An injury occurring at C1-T12 will result in what bowel and bladder dysfunction? 1. Hyperreflexic bladder, spastic bowel 2. Areflexic bladder, flaccid bowel 3. Hyperreflexic bladder, flaccid bowel 4. Areflexic bladder, spastic bowel

1. Hyperreflexic bladder, spastic bowel

An injury occurring at L1-S1 will result in what bowel and bladder dysfunction? 1. Hyperreflexic bladder, spastic bowel 2. Areflexic bladder, flaccid bowel 3. Hyperreflexic bladder, flaccid bowel 4. Areflexic bladder, spastic bowel

4. Areflexic bladder, spastic bowel

An injury occurring at S2, S3, S4 will result in what bowel and bladder dysfunction? 1. Hyperreflexic bladder, spastic bowel 2. Areflexic bladder, flaccid bowel 3. Hyperreflexic bladder, flaccid bowel 4. Areflexic bladder, spastic bowel

2. Areflexic bladder, flaccid bowel

PT Final Exam Practice Questions Flashcards by Kayla Deaton

A 60-year-old patient is being treated for a recent total knee arthroplasty that occurred 2 weeks ago. The therapist takes the patient’s vitals and obtains the following values:
• Heart rate 120 bpm
• Oxygen saturation 89%
• Blood pressure 125/85 mmHg
The patient reports that he has had significant shortness of breath and a persistent cough for the past 2 days. The patient also displays increased edema in the involved lower extremity. Which of the following conditions is MOST likely present in this patient?
1. Pleurisy
2. Pneumothorax
3. Pneumonia
4. Pulmonary embolism

Pulmonary embolism.
This patient meets the Wells Criteria for pulmonary embolism including age>50, HR > 100, O2 sats<95%, unilateral leg swelling, surgery within 4 weeks, and signs of a DVT. The significant shortness of breath and persistent cough are also indicative of pulmonary embolism. This patient warrants expeditious referral for physician follow-up.

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True or False: a DVT can cause a CVA?

No because it goes to the lung and gets stuck there - usually

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A 25-year-old runner is being evaluated by a physical therapist for a chief complaint of unilateral lower leg pain that began 2 weeks ago after he increased the speed and hardness of running surface. The pain is aggravated by running and alleviated rapidly with cessation of the activity. Besides the pain, the patient reports that his skin on the surface of his shin is swollen, shiny, and somewhat “woody.” The patient has diminished 2-point discrimination. Which of the following diagnoses is MOST likely to be present?

Achilles tendon rupture
Deep vein thrombosis
Exertional compartment syndrome
Tibial stress fractures

Exertional compartment syndrome.
Anterior compartment syndrome brought on by exertion is described by the signs and symptoms presented in the case. The signs of compartment syndrome include: pain, paralysis, paresthesia, pallor, and diminished pulses.

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What is the cheapest and easiest method typically used for in diagnosing stress fractures?

DEXA scan

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A patient presents with hypothenar eminence wasting and weakness of the intrinsic muscles of the hand. Which of the following impairments is LEAST likely to be present?

T1 nerve root compression
C8 nerve root compression
Carpal tunnel syndrome
Cubital tunnel syndrome

Carpal tunnel syndrome.
Carpal tunnel syndrome implicates the median nerve which innervates the thenar eminence. The ulnar nerve (C8,T1) innervates the hypothenar eminence, resulting in loss of the 3rd and 4th lumbricals and interossei muscles

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A patient with an injury to the inferior gluteal nerve would MOST likely demonstrate which of the following gait abnormalities?

Posterior trunk lean during initial swing
Posterior trunk lean at initial contact
Ipsilateral hip drop during stance
Contralateral hip drop during stance

Posterior trunk lean at initial contact.

The inferior gluteal nerve innervates the gluteus maximus and would result in a posterior trunk lean at initial contact.

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Can you see contralateral pelvic drop in feet together or feet apart?

Feet together because with feet apart there is more normal hip alignment so shortening occurs on the ipsilateral side resulting in overall normal appearance bilaterally

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During examination, a patient is being evaluated for hand and upper extremity strength. When asked to hold a piece of paper between the thumb and index finger in a key grip, the examiner notices that the patient flexes the interphalangeal joint of the thumb as the examiner pulls the paper away from the patient. Based on these findings, what muscle is MOST likely to display weakness during manual muscle testing?

Flexor pollicis longus
Flexor digitorum profundus (radial half)
Pronator teres
Third and fourth lumbricals

Third and fourth lumbricals.
The 3rd and 4th lumbricals are innervated by the deep terminal branch of the ulnar nerve and are most likely to be affected in a case of positive Froment’s Sign (described in the question). The Froment’s Sign tests for activity of the adductor pollicis (innervated by the ulnar nerve).

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A 65-year-old patient reports numbness and tingling extending from the lateral thigh toward the medial malleolus that has been present for the past year. During examination, the patient reports that the symptoms are alleviated while sitting and exacerbated with standing. The therapist chooses to apply lumbar traction to treat the patient. Which of the following parameters is BEST indicated for the patient?

