PEAT 5 Flashcards
A patient who sustained a right cerebrovascular accident presents with a flaccid left arm. During muscle testing, the patient is able to shrug the left shoulder. The MOST accurate explanation for shoulder movement is that the right cerebrovascular accident:
1. has affected the right shoulder and not the left shoulder.
2. did not affect the vagus nerve (X), which innervates the upper trapezius muscle.
3. did not affect spinal accessory nerve (XI), which innervates the upper trapezius muscle.
4. has affected the left biceps and triceps muscles but not the deltoid muscles.
3
A right cerebrovascular accident affects the left shoulder, not the right shoulder. The upper trapezius is controlled by spinal accessory nerve (XI), not the vagus nerve (X). The spinal accessory nerve (Xl) (supplied by the corticobulbar tract) was apparently not affected by the stroke and accounts for the patient’s ability to shrug a flaccid arm. The deltoid does not shrug the shoulder.
Manual muscle test grades are an example of which of the following levels of measurement?
1. Nominal
2. Ratio
3. Interval
4. Ordinal
4
Measurement of muscle strength by manual muscle testing uses an ordinal scale. MMT grades are ranked (and are therefore not nominal) but do not have consistent intervals between ranks as would be required for interval and ordinal levels of measurement.
A physical therapist should anticipate that an abnormal lymph node will feel:
1. soft and nonmobile and have an increased skin temperature.
2. firm and nontender and have an increased skin temperature.
3. firm, mobile, and tender or nontender.
4. soft, mobile, and tender or nontender.
3
An abnormal lymph node may feel firm and nontender, but an elevated skin temperature is not an expected accompanying feature of an abnormal lymph node. An abnormal lymph node can range in feeling from firm to hard, be mobile or nonmobile, and be tender or nontender. An abnormal lymph node would not feel soft.
A patient comes to physical therapy with the diagnosis of a medial meniscus tear of the right knee. Which of the following signs and symptoms is MOST indicative of this diagnosis?
1. Mechanical locking
2. Decreased pain with weight bearing
3. Posterior knee swelling
4. Atrophy of hamstrings
1
A history of mechanical locking is a common symptom of knee medial meniscus tear. Pain is commonly increased with weight bearing, not with decreased weight bearing. Swelling would more likely be evident anteriorly, not posteriorly. Quadriceps atrophy is more likely, not hamstrings atrophy.
A client who is participating in a weight-loss program has been walking 3 days/week for 15 minutes for the past 3 weeks. To progress the exercise program, which of the following modifications will MOST likely accomplish the weight-loss goal?
1. Maintain the current walking speed and increase the duration to 30 minutes.
2. Increase the walking speed and keep the duration at 15 minutes.
3. Walk 4 days/week and decrease the duration to 10 minutes.
4. Change from walking 3 days/week to jogging 1 day/week for 20 minutes.
1
The optimal exercise duration for achieving weight loss with a walking program is 40 to 60 minutes of continuous aerobic activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to increase the duration while maintaining the same intensity or walking speed. Increasing walking speed should only be performed once the patient can consistently tolerate 20 to 30 minutes of exercise. Decreasing the duration while increasing the frequency of exercise would not accomplish the goal of 40 to 60 minutes of continuous exercise. A patient who has been walking for only 15 minutes 3 times/week would not be ready to begin jogging, and jogging 1 time/week would be too low of an exercise frequency in general to achieve any training benefit.
A 78-year-old patient who is being treated for osteoarthritis of the knees reports centralized lower thoracic pain and epigastric pain. The pain is relieved by eating. Which of the following steps would be MOST important in screening for the cause of the new symptoms?
1. Resist the iliopsoas muscle to screen for a psoas abscess.
2. Ask if the patient has been constipated or has had diarrhea.
3. Perform an abdominal examination to screen for an abdominal aortic aneurysm.
4. Ask if the patient is taking a high dose of nonsteroidal anti-inflammatory drugs.
4
A high percentage of hospitalizations of the aging population with gastrointestinal complaints are due to the effects of nonsteroidal anti-inflammatory drugs. This patient may be taking this class of drugs for the pain and inflammation in the knees. Because the pain changes with food intake, the gastric region as a source is implicated. An abdominal aortic aneurysm would likely cause severe low back pain and would not change with eating nor cause epigastric pain. A psoas abscess would be painful in the right or left lower quadrant and refer pain to the low back. Constipation and diarrhea are symptoms related to the colon, which, when painful, relates to mid abdomen pain and refers pain to the sacral area.
A patient who is re-learning the task of moving from sit to stand following traumatic brain injury is frustrated because of repeated failed attempts. To facilitate the patient’s success, a physical therapist should FIRST:
1. permit the patient to rest until the next physical therapy session and re-attempt the activity.
2. encourage the patient to visualize success with the task before resuming attempts.
3. provide incentive by holding a desired object for the patient to reach toward.
4. decrease the challenge of the task, so that the patient experiences success.
4
It is most important for the patient to experience some form of success in order to provide motivation. Stopping the session upon failure may further frustrate the patient. Visualization, although useful, is a higher level task that should not be the first strategy used. Poor body mechanics and stimulation of tone may occur if the patient reaches forward while moving from sit to stand. Necessary to learning are motivation to try the unknown and, simultaneously, success in learning, to retain the learner’s motivation.
A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis should include all of the following EXCEPT:
1. strengthening the scapular protractors.
2. strengthening the thoracic erector spinae muscles.
3. lengthening the short suboccipital muscles.
4. lengthening the lumbar erector spine muscles.
1
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 NPTE, be alert for this type of question and read the responses so that you select the unrelated response.
A physical therapist is applying electrical stimulation to a patient with a neurapraxia. To minimize accommodation, the therapist should:
1. decrease the size of the stimulating electrode.
2. increase the pulse duration.
3. utilize a rapid rate of rise.
4. select a biphasic waveform.
