PEAT 4 Flashcards
A patient is performing a Phase I (inpatient cardiac rehabilitation exercise session. The physical therapist should terminate low-level activity if which of the following changes occurs?
1. The diastolic blood pressure increases to 120 mm Hg.
2. The respiratory rate increases to 20 breaths per minute.
3. The systolic blood pressure increases by 20 mm Hg.
4. The heart rate increases by 20 bpm.
1
During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that warrant termination are: diastolic blood pressure of 110 mm Hg or greater, systolic blood pressure above 210 mm Hg or an increase greater than 20 mm Hg from resting, and a heart rate that increases beyond 20 bpm above resting. The normal resting respiratory rate can range from 12 to 20 breaths per minute in adults, so an increase to 20 breaths per minute with low-level activity would not be a reason to terminate the activity.
A patient is being evaluated for possible carpal tunnel syndrome, and a nerve conduction velocity test is performed.
Which of the following findings would
MOST strongly support the diagnosis?
1. Decreased latency at the elbow.
2. Decreased latency at the carpal tunnel.
3. Increased latency at the carpal
tunnel.
4. Increased latency at the forearm.
3
Nerve conduction above and below the local nerve compression is usually normal. Latency is typically increased, not decreased, across the carpal tunnel compression site. Nerve conduction above and below the local nerve compression is usually normal.
When examining a patient with a history of alcohol abuse, a physical therapist notes that the patient demonstrates fine resting tremors and hyperactive reflexes.
The patient reports frequent right upper quadrant pain. Which of the following additional signs is MOST likely?
1. Jaundice
2. Hyperhidrosis
3. Hypotension
4. Nocturnal cough
1
With a history of alcohol abuse and the presence of fine resting tremors and right upper quadrant pain, the patient is presenting a history and signs and symptoms consistent with liver disease. Jaundice is a skin change associated with disease of the hepatic system. Hyperhidrosis can be present with endocrine disorders but is not associated with liver disease. Hypotension is not listed as a sign of liver disorders. A nocturnal cough can be associated with rheumatic fever, but is not characteristic of liver disease.
Which of the following examination findings would be expected in a patient who also had sustained ankle clonus?
1. An upgoing great toe when the sole of the foot is stroked
2. Weakness of ankle plantar flexors with one-repetition strength testing
3. Absence of sensation to sharp/dull testing over the posterior lower leg
4. Hyporeflexia when deep tendon reflexes are elicited in the lower leg
1
Sustained ankle clonus indicates a central nervous system dysfunction, as does the presence of a Babinski sign (that is, an upgoing great toe with stroking of the plantar foot). The other options are associated with lower motor neuron problems.
Which of the following sensory testing locations corresponds to the C7 nerve root?
1. Volar aspect of the little finger (5th digit)
2. Dorsal aspect of the middle finger (3rd digit)
3. Lateral aspect of the upper arm
4. Medial aspect of the upper arm
2
The C7 nerve root supplies sensation in the dorsal middle finger
A 3-month-old infant has poor midline head control. During evaluation, the physical therapist notes facial asvmmetry and observes that the infant has limitation of cervical rotation to the left and cervical lateral flexion to the right. A radiology report indicates premature fusion of the infant’s cranial sutures. The infant MOST likely has:
1. right congenital muscular torticollis.
2. left congenital muscular torticollis.
3. right cervical facet hypomobility.
4. left cervical facet hypomobility.
1
The infant exhibits signs of torticollis affecting the right sternocleidomastoid muscle.
Torticollis is named for the side of the limited lateral flexion. Asymmetry and premature closure of sutures (plagiocephaly) are not typically seen with cervical facet hypomobility in infants.
A patient had a split-thickness skin graft for a partial-thickness burn injury to the upper extremity. The surgeon has requested range-of-motion exercises for the patient. Currently, the patient is able to actively move the upper extremity through one-third of the range of motion for shoulder flexion. Based on this finding, what is the MOST appropriate action for the physical therapist to take at this time?
1. Defer any range-of-motion exercises until the patient is able to participate more actively.
2. Begin active assistive range-of-motion exercises.
3. Begin bed mobility training to facilitate increased use of the upper extremity
4. Continue with active range-of-motion exercises.
2
Deferring any range-of-motion exercises is not a practical choice, as contracture will develop postoperatively. Because this patient cannot achieve full range of motion by himself, active assistive range of motion is indicated to prevent contracture postoperatively. Although bed mobility training is a creative way to possibly increase upper extremity range of motion, given the acuity of the patient’s surgical wound, the patient would need more range of motion for this intervention to be more beneficial. Continuing with only active range of motion would not facilitate adequate increases in range of motion and would not prevent contractures.
Which of the following modalities BEST addresses the cause of calcific tendinitis in the bicipital tendon?
1. Sensory level interferential current at
80 Hz to 100 Hz
2. Iontophoresis with acetic acid at 60 mA/minute
3. High-volt pulsed electrical stimulation at 200 pps
4. Diathermy with a parallel treatment set-up
2
Sensory level interferential current at 80 to 100 Hz does not address the problem itself but may address any related pain. lontophoresis with acetic acid can address the cause of calcific tendinitis, not just the symptoms. High-volt pulsed electrical stimulation at 200 ps does not address the problem itself but may address any related pain. Diathermy with a parallel treatment set-up is not the best choice, as deep heat will not address the pathology.
To minimize skin irritation during functional electrical nerve stimulation, a physical therapist should use:
1. lower intensity, larger interelectrode distance, and larger electrodes.
2. lower intensity, larger interelectrode distance, and smaller electrodes.
3. higher intensity, smaller interelectrode distance, and smaller electrodes.
4. lower intensity, smaller interelectrode distance, and larger electrodes.
1
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 using larger electrodes.
Manual muscle testing of a patient’s pelvic floor muscles reveals a grade of Poor (2/5). Which of the following positions is BEST to begin strengthening?
1. Supine
2. Standing
3. Seated
4. Walking
1
A grade of Poor (2/5) is defined as full excursion in a gravity-eliminated position. All of the other options are against gravity positions, which would be inappropriate, given this grade of weakness.