Patient positioned in supine, traction force 50% body weight, intermittent traction force
Patient positioned in prone, traction force 15 kg, static traction force
Patient positioned in prone, traction force 25% body weight, intermittent traction force
Patient position in supine, traction force 15 kg, intermittent traction force

Patient positioned in supine, traction force 50% body weight, intermittent traction force.
These are the correct parameters to create joint distraction to treat the apparent foraminal stenosis present in this patient. The choice to place the patient in supine is determined by the “flexion” bias in the patient where symptoms are alleviated with sitting and decreased loading.

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What percent body weight is the correct parameter setting when setting up lumbar traction to achieve true intervertebral separation?

50%

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What percent body weight is the correct parameter setting when setting up lumbar traction in order to overcome friction?

25%

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During examination by a physical therapist, a patient presents with weakness of elbow flexion and forearm supination of the right arm. In addition, the involved upper extremity is positioned in scapular depression, adduction, and internal rotation. Which of the following conditions is MOST likely present?

Claw hand
Erb’s palsy
Klumpke’s paralysis
Thoracic outlet syndrome

Erb’s palsy
Damage to the upper brachial plexus (C5,6) will result in the “waiter’s tip position” described in this question as a result of weakness of elbow flexion/supination and loss of external rotation, abduction, and scapular elevation.
Claw hand and Klumpkes paralysis are synonymous

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While examining a patient, the patient displays a manual muscle test grade of 1/5 on the right tibialis anterior muscle. Which of the following gait deviations would MOST likely occur?

Foot slap at heel initial contact
Entire plantar aspect touching ground at initial contact
Initial contact made with the forefoot followed by the heel
Initial contact is made with the forefoot, but heel does not make contact during stance.

Initial contact made with the forefoot followed by the heel.
Severe weakness of the tibialis anterior will result in initial contact made by the forefoot followed by the rearfoot.

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What gait pattern is most associated with dorsiflexion weakness?

steppage gait

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A patient with a spinal cord injury is being examined by a physical therapist. The therapist notes that the patient’s medical chart indicates a complete spinal cord injury involving the sacral segments S2-S4. The injury was produced by a traumatic blow to the mid-lumbar region. When evaluating bowel and bladder function, the therapist would MOST likely expect which of the following presentations of symptoms?

Hyperreflexic bladder, spastic bowel
Areflexic bladder, flaccid bowel
Hyperreflexic bladder, flaccid bowel
Areflexic bladder, spastic bowel

Areflexic bladder, flaccid bowel.
Because the SCI involved the sacral segments S2-S4, it is known that the bowel and bladder function will be affected. The traumatic injury occurred in the mid-lumbar lesion, below the conus medullaris. Injuries to the cauda equina present as LMN injuries and are thus areflexic or flaccid.

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An injury occurring at C1-T12 will result in what bowel and bladder dysfunction?

Hyperreflexic bladder, spastic bowel
Areflexic bladder, flaccid bowel
Hyperreflexic bladder, flaccid bowel
Areflexic bladder, spastic bowel

Hyperreflexic bladder, spastic bowel

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An injury occurring at L1-S1 will result in what bowel and bladder dysfunction?

Hyperreflexic bladder, spastic bowel
Areflexic bladder, flaccid bowel
Hyperreflexic bladder, flaccid bowel
Areflexic bladder, spastic bowel

Areflexic bladder, spastic bowel

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An injury occurring at S2, S3, S4 will result in what bowel and bladder dysfunction?

Hyperreflexic bladder, spastic bowel
Areflexic bladder, flaccid bowel
Hyperreflexic bladder, flaccid bowel
Areflexic bladder, spastic bowel

Areflexic bladder, flaccid bowel

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A patient presents to physical therapy with intermittent buttock, hip, and thigh pain. During examination, the therapist notes a tender, palpable mass in the groin region. The patient also demonstrates a positive psoas sign and an antalgic gait pattern. While reviewing the patient’s history, which of the following conditions will LEAST likely be associated with the patient’s current complaints?

Appendicitis
Crohn’s Disease
Diverticulitis
Pyloric stenosis

Pyloric stenosis.
This patient is presenting with signs and symptoms associated with a psoas abscess (palpable mass, positive psoas sign, radiating pain to hip/back/thigh). A psoas abscess is often associated with inflammatory or infectious conditions such as Crohn’s Disease, diverticulitis, appendicitis, or ulcerative colitis.

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What typically presents as a pulsating mass that can refer to the LB?

AAA

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A patient presents to physical therapy with weakness affecting the right upper extremity. Manual muscle testing reveals the following results:
• Flexor pollicis longus: 2/5
• Pronator teres: 2/5
• Pronator quadratus: 2/5
• Lateral 2 lumbricals: 2/5
• Medial 2 lumbricals: 5/5
• Extensor digitorum: 5/5
Which of the following nerves is MOST likely involved in the patient’s weakness? 
1. Median Nerve
2. PosteriorInterosseous Nerve 
3. Radial Nerve
4. UlnarNerve

Median Nerve.
The pronator teres, pronator quadratus, flexor pollicis longus (AIN), and lateral 2 lumbricals are innervated by the median nerve.