3
A decrease in size of the electrode will intensify the current density and is not a measure to minimize accommodation. An increase in the width of the stimulus increases the amount of time that the electrical stimulation is applied but should not affect accommodation. Too slow a rise time results in changes in the tissue membrane known as accommodation, which gradually elevates the threshold required for the nerve to fire. Therefore, the rise time must be rapid enough to avoid accommodation. A biphasic waveform does not minimize accommodation.
During examination of a patient, a physical therapist notes hypoventilation, muscular twitching, and increased deep tendon reflexes. Which of the following conditions is the MOST likely cause of the signs and symptoms?
1. Metabolic alkalosis
2. Metabolic acidosis
3. Respiratory alkalosis
4. Respiratory acidosis
1
Metabolic alkalosis would result in hypoventilation and increased deep tendon reflexes.
Metabolic and respiratory acidosis result in decreased deep tendon reflexes. Respiratory alkalosis results in tachypnea.
A patient is referred to physical therapy with a diagnosis of herniated nucleus pulposus. In addition to low back pain, examination findings include hypoesthesia, weakness, and diminished deep tendon reflexes in bilateral lower extremities. Which of the following types of incontinence is MOST likely to be associated with this presentation?
1. Urge
2. Overflow
3. Stress
4. Functional
2
The patient description is one of cauda equine syndrome, which may result from a large central disc protrusion. In addition to the lower extremity signs and symptoms, an interruption of the micturition reflex occurs, leading to an inability of the internal urethral sphincter to relax in response to a stretching detrusor muscle. As the bladder pressure increases above the resistance provided by the internal urethral sphincter, urine is released, resulting in an overflow dribble.
A physical therapist is working with a patient who had a total knee arthroplasty 2 days ago. The patient’s resting electrocardiogram is shown in strip A. While gait training, the patient’s electrocardiogram changes, as shown in strip B. Based on this finding, what is the BEST action for the therapist to take at this time?
1. Stop gait training and notify the nurse.
2. Continue gait training as the heart rate is less than 100 bpm.
3. Stop gait training and allow the patient to sit down and rest.
4. Continue gait training, but allow the patient standing rest breaks.
1
The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and an indication to stop exercise and notify medical staff. Continuing gait training would endanger the patient. Stopping and resting is a plausible option. However, the medical staff should be alerted to this situation first. Continuing gait training, despite some standing rests, could allow the ischemia to progress and endanger the patient.
A physical therapist is performing sit-to-stand transfer training with a patient in a hospital room.
The patient is currently admitted for acute renal failure and has electrocardiogram monitoring in place. During the transfer training, the therapist notes new onset of one unsustained, unifocal premature ventricular contraction. Which of the following actions is MOST appropriate for the therapist to take at this time?
1. Discontinue transfer training and call the nurse immediately.
2. Discontinue transfer training and switch to passive range-of-motion exercises.
3. Allow the patient to rest and continue with transfer training, while monitoring the electrocardiogram.
4. Allow the patient to rest and measure the patient’s blood pressure.
3
An unsustained unifocal premature ventricular contraction is a stable electrocardiograph change associated with activity and therefore modification of the current intervention is not necessary. Because this type of premature ventricular contraction is stable and there is no report of dizziness in the stem, taking blood pressure is not necessary at this time.
When held in supported standing, a 14-month-old child with spastic diplegia is up on tiptoes with the toes curled. This position is characteristic of a:
1. proprioceptive placing reaction.
2. Moro reflex.
3. plantar grasp reflex.
4. traction response.
3
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.
A patient with multiple sclerosis is referred for physical therapy at home. The patient requires training in bathing, dressing, and eating, and use of adaptive devices may be needed to accomplish the training. The physical therapist should recommend that the patient be seen by alan:
1. social worker.
2. orthotist.
3. occupational therapist.
4. home health nurse.
3
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.
As a patient progresses with physical therapy, which of the following changes in a home exercise program is MOST likely to increase the patient’s adherence to the program?
1. Add additional exercises to the home program.
2. Increase the intensity of the home exercises.
3. Increase the frequency of home exercise program execution.
4. Choose exercises that can be incorporated into daily activities.
4
The top reason for noncompliance with a home program is that the exercises required too much time and did not fit into the patient’s daily life routine.
A home health patient who recently had a three-vessel coronary artery bypass graft describes experiencing bilateral lower extremity swelling, leg pain, and shortness of breath, especially when lying down. The patient MOST likely has which of the following diagnoses?
1. Deep vein thrombosis
2. Myocardial infarction
3. Pulmonary embolism
4. Congestive heart failure
4 A deep vein thrombosis corresponds to the leg pain and possibly swelling but not shortness of breath. A myocardial infarction corresponds to shortness of breath but typically does not result in swelling acutely. A myocardial infarction could result in the development of congestive heart failure, which would result in these symptoms, but this is a secondary result, not a primary result. A pulmonary embolism would result in shortness of breath, usually not changed by position, and typically cardiac arrest. Typical signs of congestive heart failure include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema.
Which of the following techniques is MOST appropriate for a patient with low postural tone?
1. Slow regular rocking while sitting on a treatment bolster
2. Continuous pressure to the skin overlying the back muscles
3. Low-frequency vibration to the back muscles
4. Joint approximation applied through the shoulders to the trunk
4
Options 1, 2, and 3 are techniques used to decrease postural tone, which is not indicated for this patient. Option 4 is the most appropriate technique for improving low postural tone.
Which of the following descriptions BEST represents the physical examination technique used to
assess tissue hydration in the hand?
1. Pinch and lift the skin and determine the time for the skin to return to normal.
2. Push into the skin and determine the time for the skin to return to normal.
3. Measure the surface temperature over the volar aspect of the wrist.
4. Obtain volumetric measurements on each arm and compare displacement measures.
1
Tissue hydration is determined by pinching and lifting the skin and timing the return to normal. Option 2 describes the measurement technique for pitting edema. Temperature is not directly related to tissue hydration. Measurement of girth/size is not related to tissue hydration.
