PEAT 5 Flashcards
1
Q
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.
A
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.
2
Q
Manual muscle test grades are an example of which of the following levels of measurement?
1. Nominal
2. Ratio
3. Interval
4. Ordinal
A
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.
3
Q
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.
A
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.
4
Q
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
A
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.
5
Q
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.
A
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.
6
Q
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.
A
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.
7
Q
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.
A
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.
8
Q
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.
A
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.
9
Q
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.
A
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.
10
Q
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
A
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.
11
Q
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
A
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.
12
Q
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.
A
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.
13
Q
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.
A
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.
14
Q
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.
A
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.
15
Q
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.
A
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.
16
Q
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.
A
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.
17
Q
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
A
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.
18
Q
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
A
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.
19
Q
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.
A
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.
20
Q
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.
A
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.
21
Q
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.
A
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.
22
Q
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
A
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).
23
Q
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
A
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.
24
Q
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
A
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.
25
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.
26
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.
27
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.
28
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.
29
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.
30
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.
31
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.
32
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.
33
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.
34
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.
35
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.
36
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.
37
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.
38
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.
39
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.
40
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.
41
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.
42
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.
43
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.
44
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.
45
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.
46
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.
47
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.
48
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.
49
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.
50
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.
51
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.
52
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).
53
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.
54
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).
55
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.
56
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.
57
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).
58
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.
59
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?"
60
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.
61
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.
62
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.
63
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.
64
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).
65
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.
66
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.
67
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.
68
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.
69
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.
70
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.
71
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.
72
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.
73
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.
74
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).
75
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.
76
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.
77
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.
78
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.
79
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.
80
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.
81
A patient with Parkinson disease demonstrates shortness of breath with activity. Which of the following tests is MOST appropriate for a physical therapist to perform to help delineate a cause for the patient's shortness of breath?
1. Deep tendon reflex testing
2. Sensory examination
3. Muscle strength testing
4. Posture examination
4
Changes in reflexes would hinder balance and equilibrium more than ventilation. In Parkinson disease, changes in sensation are less pronounced than motor changes. Depending on a patient's level of tone, muscle strength is difficult to accurately examine in patients with Parkinson disease and also would be less likely to directly contribute to shortness of breath.
With regard to posture examination, as bradykinesia and rigidity evolve in Parkinson disease; concomitant kyphosis also develops. Thoracic kyphosis contributes to a restriction in ventilation and subsequent shortness of breath.
82
A balance test correctly identifies three persons as frequent fallers in a group of 10 persons who fall frequently. The same test correctly identifies eight persons as non-fallers in a group of 10 persons with no history of falling. This test has which of the following characteristics?
1. High reliability and low validity
2. High sensitivity and low reliability
3. High predictability and low validity
4. Low sensitivity and high specificity
4
A screening tool with high sensitivity can correctly identify the presence of a target condition. Identification of only 3 of 10 is a low sensitivity. Specificity is the ability of a tool to identify the absence of a target condition. In this case, 8 of 10 is high, so there is a high specificity. Reliability refers to measurement error, and validity deals with an instrument's ability to measure what it is intended to measure. Reliability and validity are not addressed in the stem.
83
A patient with type 2 diabetes is evaluated by a physical therapist and found to be alert and oriented to person, place, and time. When continuing the evaluation, the therapist should give the HIGHEST priority to which of the following systems?
1. Cognitive
2. Sensory
3. Genitourinary
4. Musculoskeletal
2
Type 2 diabetes can result in dysfunctions in all of the systems listed, but deficits in the sensory system pose significant risk to the patient's skin integrity. Given that the patient is oriented to person, place, and time, the therapist can assume that the patient would inform someone in the case of developing pain over a bony prominence (a common site of decubitus ulcers), given an intact sensory system. Establishing the integrity of the sensory system is of highest priority, because an unchecked and unrecognized ulcer can quickly become life-threatening.
84
A physical therapist is examining a 70-year-old patient who reports left knee pain. The therapist notes mild edema, brownish discoloration, and skin contraction in the ankle region bilaterally.
The patient's skin is flaky, dry, and scaling. The patient MOST likely has which of the following conditions?
1. Cellulitis
2. Venous insufficiency
3. Age-related trophic changes
4. Arterial disease
2
Edema, brownish discoloration (hemosiderin deposits), and skin contraction in the ankle region are characteristics of venous insufficiency. Trophic changes that can occur with aging and with arterial disease include absence of hair and shiny, pale skin. With cellulitis, the skin is erythematous.
85
A patient who is currently participating in an outpatient cardiac rehabilitation program asks the physical therapist about intervention options for an apparent athlete's foot fungal infection on both of the patient's feet. The patient has been using an over-the-counter analgesic ointment for 5 days, but the condition does not seem to be improving. Which of the following responses is MOST appropriate for the therapist to make?
1. Refer the patient back to the cardiologist.
2. Recommend an over-the-counter antifungal ointment.
3. Tell the patient to continue using the ointment for another 5 days and then reassess.
4. Instruct the patient to discuss the situation with a pharmacist.
4
The cardiologist is not the best referral, as this appears to be an integumentary problem unrelated to the cardiac condition. A physical therapist should not recommend any over-the-counter medications, as it is outside the scope of practice of a physical therapist. Any pharmaceutical education or advice, except "as prescribed by your physician," is outside the physical therapist's scope of practice. A pharmacist is the most appropriate heath care professional of those given to assist this patient.
86
A 70-year-old female patient reports the onset of mid back pain after working in a garden for several hours. The patient reports constant pain, which increases with deep breathing, and demonstrates limited thoracic spine active range of motion in all planes. The patient has a
40-year history of smoking and long-term use of prednisone (Deltasone). Based on this history, which of the following pathologies is MOSTlikely the cause of the patient's back pain?
1. Thoracic compression fracture
2. Lung cancer
3. Coronary artery disease
4. Abdominal aortic aneurysm
1
The data in the question are risk factors for osteoporosis and possible compression fracture. This patient could have weak bones due to long-term steroid use, smoking, or being postmenopausal. Although lung cancer may be likely with a history of smoking, lung cancer is unlikely because of symptom onset occurred after prolonged flexion and lung cancer should not cause limited active range of motion. Coronary artery disease and an abdominal aortic aneurysm would not cause limited active range of motion or pain with deep breathing. The patient's history does not increase her likelihood for having an abdominal aortic aneurysm.
87
Which of the following descriptions BEST characterizes stable angina?
1. Episodes of nonradiating chest pain each lasting 5-15 minutes
2. Episodes of severe chest pain each lasting longer than 15 minutes
3. Chest pain occurring at rest and unaffected by exertion
4. Chest pain accompanied by dysrythmias
1
Stable angina generally occurs during physical effort and is characterized by substernal, usually nonradiating pain lasting between 5 and 15 minutes. In unstable angina, the episodes occur during physical exertion or psychological stress and are more frequent, the pain may be severe, and the duration of each event is usually greater than 15 minutes. Variant angina occurs while the individual is at rest, usually during waking and at the same hour of the day.
Dysrhythmias occur more commonly in individuals who have variant angina than in those with exertional angina (either stable or unstable).
88
A patient is referred to a physical therapist for treatment of left shoulder pain. During examination of the patient's left acromion, the therapist notes an area of skin discoloration that is 1.3 cm in diameter and lopsided in shape with irregular, poorly defined edges. The center is deep red with some shades of brown. The patient reports first noticing the discoloration about 2 months ago.
The therapist should recognize these signs as characteristic of:
1. a mole.
2. a blister.
3. dermatitis.
4. melanoma.
4
Classic signs of early melanoma are skin discolorations characterized by asymmetry;
irregularity; black, brown, red, white, or blue coloring that is not uniform; and area larger than a pencil eraser.
89
Which of the following endocrine glands regulates sexual development?
1. Parathyroid
2. Thyroid
3. Adrenal
4. Pituitary
4
The anterior pituitary glands regulate sexual development via gonadotropins.
Gonadotropins regulate secretion of male and female hormones.
90
A physical therapist is analyzing data regarding functional loss in patients with fibromyalgia. The functional loss scale utilized has a normal distribution. The therapist finds that a score of 33 is two standard deviations below the mean, and a score of 55 is two standard deviations above the mean. Which of the following interpretations of these findings is MOST appropriate?
1. 50% of subjects scored 33 and 55.
2. 15% of subjects scored between below 33.
3. 95% of subjects scored between 33 and 55.
4. 6.67% of subjects scored above 55.
3
In a normal distribution, the area between +/- 2 standard deviation units represents about 95% of the population. Greater than 50% of the scores fell between 33 and 55. Approximately
2.5% of the scores fell below 33 and approximately 2.5% of the scores fell above 55.
91
In the early management of a patient with a partial peripheral nerve injury, the goal of the physical
therapy intervention will MOST likely be to prevent:
1. nerve degeneration.
2. spasticity and increased muscle tone.
3. muscle atrophy.
4. contractures and adhesions.
4 The primary physical therapy goal in this case would be joint protection and the prevention of contractures and adhesions, usually through splinting. There is no evidence to suggest that physical therapy can prevent nerve degeneration and muscle atrophy, as they are the normal effects of a peripheral nerve lesion. Spasticity would not be present in a lower motor neuron injury.
92
A patient reports weakness and tingling in the lower extremities in the past 2 weeks. The physical therapist suspects that the patient may have Guillain-Barre syndrome. Which of the following examination findings would MOST likely occur with this diagnosis?
1. Hypertonicity in the affected muscles
2. Presence of clonus with rapid passive foot dorsiflexion
3. Diminished tendon reflexes
4. Ataxic gait pattern
3
Guillian-Barre is a lower motor neuron disorder. Diminished reflexes are expected with lower motor neuron disease. Options 1 & 2 are found with upper motor lesions. Ataxia would be much more common with cerebellar disorders.
93
The physical therapy intervention for a patient with dark skin pigmentation includes superficial heat. After 5 minutes of this intervention, the physical therapist removes the heat and observes that the skin over the region being treated is blotchy with both darker and lighter areas. What is the MOST appropriate action for the therapist to take?