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A patient with meralgia paresthetica is being evaluated by a therapist for sensory disturbances. Which of the following regions is MOST likely to be affected?

Central low back
Lateral low back
Medial thigh
Lateral thigh

Lateral thigh.
Meralgia paresthetica is a nerve syndrome that is caused by compression of the lateral cutaneous femoral nerve of the thigh (LCFN). Symptoms most often include numbness and dyesthesia to the anterolateral aspect of the thigh that is most marked with walking, standing, or prone positioning.

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A nerve syndrome that is caused by compression of the lateral cutaneous femoral nerve of the thigh (LCFN). Symptoms most often include numbness and dyesthesia to the anterolateral aspect of the thigh that is most marked with walking, standing, or prone positioning.

Meralgia paresthetica

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A 59-year-old female patient is receiving physical therapy treatment for osteoarthritis and knee pain. During the exercise intervention, the patient begins to report unusual fatigue, lethargy, and weakness. In addition, the patient reports that she has been unable to sleep for the last two nights and is concerned that she may have depression. Upon further questioning, the patient reports that the symptoms are temporarily relieved by antacids. Based on these signs and symptoms, which of the following conditions is MOST likely present?

Chronic obstructive pulmonary disease
Congestive heart failure
Gastroesophageal reflux disease (GERD)
Myocardial infarction

Myocardial infarction.
Signs and symptoms of MI in women can be identical to men, or they can present with mental status changes, dyspnea, unusual fatigue, weakness, lethargy, UE heaviness/achiness, sensation of inhaling cold air, anxiety/depression, and symptoms that are relieved by antacids.

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A patient sustained a midshaft humeral fracture 8 weeks ago and is receiving physical therapy for upper extremity strengthening as a result of nerve damage due to the fracture. Which of the following muscles is LEAST likely to have impaired strength? 1. Brachioradialis 2. Flexor pollicis longus 3. Supinator 4. Anconeus

Flexor pollicis longus. A midshaft humeral fracture is most likely to damage the radial nerve as it wraps around the humerus. The flexor pollicis longus is innervated by the anterior interosseous nerve (branch of median) and is unlikely to be damaged.

A patient initiates a course of physical therapy to address cardiac function. During the initial examination, the patient reports substernal chest pain that began 1 month ago and radiates into the neck and left arm. The patient also reports difficulty swallowing, cough, and lower extremity edema. When asked about the character of the pain, the patient describes exacerbation with neck and trunk movements and alleviation with sitting upright and leaning forward. Which of the following conditions is MOST likely present? 1. Aneurysm 2. Congestiveheartfailure 3. Myocardialischemia 4. Pericarditis

Pericarditis. Pericarditis is an inflammation of the pericardial sac that presents with chest pain, cough, difficulty swallowing, and positional pain that is relieved with sitting and leaning forward.

Weakness of elbow flexion and wrist extension, diminished brachioradialis reflex?

C6 Myotome

Sensory loss over webspace of thumb?

Radial nerve

Weakness with shoulder abduction and external rotation?

Axillary nerve

Weakness with shoulder abduction and sensory loss of anterior forearm, diminished biceps reflex?

C5 nerve root

No tip-to-tip pinch of 1st-2nd fingers?

AIN Syndrome

Weakness with elbow extension and diminished triceps reflex?

C7 or Radial

Deep shoulder pain, weakness with external rotation?

Suprascapular nerve

Ape Hand?

Median nerve

Weak dorsiflexion and sensory loss over 1st webspace of foot?

Deep peroneal or L5

Weak plantar flexors, paresthesia over heel/posterior leg?

S1 nerve root

1+ patellar tendon reflex, weak hip flexion, loss of sensation on medial malleolus?

Femoral nerve L2-L4

Patellar tendon reflex innervation

Hip flexion innervation

Medial malleolus innervation

Weak eversion?

Superficial peroneal

Weak toe flexion, lateral foot paresthesia?

Tibial nerve

A patient is recovering from a distal radius fracture and open reduction internal fixation (ORIF) surgery that occurred 8 weeks ago. The patient’s bone is well healed and has been cleared for progressive range of motion and strengthening by her surgeon. The patient has great difficulty moving into wrist ulnar deviation. Which of the following joint mobilizations will be most appropriate to increase the available range of motion at the wrist? 1. Radiocarpal radial glide 2. Radiocarpal ulnar glide 3. Radiocarpal volar glide 4. Radiocarpal dorsal glide

1. Radiocarpal radial glide According to the roll and glide rules, the convex carpal portion of the radiocarpal joint must glide in a radial direction during ulnar deviation.