A physical therapist is issuing a home exercise program to a patient. Which of the following strategies MOST ensures the patient’s proper adherence with the program?
1. Provide written instructions for the program.
2. Involve a family member in supervising the exercises.
3. Demonstrate the program to the patient while providing verbal instructions.
4. Have the patient perform the exercises under the guidance of the therapist.
4
The best way to ensure proper exercise performance and adherence is to have the patient demonstrate the program. Involving a family member is a good idea, but a better option is to directly involve the patient in the program and provide an opportunity for the patient to demonstrate the program.
When training a patient to increase muscle activity with the use of electromyographic biofeedback, the physical therapist should adjust the unit so that sensitivity:
1. starts low and increases as the patient shows an increase in muscle activity.
2. starts high and decreases as the patient shows an increase in muscle activity.
3. remains at approximately mid-range during the entire treatment period.
4. is not set, since this adjustment is not necessary for this form of biofeedback.
2 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.
In a research study, the independent t-test was used as the statistical tool. How would statistically significant results be presented if alpha was set at .05?
1. p <.05
2. p > .05
3. r2 > .05
4. r2 < .05
1
A p value is the probability value. With the pre-study alpha set at .05, p values <.05 are considered statistically significant. The r value is the Pearson product-moment correlation coefficient, and r is the coefficient of determination (the percentage of variance that is shared by the two variables that are correlated).
To manually assess a patient’s lower extremity circulation, a physical therapist should palpate the patient’s peripheral pulse at which of the following locations?
1. Dorsal foot, near the base of the first metatarsal
2. Lateral lower leg, just posterior to the fibular head
3. Lateral ankle, just inferior to the lateral malleolus
4. Plantar foot, just medial to the medial calcaneal tuberosity
1
The therapist should palpate the dorsal pedal pulse, which is found on the dorsal aspect of the foot near the base of the first metatarsal. The anatomical locations in options 2, 3, and 4 are not appropriate to palpate the dorsal pedal pulse.
In which of the following conditions is a nerve conduction velocity test MOST appropriate?
1. Carpal tunnel syndrome
2. Cerebrovascular accident
3. Myotonia
4. Duchenne muscular dystrophy
1
Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron status. Carpal tunnel syndrome is the only one of the conditions listed that directlv involves a peripheral nerve. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne muscular dystrophy are primary muscle disorders.
A positive finding in which of the following examinations is MOST consistent with a diagnosis of a herniated nucleus pulposus at L4- L5?
1. Straight leg raise at 25°
2. Straight leg raise at 75°
3. Straight leg raise at 45°
4. Prone knee flexion at 90°
3
A lower lumbar herniated nucleus pulposus (involving nerve roots Ls and S) is consistent with a positive finding with straight leg raise from 30° to 60°. Prone knee flexion tests the upper lumbar nerve roots. A straight leg raise over 70° no longer tenses the lower lumbar roots. With a straight leg raise of less than 30°, there is not enough tension provided on the nerve roots to cause a positive response with a herniated nucleus pulposus.
A patient with lower extremity claudication is exercising to the point of symptom production.
Observation of the distal aspect of the patient’s skin is MOST likely to result in which of the following findings?
1. Edema
2. Hyperhydrosis
3. Hyperemia
4. Pallor
4
Pallor is caused by shunting of blood to the exercising muscle, away from the distal aspect of the extremity.
Which of the following exercises should increase a patient’s shoulder lateral (external) rotation range of motion by contraction of the tight muscle?
1. Isotonic contraction of medial (internal) rotation followed by passive motion into medial (internall rotation
2. Isometric hold resisting medial (internal) rotation followed by passive motion into medial (internal) rotation
3. Isometric hold resisting lateral (external) rotation followed by passive motion into medial
(internall rotation
4. Isometric hold resisting medial (internal) rotation followed by passive motion into lateral (external) rotation
4
According to neurophysiological principles, contraction of the involved muscle should cause a reflex relaxation of that muscle. The internal rotator muscle(s) limit lateral (external) rotation range of motion.
Which of the following community-based sport activities would LEAST likely be
CONTRAINDICATED for a patient with osteoporosis?
1. Tai-chi
2. Golfing
3. Bicycling
4. Swimming
4
Trunk motions with flexion, lateral flexion, and rotation, such as tai-chi, golfing, and bicycling, are contraindicated for patients with osteoporosis.
Which of the following joints is indicated by the arrow in the radiograph?
1. Tibiofibular
2. Subtalar
3. Talocrural
4. Midtarsal
3
The joint indicated in the radiograph is the talocrural (ankle) joint.
A physical therapist wants to use ultrasound for pain reduction. Ultrasound is
CONTRAINDICATED for which of the following conditions?
1. Dermal ulcer
2. Herpes zoster
3. Thrombophlebitis
4. Surgical incision
3
Ultrasound is contraindicated for thrombophlebitis. The other conditions may be treated with ultrasound.
During gait evaluation, a physical therapist notes that a patient demonstrates a shorter left step length and excessive left knee flexion during the left midstance phase. Which of the following problems is the MOST likely the cause of the gait dysfunction?
1. Left hamstrings contracture
2. Right iliopsoas weakness
3. Left hip flexion contracture
4. Right quadriceps weakness
1
Left hamstrings contracture is a fixed, mechanical limitation. It is the most likely cause of the gait impairment, as it directly affects both the knee joint during the midstance phase and the step length. It is the only option that can contribute to both of the gait impairments. Right iliopsoas weakness, left hip flexion contracture weakness, and right quadriceps weakness do not contribute to both gait impairments.
A physical therapist is performing a bladder retraining program with a patient who initially needed to urinate hourly. The patient has been progressed to voiding every 2 hours and now reports accomplishment of this goal with only a slight amount of incontinence between voiding.
Which of the following recommendations is MOST appropriate?
