PT365 Daily Questions Flashcards

Question

A PT works with a pt rehabing from a recent hospitalization. Which activity would be MOST likely associated with the development of syncope? a) transferring from supine to sitting position b) riding a stationary bicycle at 50 revolutions p/min c) performing a leg exercise with ankle weights in supine d) walking at 3 miles/hour on a treadmill

Answer 1

Answer: a (transfer from supine to sitting) Explain: Syncope refers to a loss of consciousness often resulting from insufficient blood flow to the brain. The condition comes on fast, like orthostatic hypotension. - Going from supine to sitting would bring on syncope as blood flow is decreased in brain. - Yes riding a bike and walking would be taxing, but wouldn't bring on syncope since it is usually brought on by positional changes

Answer 2

Answer: d (metabolic alkalosis) Explain: Oral potassium chloride is often administered when potassium levels are extremely low and need to be replenished, as well as, in pt's with ongoing potassium loss. Acid-base disorders are often related to respiratory and/or metabolic issues. - Respiratory acidosis is when pH is low due to hypoventilation, respiratory alkalosis is when pH is high

Answer 3

Answer: b (cognitive impairments) - Explain: Patient controlled analgesia allows pt to control pain meds via IV. Pt needs to have cognition intact to do this.

Answer 4

Answer: b (increase in number of muscle fibers) - Explain: Puberty aged adolescents have rapid acceleration in strength and performance. They will increase in muscle mass (which is from an increase in muscle fibers) which equates to an increase in muscle strength. BUT, the actual number of muscle fibers does NOT change (hyperplasia does not happen, but hypertrophy can).

Answer 5

Answer: b (dehydration) Explain: Hematocrit refers to % of RBC's in blood. A LOW hematocrit may indicate anemia and/or blood loss. A high hematocrit may indicate dehydration, or polycythemia vera (which is an overproduction of RBC's). Normal hematocrit is 38-45 ish. - If you are dehydrated, your fluids will be low, so RBC count is higher. Dehydration happens due to lack of water/fluid consumption or diarrhea, vomiting, or use of diuretics. - Leukemia is cancer of blood when leukocytes change into malignant cells. Often leukemia results in lowered hematocrit levels. - Lower vitamin and mineral levels also result in lowered hematocrit levels.

Answer 6

Answer: c (right side) Explain: Homonymous hemianopsia is a condition where the visual field is damaged due to damage to MCA (middle cerebral artery). Often happens with a Right sided CVA and may accompany visual neglect. - So homonymous means both eyes, and hemi means one sided. So RIGHT sided blindness means you can't see right sided visual objects.

Answer 7

Answer: c (multiple myeloma) Explain: Blood cancers affect production of blood and function of blood cells. Blood is produced in bone marrow, so most cancers originate there. 3 major blood cancers are: leukemia, lymphoma, and myeloma. - Leukemia is when leukocytes (WBC's) become cancerous. These cancerous cells affect bone marrow, where they are made, and then travel to lymph nodes, liver, spleen, etc. - Lymphoma is cancer in lymph system. This is Hodgkins or Non-Hodgkins lymphoma where abnormal lymphocytes collect in lymph nodes and impair the immune system. - Multiple myeloma is cancer of PLASMA cells. Abnormal plasma cells accumulate in bone marrow and effect body's immune system. - Hodgkin's is type of lymphoma, and is one of the most curable cancer's.

Answer 8

Answer: c (time of resolution of symptoms) Explain: A TIA is usually linked to atherosclerotic thrombosis which causes a temporary interruption to blood flow to brian. TIA's are most common, and often occur in carotid and vertebrobasilar arteries. A TIA does NOT cause permanent neurological damage, but it is an indication of future risk, thus pt should get medical help and blood thinner meds. - Aura's are experienced with migraines - Initial symptoms of a stroke and TIA are similar (F.A.S.T ... face, arm, slurred speech, vision, confusion, etc.) ... BUT SYMPTOMS and EFFECTS of a TIA RESOLVE MUCH MORE QUICKLY. Thus, any speech or vision issues with a TIA would resolve quickly.

Answer 9

Answer: a (high levels of keytones). Explain: DM I is when pancreas fails to produce enough insulin. It is usually found in children. Type II is often diagnosed past age 45. Type II they can still produce insulin, just not enough to clear out all the excess sugar. - In type I, not enough insulin can get glucose to cells, so it breaks down fat as a result to get energy, leading to high levels of keytones.

Answer 10

Answer: d (anterior) Explain: Brain's blood supply consists of two internal carotid a's and two vertebral a's. Branches of these form the Circle of Willis. Blood supply when cut off can effect different areas of body and functions depending on where the occlusion happened, and how big the occlusion was. - MCA: Most CVA's are in the MCA, and produces contralateral weakness and sensory loss in UE's and Face (LE's not impacted as much). Broca's and Wernicke's will also be impacted. - Vertebral-Basilar artery damage results in locked-in syndrome, coma, or vegetation - Posterior: Results in BLINDNESS - ACA: LE's most impacted (weakness and sensation), and frontal lobe changes like personality.