1. Discontinue superficial heat and initiate ultrasound.
2. Continue with the use of superficial heat, as this is a normal response.
3. Discontinue superficial heat and initiate diathermy.
4. Continue with the use of superficial heat, but add more towel layers.
4
There is no reason to suspect that the modality must be changed. The first logical step is to increase toweling. The patient's response is not a normal response. Uneven blotchy red and white skin in a light-skinned patient or darker and lighter areas in a darker-skinned patient could be a sign of overheating. Five minutes after initiating heating, the physical therapist should remove the pack and check the patient's skin for any blotching-mottled erythema. If it is found, the heat is too intense, and adding more towel layers would be the most appropriate action.
94
A physical therapist evaluates a 65-year-old patient with psoriasis for treatment with ultraviolet radiation. The patient's history includes the following information: total hip arthroplasty 1 year ago, penicillin allergy, calcium supplements since menopause, and daily tetracycline (Achromycin) use for the past 2 weeks for a urinary tract infection. Which of these factors should alert the therapist to use extra caution when applying ultraviolet light?
1. Arthroplasty with a metal implant
2. Daily tetracycline (Achromycin) use
3. Penicillin allergy
4. Long-standing calcium supplement use
2
Caution should be used in patients who are taking tetracycline, because the drug will enhance the effects of the ultraviolet radiation. Ultraviolet is not contraindicated in these patients; however, the dosage of the ultraviolet would probably have to be adjusted to some lower level.
The penicillin allergy, calcium supplements, and metal implants would not be affected by the ultraviolet light. It should be noted that although ultraviolet radiation therapy is not common in today's practice of physical therapy, therapists should nonetheless be aware of the precautions and be able to advise patients who may be using ultraviolet radiation at home.
95
Which of the following terms describes the intense redness of the skin observed after icing?
1. Pallor
2. Hyperemia
3. Cyanosis
4. Vasospasm
2
By definition, hyperemia is the intense redness or rubor caused by increased blood flow
96
Which of the following techniques is MOST effective in teaching a patient with insulin-dependent diabetes about foot care?
1. Reassure the patient that no infections will occur if the directions are followed, then demonstrate procedures.
2. Tell the patient how foot care is performed, then watch the patient's performance.
3. Watch the patient perform a foot inspection, and caution the patient that amputations result from untended skin problems.
4. Have the patient demonstrate a foot inspection, then give feedback on the patient's performance.
4
Learning the process of foot care is a psychomotor skill. Effective strategies to teach psychomotor skills include repeat demonstration by the patient of the skill followed by feedback from the therapist to highlight what was performed correctly and what areas need improvement, if any. Reassurance about prevention of infection with proper foot care would primarily be a cognitive skill and does not ensure that the patient can effectively perform proper foot care.
Options 2 and 3 do not include feedback that informs the patient about performance of foot care.
97
A patient demonstrates a right thoracolumbar scoliosis in standing but no scoliosis in sitting.
Which of the following dysfunctions is MOST likely the cause of the patient's scoliosis?
1. Lumbar facet dysfunction
2. Unilaterally weak gluteus medius
3. Short iliopsoas muscle
4. Leg-length discrepancy
4
A facet dysfunction would remain in sitting and in standing. A weak gluteus medius would result in more problems during gait or movement. Although the iliopsoas is passively shortened in sitting, a short iliopsoas is not a common cause of scoliosis, especially not thoracolumbar scoliosis. Leg length discrepancy is correct because when the patient is sitting, the leg length does not affect the spinal posture, however a leg length discrepancy could affect posture and standing.
98
A patient's chronic use of which of the following medications should be of MOST concern to a physical therapist when deciding whether to provide thrust manipulation for the patient?
1. Hormone replacement therapy
2. Nonsteroidal anti-inflammatory medication
3. Antidepressants
4. Corticosteroids
4
Manipulation should not be applied to areas of the body directly affected by osteoporosis due to risk of fracture. Chronic use of corticosteroids can lead to calcium loss and osteoporosis.
Estrogen therapy alone or in combination with another hormone, progestin, has been shown to decrease the risk of osteoporosis and osteoporotic fractures in women. Osteoporisis is not a side-effect of NSAIDS or antidepressants.
99
A patient fell from a ladder landing on the left side of the trunk with immediate onset of pain over the left lower ribs. The following day, the patient reports mild light-headedness along with severe pain over the left shoulder and left upper abdomen that increases with inhalation. Shoulder movement is mildly limited with reports of rib pain at end range. Which of the following conditions is MOST likely?
1. Shoulder fracture
2. Ruptured spleen
3. Acute cholecystitis
4. Pulmonary embolism
2
The spleen is positioned above the stomach and under the left ribs. The spleen can rupture with trauma, but the symptoms may occur gradually from slow hemorrhage. The symptoms of a ruptured spleen include pain in the upper left abdomen and radiating to the top of the left shoulder. The pain gets worse with breathing in and then spreads quickly over the entire abdomen. If the leak of blood is gradual, symptoms may not occur until the blood supply to the body is diminished. This will result in light-headedness, low blood pressure, blurred vision, confusion, and loss of consciousness, as the oxygen supply to the heart and brain is affected.
Symptoms of a pulmonary embolus are variable but do not include referred pain to the shoulder.
The presence of pain with shoulder movement at the initial injury site, the ribs, rather than the shoulder, decreases the likelihood that the shoulder itself has pathology. Also, inhalation shouldn't aggravate a shoulder fracture. Acute cholecystitis is associated with fever, chills, nausea and vomiting, tenderness on the tip of the 10th rib, and pain in the right upper quadrant and radiating into the right shoulder and between the scapulae.
100
A hospital administrator asks members of the rehabilitation department to develop a comprehensive program to help reduce the risk of low back injuries. Which of the following steps is the FIRST step necessary to develop this program?
1. Include all employees in a lumbar extension exercise class.
2. Design a program that meets each department's functional needs.
3. Perform an ergonomic analysis on each workstation.
4. Provide pamphlets on proper body mechanics.
3
The first step in preparing any education experience is to determine what the needs of the audience are. Since prevention of low back injury is the ultimate goal, assessment of the employee's workstations is an important first step in planning the educational program. Simply instructing all employees in lumbar extension exercises is inappropriate without a thorough evaluation of their physical needs. Option 2 cannot be done unless an assessment of the functional needs has been performed. Providing pamphlets is a useful teaching adjunct but would not be the first step to prevent low back pain effectively in this population.
101
A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST likely to have a positive result?
1. Ulnar
2. Median
3. Radial
4. Musculocutaneous
1
The overhead positioning of carrying food trays is similar to the end position of the ulnar nerve tension test. The test for the ulnar nerve includes shoulder depression, abduction, and lateral (external) rotation; elbow flexion; forearm pronation or supination; and wrist and finger extension. The median nerve tension test employs elbow extension, but the position of the waiter is more consistent with elbow flexion. The radial nerve test is low by the side, not reaching overhead. The musculocutaneous nerve does not innervate the hand.
102
A physical therapist is interviewing a patient who awoke that day with a slight loss of taste sensation, inability to close the right eye, and dryness of the right eye. The patient has had a slight headache the last few days and some mild pain around the right ear. Which of the following questions that is consistent with these signs and symptoms should the therapist ask the patient?
1. Are you able to smile?
2. Do you have pain over your right jaw?
3. Are you able to chew food?
4. Do you have difficulty swallowing?
1
All of the questions are important in history taking; however the suspected diagnosis is
Bell palsy caused by a lesion of the facial nerve. The patient would most likely have weakness in the muscles of facial expression, including smiling. Asking the patient to smile would most likely show an asymmetrical smile with weakness on the right side. Jaw pain and inability to chew food would be more likely due to a lesion of the trigeminal nerve. Inability to swallow may be caused by damage to cranial nerves IX, X, or XII.
103
A physical therapist is using the waveform shown in the diagram to apply electrical stimulation to a patient. Which of the following rationales for selecting this waveform is MOST accurate?
1. The waveform enhances a contraction in enervated muscle.
2. The waveform enhances patient comfort.
3. The waveform offers a change in frequency that promotes motor unit recruitment.
4. The waveform offers pulse width variability that enhances motor unit recruitment.
2
Regarding effective pain modulation, ramps are used to obtain a more gradual activation of muscle, rather than as a method of pain modulation. The waveform shown is monophasic with a ramp-up and ramp-down surge of the amplitude. The gradual rise and fall in the stimulus pulse amplitude allows the gradual recruitment of nerve fibers, creating a more comfortable initiation of contraction for the patient. The declining ramp at the end of the contraction allows a smooth gradual drop in the force produced by the muscle, also enhancing comfort. The gradual onset of muscle stimulation produces contractions that more closely mimic those produced in functional activities during voluntary muscle activation. Regarding frequency and motor unit recruitment, the waveform shown has a change in amplitude, not frequency. Regarding pulse width and motor unitrecruitment, the waveform has a change in amplitude, not pulse width. A monophasic pulse is not appropriate for enervated muscle, which requires direct current.
104
Utilization review and peer review are activities that are a part of a comprehensive:
1. policy and procedure manual.
2. quality improvement program.
3. audit cycle.
4. performance evaluation.
2
According to the Standards of Practice for Physical Therapy, there should be a written plan for continuous improvement of quality of care. This includes ongoing review and evaluation of the physical therapy services provided. Utilization review and peer review are two types of review processes.
105
After spinal joint mobilization procedures, a patient calls the physical therapist and reports a minor dull ache in the treated area of the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should:
1. consider a possible neurological lesion in the area.
2. refer the patient back to the physician.
3. inform the patient that this response is common.
4. add strengthening exercises to the home program.
3
Joint mobilization procedures may cause some soreness. The therapist should inform the patient of this response to treatment. The therapist should re-evaluate the patient and could alter the treatment by waiting an extra day before the next treatment or by decreasing the dosage.
There would not be a need to refer to the physician. The addition of exercises would not alter the response, and there would be no indication of neurological involvement with the reported symptoms.