During an examination of elbow strength using manual muscle testing, a patient supinates the forearm when attempting elbow flexion. Which of the following muscles is MOST likely doing the major part of the work?
1. Biceps brachi
2. Brachialis
3. Supinator
4. Brachioradialis
1
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 brachii would be the most likely muscle causing this action.
During evaluation of a patient’s balance, a physical therapist gently pushes the patient backward slightly and observes how the patient recovers from the perturbation. What strategy is the patient
MOST likely to use to correct for the perturbation?
1. Knee
2. Hip
3. Ankle
4. Stepping
3
Regarding options 1 and 2, for larger perturbations, individuals utilize hip and knee muscles to recover the balance. Regarding option 3, for slight perturbations, most individuals use an ankle strategy. Ankle musculature is used to control the perturbation and recover the balance. Regarding option 4, if the perturbation is strong enough to cause the individual’s center of mass to move outside the base of support, a stepping strategy would be employed by taking a step and increasing the size of the base of support.
Which of the following findings BEST describes normal capillary filling?
1. Rebound vasodilation after icing
2. Blood pressure of 120/76 mm Hg
3. Pulse oximetry measurement of 98%
4. Blanching of the nail bed with color return in < 3 seconds
4
By definition, the blanching of nail bed with color return in < 3 seconds is normal capillary refill
Which of the following instructions is
MOST appropriate for teaching a patient with Cs quadriplegia to transfer from a wheelchair to a mat?
1. Keep fingers extended to give a broader base of support.
2. Rotate head and shoulders in the same direction as the desired hip motion.
3. Rotate head and shoulders in the direction opposite to the desired hip motion.
4. Keep both hands next to the knees to lock the elbows.
3
The position described creates the necessary force to move the lower body in this transfer, given the level of the spinal cord injury. Finger extension against resistance would be difficult for a patient with Cs quadriplegia. The patient’s hands would be kept near the thigh or hips with one hand on the mat and one on the wheelchair.
A patient has a spinal cord injury that resulted in damage to the sacral segments and disruption of the sacral reflex arc. The patient is MOST likely to have which of the following characteristics?
1. Voluntary control of defecation
2. Tonic contraction of the external anal sphincter
3. Flaccidity of pelvic floor musculature
4. Permanent absence of the gastrocolic reflex
3
The external anal sphincter and pelvic floor muscles are composed of striated muscle fibers. They receive somatic innervation from sacral cord segments 2 through 4. With damage to these segments, the sphincter and the pelvic floor muscles remain flaccid. The individual loses voluntary control of defecation. The gastrocolic reflex, mediated by the intrinsic nervous system of the GI tract, returns after resolution of spinal shock.
A patient who reports double vision has ptosis, lateral strabismus, and a dilated pupil in the left eye. Which of the following cranial nerve test results is
MOST likely to be abnormal?
1. Pupillary light reflex
2. Facial muscle strength
3. Jaw-jerk reflex
4. Pain sensation on the face
1
The cranial nerve involved is the oculomotor nerve. This nerve innervates the medial rectus, which, if weak, would cause a lateral strabismus. The oculomotor nerve is also responsible for mediating papillary constriction and a lesion would cause papillary dilation. The ptosis is caused by loss of innervation to the levator palpabrae superioris muscle, which elevates the eyelid. The double vision would be caused by the inability to move the eyeball normally, because four of the six ocular muscles are controlled by the oculomotor nerve. The oculomotor nerve is also important in mediating the pupillary light reflex. The facial nerve innervates the muscles of facial expression. The trigeminal nerve mediates the jaw-jerk reflex and pain sensation from the face.
In addition to standard precautions, what other precaution should a physical therapist observe when working with a patient infected with methicillin-resistant
Staphylococcus aureus?
1. Airborne
2. Sterile
3. Droplet
4. Contact
4
Since methicillin-resistant Staphylococcus aureus is spread by contact, wearing a face shield or mask is not necessary. Sterile precautions or techniques are not necessary for the physical therapist to use with a patient infected with methicillin-resistant Staphylococcus aureus.
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?
1. Prone, head down at a 45° angle
2. Supine, flat surface
3. Sidelying, head elevated at a 30° angle
4. Sitting, leaning forward
1
The best position for draining 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°.
Clubbing of the fingers is MOST associated with which of the following pathologies?
1. Lymphedema
2. Pulmonary disease
3. Chronic venous insufficiency
4. Complex regional pain syndrome
2
Conditions that chronically interfere with tissue perfusion and nutrition may cause clubbing. Pulmonary disease is the most predominant cause of digital clubbing, present 75% to 85% of the time clubbing is noted. Since the other conditions also affect tissue perfusion, they could contribute to the condition, but are not listed as common findings.
A patient who is 8 months pregnant has an abdominal diastasis recti with a separation of 1.5 in (4 cm). Which of the following exercises would be the MOST appropriate initial exercise for abdominal strengthening in a supine position?
1. Trunk curls
2. Hooklying head lifts
3. Pelvic-tilt leg sliding
4. Bilateral leg lowering
2
Trunk curls are contraindicated for a patient with diastasis recti. Supine hooklying head lifts emphasize the rectus abdominis muscle and are least likely to increase the separation of the diastasis recti. Pelvic-tilt leg sliding is more advanced than head lifts. Bilateral leg-lowering is an advanced abdominal strengthening exercise that causes excessive low back strain and should not be performed during pregnancy.
A patient with Parkinson disease has just been admitted to a rehabilitation unit. The patient is dependent in all transfers and requires moderate assistance of one person to walk 30 ft (9.1 m) with a standard walker. To facilitate good carryover for activities, instruction of the family in transfers should occur:
1. during a home visit after the patient is discharged.
2. just prior to discharging the patient.
3. early in the rehabilitation program.
4. when the family feels ready to take the patient home.
3
The family should be involved in all stages of planning and treatment. Family involvement can shorten the rehabilitation process and facilitate 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 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:
1. posterior to the axis of the right knee joint.
2. lateral to the axis of the right knee joint.