A 24-year-old patient reports to physical therapy for evaluation of low back and buttock pain. The patient reports a significant increase in pain that has occurred over the past 2 days but denies any history of trauma. The patient also reports increased urinary frequency and burning with urination as well as increased redness and tearing of the eyes. Which of the following conditions is MOST likely present? 1. AnkylosingSpondylitis 2. Reiter’s Syndrome 3. PsoriaticArthritis 4. Systemic Lupus Erythematosus

Reiter’s Syndrome. Reiter’s Syndrome is characterized by conjunctivitis, arthritis, and urethritis and is associated with venereal -acquired infections or other enteric infections. Arthritis typically occurs in the low back, SI joint, and LE joints. In addition, a dusky-blue discoloration or frank erythema accompanied by exquisite tenderness can be a sign of extreme joint destruction and septic joint.

Characterized by conjunctivitis, arthritis, and urethritis and is associated with venereal -acquired infections or other enteric infections. Arthritis typically occurs in the low back, SI joint, and LE joints. In addition, a dusky-blue discoloration or frank erythema accompanied by exquisite tenderness can be a sign of extreme joint destruction and septic joint.

Reiter’s Syndrome

A physical therapist is evaluating a patient with a non-cemented total hip arthroplasty (THA) 2 days post-surgery. The THA was performed with a posterolateral approach. Which of the following is NOT a hip protocol precaution for this individual? 1. Avoid full weight bearing until cleared by the surgeon. 2. Limit hip flexion to less than 30 degrees. 3. Avoid hip medial rotation. 4. Limit adduction past the neutral position.

Limit hip flexion to less than 30 degrees. | The standard posterolateral hip precautions include the other options and limiting hip flexion to less than 90 degrees.

``` A 65-year-old female with a history of Systemic Lupus Erythematosus is being treated in physical therapy for decreased balance and pain in multiple joints. She has been taking a low dose of prednisone to aid in the joint inflammation for the last 8 months. She has noticed that her balance has become worse and she has had multiple near falls. What side effect would be of HIGHEST concern for this patient? A. Bruising B. Depression C. Increased risk of infection D. Osteoporosis ```

Osteoporosis Due to the long-term steroid use, osteoporosis is a big side effect. When you have anyone that starts to present with balance issues, this becomes the biggest concern due to the increased risk for fracture if she does fall.

A patient with a below-knee amputation and patellar tendon bearing socket is ambulating in the parallel bars. After several brief bouts of ambulation, the patient sits down and removes the prosthetic limb. Which of the following areas would NOT be expected to show signs of pressure and weight bearing? 1. Inferior aspect of the patellar tendon 2. Superior tibial crest 3. Fibular shaft 4. Medial shaft of the tibia

2. Superior tibial crest | The superior tibial crest should not bear load in a PTB socket.

A patient is recovering from a transtibial amputation and has been fitted for a prosthetic with a solid ankle cushion heel (SACH). The patient demonstrates a prolonged loading response on the involved lower extremity. Which of the following conditions are most likely present? 1. Heel cushion is too soft 2. Heel cushion is too hard 3. Prosthetic socket is too small 4. Prosthetic socket is too large

Heel cushion is too soft—a softer heel delays the loading response

A patient has the following impairments: pain at the C4-5 junction on the left facet joint, difficulty sidebending and rotating his neck to the right, and difficulty achieving full neck flexion due to stiffness of the left C4-5facet joint. Which joint mobilization BEST addresses this impairment? 1. PA glide on the C5 spinous process 2. PA glide on the left C4 transverse process 3. PA glide on the right C4 transverse process 4. PA glide on the left C5 transverse process PA = Posterior-to-anterior force

PA glide on the left C4 transverse process. This opens the facet joint on the left where the dysfunction is.

A patient is being fitted with an AFO with an articulating ankle joint. Upon observation, the therapist notes that there is moderate to severe genu recurvatum with stance phase on the affected side. Which of the following will most likely decrease the amount of hyperextension? 1. Dorsiflexion Assist 2. Plantarflexion Stop 3. Dorsiflexion Stop 4. Plantar flexion Assist

2. Plantarflexion stop

``` When interpreting a radiograph for diagnostic imaging, which of the following is in order of increasing radiodensity? A) Air, fat, soft tissue, bone, metal B) Air, water, soft tissue, bone, metal C) Bone, metal, soft tissue, fat, air D) Metal, bone, soft tissue, fat, air ```

A) Air, fat, soft tissue, bone, metal

``` Which special test would not be considered for diagnosing a femoral acetabular joint pathology? A) FABER Test B) FADDIR Test C) Scour Test D) Sit to Stand Test ```

D) Sit to Stand Test | Sit to stand test is a outcome measure used for lower extremity strength and a predictive value for increased fall risk.