106
A patient reports pain in the lateral aspect of the proximal forearm. The pain is reproduced with shoulder girdle depression, elbow extension, shoulder medial (internal) rotation, and wrist flexion.
The patient's symptoms are relieved when the physical therapist removes the shoulder girdle depression component. Which of the following syndromes is the MOST appropriate clinical interpretation of these findings?
1. Cubital tunnel
2. Pronator teres
3. Radial tunnel
4. Anterior interosseous
3
Cubital tunnel syndrome is ulnar nerve entrapment. The test as described is for the radial nerve. Tingling and paresthesias in the medial forearm and hand are typical findings with cubital tunnel syndrome. Pronator teres syndrome is compression of the median nerve. Although the patient may have pain on the radial side of the hand with pronator syndrome, it usually extends from the little finger (5th digit) to the index finger (2nd digit) and does not result in lateral elbow pain. The test described is for the radial nerve. Radial tunnel syndrome involves compression of the deep branch of the radial nerve and presents with symptoms similar to lateral epicondylitis, i.e., poorly localized pain over the radial aspect of the proximal forearm. Symptoms are reproduced in the test position described. Anterior interosseous syndrome is compression of the anterior interosseous nerve, which is a branch of the median nerve. The median, not the radial, nerve tension test will provoke symptoms of anterior interosseous nerve syndrome.
107
A physical therapist is monitoring the exercise of a patient with type 1 diabetes. The patient's blood glucose level would be BEST for safe exercise at which of the following values?
1. 90 ml/dL
2. 175 ml/dL
3. 0 ml/dL
4. 345 ml/dL
2
Patients with type 1 diabetes use insulin. Blood glucose levels should be between 100 and
250 ml/dL for patient safety.
108
A patient with a mild closed head injury and bilateral femur fractures requires instruction in a lower extremity exercise program. To plan the most effective teaching methods for this patient, what is MOST critical to assess at the initial visit?
1. Comprehension of written, verbal, and demonstrated instructions
2. Short-term memory capacity
3. Auditory and visual status
4. Any personality changes compared to the patient's premorbid status
1
Option 1 is the best answer. In Option 2, if the patient does not initially understand the information, then having short-term memory is irrelevant. For Option 3, hearing and vision are obviously important, but the most critical component is comprehension. Option 4 is irrelevant to the scenario.
109
The physical therapy plan for for a patient who underwent medial menisectomy includes exercising the quadriceps femoris against accommodating resistance. Which of the following exercises should be recommended?
1. Knee bends through half of the range
2. Knee extension with a sandbag at the ankle
3. Knee extension on an isokinetic exercise device
4. Straight-leg raising with a sling suspension
3
Isokinetic exercise devices utilize accommodating resistance throughout the range of motion. The other exercises do not include forms of accommodating resistance.
110
To stretch the neck muscles in a patient with an acute, right-sided torticollis, the MOST appropriate therapeutic exercise is:
1. right rotation and right lateral flexion.
2. left rotation and right lateral flexion.
3. left rotation and left lateral flexion.
4. right rotation and left lateral flexion.
4
Isolated contraction of the right sternocleidomastoid muscle would cause the head to rotate to the left and side bend (lateral flexion) to the right. To stretch the muscle, the opposite actions would be performed on the patient by the therapist: rotation of the head to the right and lateral flexion to the left.
111
Which of the following signs or symptoms is MOST likely to be present in a patient with symptomatic hyperthyroidism?
1. Steppage gait
2. Frequent calf cramping
3. Tendonitis of the shoulder
4. Atrophy of foot and hand intrinsics
3
Hyperthyroidism is an excessive secretion of thyroid hormone. Chronic periarthritis can occur, often with calcification. This occurs most often in the shoulder. Atrophy of intrinsics and steppage gait would not be likely, because proximal muscles are affected, rather than distal muscles. Calf cramping is not a symptom of hyperthyroidism.
112
A physical therapist is conducting a 12-minute walk test with a patient who has chronic obstructive pulmonary disease and uses 2 L/min of oxygen by nasal cannula. The patient's resting oxygen saturation is 91% and resting heart rate, 110 bpm. The oxygen flow should be increased if the
1. patient's carbon dioxide level increases.
2. patient reports shortness of breath.
3. patient's oxygen saturation falls below 87%.
4. patient's heart rate rises to greater than 150 bpm.
3
A fall in oxygen saturation below 87% is equivalent to a partial pressure of 55 mm Hg of oxygen in the blood, which is considered to be moderately hypoxemic (low oxygen levels). This situation would require increased oxygen levels in order to be rectified. A rise is carbon dioxide level would not be alleviated by increased oxygen levels. Complaints of shortness of breath can come from a variety of causes and would not necessarily be alleviated by increased oxygen levels. An increase in hear rate to 150 bpm may be a normal response to this activity and would not necessarily require increased oxygen levels.
113
A physical therapist is developing a new device for measuring range of back extension. To establish reliability for the device, the therapist gathers a large sample of healthy individuals all with 20° to 25° of back extension. Although the therapist applied consistent measurement techniques over successive trials, the reliability of the measurement device was low. Which of the modifications to the follow-up study is MOST likely to increase reliability?
1. Reduce the proportion of variation attributed to error.
2. Reduce total variance in the data.
3. Include subjects with a wider range of back extension measure.
4. Increase the number of trials that include the same subjects.
3
This therapist is minimizing the proportion of the total observed variance that is attributable to error by being consistent across successive trials. It is unlikely that much more can be done in the follow-up study to further reduce the systematic error. For a given amount of error variance, the reliability will improve as the total variance increases; that is, as the total variance gets larger, the error component will account for a smaller proportion of it. The original study included subjects with a very narrow range of mobility, which would result in small variance in the data. Including subjects with a wider range of mobility in the follow-up study will likely boost variance and ultimately reliability.
114
If a transtibial prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:
1. excessive knee flexion in foot flat (loading response).
2. premature knee flexion in heel off (terminal stance).
3. insufficient knee flexion in foot flat (loading response).
4. excessive knee flexion in heel off (terminal stance).
1
Upon heel contact, the heel section compresses, partially absorbing the ground impact and thus permitting a controlled plantar flexion. If the heel is too stiff, the knee flexes too soon and excessively on initial contact. An excessively firm heel wedge would not be a factor in late stance.
115
Elevating a patient's lower extremity for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive hyperemia in a dependent position. These signs are indicative of:
1. an intact circulatory system.
2. arterial insufficiency.
3. venous insufficiency.
4. acute arterial occlusion.
2
An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with arterial insufficiency may not be able to sustain adequate blood flow with the leg elevated.
The vasodilation, caused by local mechanisms, occurs in response to ischemia. An acute arterial occlusion creates a pallor, but because blood flow is blocked, the reactive hyperemia is impaired.
116
A physical therapist is assessing the lifting technique of a patient who has a history of back pain.
The patient performs a lift by picking up a light weight from the floor, without bending the knees and with excessive lumbar flexion. Limitation of which of the following measures is the MOST likely contributor to this finding?
1. Hamstring flexibility
2. Gluteal muscle strength
3. Abdominal muscle strength
4. Hip flexor flexibility
1
Tightness of the hamstrings causes excessive lumbar flexion, because tight hamstrings restrict the amount of hip flexion. Weak gluteals allow more hip flexion. Weak abdominals show up in antigravity flexion of the trunk, not passive forward bending. Hip flexor flexibility is not a factor in forward bending.
117
During the initial evaluation of a patient with right upper extremity pain, the physical therapist notes that the patient's right scapula is significantly lower than the left scapula. Shortness in which of the following muscles on the right is MOST likely to lead to this patient's postural presentation?
1. Latissimus dorsi
2. Upper trapezius
3. Levator scapulae
4. Teres major
1
The latissimus dorsi depresses the shoulder girdle and can be short in patients with depressed scapulae. The upper trapezius, if short, would elevate the scapula. The levator, if short, would elevate the scapula. The teres major, if short, would adduct the arm.
118
A physical therapist is developing a gait training program for a patient following a total hip arthroplasty of the right hip performed via an anterolateral approach 2 weeks ago. The proper instructions and rationale for crutch training utilizing one crutch include holding the crutch in the:
1. right hand to decrease activity in the right hip abductors.
2. right hand to facilitate activity in the right hip abductors.
3. left hand to decrease activity in the right hip abductors.
4. left hand to facilitate activity in the right hip abductors.
3
With an anterolateral approach, the gluteus medius is reflected or the trochanter is taken down. Postoperatively, these structures need time to heal and will not be healed only 2 weeks after surgery. The abductors should not be aggressively strengthened with exercise.
119
A patient with functional urinary incontinence should MOST benefit from which of the following exercise interventions?
1. Core stabilization
2. Cardiovascular training
3. Fine motor skill development
4. Pelvic floor muscle strengthening
3
Functional urinary incontinence occurs in patients with a normal functioning bladder who have difficulty in reaching the toilet or preparing to urinate, often as a result of decreased fine motor skills and resulting inability to manage the zippers, buttons, and drawstrings on garments.
120
A physical therapist is examining a patient who sustained a right tibial fracture 1 year ago and is now fully healed. The physical therapist's measure of the length of the patient's right tibia is 14 in (36 cm) and of the left tibia, 15 in (38 cm). As a result of the tibial shortening, which of the following muscles would MOST likely become progressively tight?
1. Left tensor fasciae late
2. Left piriformis
3. Right gluteus medius
4. Right adductor magnus
3
The left tensor fasciae late would be chronically stretched, rather than shortened. The piriformis is an extensor and lateral (external) rotator of the hip and would not be as likely to be affected. The right leg is shorter, so in standing, the patient's right hip should be lower than the left. This relatively places the right lower extremity in abduction and the left lower extremity in adduction. This chronic posturing would most likely cause tightness in the right hip abductors and the left hip adductors. Of all the options, the right gluteus medius muscle is the most likely to be tight, because it is a right hip abductor. The right adductors would be in a chronically lengthened position and would not be as likely to be affected.