3. anterior to the axis of the right knee joint.
4. medial to the axis of the right knee joint.
3
Static alignment for knee stability is established by positioning of the knee so that the lateral reference line falls anterior to the knee joint.
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:
1. sartorius.
2. tensor fasciae late.
3. adductor longus.
4. semimembranosus.
1
The sartorius flexes, laterally (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 fasciae 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 physical therapist reads that the interrater reliability of a new hand-held dynamometer is .93. What is the MOST appropriate interpretation of this value?
1. Similar scores were obtained for a group of subjects when different therapists measured the subjects
2. Similar scores were obtained for a group of subjects when the same therapist repeated the measures
3. Dissimilar scores were obtained for a group of subjects when different therapists measured the subjects.
4. Dissimilar scores were obtained for a group of subjects when the same therapist repeated the measures.
1
Interrater reliability concerns variation between two or more raters who measure the same group of subjects. The reliability coefficient has values from 0.00 to 1.00. A reliability of 1.00 means there was total agreement. Thus a value of .93 means there was a high degree of agreement on the scores from the dynamometer among several therapists. Agreement of measures by the same therapist would be intrarater reliability.
A physical therapist researcher is developing a study to compare differences in range of motion outcomes in two groups of patients who have had a total knee arthroplasty. Over an 8-week period, one group of patients receives outpatient physical therapy 1 time/week and the other group receives outpatient physical therapy 3 times/week. In this study, what is the dependent variable?
1. Range of motion
2. Frequency of visits
3. Total knee arthroplasty
4. 8 weeks
1
The dependent variable (ROM) is the factor that is caused by the independent variable (frequency of visits).
Which of the following teaching strategies is MOST appropriate for an older adult patient with mild dementia?
1. Use auditory or visual input separately.
2. Use metaphors to reinforce new concepts.
3. Establish a consistent pace for teaching.
4. Present one piece of new information at a time.
4
To minimize confusion, the patient should be presented with one new item at a time. The pace of learning should be set by the patient. Visual and auditory input together can promote learning. Concrete examples are easier to understand than metaphors.
A patient with chronic venous insufficiency of the lower extremities is
MOST likely to exhibit:
1. normal superficial veins, no edema, ulceration, and patches of gangrene around the toes.
2. dilation of superficial veins, edema, and stasis ulceration.
3. no edema, faint dorsalis pedis pulse, and cold, hairless extremities.
4. dilation of superficial veins and edema made worse during sitting or elevation of the lower extremities.
2
With venous insufficiency, the limbs would be edematous and the superficial veins would be dilated. If the venous insufficiency is not corrected, ulceration could develop. Options 1 and 3 are ruled out because they indicate no edema. Option 4 is not correct because the condition is relieved by sitting or leg elevation.
A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The patient is currently unable to independently clear secretions, despite receiving instruction in the bronchopulmonary hygiene techniques of positioning, percussion, shaking, and vibration. Which of the following interventions is MOST appropriate to help this patient clear the secretions?
1. Nasotracheal suctioning
2. Manual costophrenic assist
3. Supplemental oxygen
4. Inspiratory muscle training
2
While nasotracheal suctioning is a viable option to clear a patient’s secretions, it is usually the last resort when a patient does not have an artificial airway. So if a manual costophrenic assist doesn’t work, then suctioning may be needed. Any patient who has been receiving mechanical ventilation will likely have some respiratory muscle deconditioning. However, with superimposed neuromuscular disease, the respiratory muscle weakness will be further exacerbated. Therefore, providing manual assist at the lower ribs during cough will assist the patient in successfully clearing secretions. Supplemental oxygen can help a patient’s ventilatory muscle endurance but does not ensure that the patient will be able to generate enough force during the cough. Inspiratory muscle training would be beneficial for this patient, but not at this acute stage just after removal of ventilation. Once secretions are under control, then muscle training can begin.
An older adult patient had a total hip arthroplasty following a hip fracture from a fall in his home. The patient lived alone and was previously able to perform all activities of daily living independently. He has been admitted to a skilled nursing facility for rehabilitation. The patient’s goal is to return home. His family believes he should be admitted to a long-term care facility for his own safety after acute rehabilitation is completed. The physical therapist’s MOST appropriate action is to:
1. advise the family that the patient should determine his own discharge environment.
2. recommend a team conference with the patient and his family to discuss discharge plans.
3. schedule a home visit to determine if home modifications are needed before discharge.
4. implement a treatment plan with a long-term goal of discharge to home.
2
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 for placement of the patient. The best time for such a meeting would be prior to discharge, because such meetings are difficult to arrange after discharge. Allowing the patient to determine his own discharge environment may be fine if there are no safety concerns; however, a decision whether or not the patient is competent to make that 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.
Which of the following reasons is the
PRIMARY purpose for applying statistical analyses to single-subject research?
1. To substantiate visual analvsis of graphically displayed data
2. To determine whether observed changes are real or chance occurrences
3. To advocate changes in intervention methods
4. To establish credibility for the intervention technique
2
Data analysis in single-subject research is based on evaluation of measurements within and across design phases, to determine if behaviors are changing and if observed changes during intervention are associated with the onset of treatment. While visual analysis of graphic display of data is the most commonly used data analyses method in single-subject design, statistical analysis provides a more quantitative approach to determine whether observed changes are real or chance occurrences.
Upon removal of a wet-to-dry dressing from a patient’s draining wound, a physical therapist observes that the skin immediately surrounding the wound is macerated. What should the therapist recommend for future wound care?
1. Continue using the current dressing type.
2. Make the dressing more absorbent.
3. Leave the dressing on longer between dressing changes.
4. Change to a pressure-type dressing.
2
Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and prevent the maceration.
A 50-year-old patient had an uncomplicated open repair of a rotator cuff tear 2 weeks ago. The patient asks the physical therapist when the shoulder will be normal again. Which of the following expected outcome time frames
MOST accurately addresses this patient’s question?