Answer 11

Answer: c (glossopharyngeal) Explain: - Facial nerve 7 has both motor and sensory, but on ANTERIOR part of the tongue, and facial m's. - Glossopharyngeal will detect taste on POSTERIOR tongue - Hypoglossal nerve 12 does tongue movement

Answer 12

Answer: d (water immersion without a gel coupling agent). Explain: Ultrasound waves do NOT travel through air, so a coupling agent is required. A coupling agent can be gel, water, lotion, oil - Normally direct contact with a coupling gel would work, but irregular body surfaces are hard with ultrasound, so you can use water (but don't need gel + water).

Answer 13

Answer: b (pulmonary angiography) Explain: Remember a pulmonary embolism is when some thrombus breaks off somewhere else and travels to pulmonary arteries. s/s of pulmonary embolism are: dyspnea, coughing, hypoxic, chest pain, and may look like a MI. - An MRI can see an embolism, but is usually used to look at soft tissue: muscle, tendon, ligament, tumor, organs - Pulmonary angiography looks at blood flow specifically through the lungs. Test of choice for pulmonary embolisms - Bronchoscopy looks specifically at bronchial tree to look for foreign bodies, tumors, bleeding in airways. Not usually used for finding a pulmonary embolism. - Ultrasonography just shows images of internal organs ... usually used to detect DVT, but not pulmonary embolisms.

Answer 14

Answer: c (Broca's) Explain: Communication boards are just boards that allow a pt to point to a picture to communicate what they want/need. It has pics for: yes, no, turn on lights, turn on tv, need to take a bath, need to eat, etc. Usually used for those with verbal impairments. - Yes, this board would help someone who can't speak English, but usually a hospital would provide an interpreter for them. - Someone with Broca's (expressive aphasia) can comprehend, but can't produce language. - Those with dementia have cognitive, memory, and speaking deficits. They lose ability to communicate, but also to respond. Maybe early stage dementia might benefit, but end-stage probably would not.

Answer 15

Answer: a (35 yr old female who is obese and sedentary) Explain: - It said most pulmonary embolii occur 2-10 post surgery (not weeks later). Thus the sedentary woman who is inactive is most suseptible. And typically pulmonary embolii occur due to thrombus forming in LE's not UE's (so Colles' fracture is out).

Answer 16

Answer: d (DVT) Explain: A D-dimer blood test helps determine if there is a blood clot. It helps rule in/out a thrombos

Answer 17

Answer: D. Pain can be certainly related to psychological processes, and pain is a subjective experience. So pain is a very psychological process, and thus fear-based response during movement is common. Thus PT's should be aware of the psychological effects of ROM limitations. - It says PROM would not be limited, but AROM would, and they'd be fearful of strength testing.

Answer 18

Answer: c (Grade III) Explain: If AROM is limited, but PROM is normal, it is usually MUSCLE involved. - Adhesion of joint capsule would impact both AROM and PROM - Grade III is full rupture, so would be pain free after acute phase of injury is over, and infraspinatus is primary ER of shoulder. - Grade I tear would be painful

Answer 19

Answer: b (peripheral nerve entrapment) Explain: Nerve injury results in paresthesias, pain, and weakness. - RC impingement is when RC m's get impinged under acromion. A painful arc of motion or overhead arm elevation are signs of RC impingement. Reaching forward to the steering wheel is not really arm elevation, so this is probably more nerve related. - If a nerve is entraped it will cause pain and weakness, so can't reach forward and grasp steering wheel. Nerve damage can cause muscles to atrophy (weak)

Answer 20

Answer: a (degenerative joint disease) Explain: - OA causes damage to cartilage, and thus pain results on mvmt and during weight bearing. Then bone gets bone spurs and pain increases, and function decreases. Deviated gait results. - Key here is "long-term" ... ACL will create antalgic gait pattern yes, but OA is a long term result of change in gait pattern. - Osgood-Schlatter happens at tibial tuberosity and effects young kids in sports that run, jump, etc. Anatalgic gait may occur, but not long term (it has a good prognosis) - Patellofemoral syndrome is when the patella doesn't track properly between femoral condyles. Same as above where it won't be a long term gait pattern change.

Answer 21

Answer: b (3-5 mins) Explain: Ionto is applying medication to a superficial area through a patch where estim pushes it to effected area. PT's must check skin for any irritation frequently.