``` A 28-year-old female reports to physical therapy with complaints of acute right hip pain that started two weeks ago after running up a hill. She has a six-month history of intermittent right hip pain that is often present with activity, and states her hip almost gives out. She reports she felt sharp pain immediately following the recent running event with a pain rating of 8/10. Pain at rest is mild but worsens to a 5/10 with prolonged sitting and after climbing seven flights of stairs up to her apartment. Special tests indicate a positive FADIR and apprehension sign. Which condition is LEAST likely present in this patient? A) Femoral acetabular impingement B) Intraarticular loose body C) Labral tear D) Osteoarthritis ```

D) Osteoarthritis Based on the patient’s age, positive test findings, and painful hip flexion and internal rotation moments, this patient is most likely suffering from a femoral acetabular instability problem due to a femoral acetabular labrum tear.

A patient is being evaluated to rule out anterior compartment syndrome of the left leg. The therapist desires to check the dorsalis pedis pulse and compare bilaterally for differences. Where is the MOST appropriate anatomical location to examine the dorsalis pedis pulse? 1. Directly over the sinus tarsi and lateral neck of the talus 2. Immediately inferior and posterior to the medial malleolus 3. Inferior to the sinus tarsi along the lateral border of the foot 4. Between the extensor tendons at the junction with the 1st and 2nd cuneiform bones

4. Between the extensor tendons at the junction with the 1st and 2nd cuneiform bones The palpation point for the dorsalis pedis pulse is between the extensor tendons at the junction with the 1st and 2nd cuneiform bones.

While examining a patient, a physical therapist notes that the patient has increased pain throughout her hand and wrist joints. Upon further examination, the therapist notes that the fingers of the right hand have a marked ulnar drift. The patient is an elderly woman who reports that the pain has been increasing steadily over the last several years. Which of the following conditions is MOST likely present? 1. Osteoarthritis 2. Gout 3. Rheumatoid arthritis 4. Osteoporosis

3. Rheumatoid arthritis Rheumatoid arthritis is common in the elderly and primarily attacks the joints of the hands and fingers. There is typically an ulnar drift of the fingers noted.

A patient was admitted to the hospital following a motorcycle accident. He is suspected to have multiple fractures in the upper and lower extremities on the right side. What would be the BEST diagnostic imaging technique to view these fractures? 1. Bone Scan 2. CT scan 3. Ultrasound 4. X-ray

CT scan CT scan can produce an x-ray image to multiple parts of the body easier than any of the other options.

1. Radiocarpal radial glide According to the roll and glide rules, the convex carpal portion of the radiocarpal joint must glide in a radial direction during ulnar deviation.

A 24-year-old patient reports to physical therapy for evaluation of low back and buttock pain. The patient reports a significant increase in pain that has occurred over the past 2 days but denies any history of trauma. The patient also reports increased urinary frequency and burning with urination as well as increased redness and tearing of the eyes. Which of the following conditions is MOST likely present? 1. Ankylosing Spondylitis 2. Reiter’s Syndrome 3. Psoriatic Arthritis 4. Systemic Lupus Erythematosus

2. Reiter’s Syndrome. Reiter’s Syndrome is characterized by conjunctivitis, arthritis, and urethritis and is associated with venereal-acquired infections or other enteric infections. Arthritis typically occurs in the low back, SI joint, and LE joints. In addition, a dusky-blue discoloration or frank erythema accompanied by exquisite tenderness can be a sign of extreme joint destruction and septic joint.

2. Limit hip flexion to less than 30 degrees. | The standard posterolateral hip precautions include the other options and limiting hip flexion to less than 90 degrees.

A 65-year-old female with a history of Systemic Lupus Erythematosus is being treated in physical therapy for decreased balance and pain in multiple joints. She has been taking a low dose of prednisone to aid in the joint inflammation for the last 8 months. She has noticed that her balance has become worse and she has had multiple near falls. What side effect would be of HIGHEST concern for this patient? A. Bruising B. Depression C. Increased risk of infection D. Osteoporosis

Osteoporosis – this would be the correct answer. Due to the long-term steroid use, osteoporosis is a big side effect. When you have anyone that starts to present with balance issues, this becomes the biggest concern due to the increased risk for fracture if she does fall.