121
During examination of a patient, a physical therapist notes a red, swollen foot that is significantly warmer to the touch than the contralateral foot. The patient denies any pain or trauma. The patient has a history of diabetes, peripheral vascular disease, and congestive heart failure. The findings are MOST consistent with which of the following conditions?
1. Grade IlI sprain of the talocrural ligament
2. Fractured distal tibia
3. Bone cancer
4. Charcot disease
4 The signs and symptoms, along with a history of diabetes, are most consistent with Charcot foot. A patient with any of the other options would have referred pain or local pain. A patient with a sprain or fracture would have a history of trauma.
122
A physical therapist is observing the gait of a patient with a transtibial prosthesis. The therapist observes that at heel strike (initial contact) the patient's knee is hyperextended. What is the MOST likely cause of the patient's gait deviation?
1. The heel cushion is too soft.
2. The socket is placed too far anterior to the foot.
3. The prosthesis is too long.
4. There is inadequate suspension of the prosthesis.
1
A heel cushion that is too soft allows too rapid plantar flexion after heel strike (initial contact), which causes the knee to go into extension and stay there longer than normal. A socket that is placed too far anterior on the foot causes knee flexion, not extension. A prosthesis that is too long causes vaulting in midstance. Inadequate suspension causes the socket to slip during midswing phase, resulting in the toe of the prosthesis catching on the floor.
123
A physical therapist is trying to determine if a relationship exists between a patient's initial walking speed and length of stay in a skilled nursing facility. Which of the following statistical analyses should the therapist choose to examine the degree of this relationship?
1. Chi-square test
2. Independent t-test
3. Analysis of variance
4. Pearson product-moment correlation coefficient
4
The Pearson product-moment correlation coefficient is the only option that can be used to determine the degree of relationship between two continuous variables in the same group of subjects. All the other options relate to statistical testing between groups of subjects with differing characteristics using the same measure, such as determining the difference between the mean walking speed of a group of young people and a group of elders.
124
A patient comes to physical therapy via direct access for evaluation of insidious shoulder pain.
During examination, the physical therapist notes a yellowish color of the patient's sclera and skin.
The therapist should refer the patient to a physician for probable primary dysfunction of the:
1. liver.
2. eye.
3. duodenum.
4. heart.
1
The patient is exhibiting jaundice consistent with liver or gallbladder disorder. Eye involvement (sclera) is a symptom, not the primary disorder. There are no indications of duodenal involvement or cardiac involvement in this patient.
125
Which of the following conditions or clinical features is assessed by lifting the patient's skin and observing the time it takes to return to the original position?
1. Turgor
2. Pitting edema
3. Deep vein thrombosis
4. Collagen degradation
1
Skin turgor is tested by lifting the patient's skin between the fingers and observing for return to the original position. If this process is delayed, it is a sign of poor skin turgor.
126
An attorney calls the physical therapy department seeking information on the status of the attorney's client, a patient who is undergoing rehabilitation following total knee arthroplasty. The patient's physical therapist should:
1. refer the attorney to the patient's insurance carrier.
2. describe the patient's current status.
3. require written authorization from the patient to release information.
4. obtain verbal permission from the patient to release information.
3
Information relating to the physical therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient. Option 3 is the only one that fits these criteria.
127
Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta-blocking medication should receive an explanation of the:
1. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic levels.
2. need to use measures other than heart rate to determine intensity of exercise.
3. need for exercise training sessions to be more frequent but of shorter duration.
4. need for longer warm-up periods and cool-down periods during exercise sessions.
2
The patient taking beta-blocking medication will experience a lower heart rate and blood pressure response during exercise, compared to a patient who is not taking this type of medication. Heart rate is lower than anticipated in patients taking beta-blockers, and using heart rate to monitor exercise intensity may not give an accurate indication of intensity. Another measure, such as the Borg Scale (rating of perceived exertion), would be more beneficial.
However, even though heart rate and blood pressure would be lower, the patient actually achieves the same metabolic levels during exercise, and therefore altering the frequency or duration of exercise is unnecessary. The time for warm-up and cool-down exercises does not need to be altered.
128
Which of the following subjective reports from a patient with rheumatoid arthritis indicates the need for further medical examination by a physician?
1. Morning pain in both lower extremities
2. Numbness in both lower extremities
3. Increased pain during activities of daily living
4. Inability to sleep at night
2
Morning pain is a typical finding in rheumatoid arthritis. Symmetrical numbness could be indicative of myelopathy from either infectious or neoplastic causes. Increased pain during activities of daily living is also a typical finding in rheumatoid arthritis. Inability to sleep at night alone is too vague of a report to cause suspicion of more medical problems.
129
A physical therapist is assigned the planning and implementation of physical therapy services for all members of a community. The therapist's FIRST step should be to:
1. develop a brochure for distribution to the community.
2. organize a health fair to provide screening for the community.
3. evaluate existing services and community resources.
4. initiate contacts in the medical community to establish prescriptive relationships.
3
The most appropriate first step (pre-planning) would be to evaluate existing services within the community and work out a budget for the project. Options 1 and 2, although important, are things that would most likely be done after the practice is up and running. Option 4 may be done early on in the planning process, but would follow Option 3.
130
A patient has a history of diabetes, hypertension, and chronic heart failure. The patient's venous filling time is less than 15 seconds, Homans sign is negative, and rubor of dependency test is not slowed. These findings support which of the following diagnoses?
1. Lymphedema
2. Arterial insufficiency
3. Intermittent claudication
4. Chronic venous insufficiency
4
Unresolved edema is not indicated and would be more prevalent in lymphedema. A venous filling time of more than 15 seconds is suggestive of arterial insufficiency. Intermittent claudication is related to activity, not to dependency tests. A venous filling time of less than 15 seconds is suggestive of venous insufficiency.
131
The demographic information for the participants in a research study includes a mean age of 32 years and a median age of 35 years. The difference between the median and mean indicates:
1. the value of the standard deviation score.
2. the value of the Z-score.
3. that the distribution is skewed.
4. that the two measures should be averaged.
3
A normally distributed sample has a median and a mean that are equal in value. In that type of distribution, the median and mean would be at the halfway point. One-half of the scores (50 %) would be distributed above the median and one-half below. If the median and mean are not of equal value, the distribution is skewed. If the median is of a higher value than the mean, the distribution is skewed to the left; if lower, it is skewed to the right. The standard deviation is a measure of the variability of the mean. The Z-score is a standard score with a mean of zero and a standard deviation of one. Averaging the two measures would not be appropriate or meaningful.
132
The joint indicated by the arrow contains what soft tissue structure?
1. Glenoid labrum
2. Middle deltoid muscle
3. Subacromial bursa
4. Pectoralis minor muscle
3
The joint indicated (subacromial) in the radiograph contains several soft tissue structures, including the biceps brachii tendon, supraspinatus tendon, and subacromial bursa. The other structures listed are not located in this area.
133
A researcher who studied the effects of exercise training on balance test scores obtained balance scores pre-exercise and post-exercise. Both the exercise group and the control group were randomly selected from a group of older adults residing in an assisted living facility. A t-test was used to compare the pretest and posttest results. The balance scores were significantly improved in the group that performed regular exercises but were unchanged in the control group. In deciding whether or not to incorporate these results into practice, a physical therapist who works in an adult outpatient clinic should be MOST concerned about which type of validity?
1. External
2. Internal
3. Construct
4. Statistical conclusion
1
Threats to external validity limit the generalizability of the results. Since the research participants differ from the therapist's patient population, applying the results to a different group of people would not be appropriate due to limitation on validity. Internal validity means that internal factors other than the independent variables could be related to changes in the dependent variables. Construct validity is challenged when constructs are poorly defined or an inconsistent use of constructs occurs. Statistical conclusion validity is challenged with irregularities in the use of statistical tools or the use of incorrect statistical tools.
134
A physical therapist wants to utilize a heating modality for the hands of a patient with rheumatoid arthritis. The patient reports slight edema when performing warm soaks at home. Which of the following modalities is BEST for this patient?
1. Hotpacks
2. Paraffin
3. Ultrasound
4. Fluidotherapy
2
Although all of the listed modalities would provide heat, paraffin is the best choice, since the limb can be elevated during the application of heat. Elevation of the limb may reduce likelihood of edema.
135
Which of the following types of neurons transmit afferent information regarding proprioception and vibration?
1. Large myelinated fibers
2. Small myelinated fibers
3. Large unmyelinated fibers
4. Small unmyelinated fibers
1
Afferent sensory information regarding proprioception and vibration is transmitted on large myelinated A alpha fibers. A delta fibers are small unmyelinated fibers, and C fibers are unymelinated; both provide pain sensation.
136
Which of the following methods is MOST appropriate for handling a 1-year-old child with cerebral palsy who exhibits strong extensor tone in the trunk and extremities?
1. Carrying the child in a sitting position
2. Carrying the child over one's shoulder
3. Keeping contact with the back of the child's head
4. Picking the child up under the upper extremities
1
The sitting position promotes visual attending, use of the upper extremities, and social interaction. A child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees flexed.
137
Which of the following outcomes would NOT be appropriate for a prenatal exercise program?
1. Improved body mechanics
2. Application of relaxation techniques
3. Improved ligamentous flexibility
4. Strengthened pelvic-floor musculature
3
During pregnancy, the ligaments soften due to hormonal influences and allow some degree of separation between the joint surfaces. Additional stretching of the ligaments could result in joint instability or injury and would not be a goal of treatment. The remaining options are all appropriate interventions.
138
Which of the following joint mobilization techniques is MOST appropriate for increasing shoulder abduction?
1. Distraction with inferior glide
2. Anterior glide with medial (internal) rotation
3. Superior glide with approximation
4. Distraction with posterior glide
1
Because most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, treatment to mobilize that portion of the capsule is of primary concern. Inferior glide would stretch the inferior portion of the capsule.