Answer 22

Answer: d (lateral to right) Explain: - Posterior trunk lean would be observed during early stance due to weakness of hip extensors - Anterior trunk lean would be due to weak knee extensors - Lateral trunk lean to left means L hip abductors are weak (but this says R is weak, and L is strong) - Lateral trunk lean to right means R hip abductors are weak (which ? said they were)

Answer 23

Answer: a (delayed response time to ?s) Explain: Aphasia is impairment of processing for receptive and/or expressive language. It is a result of brain injury, head trauma, cerebrovascular accident, tumor, infection, etc. Abulic aphasia is a finding associated with occlusion of the anterior cerebral artery, along with mutism - Most common sign is reduced spontaneous speech and delayed response time to questions. Abulic means lack of motivation or passive. So reduced social interactions and reduced interest are common. - Impaired naming skills = Broca's - Inability to understand = Werneke's - Inability to produce or comprehend language = global aphasia

Answer 24

Answer: b (75)

Answer 25

Answer: c (place towel under ankle)

Answer 26

Answer: d (Grave's) Explain: - Addison's is from adrenal dysfunction where adrenal cortex is in hypofunction. So there is a decrease in cortisol and aldosterone, so weakness, but would NOT effect reflexes. - Ankylosing spondylitis is a systemic condition of inflammation of spine (and other joints). Symptoms are back pain, morning stiffness, and impaired spinal extension. This would NOT impact reflexes. - Cushing's syndrome is adrenal dysfunction of hyper function of adrenal gland, so excessive amounts of cortisol get produced. Would NOT impact reflexes. - Grave's disease is an autoimmune disease of dysfunction of thyroid gland. It causes hyperreflexia

Answer 27

Answer: c (stabilize distal femur, resist posterior tibia)

Answer 28

Answer: a (place towel under)

Answer 29

Answer: c (arterial) Explain: - Venous statis ulcers result from venous insufficiency due to impaired functioning of venous system resulting in inadequate venous return. Venous ulcers are typically shallow, irregular in shape, have a lot of exudate, and are usually in lower limb proximal to medial malleolus. There is edema around it and tropic changes. - Neuropathic ulcers are secondary complications of iscemia and neuropathy. Usually you see these in pt's with DM II. These wounds are commonly on plantar side of foot where shear of weight bearing cause ulcer where pt can't see or feel. - Arterial ulcers are from arterial insufficiency from inadequate circulation and O2 / oxidation to tissues. Could be from atherosclerosis. These ulcers are smaller, dry, round edges, distinct margins, lacks granulation and blood supply. They are typically on distal limb and foot / toes, on dorsal side of foot or around lateral malleolus. - Decubitus ulcers = pressure ulcers. From sustained/prolonged pressure on tissues with no movement. Around bony prominences

Answer 30

Answer: gowns

Answer 31

Answer: d (basal ganglia) Explain: - Bradykinesia is movement that is very slow, and commonly found in conditions like Parkinson's. Initiation and execution of mvmt is slow and difficult. - Cerebellum deficits would be manifested in posture, balance, rapid alternating movements, coordination - Medulla oblongata is below the pons and above spinal cord. It controls nervous activity like: respiration, HR, vomitting, coughing, sneezing - Hippocampus: In temporal lobe, responsible for memory - Basal Ganglia: Gray matter responsible for voluntary mvmt, so Parkinson's will lose this area (substantia nigra)

Answer 32

Answer: a (hip ext and knee ext) Explain: - Raise the seat and you get MORE hip ext and knee ext. Lower seat and you get more hip flex and knee flex

Answer 33

Answer: d (CHF) - Explain: Orthosatic hypotension is when systolic BP decreases more than 20 mmHG (or diastolic decreases more than 10 mmHG) when going from supine to sitting). - Laying with legs elevated puts pt with spinal stenosis in more lumbar flexion, which would feel GOOD to pt with spinal stenosis - Venous insuff is a condition when valves in veins are damaged and can't get blood back to heart. Compression stockings and elevation of legs will help this pt and decrease swelling. - Graves' disease is hyperactive thyroid condition when autoimmune disease attacks thyroid. Laying supine won't impact this pt. - CHF is when heart can't meet metabolic demands of body. Pt's with CHF will have pulmonary edema, dyspnea, orthopnea, SOB, etc. Elevating this pt's legs will push more fluid to the heart, which is problematic.

Answer 34

Answer: a (spinal fracture) Explain: - A halo vest cervicothoracic orthosis is for spinal fractures. It will significantly limit ROM - Pt with TBI usually doesn't have a brace or halo unless cervical structures were also damaged - A herniated disc may or may not require an orthodic, but not a halo vest.