1. Increase the voiding interval by 30 minutes.
2. Increase the voiding interval by 1 hour.
3. Maintain the voiding interval at 2 hours.
4. Decrease the voiding interval to 1.5 hours.
4
Bladder retraining attempts to reestablish cortical inhibition of sacral reflexes. The goal is to lengthen the period between voiding episodes while avoiding incontinence. Once the patient is able to void at the instructed interval without urgency or urge incontinence in between, the voiding interval is increased by 30 minutes. Because this patient still has some incontinence with 2-hour voiding intervals, the voiding interval should be reduced.
A physical therapist notes that a patient has patches of dry, erythematous skin over the extensor surfaces of the elbows and knees, as well as bony enlargement of the distal interphalangeal joints. These findings are MOST associated with which of the following diagnoses?
1. Reiter syndrome
2. Psoriatic arthritis
3. Rheumatoid arthritis
4. Systemic lupus erythematosus
2
Skin lesions described in the stem are characteristic of psoriasis. Psoriatic arthritis occurs in about one-third of persons with psoriasis. When psoriatic arthritis is present, the distal interphalangeal joints are commonly affected. The skin lesions described in the stem and involvement of the distal interphalangeal joints are not characteristic of the other three diagnoses.
For adequate documentation of physical therapy services for neurological patients, changes in which of the following factors are MOST important to record?
1. Muscle tone
2. Functional abilities
3. Cognitive status
4. Quality of movement
2
All documentation about physical therapy services should readily translate the physical findings (impairments) into functional abilities/limitations.
A physical therapist, who is newly graduated, is initiating inpatient rehabilitation with a patient who is comatose. A relative of the patient asks the physical therapist to find a more experienced therapist to work with the patient. Which of the following responses is MOST appropriate for the physical therapist to provide to the patient’s relative?
1. Do you believe that I am not competent to help with the rehabilitation?
2. Are you concerned that I won’t be able to help your loved one recover?
3. I passed my licensure examination, which indicates that I can be effective.
4. Please allow me to work with this patient, and if you are still concerned, we can discuss changes.
2
Option 1 may create a barrier to communication, because the response is defensive. Option 2 indicates that the therapist is concerned with the relative’s feelings and provides the relative with the opportunity to express any concerns. Passage of the licensure examination may not convince the relative of competency and does not promote communication between the therapist and the relative. The approach of option 4 does not encourage the patient’s relative to express concerns.
A physical therapist is reviewing peer-reviewed articles to find evidence to support a physical therapy intervention. Which of the following collections of studies would provide the BEST evidence?
1. Two randomized controlled trials
2. Three single-case controlled trials
3. One group-controlled trial and three case studies
4. One randomized controlled trial and three case studies
1
Randomized group controlled (placebo) trials (RCTs) are the most rigorous of study designs for accurately determining the effects of an intervention. Two RCTs would provide stronger evidence than any of the other options.
A physical therapist evaluates a patient with back pain and determines that the patient’s pes plans is contributing to this pain. Which of the following orthotic interventions is MOST appropriate for the patient?
1. Metatarsal pad
2. Solid ankle-foot orthosis
3. Hinged ankle-foot orthosis
4. Longitudinal arch support
4
A metatarsal pad, a solid ankle-foot orthosis, and a hinged ankle-foot orthosis will not correct a longitudinal arch. The longitudinal arch support is the only orthotic given that will address pes planus.
During the gait evaluation of a patient who has a transfemoral prosthesis, a physical therapist notices that the patient laterally bends excessively toward the prosthetic side during midstance phase. Which of the following factors is MOST likely to cause this gait deviation?
1. A prosthesis that is too short
2. A prosthetic socket that is too small
3. Inadequate prosthesis suspension
4. A locked knee unit
1
A prosthesis that is too short causes a patient to laterally bend towards the prosthetic side during stance phase. Each of the conditions given in options 2, 3, and 4 would make the prosthesis seem too long, and none would cause the problem described.
A physical therapist examines a patient with multiple sclerosis who is in a period of exacerbation.
The patient is independent with bed mobility, can sit unassisted at the edge of the bed, and requires physical assistance to stand with a walker. Which of the following interventions would have the HIGHEST priority?
1. Wheelchair propulsion up a 10-ft (3-m) ramp
2. Wheelchair transfers
3. Walking with an assistive device
4. Tub transfers
2
Physical therapy intervention should focus on helping the patient obtain maximal functional independence. Wheelchair transfers are the means to enable the patient to be independently mobile and will be a requirement before more difficult tasks are performed such as ascending a 10-foot ramp. The patient is presumably too weak to walk at this point in time.
Tub transfers are important, but the wheelchair will be the best means to get the patient to the tub. Therefore, for the initial intervention session, wheelchair transfers would be the most important.
A patient with a hiatal hernia is receiving physical therapy. Which of the following exercises would MOST likely worsen the symptoms related to the hernia?
1. Wall sits
2. Overhead press
3. Bilateral leg lifts
4. Hamstring stretch
3
Individuals with a hiatal hernia should avoid the supine position and avoid the Valsalva maneuver. Bilateral leg lifts must be done supine and require a strong contractions of the stomach muscles, encouraging the Valsalva maneuver and thus worsening the hiatal hernia. The other exercises could be modified to be done in a position other than supine.
A physical therapist is designing a rehabilitation program for a patient with a recent diagnosis of ankylosing spondylitis. The therapist should anticipate that as the disease progresses, the patient is MOST likely to require:
1. special precautions for osteoporosis.
2. a wheelchair for community mobility.
3. assisted ventilation.
4. bilateral ankle-foot orthoses.
1
Osteoporosis is a skeletal complication associated with long-standing ankylosing spondylitis. Regarding requiring a wheelchair, the patient should still be able to walk, even with advanced stages of ankylosing spondylitis. Although lung expansion is generally decreased, assisted ventilation would not be required, because the muscles of respiration remain functional.
Peripheral neuropathies are not characteristic of ankylosing spondylitis.
A physical therapist is working with a patient who has multiple medical issues and has just finished chemotherapy. Which of the following tests is MOST appropriate to measure changes in this patient’s endurance over time?