2. Superior tibial crest | The superior tibial crest should not bear load in a PTB socket.

1. Heel cushion is too soft—a softer heel delays the loading response

2. PA glide on the left C4 transverse process. This opens the facet joint on the left where the dysfunction is.

2. Plantarflexion Stop

A) Air, fat, soft tissue, bone, metal

``` Which special test would not be considered for diagnosing a femoral acetabular joint pathology? A) FABER Test B) FADDIR Test C) Scour Test D) Sit to Stand Test ```

D) Sit to Stand Test

3. Rheumatoid arthritis Rheumatoid arthritis is common in the elderly and primarily attacks the joints of the hands and fingers. There is typically an ulnar drift of the fingers noted.

2. CT scan – this would be the correct answer, CT scan can produce an x-ray image to multiple parts of the body easier than any of the other options.

A patient presents for the initial physical therapy encounter with a primary complaint of numbness and paresthesia in bilateral hands. During the examination, the patient displays a tremor at the wrists when the physical therapist moves the wrists into full extension. Which of the following factors is MOST likely to be reported in a detailed history of the patient? 1. Excessive typing at a computer 2. History of alcohol abuse 3. Frequent overhead lifting 4. History of pulmonary emboli

2. History of alcohol abuse. A presentation of bilateral carpal tunnel syndrome and asterixis (liver flap) of the wrist is strongly indicative of liver dysfunction. One major risk factor of liver disease is alcohol abuse. With the presence of bilateral symptoms and asterixis, a musculoskeletal origin is unlikely to be the underlying causative factor.

A patient with a lower extremity fracture is ambulating with axillary crutches. After several days, the patient reports that he is beginning to experience numbness on the dorsum of his forearms and hands related to the use of his axillary crutches. What muscular weakness is MOST likely to be detected in relation to this patient’s sensory disturbances? 1. Weak wrist extension 2. Weak elbow flexion 3. Weak forearm pronation 4. Weak shoulder flexion

1. Weak wrist extension. This is the correct answer. Axillary crutches that are improperly used and fitted can cause compression of the radial nerve in the axillary region, resulting in numbness and paresthesia along the dorsum of the forearm and hand (crutch palsy). The radial nerve also supplies the triceps and anconeus, resulting in marked elbow extension weakness

A physical therapist is testing a patient for clonus. What is the MOST appropriate action to complete this test? 1. Anterior posterior glide of the talocrural joint 2. Posterior anterior glide of the talocrural joint 3. Quick stretch to the dorsiflexors 4. Quick stretch to the plantarflexors

4. Quick stretch to the Plantar flexors Clonus is evaluated by the therapist providing a quick stretch to the plantar flexors. The patient should be in a relaxed position and the knee should be placed in slight flexion.

A 35-year-old female is being treated for Posterior Canalolithisais, what is the BEST intervention to correct this condition? 1. Dix-Hallpikemaneuver 2. Epley maneuver 3. Fostermaneuver 4. Semont maneuver

2. Epley maneuver Rationale – Epley would be the best option to treat a posterior canal issue. Dix hall pike is a diagnostic test, whereas the following 2 options would be used to treat Cupololithiasis

``` The patient’s head is moved into different positions in a sequence that will move the debris (otoconia) out of the involved semi-circular canals and into the vestibule. The head is rotated towards the affected ear first. The patient's head is rotated 45 degrees to each side and when in supine 30 degrees of cervical extension. This intervention is repeated 3-5 times, up to 3 times per day. This is continued until the symptoms are resolved for 2 consecutive days. Used to treat canalithiasis ```