Answer 35

Answer: d (increased cough with blood) Explain: - A pulmonary embolism occurs when a thrombus in LE detaches and travels to lungs (pulmonary artery). s/s of pulmonary embolii is: SOB, dyspnea, coughing, hypoxic, chest pain - Normal range of PaO2 is 80-100, so 85 is NORMAL - Normal RR is 12-20 bpm - Tachycardia is HR over 100 bpm - Cough with blood is common sign of pulmonary embolism

Answer 36

Answer: b (right knee flexion) Explain: - Impairments in knee extension would be seen when foot/peddal is at the bottom. Knee flexion impairments would be seen when foot/peddal is at top of the cycle. Remember Deanne - pt who hip hiked

Answer 37

Answer: b (paraffin) Explain: - Diathermy: a medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot. - Paraffin: Needs to be about 113-126 degrees F. - Ultrasound: doesn't require specific temperature, uses sound waves - Whirlpool: temps are usually 99-104 degrees F (temps greater are more risky for burns)

Answer 38

Answer: c PT's should report any changes to the pt's urine color through documentation and to nursing staff.

Answer 39

Answer: a (adjuvant) Explain: - Anticonvulsant meds such as gabapentin and carbamazepine have been found effective with treatment of neuropathic pain. Neuropathic pain includes conditions like: MS, DM, Shingles, cancer. - An adjuvant analgesic is a medication that is not primarily designed to control pain but can be used for this purpose. Some examples of adjuvant drugs are medications like antidepressants and anticonvulsants. They may also be called coanalgesics. - Immunomodulating meds assist with modifying the body's immune responses. They don't help with neuropathic pain. - Interventional meds will manage pain like: nerve blocks, injections, etc. - Alternative medicine is different than Western medicine. Examples: homeopathy, acupuncture, dry needling, tai chi, etc. Don't help those with MS.

Answer 40

Answer: c (nociceptive: superficial pain) Explain: - Somatic pain is when there is damage to muscle, bone, ligament, connective tissue, etc. This pain can refer. - Visceral pain is pain from organs. This pain can refer. - Pain to skin (cutaneous) is localized. This pain does NOT refer, and is localized. - Central Neurogenic pain is damage to spinal cord or CNS.

Answer 41

Answer: d The tricpes is a 2 jt muscle. It extends shoulder and elbow. Elbow flexion and shoulder flexion are both opposite the action of the triceps and therefore would elongate both ends of the muscle

Answer 42

Answer: b (20 mins) Explain: - You always need 6-8 layers of towels, and will heat tissues superficially up to 2 cm. - 10 mins isn't long enough, hot packs require 15-20 mins to get an effect, and anything longer is too long and heat would be lost from hot pack

Answer 43

Answer: a Explain: - 38 breaths per min is WAY high = tachypnea, and can't wean from vent at this rate. - 350 mL of tidal volume is not too concerning during weaning process. Less than 325 is when distress sets in. - Pulse Ox reading lower than 90 is when you get concerned - The HR would have to go 20 over baseline to be concerning

Answer 44

Answer: b (tremor) Explain: - Whole body vibration consists of transferring vibration of varying frequencies to the body as a whole in one or multiple planes. Vibration training can be utilized as an intervention to improve muscle strength, power, flexibilty, and coordination. - Dysphagia: inability to swallow properly. Whole body vibration isn't used for dysphagia - Whole body vibration has been found to decrease tremors and rigidity in Parkinson's pt's. Vibrations impact input to muscle spindles / muscle length - Akinesia refers to inability to INITIATE movement - Whole body vibration won't impact cognition

Answer 45

Answer: b (performing a standing transfer) Explain: - A hemiplegic chair incorporates a seat that is approximately two inches lower than a standard chair to enable the user to use the LE to propel the chair. The pt typically uses one handrim and one or both feet to help propel and steer the w/c. One or both front riggings on the w/c are removed to provide the feet with necessary space for propolsion. - A hemiplegic chair won't limit someone reaching out of BOS - Performing a standing transfer will be harder due to the lower seat - Performing pressure relief would be same in this chair or any w/c - Propelling this w/c is easier - it is designed as a hemiplegic chair to help those with a stroke propel it easier.

Answer 46

Answer: a (genu recurvatum) Explain: Plumb line is the line of ideal posture (through ear, acromion, hip, lateral knee, malleoli, etc.). - Genu recurvatum is knee hyperextension (so knees are posterior to plumb line) - Genu valgum is knocked knees (knees touch and ankles apart). Can't see as well in lateral view. *** Valgus will increase compression of LATERAL tibial condyle and increase stress to medial structures. - Genu varum is bow legged (knees apart, ankles closer). Also can't see as well in lateral view. Varum will increase compression of MEDIAL tibial condyle and increase stress to lateral structures. - Patella baja is a lower patella (not viewed from lateral view). Patella Alta is a higher patella.

Answer 47

Answer: d (check pt's wrist band) Explain: Checking the pt's chart allows the health care provider to access medical info, but not verify pt's identity. But checking the wristband is most reliable method to verify the patient's identity in the hospital. And you can ask pt to tell you their first and last name and DOB to verify.