1.10-meter walk for time
2. 6-minute walk
3. Timed Up and Go
4. Maximum VO2 assessment
2
The 10-m walk for time test addresses speed more than endurance. By definition, the
6-minute walk test is the only option that addresses endurance. The timed up and go test does not measure endurance. A maximum VO2 assessment does not directly measure functional endurance.
A patient with idiopathic pulmonary fibrosis completed a 6-minute walk test and demonstrates the following results: total walking distance of 1200 ft (366 m) in 6 minutes, heart rate of 82 to 110 bpm (pretest to posttest), blood pressure of 125/80 to 145/85 mm Hg (pretest to posttest), respiratory rate of 18 to 40 breaths/minute (pretest to posttest), and oxygen saturation of 98% to 92% (pretest to posttest); an electrocardiogram showed normal sinus rhythm throughout the test.
Based on these results, the physical therapist should determine that the patient has impaired:
1. aerobic capacity and endurance associated with cardiovascular pump dysfunction.
2. ventilation, respiration, and aerobic capacity associated with airway clearance dysfunction.
3. ventilation, respiration, aerobic capacity, and gas exchange associated with ventilatory pump dysfunction.
4. aerobic capacity and endurance associated with cardiovascular pump failure.
3
Based on the walk test results, the heart rate and blood pressure have normal physiologic rise in response to exercise and would not indicate cardiovascular pump dysfunction. Although the walk test results do indicate impaired ventilation and respiration, there is no indication of airway clearance issues in the question. In general a patient with pulmonary fibrosis will have an impaired ventilatory pump. This is further evidenced by the exaggerated respiratory rate response and desaturation in the 6-minute walk test results.
During gait evaluation, a physical therapist notes that a patient demonstrates a shorter step length with the right lower extremity. Which of the following problems is the MOST likely the cause of the gait dysfunction?
1. Right iliopsoas contracture
2. Painful left knee
3. Decreased ankle pronation on the right
4. Left gluteus medius weakness
2
Right illopsoas contracture may cause a shorter step length with the left lower extremity, but the not the right lower extremity. Left knee pain will cause the patient to spend less time in left-sided stance, as the patient will try to minimize the time spent in stance (weight bearing on the knee) to minimize the pain. Therefore, the patient will take a shorter step with the right lower extremity. Decreased ankle pronation would not have an effect on right-sided step length.
Gluteus medius weakness would be seen as an increase in lateral pelvic tilt, not step length.
Tibial rotation during knee motion is possible when the knee is positioned in 90° or more of flexion because in this position the:
1. condyles of the femur glide posteriorly on the condyles of the tibia.
2. hamstrings act as a rotating force.
3. patella deviates inferiorly.
4. tension on the ligaments is decreased.
4
When the knee is extended the medial and lateral collateral ligaments are taut. During knee flexion the ligaments slacken. Therefore there is very little tibial rotation when the knee is extended (close-packed position) and approximately 40° 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.
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 of the hip:
1. abductors of the swing extremity.
2. adductors of the swing extremity.
3. abductors of the stance extremity.
4. adductors of the stance extremity.
3
The abductors are particularly active during the midstance phase (single limb support) of gait to prevent the contralateral pelvis from excessive lateral tilting. Weakness of the hip abductors, particularly the gluteus medius, causes the hip to drop down on the side opposite the weakness. For example, weakness in the right gluteus medius would show up during stance phase on the right by excessive downward movement (lateral tilt) of the left pelvis. The hip adductors are active during terminal stance and through 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.
A physical therapist is educating a patient on the use of a moist hot pack for home treatment. For the patient to prevent burns and still receive the benefits of superficial heat, which of the following heat application time frames is MOST appropriate?
1. 5 to 10 minutes
2. 20 to 30 minutes
3. 45 to 60 minutes
4. 61 to 90 minutes
2
Five to 10 minutes is an insufficient amount of time for therapeutic heating effects. The ideal amount of time for therapeutic heating effects with minimal risk of burns is 20 to 30 minutes.
Forty-five to 60 minutes is too long a period of time, as there is an increased risk of burn.
Sixty-one to 90 minutes is also too long and presents a significantly increased risk of burn.
A physical therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient’s right scapula is more abducted than the left scapula at the end range of movement. Which of the following conditions is the MOST likely cause of the altered scapula position on the right?
1. Tightness of the rhomboid major and minor
2. Weakness of the serratus anterior
3. Restricted motion of the glenohumeral joint
4. Weakness of the upper trapezius
3
Tightness of the rhomboid major and minor would promote downward rotation of the scapula. Weakness of the serratus anterior would limit the upward rotation of the scapula. The most likely reason for the increase in scapular motion is restriction of the glenohumeral joint. To fully abduct the shoulder, the scapula and glenohumeral joint both have to contribute to the motion. If the glenohumeral joint is restricted, the scapula has to increase its motion to accomplish the task. Weakness of the upper trapezius would demonstrate a scapular lag in upward rotation.
A physical therapist is evaluating a patient who had a right lower lobe resection due to lung cancer 1 day ago. During auscultation of the patient’s lungs, the therapist notes decreased low-pitched crackles bilaterally. The patient’s vital signs are heart rate - 99 bpm; blood pressure 115/75 mm Hg; and pulse oximetry - 92% while receiving 2 liters of oxygen in sitting at the edge of the bed. Which of the following actions should the therapist take NEXT?
1. Begin walking activities, with the patient receiving 4 liters of oxygen.
2. Contact the physician.
3. Perform active range-of-motion exercises with the patient at bedside.
4. Initiate bronchopulmonarv hygiene.
4
The crackles and low pulse oximetry indicate that the patient needs better ventilation and secretion clearance, probably secondary to the recent surgery. Bronchopulmonary hygiene, including postural drainage, percussion, vibration, suctioning, and incentive spirometry, are beneficial in treating and preventing postoperative atelectasis. Although walking usually helps to clear the lungs, the pulse oximetry measure is too low to initiate walking before the patient’s lungs are cleared. The therapist should clear the lungs first, not contact the physician. If the therapist is completely unsuccessful with clearing the lungs and the pulse oximetry remains low, then contacting the physician may be appropriate. Range of motion exercises are important post-thoracotomy, but again, the patient’s breathing should be addressed first.