Epley maneuver

``` The patient’s head is rotated to 45 degrees while sitting at edge of bed. The patient quickly lies down to the side opposite of the rotation. The position is held for 1 minute. The patient then sits back up at edge of bed, rotates the head in the opposite direction to 45 degrees and quickly lies down to the side opposite the rotation. This is repeated 5-10 times, 3x a day. Used to treat canalithiasis ```

Brandt-Daroff

The patient’s head is rotated to 45 degrees while sitting at edge of bed, the patient quickly lies down to the side opposite of the rotation x 1 minute. Then quickly moved to lying down on the opposite shoulder with the head kept in the same position throughout. This is repeated 5-10 times, 2-3x per day. Used to treat cupulolithiasis

semont maneuver

the most common and occurs when otoconia are moving within the semicircular canal, causing vertigo and nystagmus that resolves within 60 seconds

Canalithiasis

occurs when otoconia adhere to the cupula and cause vertigo and nystagmus that persist for a longer period of time.

Cupulolithiasis

lateral canal BPPV is treated via this maneuver

roll

anterior canal BPPV is treated via this maneuver

semont

A patient with a T1 incomplete spinal cord injury is being treated on the mat table in supine. The patient starts to exhibit signs of autonomic dysreflexia. What should the therapist do NEXT? 1. Check the urinary catheter 2. Begin chest compressions 3. Elevate the patient’s legs 4. Sit the patient up

4. Sit the patient up Rationale – If a patient exhibits signs of AD the therapist should sit the patient up to reduce the increase in BP. After sitting the patient up, the therapist should check for and address the noxious stimulus.

An injury to the frontal lobe of the brain would MOST likely result in problems with which of the following choices: 1. Basic body functions – breathing, blood pressure, and pulse. 2. Emotional behavior, personality, reasoning and judgment 3. Muscle coordination 4. Sensory information – taste, smell, touch, and hearing

2. Emotional behavior, personality, reasoning and judgment Rationale: The frontal lobe is the part of the brain that controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language, judgment, and sexual behaviors. It is, in essence, the “control panel” of our personality and our ability to communicate.

A 56-year-old female patient with a recent T1 spinal cord injury (SCI) ASIA level C is being seen at an inpatient rehabilitation unit. The plan for the session was to use the tilt table to work on increased weight bearing and postural control. Two minutes into standing, the patient’s blood pressure reads 80/46 mmHg and she reports dizziness and nausea. What is the therapist’s NEXT step? 1. Check the catheter 2. Recline the tilt table 10 degrees 3. Return to flat position 4. Wait and recheck BP in 1 minute

3. Return to flat position Rational – This patient is showing signs of orthostatic hypotension. The first step is to lay the patient down and then recheck blood pressure.

A 65-year-old male presents to the hospital with a sudden onset of loss of sensation on the left side of his body as well as his lower face and reports severe weakness. All his right side sensory and motor functions are normal. During his evaluation, it is observed in sitting or standing he will not bear weight through the left side. He has severe difficulty with walking and his left sided AROM is severely limited, and an upper extremity synergy pattern is observed. Reduced sensory testing is also found on the left side. Which of the following BEST describes the type of lesion? 1. Cerebellar lesion 2. Brainstem lesion 3. Medial medullary lesion 4. Cortical lesion

4. Cortical lesion | Rationale: Choice D is the only correct choice. Lack of attention to his left side indicates a cortical lesion.

In children with OI, fractures heal a) Within the normal healing time b) More quickly than normal c) More slowly than normal d) Only with assistance of medication

a) Within the normal healing time Healing time is unaffected with this patient population therefore the period of immobilization should not be extended in this patient population. Recently medicine recommended the use of bisphosphonates to improve healing time but not enough evidence was found, however these medicines are very effective in increasing the bone density thus decreasing the incidence of fractures

Which of the following is the STRONGEST predictor of walking for children with typical development? a) Age b) Duration of time since walking began c) Weight d) Extent of walking practice

d) Extent of walking practice Age and weight do not affect the walking in development, kids do learn best with trial and error so yes extent of walking practice will be the most plausible choice

A patient has right side thoracolumbar scoliosis in standing but no scoliosis in sitting. What is the cause for this dysfunction? a) Lumbar facet dysfunction b) Weak gluteus medius c) Shortened iliopsoas d) LLD

D) LLD | LLD will not affect the child in sitting but will typically affect as he rises to go in standing.

A 14 year old girl with right thoracic scoliosis is referred to PT. What will be the clinical presentation for the girl: a) Left shoulder high, left scapula prominent, and right hip high b) left shoulder low, right scapula prominent, and left hip high c) Right shoulder high, right scapula prominent, and right hip high d) Right shoulder low, right scapula prominent, and left hip high

b) left shoulder low, right scapula prominent, and left hip high Direction of the curve is determined by whether the convex side of the curve bends to the right or the left. For example in the right scoliosis, apical vertebra in the thoracic/ upper region of the back and the curve both bend to the right

Which of the following interventions is MOST plausible for a child with JRA who has complains of pain and swelling in b/l knees? a) Resistance exercises b) Stretching to prevent contractures c) Gentle active exercises d) Walking program

c) Gentle active exercises Pain and swelling are both indicative of an acute exacerbation episode therefore both resistive exercises and stretching to avoid contractures are contra indicated Walking program is also not advisable. During an acute episode, just active gentle exercises while respecting fatigue and therex to promote energy conservation, activity pacing, and joint protection strategies should be indicated.

An 8-year old female is admitted to the hospital with hepatosplenomegaly, low grade fever, and swollen stiff ankle, knee, hip, elbow, and wrist joints. What is the most likely Dx: a) Systemic onset JRA b) Polyarticular JRA c) Pauciarticular JRA d) Oligoarticular JRA

b) Polyarticular JRA Polyarticular JRA as it presents with involvement of >=4 joints (swollen and warm but rarely red) large and small of u/e as well as l/e along with some systemic s/s like low grade fever, mild to moderate hepatosplenomegaly and lymphadenopathy Why not systemic JRA as in this kind of JRA, joints are very rarely involved and more severe systemic s/s are noticed

A parent of a child with myelomeningocele at L2 asks the PT about probability of the child’s prognosis for walking. What will be the BEST prognosis for this child? a) Walk with AFO’s through out home and school b) Walk with KAFO through out home and school c) Walk with KAFO in home d) Stand using a parapodium; walking not possible

c) Walk with KAFO in home Most plausible : RGO (high energy required) and KAFOS for home, kids at this level of lesion are capable of independent ambulation with KAFO’S for short distances in home Functional goal: Wheel chair for all community ambulation.

A child with myelomeningocele and h/o hydrocephalous begins to exhibit irritability, lethargy, and vomiting. Which of the following is the MOST likely cause: a) Tethered cord b) UTI c) Arnold Chiari Malformation d) Shunt malfunction

d) Shunt malfunction

A PT working in an early intervention program is providing intervention to an infant diagnosed with Erb’s palsy. What nerve roots will be affected? What muscle out of the following muscles would not be paralyzed and why? a) FCU b) Rhomboids c) Brachialis d) Teres Minor

a) FCU since it is innervated by C8-T1 all others are C5-C6

You are performing an examination of a 2 month old infant diagnosed with Klumpke’s palsy. The classic findings of the palsy are: a) Lack of forearm supination, elbow extension, and wrist flexion. b) Lack of forearm supination, elbow flexion, and wrist extension. c) Lack of shoulder external rotation, elbow flexion, and wrist extension. d) Lack of forearm pronation, elbow extension, and wrist flexion.

d) Lack of forearm pronation, elbow extension, and wrist flexion. Klumpke’s involves paralysis of C8-T1, resulting in the weakness of triceps, forearm pronators, and wrist flexors.

A physical therapist is assessing the posture of a 12 year old female with CF. Her posture will have all of the following EXCEPT: a) Thoracic Kyphosis b) Forward head posture c) Scapular retraction d) Cervical Lordosis

c) Scapular retraction CF typically presents as thoracic kyphosis that leads to forward head as well as cervical lordosis but not scapular retractions

A PT is assessing the endurance of a 12 year old female with CF. Which objective screening tool will be the most appropriate to quantify the patients endurance level? a) Six minute walk test b) Tinetti performance oriented mobility assessment c) VO2 max test d) Romberg’s test

a) Six minute walk test

What other additional characters are are evaluated with APGAR besides heart rate and color? 1) Respiration, Temperature, and weight 2) Reflex irritability, temperature, and weight 3) Respiration, muscle tone, and weight 4) Respiration, muscle tone, and pulse