Answer 48

Answer: c (rooting) Explain: Review the primitive reflexes. They all integrate (go "away") at varying stages. Absent primitive reflexes indicate CNS issue which will also result in later developmental delays.

Answer 49

Answer: b (genetic inheritance) Explain: Osteogenesis Imperfecta, also known as brittle bone disease, is a group of genetic disorders that mainly affect the bones. It results in bones that break easily. OI can vary widely depending on which of the 4 types is diagnosed. - The frequency of fractures may be more or less often depending on the type of OI pt is diagnosed with. But, fracture frequency may also just be a result of the pt's activity level, so thus isn't determined to diagnose the disease. - Genetic testing is best way to get info regarding specific types of OI and thus prognosis. You could have a dormant or recessive type, and that will greatly impact prognosis/mortality. - Age is not considered when making diagnosis - Life expectancy can vary widely, based on the type of OI.

Answer 50

Answer: b (walker height is too high) Explain: Proper fitting by measure is usually ulnar styloid process, but if doing it by degree, it should be 20-25 degrees of elbow flexion for an AD. This degree amount is for optimal function during ambulation.

Answer 51

Answer: b (diverticulitis) Explain: - Crohn's Disease: is a specific form of inflammatory bowel disease in which the lining of the GI tract becomes abnormally inflammed. Treatment for Crohn's disease includes medication to reduce intestinal inflammation and to manage flare ups. - Diverticulitis refers to possessing inflammed or infected diverticula. Treatment for diverticulitis includes diet modification, controlling infection, and lowering colonic pressure through increased fiber intake. 20-35 grams of fiber is recommended per day. - Irritable bowel syndrome (IBS) is when colon isn't functioning properly. Pt's should avoid large meals, wheat, rye, barley, alcohol, and caffeine. - Malabsorption syndrome is a condition characterized by a group of pathologies where there is reduced intestinal absorption and inadequate nutrition.

Answer 52

Answer: b Explain: Patellofemoral syndrome is a general term for describing pain or discomfort in the anterior knee. The condition is a repetitive overuse disorder resulting from increased force at the patellofemoral joint. s/s are anterior knee pain, pain with prolonged sitting, swelling, crepitus, and pain going up/down stairs. - The quads act CONCENTRICALLY doing knee extension, so going UP stairs. The quads act ECCENTRICALLY going down stairs to control the amount of knee flexion (and this causes increased pressure in knee joint).

Answer 53

Answer: b (pt has fair trunk control but is able to ind propel w/c) Explain: - Back height of a w/c is determined by measuring from the seat of the chair to the floor of the axilla with the pt's shoulder flexed to 90 degrees (and then subtract 4 inches). Normal back height is 16 inches. Normally back height is below inferior angle of scapula, so higher back height is for increased trunk control (due to poor trunk control). - Pelvic obliquity would need a custom molded seat - Increased back height helps give more back control - Lateral support for scoliosis might help back, but not the lateral support they need. - Extensor tone pt's need more of a solid tilt-in-space frame

Answer 54

Answer: c (macerated) Explain: It wouldn't get infected as a result, and certainly not gangrene. But would become wet (macerated = wet).

Answer 55

Answer: c (blood tests) Explain: RA is an autoimmune disease with unknown etiology. Blood test is best way to rule in RA (since OA and RA could have similar pain and s/s). High levels of RF (rheumatoid factors) indicate autoimmune disease like RA.

Answer 56

Answer: D Explain: This is a SAFETY question. Think of what is safest. Initially I thought getting pt to a chair is best, but what if chair is far away. If their legs are shaking, get them down quickly for safety. It is clear the pt is in distress, so get pt down and safe fast. Walking the pt to the chair may take time and pt may collapse in the process. Assessing vital signs is appropriate, but get them down and safe first so they don't collapse.

Answer 57

Answer: a (leave dentures in place) Explain: Cardiopulm resuscitation (CPR) is done on pt's with no pulse. You need to act quickly. If the dentures are secure, leave them, and give them breath and compressions ASAP, don't waste time getting the dentures out. Only remove them if they are loose and you can't get a good seal, and it is quick to remove them. - And you should do compressions and ventilations

Answer 58

Answer: d (RR) Explain: All others are subjective. RR is only objective option.

Answer 59

Answer: c (impingement)

Answer 60

Answer: b (pt breathe through an open mouth) - One breathe, not 3 is usually sufficient - Breathing deeply through an open mouth increases turbulence in the airways making it easier to hear the sounds - In pt's without lung disease, tubular lung sounds, or bronchial breath sounds, are normally found over the trachea. Vesicular breath sounds are normally found over the distal portions of the lung in a person without lung disease. - Adventitious breath sounds are abnormal breath sounds. These are wheezes, rhonchi, crackles, rales, pleural friction, etc. Wheezes and crackles often mean secretions in the airways.