A physical therapist plans to use a tilt table for a patient who is having difficulty tolerating upright sitting. The therapist should stop inclining the tilt table when the patient experiences which of the following signs and symptoms?
1. Decrease in diastolic blood pressure of 15 mm Hg
2. Increase in systolic blood pressure of 10 mm g
3. Increase in heart rate of 15 bpm
4. Decrease in oxygen saturation to 93%
1
Excessive drop in blood pressure is indicative of patient intolerance to upright posture.
Systolic blood pressure may increase slightly, and heart rate may increase slightly. Oxygen saturation of 93% is within the acceptable range.
A physical therapist is prescribing therapeutic exercises for a patient to perform in the physical therapy gym. The patient had a left cerebrovascular accident 2 weeks ago with resultant right lower extremity paresis. The patient also has a history of gastrosophageal reflux disease. The physical therapist should AVOID placing the patient in which of the following positions during the exercises?
1. Sitting upright at 90°
2. Standing
3. Supine
4. Sitting semi-upright at 45°
3
Neither the standing, sitting upright, nor semi-upright position promotes reflux. Supine position could facilitate relaxation of the lower esophageal sphincter and promote reflux from the stomach into the esophagus.
An important change in gastrointestinal function that occurs with aging is a(n):
1. increase in gastric motility.
2. increase in salivary secretion.
3. decrease in tooth decay.
4. decrease in nutrient absorption.
4
Changes associated with aging include a decrease in nutrient absorption. Gastric motility and salivary secretion also decrease with aging. Tooth decay increases (because of tooth enamel and dentin wear and decreased saliva).
An older adult patient has a sacral pressure ulcer measuring 15 cm × 15 cm. The wound has moderate serous fluid drainage and is loosely covered with necrotic and fibrotic tissue, although no indications of infection are present. The BEST method of debridement is:
1. daily vigorous scrubbing of the wound.
2. wet-to-dry dressings with normal saline 2 times/day.
3. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine).
4. whirlpool jet agitation 2 times/day.
2
Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage would require more frequent (i.e., 2 times/day) dressing changes. Vigorous scrubbing of the wound could damage viable tissue. Betadine can be cytotoxic. Whirlpool, by itself, would not be effective in removing necrotic and fibrotic tissue, which usually requires the addition of other methodes of debridement.
When examining a patient with right facial weakness, a physical therapist notes the presence of a right Bell phenomenon. Which of the following additional findings is MOST likely to be present?
1. Decreased taste sensation on the tongue
2. Abnormal tone of the right limbs
3. Posis of the right eyelid
4. Loss of pain and temperature sensation across the lower right jaw
1
The facial nerve, while primarily motor, does carry some sensations, particularly taste sensation from the anterior two-thirds of the tongue. Abnormal tone is associated with a supranuclear (central) lesion. Supranuclear lesions produce contralateral voluntary lower facial paralysis, so weakness would be on the other side. A Bell phenomenon is not present with central lesions. Posis or sagging of the eyelid occurs with weakness of the levator palpebrae muscle. The levator palpebrae muscle is innervated by the oculomotor nerve (Ill). Pain and temperature sensation from the face (jaw) is carried by the trigeminal nerve (V).
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:
1. assess vital signs, let the patient rest a few minutes with the feet elevated, and then resume with a less vigorous program.
2. sit the patient up, assess vital signs, and call a nurse or physician for further instructions.
3. lay the patient supine, transfer the patient to a stretcher, and return the patient to the nursing unit.
4. lay the patient down flat, call for assistance, and begin cardiopulmonary resuscitation.
2
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 (dyspnea). Positions that increase blood flow to the heart, such as lying flat, will increase the signs and symptoms. Therefore, the patient should be positioned with the head up or 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.
Instruction in energy conservation and joint protection should be provided to a patient with rheumatoid arthritis, because:
1. the joints may be predisposed to damage by overuse.
2. fatigue often masks joint pain.
3. phagocytes remove more pannus in a resting joint.
4. activity of the antigen-antibody complex is diminished with rest.
1
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. Patients 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, patients must realize that some activity is recommended, to prevent contractures and to maintain strength and endurance.
Fatigue and joint pain can and often do coexist 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.
A manual muscle test of a patient who sustained a gunshot wound immediately superior to the elbow joint reveals specific muscle weakness from a partial median nerve injury. The physical therapy intervention for the patient should include strengthening activities for wrist flexion, forearm:
1. pronation, finger flexion, and thumb adduction.
2. pronation, finger flexion, and thumb opposition.
3. supination, finger abduction, and thumb opposition.
4. supination, finger flexion, and thumb extension.
2
The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2) flexor digitorum superficialis, (3) flexor digitorum profundus (index and middle fingers), (4) thenar muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis).
Therefore, a lesion of the median nerve would affect those muscles and their accompanying actions: forearm pronation, finger flexion, and thumb opposition. Thumb adduction is accomplished by the adductor pollicis (ulnar nerve). Finger abduction is performed by the dorsal interossei (ulnar nerve). Forearm supination is the action of the supinator (radial nerve) and biceps brachii (musculocutaneous nerve).
For a patient with a bilateral transfemoral amputation to maximize balance in a wheelchair, the rear wheels should be positioned more:
1. laterally.
2. posteriorly.
3. anteriorly.
4. inferiorly.
2
The center of gravity of a person with bilateral transfemoral amputations is more posterior than the center of gravity of a person with lower extremities intact. Setting the back wheels more posteriorly will make the patient more stable in the chair. This adjustment prevents the wheelchair from tipping backward.