139
During evaluation of a patient's gait, a physical therapist observes that the patient leans forward shortly after heel strike (initial contact). The patient's forward bending is MOSTlikely a compensation for weakness in the:
1. quadriceps.
2. hamstrings.
3. gluteus maximus.
4. tibialis anterior.
1
The quadriceps are active shortly after heel strike (initial contact) to prevent excessive knee bending during the loading phase of initial stance. Weakness of the quadriceps causes the patient to compensate by leaning forward at heel strike (initial contact) and to use the body weight to help keep the knee extended. Weakness of the hamstrings causes excessive knee extension (recurvatum) prior to heel strike (initial contact). Weakness of the gluteus maximus would be observed shortly after heel strike (initial contact). However, the patient would lean backward to compensate. Weakness of the anterior tibialis causes a "foot slap" just after heel strike (initial contact).
140
During an examination, a physical therapist strokes the lateral plantar aspect of a patient's foot.
Which of the following responses indicates an upper motor neuron dysfunction?
1. Absence of sensation
2. Extension of the great toe
3. Flexion of the first through fifth toes
4. Four beats of repeated plantar flexion
2
A positive Babinski reflex is characterized by great toe dorsiflexion and fanning or splaying of the other toes. A positive Babinski reflex indicates upper motor neuron or central nervous system involvement.
141
A physical therapist is teaching a patient to walk with a prosthesis on stairs and uneven surfaces.
Which of the following methods should MOST promote long-term retention of these motor skills?
1. Ensure mastering of use of stairs before practicing walking on uneven surfaces.
2. Practice walking on stairs and uneven surfaces in random order several times during a session.
3. Focus the training session on the movement components the patient finds most difficult.
4. Provide immediate feedback on the patient's performance when walking on the stairs or on uneven surfaces.
2
Greater retention of motor skills is achieved when tasks are practiced randomly and are practiced in a distributed fashion rather than massed. Mastering use of stairs before attempting walking on uneven surfaces would eliminate use of randomization. Practice of a movement in its entirety, rather than focusing on smaller components, leads to better retention. Immediate knowledge of results can be detrimental to learning because it provides too much information and can result in the person relying too much on the external feedback rather than internalizing the information.
142
Which of the following outcomes is the highest expected functional outcome for a patient with a complete C7 spinal cord injury?
1. Minimal assistance with transferring from floor to wheelchair
2. Independent with wheelchair mobility on smooth surfaces
3. Minimal assistance with transferring from supine to sitting
4. Independent with ascending a curb in a wheelchair
2
Patients with a complete C7 spinal cord injury require maximal assistance for floor-to-wheelchair transfers because they typically do not have the trunk control required to perform this task. Typically with C7 spinal cord injury, patients are able to perform wheelchair mobility on smooth surfaces independently. They may require an upright wheelchair to assist with trunk control. These patients usually are independent with supine-to-sit transfers; by rolling from side to side and getting their arms behind them, they are able to come to long sitting. They do not have the trunk control to perform a wheelie, which is required for ascending a curb in a wheelchair.
143
A patient involved in a motor vehicle accident 1 week ago has multiple fractures of the lower extremities and has bilateral non-weight-bearing status. The patient lives with an elderly parent and is scheduled for discharge soon. Which of the following transfers is MOST appropriate in this situation?
1. Standing pivot
2. One-person lift
3. Sliding board
4. Two-person lift
3
Since the patient is non-weight-bearing bilaterally, the standing-pivot transfer is contraindicated. Since the caregiver is elderly, neither a one-person nor a two-person lift is a safe choice. Since the caregiver is elderly and the patient is non-weight-bearing bilaterally, the sliding-board transfer is the best choice of the options given.
144
During an initial evaluation, which of the following tests is MOST appropriate to perform with a patient who has acute right-sided congestive heart failure?
1. Sensory testing of upper extremities
2. Pitting edema measurements in the lower extremities
3. Resisted manual muscle testing of all extremities
4. Reflex testing of lower extremities
2
Although sensory testing is important in an initial examination, impaired sensation is less likely to occur in a patient with congestive heart failure only. Right-sided congestive heart failure results in dependent edema; measurements of pitting edema are appropriate to determine the severity of congestive heart failure and aid the therapist in treatment planning. Manual muscle testing is also appropriate for an initial exam. However, with acute congestive heart failure, resisted manual muscle testing is generally avoided until the congestive heart failure is more stable. Reflex testing is also important in an initial examination, but because the patient has congestive heart failure only, reflexes are less likely to be impaired.
145
Cool-down exercises are performed immediately after a general aerobic exercise program
PRIMARILY to prevent:
1. venous pooling.
2. cardiac arrhythmia.
3. decreased body temperature.
4. muscle tightening.
1
During aerobic exercise, vascular dilation occurs in order to optimize blood flow, and the venous system relies on muscular pumping in order to return blood back to the heart. Without a cool-down period, there would be no muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well but is less likely in someone without cardiac disease. Cessation of activity by itself would result in a gradual decrease in body temperature, and specific exercises are not necessary. Muscle tightening may occur as a result of metabolites accumulating in the circulatory system, but this would occur as a result of the venous pooling.
146
A physical therapist is examining a patient who has a history of congestive heart failure and peripheral vascular disease. Bilateral peripheral edema with grade 1+ pitting along with varicose veins is also present. The patient reports a sedentary lifestyle. The patient is at high risk for developing which of the following types of ulcer?
1. Arterial
2. Pressure
3. Neuropathic
4. Venous stasis
4
This patient has a history that would lead to a venous stasis ulcer.
147
What is the close-packed position of the hip?
1. Medial (internal) rotation with extension and abduction
2. Extension with adduction and lateral (external) rotation
3. Lateral (external) rotation with flexion and abduction
4. Flexion with adduction and lateral (external) rotation
1
The close-packed position for the hip is medial (internal) rotation with extension and abduction. An alternative position is 90° of hip flexion with abduction and slight lateral (external) rotation.
148
A physical therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve (Ill). During the cranial nerve examination, which of the following signs would be the MOST significant?
1. Inability to close the eyelid
2. Medial strabismus
3. Ptosis of the eyelid
4. Constricted pupil
3
The oculomotor nerve innervates the levator palpebrae superiors muscle that elevates the upper eyelid and the pupillary constrictor muscle. Therefore, a lesion of the oculomotor nerve would make it difficult, if not impossible, for the patient to fully raise the lid (open the eye) and would cause a condition termed posis. In addition, the eye may not react to light and therefore would not show pupillary constriction when light is directed into the eye. Inability to fully close the eye would be seen with a lesion of the facial nerve (Bell palsy). Medial strabismus would be caused by damage to the abducens nerve, innervating the lateral rectus, causing a medial strabismus.
149
A patient receiving physical therapy reports frequent urination, weight loss, and feeling constantly thirsty. The physical therapist should contact the physician regarding the patient's symptoms because they are MOST likely consistent with which of the following pathological conditions?
1. Cancer
2. Cystitis
3. Renal calculi
4. Diabetes mellitus
4
These symptoms are consistent with diabetes mellitus. Cancer would not likely include the feeling of thirst and frequent urination. Cystitis would not include symptoms of weight loss and thirst. Renal calculi are characterized primarily by pain and not thirst, frequent urination, or weight loss.
150
For an individual with a T12 spinal cord injury to be able to walk, achievement of which of the following ranges of motion is MOST important?
1. Neutral dorsiflexion
2. Full hip extension
3. Normal knee flexion
4. 110° straight-leg raise
2
Ten degrees of dorsiflexion is required for normal walking. Full hip extension is required for walking for a person with a T12 level injury. Normal knee flexion is not required for normal walking. While option 4 is important for long sitting and floor-to-wheelchair transfers, this is not required for gait.
151
A 55-year-old patient is referred to physical therapy from the emergency room after casting following a right femur fracture caused by a motor vehicle accident. The patient is nauseous but has good balance during initial attempts at non-weight-bearing gait training on the right lower extremity. The patient lives alone on the second floor of an apartment building with no elevator.
Which of the following assistive devices is MOST appropriate for the patient?
1. Standard walker
2. Axillary crutches
3. Quad cane
4. Two straight canes
2
A standard walker on stairs is not as safe as crutches. As the patient was previously active, has stairs at home, and must be non-weight-bearing on one lower extremity, axillary crutches would provide the greatest safety margin and independence. A quad cane would not be sufficient, since the patient is non-weight-bearing on one lower extremity. The patient would not be able to be non-weight-bearing on one lower extremity with two straight canes.
152
A physical therapist is treating a patient with moderately controlled type 1 diabetes. One of the goals is to help the patient regulate insulin dosage through exercise. In establishing an exercise program, the therapist should be aware that regular exercise wil generally:
1. lower blood glucose levels and decrease the amount of insulin required.
2. lower blood glucose levels and increase the amount of insulin required.
3. raise blood glucose levels and decrease the amount of insulin required.
4. raise blood glucose levels and increase the amount of insulin required.
1
In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise. Exercise has been shown to increase sensitivity of the insulin receptors, leading to a decrease in the amount of insulin required.
153
A patient sustained a severe brainstem injury 1 week ago and has demonstrated minimal change since the incident. The patient's cognitive status is MOST likely to include which of the following characteristics?
1. Decreased level of arousal
2. Decreased level of intelligence
3. Increased level of agitation
4. Increased level of impulsivity
1
A state of alertness to the internal and external environment must be maintained for motor or mental activity to occur. The brainstem reticular activating system brings about this state of general arousal. To proceed from a state of general arousal to one of selective attention requires the communication of information to and from the cortex, the thalamus, and the limbic system and its modulation over the brainstem and spinal pattern generators.
154
When treating a patient who has ankylosing spondylitis, which of the following muscles require the MOST emphasis in strengthening exercises?
1. Pectorals
2. Hip flexors
3. Back extensors
4. Abdominals
3
Trunk ROM exercises and strengthening to minimize thoracic kyphosis are essential.
Persons with ankylosing spondylitis tend to assume flexed postures. Disproportionately strong pectorals, hip flexors, or abdominals could worsen the kyphosis.