Answer 61

Answer: a (diuretics) Explain: CHF occurs when heart can't contract, so cardiac output decreases, and fluid builds up and backs up into pulmonary and systemic circulation. - Diuretics are for CHF and HTN to reduce preload - Inhaled corticosteroids are to reduce inflammation in airways - Mucolytics are used to improve the expectoration of bronchopulmonary secretions in pt's with chronic bronchopulmonary diseases - Bronchodilators work to relieve bronchospasm in pt's with COPD be relaxing smooth muscle of bronchi.

Answer 62

Answer: b (localizes and moves towards pain source) Explain: GCS is used to assess pt's consciousness following injury. It is scored based on verbal response, motor response, and ability to open their eyes. A pt that opens eyes in response to speech is given a 3, and a pt who makes incomprehendible sounds would be given a 2. - Motor subscale is scored 1-6. A pt who withdraws their arm away from the source of pain would be given a 4, therefore, the total score would be 9. - A pt who can localize the source of pain and move their hand toward it would be given a score of 5, therefore, a total score of 10. - A pt who extends elbow in response to pain is given a 2, so total score is 7 - A pt who flexes elbow in response to pain is given 3, therefore, total score of 8

Answer 63

Answer: a (volumetric) Explain: Volumetric measurements are often used to quantify the presence of edema in the wrist and hand by examining how much water is displaced. You can compare bilaterally to non-involved hand in terms of water displacement. - Circumferential measurements use a tape measure. It is good, just not as accurate. - GIRTH = CIRCUMFERENTIAL (synonymous) - Anthropometric measurements are height, weight, BMI, waste to hip ratio, % of body fate. These measurements are then referenced against norms for that person's age.

Answer 64

Answer: b (30 secs) Explain: Rinne test is when PT holds a tuning fork against the mastoid process until the sound is no longer heard by the pt. Then PT holds tuning fork 1-2 cm away from auditory canal until they can't hear the sound. The duration of time it takes until pt can't hear sound is recorded in each position. Normal ratio is 2:1 (conduction of air being longer than bone conduction) - So 2:1 (air:bone) is normal. So if both were 15 seconds, that would be 1:1, which is not normal (so probably hearing impairment) - If pt hears air for 30 secs, it would be 2:1 ratio, which is normal for air:bone conduction - If it is 45 seconds, that means the ratio would be 3:1, which is not normal

Answer 65

Answer: b (eccentric) Explain: - When sitting down, the hip extensor m's (gluts and HS's) will work eccentrically to control the motion. Standing up will kick in hip extensors to work concentrically. - Concentric = shortening of involved muscle. Eccentric = lengthening of involved muscle. Typically eccentric contractions happen to SLOW down a motion.

Answer 66

Answer: d (lateral calf) Explain: Measuring skin folds helps determine amount of subcutaneous fat which will help you know total fat. This technique is actually better than height, weight, and circumference. But, hydrostatic weighting is even better. - Suprailiac site, triceps, and below inf. border/angle of scapula are all sites used. Lateral calf site is not used, but medial calf is used

Answer 67

Answer: c (VAS) Explain: There are a variety of pain scales used in PT. - The Descriptor Differential Scale consists of 12 descriptor items each centered over 21 horizontal dashes. At the extreme left dash, a minus sign and at the extreme right is a plus sign. Patients are asked to describe their pain based on each descriptor. - Verbal pain scale asks pt to use certain words like: agonizing, fair, unpleasant, etc. - VAS is a 10 cm line with NO PAIN at left and WORSE PAIN on right. - Numerical Rating Scale asks the pt to rate their pain on a scale of 0-10 (or 0-100)

Answer 68

Answer: d (wheezes) Explain: - Wheezes are HIGH pitched adventitious (abnormal) breath sounds as air moves through airway (weeeeee is HIGH pitched). Wheezes are often heard with asthma and bronchitis. - Crackles are adventitious (abnormal) sounds due to fluid accumulation in airways - Rales are synonymous with crackles - Rhonchi are LOWER pitched adventitious sounds during breathing

Answer 69

Answer: a (positive Kernig's sign) Explain: The athlete is presenting with s/s of meningitis which can be fatal if not treated immediately. Meningitis refers to the inflammation of the meninges of the brain and spinal cord and can occur through bacteria or viral forms. - A positive Kernig's sign is when pt is in supine and can NOT tolerate hip flexion and knee extension (which puts meninges on stretch). This is positive for meningitis. Refer immediately. - A positive Brudzinski's sign occurs when a pt placed in supine experiences pain with passive flexion of the neck. Passive neck flexion will also produce hip and knee flexion since the pt will try to decrease neural tension of the meninges. Brudzinski's is also another special test to help rule in meningitis.