1. 3 weeks to lift a 5-Ib (2.3-kg) object
2. 3 weeks to sleep on the involved side
3. 3 months to lift the upper extremity overhead to reach into a cabinet
4. 3 months to play golf
3
Three weeks is too early to lift 5-Ib (2.3-kg) objects. Three weeks is too early to sleep on the involved side. Usually by 8 to 12 weeks, a patient who has had an uncomplicated open repair of a rotator cuff 2 weeks ago is able to actively elevate the arm to functional heights. Three months is too early to play golf.
A physical therapist is preparing to evaluate a patient who had a closed reduction with cast fixation for an ankle fracture 1 day ago and currently has non-weight-bearing status. The patient reports foot pain in the injured extremity.
Based on the patient’s report, which of the following procedures should the physical therapist perform?
1. Gait examination
2. Transfer abilities
3. Capillary refill in toes
4. Blood pressure examination
3
Since the patient is non-weight-bearing, transfer abilities and gait examination are less likely to yield information regarding the cause of foot pain. With regard to capillary refill in toes, complications of cast fixation may include swelling and, if severe, compartment syndrome.
Improperly fitted casts and/or patients leaving limbs in a dependent position can result in painful swelling that creates occlusion to distal blood flow. Testing capillary refill is an easy test to examine distal extremity perfusion. Blood pressure changes could cause changes in perfusion to distal extremities, but it would be very difficult to measure lower extremity blood pressure with the cast on.
Which of the following motions are MOST restricted with a hip capsular pattern?
1. Medial (internal) rotation and abduction
2. Lateral (external) rotation and abduction
3. Extension and adduction
4. Flexion and lateral (external) rotation
1
The capsular pattern of restriction at the hip is loss of medial (internal) rotation and abduction, followed by a loss of flexion and extension; loss of lateral (external) rotation is insignificant.
The parent of a 4-year-old child who has myelomeningocele is interested in obtaining orthoses for the child’s gait training. The child has an L1 neurological level lesion. Which of the following orthoses is the MOST appropriate selection for the physical therapist to discuss with the parent?
1. Hip-knee-ankle-foot with locked hips
2. Reciprocating-gait
3. Knee-ankle-foot with a pelvic band
4. Ankle-foot
2
Options 1, 3, and 4 would provide insufficient orthotic support for the child to walk. A child with an L1 lesion can walk only with support of reciprocating gait orthoses or thoracic lumbar sacral orthosis.
A patient who has rheumatoid arthritis comes to physical therapy with signs of muscle atrophy, ecchymosis, puffy cheeks, and a diagnosis of osteoporosis.
Which of the following medications is the patient MOST likely receiving?
1. Penicillin (Ampicillin)
2. Prednisone (Deltasone)
3. Acetylsalicylic acid (aspirin)
4. Gold salts
2
Prednisone is a glucocorticoid that exhibits the side effects described in the stem. The primary side effect of penicillin is an allergic reaction, such as skin rashes and difficulty breathing. The primary side effect of aspirin is gastritis. The primary side effect of gold therapy is diarrhea, irritation of oral mucosa, and skin rashes.
Regular aerobic exercise lasting at least 30 minutes should be MOST beneficial in decreasing the pathology associated with which of the following conditions?
1. Type 1 diabetes
2. Type 2 diabetes
3. Multiple sclerosis
4. Amyotrophic lateral sclerosis
2 Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving skeletal muscle glucose transport and whole-body glucose homeostasis. Regular exercise can help the body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication needed to treat diabetes, or even eliminate the need for medication. Exercise has not been shown to improve glycemic control for the person with type 1 diabetes. Patients with degenerative neuromuscular diseases such as multiple sclerosis should use caution when exercising to avoid excessive fatigue, which can result in permanent losses in strength.
Respiratory system impairment in individuals with multiple sclerosis and amyotrophic lateral sclerosis may lead to poor tolerance of intense aerobic exercise.
A patient has been receiving physical therapy for a large wound on the lower leg.
After 3 weeks of treatment, the wound is free of necrotic tissue, but a copious amount of exudate is present. Which of the following dressings is MOST appropriate for the wound at this time?
1. Saline-saturated gauze
2. Semipermeable film
3. Gauze impregnated with zinc oxide
4. Hydrocolloid paste
4
Saline-saturated gauze is not advised to control copious amounts of drainage.
Semipermeable film cannot absorb copious amounts of exudate. Gauze impregnated with zinc oxide has not been shown to be beneficial. Hydrocolloid paste is the only option given that would be appropriate for managing wounds with high levels of exudate.
A patient with a right transtibial prosthesis describes right-knee buckling in the foot flat (loading response stance phase of gait. Which of the following conditions in the patient is MOST likely present to cause this problem?
1. Excessive plantar flexion
2. Stiff heel cushion
3. Low shoe heel
4. Excessive foot inset
2
Excessive prosthetic plantar flexion can cause insufficient knee flexion. A stiff heel cushion can cause excessive knee flexion and therefore buckling. A low prosthetic shoe heel can cause delayed knee flexion. Excessive prosthetic foot inset can cause excessive lateral thrust.
Which of the following recommendations is MOST appropriate for a patient with gastrosophageal reflux disease?
1. Sit upright for at least 10 minutes after a meal.
2. Lie on the right side before performing exercises.
3. Head-lifting exercises should be performed in the upright position.
4. Activities that require the supine position should be performed before a meal.
4
Exercises that require a supine position should be performed before eating so that the stomach is relatively empty. The recommended time to remain upright after a meal is 3 hours.
Head lifting in supine is the recommended exercise to strengthen the upper esophageal sphincter muscle. If performed in upright, the head falls into gravity and the exercise is no longer resistive. A patient should lie on the left side to reduce reflux, because lying on the right side makes it easier for acid to flow into the esophagus, since the lower esophagus bends to the left and this straightens out with right sidelying.
A physical therapist is completing an examination of an inpatient with multiple comorbidities who had a total knee arthroplasty 2 days ago. The therapist observes a bluish discoloration of the toes on the operative extremity. This finding should be documented as:
1. cyanosis.
2. deep vein thrombosis.
3. Raynaud disease.
4. cardiac pathology.