A physical therapist is taking the history of a patient with low back pain. If the therapist suspects the pain is caused by an inflammatory reaction, which of the following questions is BEST for the therapist to ask?
1. Is your pain constant or intermittent?
2. What activity bothers you the most?
3. Is it difficult to stand up straight after you’ve been sitting?
4. Does your pain radiate down into the leg?
1
All of the questions are important in history taking. However, constant pain is usually a hallmark of an inflammatory reaction. Mechanical pain generally changes with positions or activities. “What bothers you the most” is a good question to ask to find out what makes the pain better or worse and often helps determine the best course of intervention. Difficulty standing up from a sitting position is usually indicative of mechanical (disc) pain. Radiating pain could occur with mechanical or inflammatory disorders, so is not as discriminating as “Is your pain constant or intermittent?”
Which of the following locations corresponds to the sensory function of the nerve root exiting below the fifth lumbar vertebra?
1. Plantar aspect of the heel
2. Central anterior distal thigh
3. Medial aspect of the knee joint
4. Dorsal web space between the first and second toes
4
The L5 nerve root exits below the fifth lumbar vertebra and supplies sensory information from the dorsal aspect of the web space between the first and second toes.
A patient had a brainstem stroke 2 months ago and is currently able to independently walk 65 ft
(20 m) over level surfaces with a straight cane and ascend stairs with minimum assistance. Which of the following activities would MOST appropriately challenge this patient’s balance during a physical therapy session?
1. Ascending stairs using a single handrail
2. Standing on one leg with eyes closed
3. Walking over uneven terrain
4. Walking 130 ft (40 m) with a straight cane
3
Option 1 is not a more difficult activity than the one the patient is currently able to perform.
It is not challenging the patient. Option 2 addresses balance, but is not a functional activity.
Option 3 is correct, as it challenges the patient, addresses endurance, and is safe for this patient.
Option 4 progresses endurance, not balance.
When evaluating wheelchair positioning of a child with cerebral palsy, a physical therapist should
FIRST examine the position of the child’s:
1. pelvis.
2. lower extremities.
3. head.
4. spine.
1
The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. The orientation and range of mobility of the pelvis in all three planes will in turn determine the alignment and support needed at the trunk, head, and extremities.
A physical therapist is using transcutaneous electrical nerve stimulation to treat a patient with back pain. Biphasic pulsed current and conventional transcutaneous electrical nerve stimulation parameters are being used. The patient reports a painful response during the initial treatment.
Which of the following treatment modifications is MOST appropriate in this situation?
1. Decrease the electrode size
2. Decrease the pulse width
3. Increase the pulse rate
4. Switch to a monophasic current
2
Decreasing the electrode size will increase current density and make the treatment more intense and uncomfortable. Decreasing the pulse width will make the treatment more comfortable, still affecting large fibers (A beta) without stimulating the A delta and C fibers (pain).
Increasing the pulse rate while using pulsed current will not make the treatment any more comfortable. It has been proposed that a higher frequency is more comfortable with alternating current, but this is not true with pulsed current. Switching to a monophasic current without any other changes will not affect this patient’s comfort.
A physical therapist is conducting a study in which the disability index scores for two groups of patients with subacromial impingement are compared. One group receives ultrasound and exercise; the other group receives exercise only. Both groups receive treatment at 2 visits/week for 4 weeks. What is the independent variable in the study?
1. Disability index score
2. Frequency of visits
3. Subacromial impingement
4. Intervention
4
The independent variable is the factor (intervention) that causes a change in the dependent variable (disability index score).
A physical therapist is interviewing a female patient who reports mid-thoracic pain that is limiting her ability to work. Which of the following additional symptoms should prompt the therapist to refer the patient to a physician?
1. Increased pain with prolonged computer work
2. Nausea, excessive fatigue, and sleep disturbance
3. Intermittent numbness and tingling in the right hand
4. Decreased pain with exercise and increased pain in the mid-morning
2
Mid-thoracic pain may be a pattern of cardiac ischemia, especially in women. Additional symptoms would include fatigue, nausea, shortness of breath, and sleep changes. Pain not induced by activity or static sitting posture would suggest a possible cardiac source.
Which of the following elements of motor learning contributes MOST to retention of a motor skill?
1. Performance under variable conditions
2. Manual contact to guide the patient
3. Summary knowledge of results
4. Practice of the motor skill
4
Generally, the more practice a patient has, the more the patient learns. Therefore for optimal retention, ample practice sessions should be available while avoiding fatigue. The other options are components of learning and are certainly important, but actual practice of the motor skill remains the most salient aspect.
A physical therapist is working with a patient who has a complete T6 spinal cord injury. The therapist has the patient perform seated push-ups on a mat by having the patient push down on the mat with both upper extremities while attempting to lift the buttocks off the mat. This activity is aimed at strengthening which muscle group?
1. Quadratus lumborum
2. Internal obliques
3. Latissimus dorsi
4. External obliques
3
The quadratus lumborun, internal obliques, and external obliques are all innervated below the level of the lesion. Sitting push-ups are often used as preparation for gait training and transfers. The push-ups are done to strengthen the muscles that “hike the pelvis” or lift the buttocks from the mat in a seated position. In a patient with a complete spinal cord injury at the Te level, the only muscle group that is still capable of lifting the pelvis is the latissimus dorsi, which is innervated by the cervical roots C6-Cs. The therapist is attempting to strengthen these muscles because they are capable of lifting the pelvis in the absence of the erector spine and abdominal musculature, which are innervated below the level of the lesion.
Following a cerebrovascular accident, a patient is evaluated for cognitive and perceptual dysfunctions. The patient is asked to stack several wooden blocks. After picking up a block, the patient is unable to determine how the block should be used. This dysfunction is MOST likely due to:
1. homonymous hemianopsia.
2. astereognosis.
3. unilateral neglect.
4. apraxia.