Answer 70

Answer: b (right sidelying) Explain: Scapula mobility should assess scapula elevation and depression, protraction and retraction, and upward and downward rotation. The passive assessment proceedure requires the pt to be in a position where the PT can gain access to the scapula to perform the required manual movements, yet relax the surrounding muscles.

Answer 71

Answer: a Explain: Just go to the chart and review this. There will absolutely be some question on the boards from this chart. Remember, they may not ask this question, but they will ask some other question related to it, so know all values.

Answer 72

Answer: b (Tegretol) Explain: PT's must be aware of common side effects of commonly prescribed medications. Anticonvulsant medications generally attempt to inhibit firing of certain cerebral neurons through various channels. Side effects of anticonvulsants are: drowsiness, dizziness, fatigue, sedation, nausea, and cardiac arrythmias.

Answer 73

Answer: d (quadratus lumborum) Explain: - Erector spinae (3 m's) primarily extend the back and help laterally flex back - Internal obliques help bilaterally flex trunk and help do lateral bending/rotation of spine - Multifidi is mainly around sacrum and lower lumbar region to stabilize lower spine and help distribute weight off lower lumbar discs. - Quadratus lumborum goes from iliac crest to 12th rib and is a primary stabilizer of the spine. Strongest activation of this muscle is a side plank.

Answer 74

Answer: b (active movement)

Answer 75

Answer: a (L4)

Answer 76

Answer: a (distal end of humerus) Explain: It said stabilizing proximal end of humerus was too far away to adequately stabilize the joint, so you go closer to the joint to stabilize.

Answer 77

Answer: b (elevated protien levels) Explain: GBS is a temporary inflammation and demyelination of myelin sheaths over peripheral nerves. It can be diagnosed through CSF (cerebrospinal fluid) sample that contains high protein levels without an increase in leukocytes. You'll also see slowed nerve conduction. If there are high levels of leukocytes, probably means they have some infection. - The HIGH protein levels are high levels of albumin in the CSF to confirm GBS. Most common finding to confirm GBS is high levels of albumin (proteins) in CSF withOUT an increase in leukocytes. - It is MS (Multiple Sclerosis) where you will find elevated levels of gamma globulin

Answer 78

Answer: c (AAROM)

Answer 79

Answer: b (compression fracture) Explain: Vertebroplasty is a minimally invasive proceedure used to stabilize vertebral compression fractures (usually in osteoporosis pt's). The surgeon uses fluoroscopy to locate the fractured vertebrae and injects some bone cement into the fracture site. The cement hardens, and provides stability while the bone then heals (reducing pain and improving mobility). *** Kyphoplasty is a proceedure to place a balloon type object in between vertebrae that have lost height due to osteoporosis to get pt out of kyphotic posture. - With disc herniations, conservative treatment is tried first, then cortisone shot, then eventually surgery called microdiscectomy. - Osteoporosis creates thin and weak bones that fracture easily. This compression fracture is corrected through vertebroplasty (cement into fracture site), and then PT works on weight bearing and stabilization activities. - Spinal fusion is another surgery that can be done is portions of vertebrae or disc were removed. - Spondylolysis is a stress fracture through the pars portion of vertebrae (usually in lower lumbar area)

Answer 80

Answer: c (initial contact) Explain: Review phases of gait and nomenclature/terminology. Rancho Los Amigos terminology specifically refers to what action happens at certain time frames during gait. - Standard terminology includes: heel strike, foot flat, midstance, heel off, toe off, acceleration, midswing, and deceleration. - Rancho Los Amigos terminology includes: initial contact, loading response, midstance, terminal stance, pre-swing, initial swing, midswing, and terminal swing.

Answer 81

Answer: a (effleurage) Explain: Massage is a manual therapy technique that produces physiologic effects in the tissue. Different types of strokes include: stroking, rubbing, and pressure. - Effleurage is a light touch that generates relaxation. Performed at beginning and end of treatment to get pt to relax. - Vibration is a technique is where therapist uses hands to vibrate pt - Petrissage is a technique like kneading where the muscle is squeezed and rolled under the PT's hand. - Tapotement is a technique is rappid movements like tapping, hacking, cupping, slapping, etc.

Answer 82

Answer: b (vibration) Explain: tuning fork will provide a fixed tone when struck. The base of it is placed on a bony prominence after being struck and the pt percieves the vibratory stimulus. If vibration sense is intact, the patient will percieve the vibration. If there is impairment, pt will be unable to distinguish between vibration and no vibration. - Joint position awareness = proprioception. There are specific proprioceptive tests to assess joint position (or proprioception) - Vibration is assessed using a tuning fork - Stereognosis refers to ability of a pt to identify objects placed in the hand without visual assistance (your ability to feel what something is without seeing it). It could be a pen, comb, pin, anything. - Barognosis refers to the recognition of weight. The patient is asked to identify the comparative weights of similar sized objects.

