscle and its surrounding connective tissue (passive tension). The graph shows that as the muscle is stretched, the passive components are stretched and add to the total amount of tension that can be developed in a muscle. During plyometric exercises, a muscle is quickly stretched activating the muscle spindle and the stretch reflex, as well as stretching the connective tissue elements surrounding the muscle fibers. This combination produces a quicker, more forceful, contraction by the muscle. Closed chain exercise use is not explained by the length tension curve. The hold relax technique is thought to be mediated via the Golgi tendon organ, not length tension.
In the early management of a patient with a partial peripheral nerve injury, the goal of the physical therapy intervention will MOST likely be to prevent:
A. nerve degeneration
B. spasticity and increased muscle tone
C. muscle atrophy
D. contractures and adhesions
D.
The primary physical therapy goal in this case would be joint protection and the 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 nerve lesion. Spasticity would not be present in a lower motor neuron injury
A physical therapist is developing an educational program for individuals with lower extremity peripheral neuropathies due to diabetes. Which of the following information is MOST important for the physical therapist to recommend for the prevention of injury to the feet?
A. Orthoses to support the extremity
B. Use of proper footwear
C. Moisturizing the skin to prevent dryness
D. Exercise parameters
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 lower extremity 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 vasodilation, caused by local mechanisms, occurs in response to ischemia. An acute arterial occlusion creates a 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 late
C. gluteus maximus
D. erector spinae
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 on 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.
An inpatient physical therapy department has only 1 physical therapist and 1 physical therapist assistant on duty, due to staff illness. A patient with which of the following conditions and circumstances 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 evaluation has not been completed
C. Multiple sclerosis, who 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 plans for the patient. The patient who is stable and on an existing program would be the most appropriate patient to be delegated to the assistant. Therefore, the patient who has multiple sclerosis and who is on an established gait training program would be the most appropriate. The other three patients are receiving their initial treatments.
The brother of a patient who was recently discharged from the hospital’s outpatient physical therapy department telephones on the patient’s behalf to request a copy of the patient’s medical record. The physical 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 brother upon written 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 and 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 subiect 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 physical therapist is examining a patient for possible lower extremity weakness. Passive range of motion is within normal limits. The patient is seated. When the patient tries to dorsiflex and invert the right foot, the patient is unable to move it through the full range of motion and is unable to take any resistance applied by the therapist. During the subsequent gait examination, the therapist should expect the patient to display which of the following?
A. Normal gait with no deviations
B. Increased right hip flexion during midswing phase
C. Throwing the trunk backward on the right side shortly after heel strike (initial contact)
D. Laterally bending towards 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 deviations 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 abductors, the 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 the hip extensors (gluteus maximus).
A patient is referred to physical therapy with a diagnosis of chondromalacia patella. The physical therapist should decide to include quadriceps setting and straight-leg raises as part of the home exercise program, because:
A. the vasts medialis muscle is primarily responsible for terminal knee extension.
B. quadriceps setting and straight-leg raises help improve patellar tracking.
C. patello-femoral compression forces are increased when the knee is extended.
D. the vasts medialis muscle is preferentially activated during a straight-leg raise.
B.
The patient’s symptoms would be aggravated by exercises that cause increases in patellofemoral joint reaction forces. One of the goals of treatment would be to promote proper patellar tracking. Isometric exercises such as quadriceps setting and straight leg raises (SLR) 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 quadriceps setting. This muscle tends to pull the patella medially during contraction and thus acts as a dynamic medial stabilizer, which promotes proper patellar tracking. The vastus medialis is not preferentially recruited during a straight leg raise, nor is it the only muscle responsible for terminal knee extension. Patello-femoral compression forces are generally less during a SLR than when doing extension exercises with the knee bent.
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 walked 100 ft (30.5 m) with minimal assistance after 1 week.
D. The patient attended physical therapy sessions 3 times/week for 2 week.
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 a reduced vital capacity in a patient who has quadriplegia at the C5-C6 level?