4
Homonymous hemianopsia describes a visual impairment. There is no evidence of visual limitations in the stem. Astereognosis is the inability to recognize an object by handling the object without looking at the object. Unilateral neglect describes the inability to register and integrate stimuli from one side of the body. Constructional apraxia describes a cognitive dysfunction in which a patient does not know what to do with the blocks.
A patient with peripheral vascular disease comes to physical therapy for evaluation of leg pain that gets worse when walking. The patient will MOST likely also have:
1. relief of pain with the legs elevated.
2. purple or brown pigmentation of the skin on the legs.
3. relief of pain with the legs in the dependent position.
4. a positive Homans sign.
3
Elevating the legs in the presence of arterial insufficiency decreases blood flow, which increases pain. Purple or brown pigmentation of the skin on the legs is associated with venous insufficiency, not arterial insufficiency. The patient most likely has intermittent claudication caused by arterial insufficiency. Placing the patient’s legs in the dependent position facilitates blood flow and reduces pain. Pain with exercise is indicative of intermittent claudication, not deep vein thrombosis, which is associated with a positive Homans sign.
A new special test used to evaluate shoulder instability is reported to have a specificity of 0.88.
This means that the test has a high percentage of:
1. true positives.
2. false positives.
3. true negatives.
4. false negatives.
3
A high percentage of true positives would indicate high sensitivity. A high percentage of false positives would indicate low sensitivity. A high percentage of true negatives indicates high specificity. A specificity of 0.88 is considered high. A high percentage of false negatives indicates low specificity.
Which of the following clinical features is assessed by pressing into the patient’s skin and observing for persistent indentation?
1. Turgor
2. Pitting edema
3. Dependent edema
4. Deep vein thrombosis
2
The definition of pitting edema is described in the stem.
Which of the following properties describes hyaline cartilage?
1. Hydrophilic
2. Highly innervated
3. Well vascularized
4. Easily damaged under compression
1
Hyaline cartilage is avascular, aneural, hydrophilic (70% 80% water), and can deform under compressive loading.
On the first day following a patient’s total knee arthroplasty, a physical therapist begins treating the patient with a continuous passive motion device with a setting of 0° to 40° of motion. Which of the following reasons for using a continuous passive motion device is MOST appropriate for this patient?
1. To decrease length of the patient’s hospital stay
2. To decrease incidence of deep vein thrombosis
3. To help the patient regain knee flexion
4. To prevent knee flexion contracture
3
There is no clear evidence that a continuous passive motion device reduces hospital stay or prevents deep vein thrombosis. Evidence suggests that a continuous passive motion device can help the patient to regain knee flexion. If the knee is not placed in full extension outside the continuous passive motion device unit, a knee flexion contracture may result.
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 gait patterns?
1. Normal gait with no deviations
2. Increased right hip flexion during the midswing phase
3. Throwing the trunk backward on the right side shortly after heel strike (initial contact)
4. Laterally bending toward the right side during midstance
2
The anterior tibialis showed 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 plantar flexion after initial contact.
During the 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).
In treating a patient who has had recurrent anterior shoulder dislocation, a physical therapist
should AVOID which of the following extreme shoulder motions?
1. Adduction and lateral (external) rotation
2. Abduction and lateral (external) rotation
3. Hyperextension and medial (internal) rotation
4. Abduction and medial (internal) rotation
2
The mechanism that creates an anterior dislocation of the shoulder is forced abduction and lateral (external) rotation of the shoulder. This frequently results in a tear of the anterior portion of the capsule. Abduction and lateral (external) rotation may subject the patient to recurrent subluxations and/or dislocations and should therefore be avoided.
A physical therapist is testing the deep tendon reflex of a patient as shown in the photograph.
The patient has a partial nerve injury of the tested nerve root. Which of the following reflex grades is the therapist MOST likely to find in the patient?
1. 0
2. 1+
3. 2+
4. 3+
2
A grade of 0 indicates complete severance of the nerve. A partial nerve injury causes a diminished reflex grade, which is graded as 1+. A 2+ grading is normal. A 3+ grade indicates an upper motor neuron lesion, not a peripheral nerve injury.
A patient with early symptomatic human immunodeficiency virus infection is MOST likely to report which of the following symptoms?
1. Fatigue
2. Blurred vision
3. Easy bruising
4. Poor wound healing
1
Fatigue is an early symptom of HIV infection. Blurred vision is not associated with early HIV infection. Easy bruising and poor wound healing are found at more advanced stages of the disease.
A physical therapist receives a telephone call from a woman who identifies herself as a friend of one of the therapist’s patients. She wants to know how the patient is doing and whether the patient will be able to go up and down stairs, because she wants to take the patient home for a weekend visit. Which of the following actions is MOST appropriate for the therapist to take?
1. Discuss the patient’s program and functional status with the caller.
2. Invite the caller to observe the patient’s next therapy session.
3. Refuse to discuss the patient, unless the patient’s permission is obtained.
4. Refer the caller to the patient’s social worker.
3
Information relating to the physical therapist/patient relationship is confidential. It may not be communicated to a third party not involved in the patient’s care without the patient’s prior written consent. Option 3 is the only one that fits these criteria.
In splinting or immobilization, the functional position of the hand includes wrist extension, phalangeal:
1. flexion, and abduction of the thumb (1st digit).
2. extension, and abduction of the thumb (1st digit).
3. flexion, and adduction of the thumb (1st digit).
4. flexion, and adduction of the thumb (1st digit).
1
The functional position of the wrist and hand describes the position from which the optimal function is most likely to occur. This position is described as: (1) slight wrist extension, (2) slight ulnar deviation, (3) fingers flexed at the MCP, PIP and DIP joints and (4) thumb slightly abducted.
A patient with cervical radiculopathy reports numbness of the right little finger (5th digit). A physical therapist will MOST likely find a diminished tendon reflex in the:
1. biceps brachii.
2. deltoid.
3. triceps brachii.
4. brachioradialis.
3
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 brachil, deltoid, and brachioradialis are innervated by the C5, C6 and sometimes
C7 nerve roots.