``` 4) Respiration, muscle tone, and pulse Temperature and weight are not scored on APGAR Scoring: 0-3 critically low 4-6 fairly low 7-10 generally normal ```

Evaluation of a five year old reveals difficulty in climbing stairs, rising from the floor, as well as proximal muscle weakness. Upon clinical observation, the PT notices pseudo hypertrophy of both calf muscles, along with lumbar lordosis and abdominal protuberance. What is the MOST likely Dx for this little kid? 1) LCPD 2) CP 3) DMD 4) Charcot Marie tooth disease

3) DMD All these are classic features of DMD. Sensory nerves are involved too with DMD that leads to loss or decreased ability to feel heat, cold, and pain.

What sign is it called: difficulty rising from floor and therefore child will use hands as a support on l/e to walk up?

gowers

what gait abnormality would you expect with LCPD?

psoatic limp or antalgic gait

what position of the LE would LCPD be held in?

FADER

where will a child with LCPD report experienced pain at?

thigh, hip, groin

what is another name for LCPD?

avascular necrosis of femoral head

A 5 year old patient is experiencing pain at insertion of quadriceps tendon has been referred for PT . Which is the MOST plausible Rx? 1) Mobilization of tibiofemoral joint 2) Whirlpool 3) Phonophoresis 4) Cryotherapy

4) Cryotherapy Most plausible as it will help reduce inflammation and ease pain 1) Not indicated in acute stages 2) Cold water whirlpool might be plausible for distal parts of the extremity but considering the age of the child, this might be not the best choice of actions. 3) Phonophoresis: considering its use on the epiphyseal plate, this modality might be indicated with precaution so not the best choice.

``` Your patient is a 35 year old female who has been having severe low back pain for the past day. She has no mechanism of injury but the pain that is located on the left side is greater than on the right. Her only position of ease is in the left fetal position. Her pain has increased in the last day and now is at a constant level that waxes and wanes. She has mild temperature and has been feeling weak and lethargic since the pain began. She has been experience N/V, and diarrhea for the past day. What is the most likely source of the patient’s symptom? A. Gastro-intestinal B. Urogenital C. Musculoskeletal D. cardiovascular ```

A. Gastro-intestinal Urogenital is plausible but in this there is almost often the centralization of symptoms and the urogenital system often does not result in nausea and diarrhea. Musculoskeletal can cause similar symptoms but with MS system, the pain will increase with respect to the change in the mechanical changes in the body and this pain is relatively constant. cardiovascular not the correct answer.

Which of the following pathologies should be ruled out by a clinician while he is evaluating a patient with non specific neck pain? A. Myocardial infarction B. Hepatomegaly C. Spleen injury and rupture D. Cholecystitis

A. Myocardial infarction Hepatomegaly RUQ / right hypochondriac pain Spleen injury and rupture LUQ/ Left hypochondriac pain Cholecystitis RUQ pain

A patient presents to an outpatient PT clinic with a sudden onset of LUQ, left flank and mid back pain since the last two weeks due to a motor vehicle accident. What can be the most likely causative factor? A. Spleen referred pain B. PTSD (post traumatic stress disorder) C. Bladder infections D. Chronic fatigue pain syndrome

A. Spleen referred pain PTSD (post traumatic stress disorder) pain will typically be localized to where the area of physiological loss of function is. Bladder infections refer pain to lower abdomen with an urgency and increased frequency to urinate Chronic fatigue pain syndrome characterized by fatigue not relieved with rest for more than 72 hrs along with sleep disturbances provided all other medical disorders have been excluded.

Which of the symptoms are most likely to raise suspicion of liver disease: A. Fever, melena, urinary frequency. B. Left shoulder pain, pallor, coffee ground emesis. C. Jaundice, ascites, asterixis. D. LUQ, nausea, and diaphoresis.

C. Jaundice, ascites, asterixis.