A. Decreased anterolateral chest expansion resulting from paralysis of the external intercostal muscles
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 the 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 external intercostals muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the C5-6 level, the diaphragm would still receive innervation from the phrenic nerve (C4). The anterior scalene (C4-6) would be partially innervated and the sternocleidomastoid (C2-3) 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.
Instruction in energy conservation and joint protection should be provided to a 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 a 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 spaces. 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 rheumatoid arthritis. 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 to maintain strength and endurance. Fatigue and joint pain can and often do co-exist in patients with rheumatoid arthritis. 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. Walking 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.
To minimize skin irritation during functional electrical nerve stimulation, the physical therapist should use:
A. lower intensity, larger interelectrode distance, and larger electrodes.
B. lower intensity, larger interelectrode distance, and smaller electrodes.
C. higher intensity, smaller interelectrode distance, and smaller electrodes.
D. lower intensity, smaller interelectrode 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 NEXT:
A. assess vital signs, let the patient rest a few minutes with the feet elevated, and then 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 a 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 congestive heart failure and resultant pulmonary edema. Congestive heart failure 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. This leads to the presence of pink, frothy sputum that can be expectorated along with shortness of breath (dyspne). 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
A patient who sustained a mild cerebrovascular accident 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.
A physical 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 a 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 a training room 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. Therefore, the most appropriate action would be to refer the patient to the team physician. Moist heat may increase 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 transtibial amputation 2 years ago and a right transtibial amputation 3 weeks ago is being evaluated for possible walking 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.
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 range of motion.
A. Prone standers are used frequently for children who cannot achieve or maintain upright standing. The patient 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 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 blood pressure.
B. Pressure receptors (baroreceptors) are present in the carotid sinus and these receptors respond to changes in blood pressure. 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 simulate an increase in blood pressure 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 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 physical therapist should
PRIMARILY emphasize:
A. range of motion 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 upper extremity 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 the restoration of ROM. However, functional ROM would be the primary goal.
A physical therapist plans to study the effect of cold compresses on passive range of motion in a group of 10 patients. The plan is to apply these compresses to the hamstring muscles 1 time/day for 5 days. Which of the following experimental designs is MOST appropriate for this type of study?
A. For both the experimental and control groups, gather data from patient records.
B. For both the experimental and control groups, measure range of motion of both groups on day 5.
C. For both the experimental and control groups, measure range of motion on days 1 and 5.
D. For the experimental group, measure range of motion every day. For the control group, measure range of motion on days 1 and 5.
C.
The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same times, 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 of 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 brachi
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° (approximately the muscle testing position). The brachialis does not cause supination (only flexion). The supinator does not flex the elbow. The brachioradialis would move the forearm to a 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 patient has pain, swelling, and tenderness over 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. Complex Regional Pain Syndrome
D. carpal tunnel syndrome.
C. All of these symptoms 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.
While a patient is walking in the parallel bars, the physical therapist observes that the pelvis drops down on the side opposite the stance extremity. This gait deviation is an indication of weakness ofthe 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 mid stance 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 mid-swing and would not play a role in controlling the lateral rotation of the pelvis. The hip abductors show little activity during swing phase.
Which of the following structures is indicated by the arrow in the radiograph?
A. Intertubercular groove
B. Greater tubercle
C. Lesser tubercle
D. Coracoid process
B. The structure indicated by the arrow is the greater tubercle. The arm is internally rotated in this radiograph.
When treating a patient who has ankylosing spondylitis, the muscles 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 MOSTlikely is:
A. hemiparesis
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 central nervous system and would not normally affect just the C5 and C6 nerve roots.
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 may be needed to accomplish this. The physical 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 members 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 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 1 person to walk 30 ft (9.1 m) with a standard walker. 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 the 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 reports to the physical therapist that the prosthesis is too heavy. The patient will benefit
MOST from:
A. an evaluation of the socket fit by the prosthetist.
B. a prescription from the physician for a lighter-weight prosthesis
C. re-evaluation of hip strength by the physical 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 muscle groups, which control the prosthesis. A fork strap attachment will assist with suspension, but will not reduce the weight of the prosthesis.