155
To obtain informed consent for an intervention, a physical therapist must disclose to the patient all of the following types of information EXCEPT the:
1. cost of the intervention.
2. goals of the intervention.
3. possible risks of the intervention.
4. alternative interventions available.
1
Option 1 is not among the information that must be disclosed to a patient to obtain informed consent. The goals of the intervention, the possible risks of the intervention, and any alternative interventions available must be disclosed to the patient to obtain the patient's informed consent.
156
During steady rate exercise, the blood pressure in a healthy person MOSTtypically responds with:
1. systolic pressure increase and no change in diastolic pressure.
2. no change in systolic pressure and marked decrease in diastolic pressure.
3. systolic pressure decrease and diastolic pressure increase.
4. no change in systolic pressure until the end point of the exercise session.
1
Steady rate exercise such as jogging or cycling causes a relatively rapid increase in systolic pressure, with diastolic pressure remaining the same or decreasing only slightly.
Systolic pressure may level off somewhat during the exercise, if exercise intensity remains the same.
157
A patient's symptoms include muscle atrophy, tachycardia, heat intolerance, brittle hair, and increased appetite with weight loss. The patient is MOST likely to have which of the following
disorders?
1. Hyperthyroidism
2. Hypothyroidism
3. Cushing syndrome
4. Hypoparathyroidism
1
Normal function of thyroid hormone generally regulates metabolism. Excessive thyroid hormone creates a generalized elevation of body metabolism that manifests in most systems of the body. The patient described in the stem has these manifest symptoms of increased metabolism. Hypothyroidism would have nearly the opposite manifestations, such as bradycardia and cold intolerance. Cushing syndrome is a problem of hypercortisolism and has a very different set of manifestations. Hypoparathyroidism leads to problems of calcium regulation and also has a different set of manifestations.
158
A physical therapist is examining a patient who has a tentative diagnosis of fibromyalgia syndrome. Which of the following symptoms from the patient's history would help rule out this diagnosis?
1. Fatigue
2. Recent weight loss
3. Sleep disturbances
4. Paresthesias
2
Weight gain is common with this disorder, not weight loss. All other options are seen in patients with fibromyalgia.
159
Following trauma at the C5 spinal cord level, a patient was admitted to the hospital. Twenty-four hours later, the patient shows no reflexes, sensation, or voluntary motor activity below the level of injury. These findings indicate:
1. the presence of spasticity.
2. decerebrate rigidity.
3. spinal shock.
4. a lower motor neuron lesion.
3
Spinal shock occurs as a reaction to spinal cord injury and is characterized by an absence of all reflex activity below the level of the lesion. Depending on the extent of the lesion, the patient may lose all or some sensation and motor activity below the level of the lesion. Spasticity is associated with hyperreflexia and increased muscle tone. Spasticity would be expected to develop following the spinal shock stage. Decerebrate rigidity involves a sustained contraction of the upper and lower extremities in extension. With a lower motor neuron lesion, the loss of sensation and motor activity would be confined to a much smaller region (depending on the exact lesion) and would not affect all levels below the lesion.
160
An initial physical therapy evaluation is conducted for an older adult patient 1 day after the patient had a total left hip arthroplasty (noncemented) using a posterolateral approach. The patient has no complicating medical history and was active and independent preoperatively.
Which of the following activities is LEAST appropriate for the first week of therapy?
1. Active-assistive positioning of the left hip to 60° of flexion
2. Active left hip abduction in right sidelying
3. Independent bed mobility with use of a trapeze
4. Walking with moderate assistance with a standard walker to 25 ft (7.6 m)
2
Although protocols depend on the surgeon and the approach, it is generally recommended that anti-gravity hip abduction exercises not begin until 5 to 6 weeks post surgery. Patients are taught to avoid excessive hip flexion, usually beyond 80°. Bed mobility and ambulation would be started 1 or 2 days postoperatively.
161
A patient with a recent onset of upper extremity lymphedema is MOST likely to have which of the following findings?
1. Pallor
2. Shiny skin
3. Dorsal hand swelling
4. Nonpitting edema in the forearm
3
In the early stages of lymphedema (Stage I), reversible swelling is common, especially in the dorsum of the hand. Signs of lymphedema development include slow progression of swelling, which is typically distal to proximal progression. Nonpitting edema is present with Stage Il lymphedema. Pallor and shiny skin are changes associated with conditions resulting in arteriospasm.
162
A patient is referred to physical therapy for treatment of tenosynovitis. The patient reports a "pins and needles" sensation on the palmar surface of the thumb (1st digit), index (2nd digit), and middle (3rd digit) fingers. The physical therapist's examination reveals a positive Tinel sign at the wrist and Good (4/5) opposition of the thumb (1st digit). Based on these findings, the therapist should suspect:
1. median nerve compression at the wrist.
2. ulnar nerve compression distal to the elbow.
3. tenosynovitis of the abductor pollicis longus.
4. thoracic outlet syndrome.
1
The median nerve supplies sensory innervation to the palmar surface of the thumb, index, and middle fingers (1st, 2nd, and 3rd digits). A positive Tinel sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) and weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory and motor changes in the little and ring fingers (4th and 5th digits), not the thumb (1st digit). Tenosynovitis of the abductor pollicis longs muscle would most likely reveal a positive Finkelstein test (stretching of the abductor muscle) with pain over the dorsum of the thumb (1st digit). Thoracic outlet syndrome would most likely be revealed with special tests that cause alteration of the radial pulse.
163
A clean, well-granulating Stage Il pressure ulcer with minimal serous drainage is MOST appropriately dressed with:
1. a nonadherent dressing.
2. a packed dressing.
3. topical medication only.
4. dry-to-dry gauze.
1
A nonadherent dressing is best choice because any adherence of the dressing to the fragile granulating tissue could cause additional trauma. This is a superficial wound, so there would be no need to pack the wound. Because there is some drainage, a covering is preferred to topical medication only.
164
The brother of a patient who was recently discharged from a hospital's outpatient physical therapy department telephones on the patient's behalf to request a copy of the patient's medical record. The physical therapist should explain to the patient's brother that the medical record is the property of the:
1. patient's family and can be released to the brother upon written request.
2. patient's insurer and the request for a copy must be made in writing to the insurer.
3. hospital and the patient and can be released only with written authorization from the patient.
4. hospital and can be released only with written authorization from the patient's physician.
3
The medical record is owned by the hospital subject to the patient's interest in the information it contains. Unless restricted by state or federal law or regulation, a hospital shall furnish to a patient, or a patient's representative, parts of the hospital record upon request in writing by the patient or the representative. Option 3 is the only correct answer in this case, because it specifies that the patient must authorize the release of information.
165
A physical therapist has been treating a female patient with low back pain for 6 weeks. The patient reports that the pain seemed to lessen earlier in the course of treatment but has intensified again in the past week. To help identify a systemic cause for the pain, the therapist should ask the patient whether the pain:
1. decreases when she lies down.
2. corresponds with her menstrual cycle.
3. increases when she is driving to work.
4. increases when she has a bowel movement.
2
Pain from endometriosis often is cyclic in nature and corresponds with the menstrual cycle.
The other options are more likely to indicate mechanical causes of pain.
166
A patient, who has fallen three times while walking on uneven surfaces, comes to physical therapy for intervention. Examination reveals that the patient does not have difficulty maintaining balance with the eyes closed or with the introduction of visual conflict. Which of the following interventions is MOST appropriate for this patient?
1. Instruct the patient to walk a straight line while glancing left and right.
2. Instruct the patient in exercises to strengthen the gastroc-soleus muscle group.
3. Refer the patient to an orthotist for a custom ankle-foot orthoses fitting.
4. Provide the patient with a cane for walking.
4
Instructing the patient to walk a straight line while glancing left and right would address a vestibular problem, specifically oscillospsia, but would not help a patient with a primarily somatosensory deficit, as described in the question. Instructing the patient in exercises to strengthen the gastroc-soleus muscle group would not provide protection against falling, although it may be an appropriate adjunct in a comprehensive therapy program. Referring the patient to an orthotist for a custom ankle-foot orthoses fitting may be included at some point in the intervention scheme, but the most important factor is immediate protection from falling, which is best addressed with a cane. This patient has a somatosensory deficit, and while introducing somatosensory challenges is appropriate, the most important thing to do is provide the patient with a cane for balance and upper extremity proprioceptive input.
167
An 8-year-old child with juvenile rheumatoid arthritis is developing bilateral knee flexion contractures. Which of the following interventions is LEAST appropriate?
1. Exercises to increase joint mobility
2. Ultrasound to the hamstring insertions to increase tissue extensibility
3. Progressive weight bearing by walking in a therapeutic pool to increase endurance
4. Exercise to increase quadriceps strength
2
Options 1, 3, and 4 are acceptable interventions for this patient. The epiphyseal areas (growth areas of bones) in children should not be exposed to ultrasound. The application of ultrasound over the knee joint (hamstring insertion) could expose epiphyseal areas to the ultrasound.
168
A physical therapist recognizes that departmental patient education materials are written at a reading level that is too difficult for some of the patients. The therapist can help the patients to better understand the materials by:
1. including illustrations with captions in large print.
2. including illustrations and a simpler sentence structure.
3. reducing the number of syllables and lengthening the sentences.
4. using a large-print format to present specific medical terminology.
2
Larger print will not simplify the meaning, nor will lengthening the sentences. Only Option 2, the choice of illustrations and a simpler sentence structure, is likely to improve patients' understanding of the materials.
169
A physical therapist is gait training a patient who suddenly becomes weak and falls to the floor.
The patient is now unresponsive. The therapist should FIRST:
1. open the patient's airway.
2. activate the emergency response system.
3. quickly start breathing assistance.
4. begin chest compressions.
2
Although all of the options are steps in the cardiopulmonary resuscitation guidelines, based on the presented signs and symptoms, activation of the emergency response system is the first thing the therapist should do, as the patient is located within a hospital setting.
170
Which of the following nerves innervates the muscles that control micturition?