1
Cyanosis is described in the stem. Although this finding often accompanies cardiac / pulmonary pathology or may occur with hematological or central nervous system disorders, the objective description is cyanosis.
A physical therapist is evaluating a
70-year-old female patient who reports the onset of midthoracic pain after working in a garden for several hours.
The presence of which of the following history items should increase the therapist’s suspicion of a thoracic compression fracture in the patient?
1. Bowel and bladder dysfunction
2. Smoking and prolonged steroid use
3. Hypertension and diabetes
4. Emphysema and hormone replacement therapy
2
Bowel and bladder dysfunction are related to spinal cord/upper motor neuron dysfunction.
Smoking and steroids can weaken bone and increase the likelihood for a compression fracture.
Hypertension and diabetes are not risk factors for a compression fracture. By themselves, neither emphysema nor hormone replacement therapy increases the likelihood of a compression fracture.
Which of the following modalities is
MOST appropriate for decreasing pain and increasing tissue extensibility prior to active hand exercises in a patient with rheumatoid arthritis?
1. Cold gel pack
2. Direct contact ultrasound
3. Continuous short-wave diathermy
4. Paraffin wax bath
4
Paraffin wax baths are used in the nonflare phases to decrease pain and increase tissue extensibility in patients with rheumatoid arthritis. The increase in collagen extensibility associated with heating may decrease pain perception and increase tolerance for and participation in active exercise. Option 1 is incorrect because cyrotherapy (cold gel pack) decreases tissue extensibility. Options 2 and 3 are incorrect because these modalities are not easily applied over areas with thin soft tissue (hands and fingers). Paraffin allows for even distribution of heat to fingers (all joints).
Which of the following trunk strengthening exercises is BESTfor a patient to help minimize the complications associated with osteoporosis?
1. Flexion
2. Rotation
3. Extension
4. Lateral flexion
3
Trunk extension is the safest exercise for patients with osteoporosis and is necessary, given the high risk for kyphosis with vertebral fractures. The other trunk motions are contraindicated for patients with osteoporosis.
A physical therapist is working on progressive functional mobility with a patient who had a transverse colectomy 2 days ago. The patient has developed a low grade fever. What is the MOST appropriate examination for the therapist to perform prior to continuation of the patient’s intervention?
1. Heart rate
2. Blood pressure
3. Respiratory rate
4. Auscultation
4
Changes in heart rate, blood pressure, or respiratory rate can accompany fever, but none of those measurements will help in delineating the cause of the fever. Common causes of immediate postoperative fevers are atelectasis or pneumonia. Ausculation of the lungs would help the therapist in delineating this as a cause of the fever and determining the appropriate physical therapy intervention.
A patient is entering a cardiac rehabilitation program. The physical therapist should FIRST ask the patient to:
1. describe the correct aspects of exercise demonstrated by the therapist.
2. list problems associated with poor nutritional habits.
3. identify the harmful effects of smoking with regard to cardiac disease.
4. describe the type of angina that the patient experiences.
4
In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation are 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 who works in a home health agency is treating a patient with diabetes mellitus. The patient reports that he is longer taking insulin. The therapist’s
FIRST course of action should be to:
1. instruct the patient in the proper technique for injection of insulin.
2. contact the patient’s home health nurse.
3. tell the patient’s family to report this information to the physician.
4. have the patient perform a urine glucose test while the therapist is in the home.
2
Contacting the patient’s home health nurse is the appropriate first course of action because of the possible safety risk associated with the patient’s not taking insulin. Injections and glucose testing would go beyond the scope of practice for physical therapy. Placing the responsibility on the family would not be appropriate because of the gravity of the situation.
A measurable objective for a community education program on proper exercise techniques would be for participants to:
1. understand the importance of a sufficient warm-up period.
2. list five stretching techniques that can be used when warming up.
3. overcome lower extremity problems and adhere to a regular exercise program.
4. appreciate the effects of increasing intensity of exercise on heart rate.
2
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.
While ascending stairs, an older adult patient leans forward with increased hip flexion. Which of the following muscles is being used to BEST advantage with this forward posture?
1. Rectus femoris
2. Tensor fasciae late
3. Semitendinosus
4. Lumbar paraspinal
3
The hamstrings are hip extensors that are more active when the hip is in flexion, especially in functional activities such as stair climbing. In this case, the patient flexes the hip, placing the semitendinosus on stretch and increasing its moment arm and increasing its ability to produce hip extension. Therefore, the patient is leaning forward to maximize the ability of the hamstrings to extend the hip during the stair climbing activity. The other muscles listed would not benefit as much from the increased hip flexion.
The authors of a research article describe a favorable study outcome as insignificant because the study results were not statistically significant. The insignificant finding would MOST likely be due to poor research methods if which of the following study characteristics was present?
1. Small sample size
2. Small within-group variance
3. 85% analysis power
4. Controlled alpha level
3
A small sample size can be linked to errors in statistical conclusions because there may not be enough participants to allow application of the findings to all patients in the population of interest. The within-group variance being smaller enables less overlapping of sample distributions. Greater than 80% analysis power is linked with a higher probability that study conclusions are accurate. An inflated alpha level (i.e., noncontrolled) results in a higher level of statistical significance and greater probability of a type 1 error.
As a patient progresses in learning a new motor skill. there should be a resultant increase in which of the following types of feedback?
1. Tactile
2. Visual
3. Intrinsic
4. Verbal
3
As learning progresses, feedback should progress from extrinsic (which included tactile, visual, verbal) to intrinsic feedback from the muscle spindle and joint receptors.
A patient is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced QRS complexes on the electrocardiogram represents:
1. ventricular depolarization.
2. premature ventricular contractions.
3. atrial fibrillation.
4. atrial repolarization.
2
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 as a wide, irregularly spaced 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.
While working in a private practice clinic, a physical therapist observes a patient fall in the parking lot outside the office. The patient sustains a severe laceration to the forearm. The therapist secures a pressure dressing to the wound site but notes that blood is soaking through the dressing and the bandage. Which of the following actions should the therapist perform NEXT?