1. Genitofemoral
2. Superior gluteal
3. Obturator
4. Pudendal
4
Micturition is the physiologic process of urination. The pelvic floor muscles control urination by stopping the flow of urine. The pelvic floor muscles are innervated by the pudendal nerve. The superior gluteal muscle innervates the gluteus minimus, gluteus medius, and tensor fasciae late. The genitofemoral nerve provides sensory innervation, but not motor innervation.
The obturator nerve innervates the adductor muscle, gracilis, and obturator externus.
171
A patient spilled boiling water on the right arm when reaching for a pan on the stove. The forearm, elbow, and lower half of the upper arm appear blistered and red, with some subcutaneous swelling and pain on touch. To facilitate optimal function, which of the following interventions should a physical therapist PRIMARILY emphasize?
1. Range of motion exercises to the right hand, wrist, and elbow
2. Application of compression dressings
3. Sterile whirlpool to the right upper extremity
4. Splinting of the right upper extremity in full elbow extension
1
The patient will be reluctant to move the limb because it is painful. ROM is essential to regain and maintain a functional ROM. In this case, the physical therapist's primary goal is to restore function with ROM exercises. Compression dressings, whirlpool, and splinting are all acceptable aspects of care that help in the restoration of ROM. However, functional ROM would be the primary goal.
172
A physical therapist is treating a patient who has lymphedema in the right lower extremity. The therapist decides to use mechanical, intermittent pneumatic compression as an intervention, using a sleeve that covers the foot, leg, and thigh. The therapist measures the patient's blood pressure at 135/85 mm Hg. Which of the following inflation pressures for the sleeve is MOST appropriate for the first treatment session?
1. 20 mm Hg
2. 60 mm Hg
3. 100 mm Hg
4. 140 mm Hg
2
The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 mm Hg (higher for the lower extremities than upper extremities). It is also recommended that the pressure be below the diastolic pressure. Pressures below 30 mm Hg are not considered to be effective. Pressures above the diastolic pressure can be used with caution.
For the first treatment, it would be most appropriate to use a pressure that is considered effective, yet not so high as to cause potential problems for the patient. If the patient responds positively to the intervention, a higher pressure could be instituted.
173
A physical therapist examines a patient lying supine with the hip and both lower extremities extended. The therapist notes that both of the patient's medial malleoli are aligned with each other. The therapist asks the patient to assume the long-sitting position and notes the position of the malleoli as shown in the photograph. What is the MOST likely cause of this patient's test results?
1. Excessive femoral anteversion
2. Anterior rotation of the innominate on the right
3. Functional leg-length discrepancy due to left lateral pelvic tilt
4. Posterior rotation of the innominate on the right
4
Excessive femoral anteversion could cause toeing in during standing. Anterior rotation of the innominate would cause shortening of the extremity. Pelvic tilt may cause a leg-length discrepancy with the longer leg being on the side of the tilt. When the malleoli are aligned in supine and then change with long sitting, it is indicative of innominate rotation. In this case the right malleolus shifted inferiorly (got longer), indicating a posterior rotation of the pelvis on the side of the longer leg.
174
Which dermatome is associated with the area including the umbilicus?
1. T3
2. T10
3. L1
4. L3
2
The T10 dermatome includes the umbilicus. T5 is closer to the nipple line, and L1 includes the region over the inguinal ligament. L3 covers the anterior thigh.
175
A physical therapist is treating a 12-year-old athlete who has had lateral epicondylitis for 3 weeks.
Which of the following modalities presents the GREATEST concern for possible harm to this patient?
1. Ice massage
2. lontophoresis
3. Moist heat packs
4. Continuous ultrasound
4
Use of therapeutic ultrasound over epiphyseal plates of growing bones is contraindicated.
There is potential for damage to the growth plate with intense thermal ultrasound and for increased stimulation of bone formation even with very minimal ultrasound exposure. There are no contraindications or unusual precautions for use of ice massage, moist heat, or iontophoresis in the elbow region in healthy adolescents.
176
A 22-year-old patient is hospitalized awaiting a lung transplant due to cystic fibrosis. The patient's physician is interested in an objective measure of the patient's preoperative endurance.
Which of the following tests is MOST appropriate for the physical therapist to administer to this patient?
1. VO2 max treadmill test
2. Two-step exercise test
3. Submaximal exercise test on a cycle ergometer
4. 6-minute walk test
4
The patient is too ill for either the VO2 max treadmill test or the two-step test. The submaximal exercise test is not as sensitive or specific a test as the 6-minute walk test. The
6-minute walk test is designed for acutely ill cardiopulmonary patients.
177
A patient has difficulty palpating the carotid pulse during exercise. The patient should be instructed in alternate methods of self-monitoring, because repeated palpation is likely to result in:
1. an increase in the heart rate.
2. a decrease in the heart rate.
3. an irregular heart rhythm.
4. an increase in systolic blood pressure.
2
Pressure receptors (baroreceptors) are present in the carotid sinus, and these receptors respond to changes in blood pressure. An increase in blood pressure that is sensed by these receptors will stimulate the parasympathetic system to decrease the rate and force of contraction of the heart in order to help lower the pressure. Repeated palpation in the carotid sinus area may simulate an increase in blood pressure and cause this reaction. Therefore increased heart rate and blood pressure are incorrect. Irregular heart rhythms generally result from electrolyte imbalance and/or ischemia to the conduction system of the heart.
178
A patient with the diagnosis of astrocytoma malignancy is receiving physical therapy in her home.
While sitting in a chair at her dining room table, the patient begins to have a grand mal seizure.
The physical therapist lowers her to the floor. The MOST appropriate next step for the therapist is to:
1. activate the emergency response system.
2. protect the patient from biting her tongue by inserting a tongue blade.
3. roll the patient on her side.
4. extend the patient's neck for airway clearance.
3
Activating the emergency response system is not the first step and may not be indicated until further assessment is completed after the seizure. There is no need to try and keep the patient from biting her tongue or to insert an object into the mouth, which could cause damage to the patient's teeth. During a seizure, injury should be prevented. Rolling the patient on her side will help prevent aspiration. Option 4 is not an appropriate response to the patient having a seizure.
179
The MOST appropriate position in which to mobilize the radial nerve is:
1. abduction, elbow extension, and wrist extension.
2. flexion, elbow flexion, and wrist extension.
3. abduction, elbow flexion, and wrist flexion.
4. extension, elbow extension, and wrist flexion
4
The shoulder abduction, elbow extension, wrist extension position is for the median nerve.
The shoulder flexion, elbow flexion, wrist extension position is for the ulnar nerve. Option 3 is incorrect because the radial nerve stretch requires elbow extension, not flexion. Option 4 is the correct position for end-range gliding of the radial nerve.
180
A physical therapist is measuring ankle range of motion in a patient. The measurement shown in photograph A is greater than the measurement shown in photograph B. The MOST likely cause of the difference in measurement is:
1. talocrural joint capsule restriction.
2. weakness of the ankle dorsiflexors.
3. tightness in the hamstrings.
4. tightness in the gastrocnemius.
4
Capsular restriction would show up in both measurements. Dorsiflexor weakness would show up in both measurements. Hamstring tightness would affect knee range of motion, not ankle range of motion. In photograph A, there is more dorsiflexion present with the knee bent. In this position, the gastrocnemius is on slack across the knee joint, which allows greater range of dorsiflexion. In photograph B, the gastrocnemius is stretched over the knee joint, so the ankle joint and tightness in the gastrocnemius would restrict ankle dorsiflexion.
181
Which of the following considerations is MOST reasonable when deciding to use a nonparametric test of difference in data analysis?
1. Nonparametric tests are more powerful than parametric tests.
2. Nonparametric tests are based on stringent statistical assumptions.
3. Comparison of mean differences between two treatment groups is the main focus of the study.
4. The underlying distribution of the data in the research population is unknown.
4
Nonparametric tests are not based on specific assumptions about the distribution of data within a population. They are used with rank or frequency information to draw conclusions about differences between populations. While versatile, they are generally considered less powerful than parametric tests.
182
A physical therapist is planning to use functional electrical stimulation to decrease shoulder subluxation in a patient post stroke. Which of the following techniques is MOST appropriate?
1. Use direct current.
2. Limit on times to less than 10 seconds.
3. Adjust electrode placement to achieve upper trapezius muscle contraction.
4. Place electrodes over the posterior deltoid and supraspinatus muscles.
4
Recommended electrode placement for reducing shoulder subluxation is over the posterior deltoid and supraspinatus muscles. The goal is to increase on time and decrease off time as muscle endurance improves. On times up to 30 seconds can be used if tolerated by muscles or if pulsed current is used. Direct current is not well suited for this type of application. A pulsed current (symmetrical or asymmetrical biphasic PC) is recommended for treatment of shoulder subluxation. Activation of the trapezius muscle should be avoided.
183
A physical therapist is setting up a home program of electrical stimulation for a patient who has
Bell palsy. Which of the following muscles should be stimulated as part of the home program?
1. Sternocleidomastoid
2. Masseter
3. Temporalis
4. Frontalis
4
Bell palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by the facial nerve. The sternocleidomastoid is innervated by the spinal accessory nerve, and the masseter and temporalis are innervated by the trigeminal nerve.
184
The PRIMARY purpose of pursed-lip breathing is to:
1. help prevent the collapse of pulmonary airways during exhalation.
2. decrease the removal of carbon dioxide during ventilation.
3. increase the residual volume of respiration so that more oxygen is available for body metabolism.
4. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated.
1
A patient with COPD has premature collapse of the airways upon exhalation, which leads to air trapping and ultimately poor gas exchange. Breathing out through pursed lips slows the airflow and creates a back pressure, which helps to prevent the airways from collapsing while exhaling. By exhaling more fully through pursed lips, more carbon dioxide is removed. By preventing airway collapse and air trapping in the lungs, the residual volume is actually decreased. Pursed-lip breathing helps with ventilation but does not necessarily assist with secretion mobilization.
185
A patient reports numbness and tingling on the lateral side of the right lower leg that sometimes extends into the top of the foot. Which of the following structures is MOST likely involved?
1. Lateral sural cutaneous nerve
2. L3 nerve root
3. Superficial fibular (peroneal) nerve
4. S1 nerve root
3
The sensory distribution for the lateral sural cutaneous nerve includes the upper portion of the lateral lower leg but does not extend into the foot. The L nerve root usually covers the medial knee. The information given in the question includes the sensory distribution of the superficial fibular (peroneal) nerve. The St nerve root extends into the lateral portion of the foot, not the top portion of the foot.
186
While examining a patient who had a baby 3 days ago by vaginal delivery, a physical therapist notices that the patient has a 2-cm diastasis of the rectus abdominis. To address this problem, the patient should:
1. perform partial sit-ups supporting her abdominal muscles with her hands, while lifting her head in the supine position.
2. not perform exercises until the diastasis heals spontaneously.
3. perform sit-ups with the knees bent and arms behind the head.
4. perform partial sit-ups with legs straight and arms in front.
1
Raising just the head activates only the recti muscles, and supporting the abdominal muscles with the hands provides external support to the stretched abdominal muscles. This is the optimal position to initiate abdominal strengthening following delivery for a patient with diastasis rectus abdominis. Doing no exercise would not be appropriate. With no support of the abdominal muscles, Options 3 and 4 would be too aggressive at this time.
187
A patient who is transported to the physical therapy department in a wheelchair reports severe, bilateral lower extremity pain. A purple discoloration of both feet is observed. The pain is relieved when the patient's feet are raised just above the horizontal plane. These signs are MOST indicative of:
1. arterial insufficiency.
2. intermittent claudication.
3. venous insufficiency.
4. a psychosomatic episode.
3
With arterial insufficiency, elevation increases ischemia and therefore pain. Intermittent claudication is a phenomenon associated with metabolic demands exceeding the capability of the vascular system to supply adequate blood flow. Placing the limb in a dependent position increases swelling and therefore possibly pain with venous insufficiency. An objective sign such as purple discoloration rules out a psychosomatic episode.
188
A physical therapist is treating a patient who had knee surgery after a car accident. The patient is suing the driver of the other car and has hired an attorney. The patient is coming into physical therapy as an outpatient 3 times/week. After the third session, the patient's niece calls and wants to know how much weight her aunt can bear on the leg. The therapist should:
1. have the aunt's attorney call the niece.
2. describe the weight-bearing limits in general terms.
3. have the niece call the medical records office.
4. ask the niece to visit directly with her aunt.
4
A patient must give informed consent regarding information about the treatment. The best alternative for the therapist is to have the niece visit directly with the aunt or have the niece attend a treatment session with the aunt's permission. Informed consent can only be given by the patient, unless the patient is incapable of doing so. In this case, there is nothing to suggest that the patient is unable to give her own consent.
189
A physical therapist reviews the chart of an inpatient and finds that the patient's angiogram shows a complete blockage of the left middle cerebral artery. Which of the following is the therapist MOST likely to note upon performing an evaluation?
1. Hemiparesis in the left upper extremity
2. Presence of hemineglect syndrome
3. Left homonymous hemianopsia
4. Presence of expressive aphasia
4
Left hemiparesis occurs with a blockage of the right middle cerebral artery. Hemineglect syndrome is much more common in right cerebral hemisphere lesions. Left homonymous hemianopsia occurs with a blockage of the right middle cerebral artery. Complete blockage of the left middle cerebral artery would most likely cause a problem with expressive speech (Broca aphasia), especially in a right-handed individual.
190
A physical therapist is developing an educational program for individuals with lower extremity peripheral neuropathies due to diabetes. Information about which of the following topics is MOST important for the therapist to provide to help prevent injury to the feet?
1. Orthoses to support the extremity
2. Use of proper footwear
3. Moisturizing the skin to prevent dryness
4. Exercise parameters
2
While all of the options would help prevent injury to a diabetic foot, information about proper footwear is the most important information to provide. Properly fitting footwear would alleviate risk of skin breakdown as well as provide appropriate cushioning to the articular cartilage of the foot joints that are prone to injury from repetitive trauma and compression.
Orthoses may not be necessary for all patients. Despite moisturizing the skin, if there is improper protection, skin breakdown can still occur. Exercising within appropriate parameters will not be beneficial if the patient's footwear is not supportive or properly fitting.
191
A patient with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While on the tilt table, the patient begins to have a pounding headache with flushing and profuse sweating. The physical therapist should FIRST:
1. lower the tilt table to a flat position
2. remove the patient from the tilt table and return to room.
3. check the patient's urine catheter.
4. check the patient's blood pressure.
3
These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated bladder. The FIRST step is to remove the noxious stimulus.
192
A patient slips, falls, and cuts her arm in the clinic. The cut is bleeding. The patient is alert and well oriented. In performing first aid for the patient, the FIRST action that a physical therapist should take is to:
1. don a pair of gloves.
2. clean the cut with an antiseptic.
3. check the patient's blood pressure.
4. cover the cut with a sterile dressing.
1
Infection control requires that the wound not be contaminated further and that the health care workers protect themselves from disease by avoiding contact with body fluids. In this case the patient does not appear to be in life-threatening danger and so the wound should be attended to. Therefore, checking blood pressure would not be the first thing to do. Once the gloves are donned, cleaning the wound and covering it with a sterile dressing would be appropriate.
193
Which of the following examination findings is indicative of developing nerve root signs?
1. Upgoing Babinski sign
2. Absence of sharp sensation
3. Cogwheel weakness with strength testing
4. Fading deep tendon reflex with repetitive tapping
4
A fading deep tendon reflex with repetitive tapping indicates developing nerve root signs.
The Babinski sign and cogwheel rigidity are signs of a central nervous system dysfunction. An absence of sensation does not indicate developing root signs, as paresthesia or diminished sensation would.
194
To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients into two groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the:
1. continuous variable.
2. dependent variable.
3. discrete variable.
4. independent variable.
4
The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables.
195
A physical therapist is examining hip range of motion in a patient as shown in the photograph.
Passive range of motion is applied to the patient's legs in the direction of the arrows. The photograph shows the end points of the range of motion. The MOST likely cause of the hip dysfunction occurring in the patient is:
1. hypomobility of the hip medial (internal) rotators on the left.
2. weakness of the left hip medial (internal) rotators.
3. laxity of the left hip capsule.
4. tightness of the hip lateral (external) rotators on the left.
4
Medial (internal) rotation of the left hip is limited. This could be caused by hypomobility of the left hip capsule or tightness of the left lateral (external) rotators, especially the piriformis.
Hypomobility of the medial (internal) rotators would cause limited lateral (external) rotation.
196
After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right transfemoral amputation. For this patient, which of the following factors is MOST important in establishing long-term goals for functional walking?
1. Status of the wound at the amputation site
2. Range of motion of the right hip
3. Condition of the left lower extremity
4. Ability to maintain upright posture
3
The left limb must function as the main support limb. Any treatment strategy for ambulation must ensure that the remaining limb is optimally functioning and that the limb is healthy. While the other factors are relevant, the integrity of the remaining limb is the greatest concern for this patient in establishing long term, functional goals.
197
A physical therapist notes that a patient is taking 180 mg of codeine orally every 3 to 4 hours.
Which of the following signs and symptoms is MOSTlikely to occur as a side effect of the medication?
1. Urinary frequency
2. Hypertension
3. Constipation
4. Diaphoresis
3
Urinary frequency is not a side effect of opioids. Hypertension is a potential side effect of stronger opioids such as morphine. Constipation is a frequent side effect of opioid analgesics, because they decrease gastrointestinal motility. Diaphoresis is a symptom of narcotic withdrawal, but is not expected in a patient who is still taking the medication.
198
A patient comes to physical therapy with a wound on the plantar aspect of the heel. The patient reports that the wound developed after the patient stepped on a tack without realizing it. The wound is now round, measures 2 cm in diameter, and displays no signs of infection. Which of the following initial interventions is MOST appropriate?
1. Bed rest
2. Custom molded shoe
3. Crutches with toe-touch weight-bearing
4. Total-contact casting
4
Although bed rest would decrease pressures on the foot and may allow healing, it would also lead to deconditioning and other avoidable side effects. A custom molded shoe would not be sufficient as an initial treatment option, as the wound is still open. Crutches with toe-touch weight-bearing would help to decrease the pressure on the heel if the patient were able to appropriately follow instructions. However, as the patient most likely cannot feel the foot, there is a high probability of noncompliance. Also, it would not protect the foot from further injury as does the total-contact casting. The patient's report of stepping on a tack without realizing it indicates that this patient has a neuropathy. The best way to treat a neuropathic foot ulcer is with total-contact casting.
199
A patient comes to physical therapy with a 4-month history of low back pain. The patient had previously received therapy from other health care practitioners for this same pain, without resolution. During examination by the physical therapist, the patient reports a history of difficulty sleeping, concern that the pain will never improve, and irritability. The physical therapist should refer the patient to a:
1. social worker.
2. psychiatrist.
3. nutritionist.
4. physiatrist.
2
Neither a social worker nor a nutritionist can adequately treat the patient's depression. A patient exhibiting symptoms of chronic pain and depression warrants a referral to a psychiatrist or psychologist. A physiatrist can address the patient's chronic pain, but is not as well equipped as a psychiatrist to address the patient's depression.
200
A patient with a traumatic brain injury is receiving outpatient physical therapy. The physical therapist notices that the patient becomes agitated during therapy sessions. To which of the following professionals should the patient be referred for assessment and diagnosis?
1. Occupational therapist
2. Neuropsychologist
3. Vocational counselor
4. Speech-language pathologist
2
Because the problem is a behavioral disorder, the most appropriate person to assess this patient would be a neuropsychologist. The neuropsychologist is trained to assess intellectual, emotional, and coping functions of the patient as well as levels of depression and anxiety. A neuropsychologist could also provide consultation to help the rehabilitation team members deal with the problem.