1. Elevate the limb and apply pressure to the wound.
2. Remove the dressing and bandage and start over with a tighter bandage.
3. Apply additional dressings and bandages and apply pressure to the brachial artery.
4. Call the patient’s physician and arrange transportation for medical care.
1
Elevation and pressure is the correct next step in controlling bleeding. Removal of the dressing and bandage would potentially irritate the wound and increase the hemorrhage.
Elevation and pressure should be applied first, before additional dressings, bandages, and pressure to the brachial artery. While calling the patient’s physician to arrange transportation for medical care may be necessary, it does not immediately control the bleeding.
A physical therapist is conducting a reflex text as shown in the photographs. The arrow indicates the path of the applied stimulus. The results of the test are MOST likely to indicate:
1. a peripheral nerve injury.
2. a lesion of the anterior horn cells.
3. a normal response.
4. an injury to the spinal cord.
4
The therapist is testing for a positive Babinski sign. When the Babinski sign is positive, the toes flare at the end of the test. The presence of a positive Babinski sign indicates an upper motor neuron lesion such as a spinal cord injury. If no upper motor neuron lesion is present, the toes will flex. The only upper motor neuron lesion is injury to the spinal cord. Peripheral nerve injuries and lesions of the anterior horn cells are lower motor neuron lesions.
The work modification (standing) shown in the photograph is MOST appropriate for a patient with which of the following pathologies?
1. Central lumbar stenosis
2. Deep vein thrombosis
3. Thoracolumbar scoliosis
4. Posterolateral lumbar disc bulge
4
The photograph shows a standing desk/work station. A patient with stenosis will do better in sitting, not standing. A patient with a deep vein thrombosis will need to move, not be stationary. A scoliosis alone does not warrant a standing work station. Sitting increases intradiscal pressure, so standing is often preferred to sitting.
A long-distance runner comes to physical therapy with insidious onset of lower leg pain. The patient’s examination results reveal weakness of toe flexion and ankle inversion. The physical therapist suspects vascular compromise associated with this presentation.
Palpation at which of the following locations is MOST likely to reveal diminished arterial pulses in the patient?
1. Dorsal aspect of the foot
2. Posterior to the lateral malleolus
3. Posterior to the medial malleolus
4. Lateral aspect of the popliteal fossa
3
The posterior tibial artery is most likely to be involved in chronic posterior compartment syndrome, which is described in the question. This artery should be palpated posterior to the medial malleolus. The dorsal aspect of the foot is the site for palpation of the dorsalis pedis pulse. The dorsalis pedis artery is not involved in posterior compartment syndrome. The palpation site posterior to the lateral malleolus is used to access the fibular (peroneal) artery.
The fibular (peroneal) artery is not involved in posterior compartment syndrome. Palpation in the popliteal fossa is a poor choice of palpation location in association with posterior compartment syndrome. The popliteal artery may be palpated here, but the compartment syndrome manifestations are distal to this site.
During an intervention session with a patient with a recent onset of hemiplegia, a physical therapist plans to focus on transfers to and from a wheelchair, a bathtub, and an automobile. Which of the following methods should be MOST effective for long-term retention of these skills?
1. Practice the activities in random order.
2. Sequence the activities from easiest to most difficult.
3. Allow the patient to determine the sequence of activities.
4. Establish a predictable but variable practice sequence.
1
It has been determined that a critical factor in improving learning is that the subject must do something different on consecutive trials. Therefore the traditional approach for retraining by practicing one skill repeatedly is not the most effective. It is believed that having a patient practice a number of tasks in random order would probably be more successful for long-term retention. The other options do not provide for randomization of the activities and are therefore less likely to provide for long-term retention.
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?
1. Iliopsoas
2. External abdominal oblique
3. Quadratus lumborum
4. Upper rectus abdominis
1
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 (iliosoas among others) would have to complete this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas muscle.
A patient has medication-induced
Cushing syndrome. Which of the following physiological problems is a common manifestation of this disorder?
1. Hypotension
2. Hypercalemia
3. Muscle catabolism
4. Decreased protein metabolism
3
Corticosteroid-induced myopathies are common after prolonged use of the drug, and they are common in the proximal musculature of the extremities. The other options are the opposite of symptoms commonly found with steroid-induced conditions. Usually there are problems with hypertension, hypocalemia, and increased protein metabolism.
A 90-year-old patient with chronic congestive heart failure has been nonambulatory and has resided in a nursing home for the past year. The patient was recently admitted to the hospital after an episode of dehydration.
Which of the following plans for prophylactic respiratory care is MOST appropriate?
1. Turning, coughing, and deep breathing every 1 to 2 waking hours
2. Vigorous percussion and vibration 4 times/day
3. Gentle vibration with the foot of the bed elevated 1 time/day
4. Segmental postural drainage using standard positions throughout the day
1
A patient who is immobile and restricted to bed is at risk for 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.
Which of the following joint mobilizations would be MOST effective for improving a patient’s ability to progress into terminal stance?
1. Posterior glide of the talus on the tibia
2. Posterior glide of the calcaneus on the talus
3. Plantar glide of the 1st proximal phalanx on the metatarsal
4. Dorsal glide of the 1st proximal phalanx on the metatarsal
4
Extension of the 1st metatarsophalangeal joint is needed in terminal stance. The distal metatarsal is convex. The proximal portion of the articulating phalanx is concave. According to the convex-concave rule, when a therapist moves a concave joint surface on a convex joint surface, the concave joint surface is moved in the same direction as the range-of-motion limitation. Therefore, the appropriate accessory glide is a dorsal glide of the proximal phalanx on the metatarsal. Posterior glide of the talus on the tibia and plantar glide of the 1st proximal phalanx on the metatarsal promote plantar flexion. Posterior glide of the calcaneus on the talus is not as relevant for terminal stance, which involves the 1st M TP joint.
A physical therapist is examining muscle strength in a patient. The patient is asked to move the leg along the path indicated by the arrow shown in the photograph and to hold the leg in place while the therapist applies resistance to the leg.
The patient moves through the range of motion shown and is able to take maximal resistance. Intervention should address which of the following problems?
1. Tightness of the hip medial (internal)
rotators
2. Weakness of the gluteus minimus and medius
3. Correction of the right lateral (external) trunk shift
4. Piriformis weakness
1
The fact that the patient has normal muscle strength of the hip lateral (external) rotators along with limitation of range of motion indicates either tightness of the medial (internal) rotators or hip capsule tightness. The gluteus medius and minimus are medial (internal) rotators of the hip. The trunk shift is a normal substitution pattern found in individuals who lack hip range of motion. The problem is related to the hip, not the trunk. The patient’s piriformis shows normal strength, so it is not weak.
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:
1. when the patient shows signs of pressure sores.
2. every 15 to 20 minutes.
3. every 1 to 2 hours.
4. if the patient does not have an appropriate cushion.
2
A patient with a thoracic spinal cord level injury is able to perform independent pressure relief strategies and should complete pressure relief every 15 to 20 minutes.
Which of the following lower extremity findings is MOST likely to be the FIRST sign of vascular occlusive disease?
1. Edema of the legs and ankles
2. Brown discoloration at the ankles
3. Increased cyanosis when legs are dependent
4. Lack of hair on the toes
4
Poor hair growth is characteristic for arterial disease due to inadequate cellular nutrition.
The first sign of arterial disease is often loss of hair on the toes. Edema may be present with advanced cases of arterial disease. Increased cyanosis with legs in the dependent position is present in advanced disease. Brownish discoloration at the ankles is characteristic of chronic venous disorders.
A physical therapist is teaching a patient who has recently undergone knee surgery to use a cane while descending stairs without a railing. The patient has partial weight-bearing status on the right. Which of the following instructional methods should the therapist use to teach the patient this activity?
The therapist stands behind the patient, and the patient descends with the cane and left leg first.
2. The therapist stands beside the patient, and the patient descends with the right leg first and then the cane.
3. The therapist stands below the patient, and the patient descends with the cane and right leg first.
4. The therapist stands behind the patient, and the patient descends with the left leg first.
3
Options 1, 2, and 4 are neither safe nor appropriate. When descending stairs, it is generally best for the therapist to be positioned below the patient as protection from falling. However, the patient should always descend stairs leading with the involved leg, the right leg in this case, and
the cane.
A patient with low back pain also reports constipation, occasional nausea and vomiting, and unexplained weight loss.
The pain worsens when the patient is supine and decreases when the patient leans forward when sitting. The sclerae are yellow. The signs and symptoms are
MOST consistent with which of the following disorders?
1. Appendicitis
2. Cholecystitis
3. Pancreatic carcinoma
4. Irritable bowel syndrome
3
Pancreatic cancer is characterized by nonspecific and vague symptoms, which can include nausea, weight loss, pain radiating to the back or back pain alone, and jaundice. Sitting up and leaning forward may provide some relief by taking pressure off the pancreas. Irritable bowel syndrome is characterized by abdominal pain with constipation and diarrhea, nausea and vomiting, but not referred back pain or jaundice. Cholecystitis is an inflammation of the gallbladder and typically produces right upper quadrant abdominal pain. There may be nausea and vomiting, weight loss, and jaundice. However, the pain is referred to the upper back or right shoulder, not the low back. There is also anorexia, nausea and vomiting with appendicitis, but the pain is present generally over the right lower quadrant. Bending forward may worsen the symptoms because of the resultant increase in intraabdominal pressure.
Excessive upward rotation of the right scapula is noted when a patient attempts to perform shoulder flexion. Which of the following exercises is MOST appropriate to help correct the excessive scapular rotation?
1. Right scapular protraction against resistance with the right arm at 90° of flexion
2. Bilateral scapular elevation with the upper extremities at 180° of flexion
3. Wall push-ups with an isometric hold at end range with the elbows extended
4. Bilateral scapular adduction with the upper extremities medially (internally)
rotated and adducted across the back
4
Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi (downward rotators). The scapular adduction with medial (internal) rotation and adduction of the arm would require action by those muscles. Option 1 would help strengthen the serratus anterior, an upward rotator of the scapula. Option 2 would activate the upper trapezius as well as the rhomboids, and, since the upper trapezius is also an upward rotator of the scapula, this would not be the best exercise to use. Option 3 would also help strengthen the serratus anterior, which would tend to aggravate the problem.
Which of the following diagnoses is
MOST associated with urinary incontinence?
1. Orchitis
2. Testicular cancer
3. Testicular torsion
4. Benign prostatic hyperplasia
4
The nodular hyperplasia that occurs with benign prostatic hyperplasia causes obstruction of the urethra, resulting in urinary frequency and urge incontinence. Testicular torsion, orchitis, and testicular cancer are not associated with urinary dysfunction.
A physical therapist is working on transfers with a patient who had a brainstem cerebrovascular accident. The patient has ataxia in all four extremities and a high level of extensor tone in the lower extremities. The patient has fair to good trunk control. Which of the following transfers is BEST for this patient?
1. Squat pivot
2. Sliding board
3. Standing pivot
4. Dependent tuck
1
A squat-pivot transfer avoids full lower extremity extension, thus minimizing lower extremity extensor tone. A sliding-board transfer is not appropriate with a high level of ataxia in the upper extremities. A standing-pivot transfer is not appropriate because it may increase the extensor tone in the lower extremities. A dependent tuck transfer does not encourage active patient participation or promote independence.
A physical therapist wants to examine the relationship between lower extremity manual muscle test grades and five ranked categories of functional ambulation ability in a group of older adults. Which of the following statistics is MOST appropriate for testing this relationship?
1. Paired t test
2. Pearson product-moment correlation [r)
3. Mann-Whitney U test
4. Spearman rho (rs)
4
The research question is one of relationship or correlation between measures, not comparison of group means, so the t test and the Mann-Whitney U test are not appropriate.
Because the data for both variables are ranked (ordinal), Spearman rho (Spearman rank correlation coefficient) should be used. This is the nonparametric analog of the Pearson correlation coefficient (r). The Pearson r requires continuous, not ordinal, data.
In a research study, a correlation coefficient of .30 was found for the relationship between two variables.
Which of the following interpretations of this finding is MOST appropriate?
1. The variables have a low correlation.
2. Thirty percent of the variability in one variable can be accounted for by the other variable.
3. There are no significant differences between the variables.
4. There is low positive predictive value between the variables.
1
A correlation coefficient of .26 to .49 is considered low.
Which of the following conditions is the
MOST likely cause of a reduced vital capacity in a patient who has quadriplegia at the C5-C6 level?
1. Decreased anterolateral chest expansion resulting from paralysis of the external intercostal muscles
2. Inability of the patient to generate a negative intrapleural pressure secondary to a denervated diaphragm
3. A relatively high resting position of the diaphragm resulting from paralvsis of the abdominal muscles
4. Reduced rib-cage elevation due to paralysis of the anterior scalene and sternocleidomastoid muscles
1
The rib cage would not be able to expand normally during inspiration due to weakness of the external intercostal muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the Cs-Cs level, the diaphragm would still receive innervation from the phrenic nerve (Ca). The anterior scalene (Ca-Cs) would be partially innervated and the sternocleidomastoid (C2-C;) 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.
A physical therapist places electrodes on a patient to monitor surface
electromyographic activity. The electrode placement shown in the photograph is MOST appropriate to monitor which of the following muscles?
1. Tensor fasciae late
2. Sartorius
3. Rectus femoris
4. Gluteus minimus
1
The electrode placement in the photograph is the best placement for the tensor fasciae late. The electrodes are placed over the muscle belly and lined up parallel to the muscle fibers.
The sartorius is found more distally and medially and following the direction of the muscle fibers.
The rectus femoris is found more distally and central to the thigh. The gluteus minimus is a deep muscle that cannot be easily monitored directly by surface electromyography.
A physical therapist places a patient on a strength training program for the lower extremities. The mode of exercise is a double-leg press unit using free weights.
After 1 week, the patient shows a 10-Ib
(4.5-kg) increase in the amount of weight the patient is able to lift. What is the MOST likely cause of the patient’s increase in strength?
1. Muscle fiber hypertrophy
2. Neurological adaptation
3. Hyperplasia of the muscle fibers
4. Increase in the amount of actin and myosin
2
Strength increase in muscle is due to a number of factors, including neurological adaptation and muscle fiber hypertrophy with an increase in actin and myosin. Hyperplasia in humans is still controversial. Long-term changes in muscle strength are due to all of the factors listed. However, short-term changes, such as changes in 1 week, are most likely to due to neurological factors such as more efficient motor unit recruitment, autogenic inhibition, and more efficient co-activation of muscle groups.
A physical therapist is considering the use of phonophoresis as part of an intervention plan. Which of the following steps is the correct FIRST step in the decision-making process to use phonophoresis?
1. Outline the therapeutic goals and outcomes.
2. Select the appropriate coupling agent and medication.
3. Decide on the dosimetry by choosing the appropriate mode and frequency.
4. Determine if there are any contraindications.
4
Although all of options are involved in the decision-making process, the determination of contraindications is the first thing to consider, because all other options are unnecessary if the patient has other pathologies that could be a contraindication.
A physical therapist is evaluating a patient who has shoulder pain. The patient notices the shoulder pain at work when stocking shelves that are overhead.
The pain is not apparent when stocking shelves at waist or chest level. The patient MOST likely has weakness in which of the following muscles?
1. Pectoralis minor
2. Upper trapezius
3. Deltoid
4. Rhomboid major
2
Weakness in the pectoralis minor would not cause restriction of the scapula but would likely cause scapular hypermobility. Weakness in the upper trapezius would decrease upward rotation of the scapula during shoulder flexion and abduction. The more the shoulder is elevated, the more noticeable this would be. The decreased scapular movement would increase the predisposition toward impingement. Weakness in the deltoid would cause the humerus to move downward, not upward, during shoulder elevation. Weakness in the rhomboid major would not cause restriction of the scapula, but would likely cause scapular hypermobility.
A patient who sustained a mild cerebrovascular accident 3 weeks ago is being prepared by a 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:
1. skilled nursing coordinator.
2. occupational therapist.
3. medical social worker.
4. primary physician.
3
Medical social service staff deal with home situations and financial supports and act 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 the patient while the patient is 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.
In a research study, a physical therapist performs the same goniometric measurement on the same group of control subjects during two consecutive testing sessions. This process is used to demonstrate which of the following measurement properties?
1. External validity
2. Instrument reliability
3. Intrarater reliability
4. Interrater reliability
3
Intrarater reliability describes the repeatability of measurements made by one person (repeatability within that person).
Sensory-level electrical stimulation is
MOST appropriate for a patient with which of the following conditions?
1. Chronic low back pain of somatic origin
2. Acute ankle sprain with edema
3. Supraspinatus tendonitis
4. Active Raynaud syndrome
4
Regarding chronic low back pain of somatic origin, the patient has a chronic problem, so will most likely require motor-level stimulation, because it provides a longer-lasting analgesia.
There is no evidence to indicate that sensory-level stimulation is effective in the treatment of edema. For edema reduction, rhythmic muscle contraction is preferred. lontophoresis is more appropriate than sensory-level electrical stimulation for treatment of a tendonitis, because it involves the delivery of anti-inflammatory medications. Raynaud syndrome is a condition in which the smallest arteries that bring blood to the fingers or toes constrict when exposed to cold or from an emotional upset. Sensory-level stimulation over nerve roots and trunks can increase peripheral vasodilatation.
A patient with which of the following diagnoses would MOST likely benefit from pursed-lip breathing during exercise?
1. Peripheral vascular disease
2. Congestive heart failure
3. Emphysema
4. Sarcoidosis
3
Peripheral vascular disease is a vascular problem, not a pulmonary problem. Congestive heart failure may lead to pulmonary problems, but not obstructive problems. Emphysema is an obstructive lung disease, for which pursed-lip breathing may be beneficial. Sarcoidosis is a restrictive lung disease for which pursed-lip breathing is not beneficial.