Answer 83

Answer: c (35 yrs old) Explain: Cystic fibrosis is an inherited disease of the exocrine glands of the lungs. Pt's can get anit-inflammatory meds, do chest PT, nutrition, etc. to help improve life expectancy, but it has low age mortality.

Answer 84

Answer: d (drop arm) Explain: - Ludington's test is performed having the pt positioned in sitting and asking pt to clasp both hands behind the head. The pt is then asked to alternately contract and relax the biceps muscles. A positive test is indicated by the absense of movement in the biceps muscle and may indicate a biceps tendon rupture. - Speed's is basically a biceps RSC (of shoulder flexion with arm straight) - Yergason's is RSC of supination - Drop arm test is for RC tear

Answer 85

Answer: a (congenital heart defects) Explain: Congenital heart defects are common in infants with Down Syndrome. These can delay gross motor development. - Congenital heart defects are found in 2/3's of kids with DS. These kids will need additional time in NICU and surgeries. - Seizures can delay gross motor development, but they are uncommon in kids with DS - Atlantoaxial instability is common in kids with DS, but gross motor development isn't impacted - Obesity alone does not impact gross motor development, but because these kids are very inactive, they often become obese (but it won't delay gross motor development)

Answer 86

Answer: a (lip smacking ...)

Answer 87

Answer: D (hour after b-fast) Explain: Parkinson's is degenerative disease where dopamine production decreases in substantia nigra. Levodopa is dopamine replacement therapy to reduce symptoms of Parkinson's (bradykinesia, tremors, rigidity). PEAK performance is 1 hour after dose was taken, and the patient will have more energy in the morning.

Answer 88

Answer: C (lorazepam) Explain: Medications do have side effects and can impact treatment/interventions. Benzodiazepines are antianxiety meds so will have a calming effect on a pt. Drugs reach peak effectiveness typically an hour or 2 (or 3) after oral injestion, so keep that in mind. - Prednisolone (Pediapred) would not impact balance - Methotrexate (Rheumatrex) is for RA and wouldn't impact balance - Lorazepam (Ativan) is a sedative used for anti-anxiety, so has a GABA effect, so they are more relaxed and sedated (thus impacting balance). - Levodopa is for Parkinson's pt's

Answer 89

Answer: D (decreased blood to brain) Explain: A flutter is common heart arrythmia (rapid atrial tachycardia). This rapid rate creates decreased filling of ventricles, so less ejection fraction, so less blood out to body. - With answer A: you'd get less filling of ventricles - With answer B: you get congestion with CHF * ** With answer C - it would be INCREASED atrial depolarization

Answer 90

Answer: B Explain: End-feels are the type of resistance you feel when passively taking someone to end ROM. - Soft: Soft end-feels are like knee or elbow flexion where muscle/fat prevents further movement - Firm: Most end feels are firm due to ligament / tendon / capsule strain not allowing further movement. - Hard: Bone on bone (like elbow extension, knee extension) - Empty: this is when pain prevents getting to end range so resistance is not even felt

Answer 91

Answer: C (coma) Explain: Someone in an abnormal state of consciousness can be termed many things: delirium, stupor, dementia, vegetative state, coma, locked-in syndrome, brain dead, etc. But each are different: - Brain dead: loss of function of entire cerebrum, brain stem, etc. Pt is in a coma, can't breathe independently. Only reflexes that remain are deep tendon, withdrawl, plantar flexion. Recovery doesn't happen. - Coma: unresponsive so pt can not be aroused and does not respond to stimulation. Recovery can happen, but depends on extent of injury to brain. - Locked-in syndrome: lesion in brainstem. Pt is conscious and aware of surroundings (can even move eyes), but voice and physical function is lost.

Answer 92

Answer: A (tetany) Explain: Hypoparathyroidism results from a decrease in secretion of parathyroid hormone by parathyroid glands, so you get decreased calcium levels in blood (hypocalcemia). - Tetany is sustained muscular contraction and is a result of hypoparathyroidism - Weight loss is more commonly associated with hypoadrenalism which is undersecretion of hormones by adrenal cortex. Addison's disease would be weight loss. - Hypercalcemia is opposite of what would happen in hypoparathyroidism - Moon shaped face (fat in face) is a result of hyperadrenalism

Answer 93

Answer: B Explain: A MET is the amount of O2 consumed while sitting at rest (3.5mL O2/kg/min). METs are critically useful since they tell you how much energy is expended (or energy cost) for particular activities.

Answer 94

Answer: C Explain: Asthma is an obstructive respiratory condition characterized by airway inflammation, bronchospasm, and mucus plugging. Symptoms include SOB, wheezing, coughing. Triggers include: exercise, allergens, pollution, stress. - Mucolytic drugs are used to treat secretion build up in airways. These can be used for CHRONIC asthma pt's to reduce mucus buildup, though they would not be effective in treating symptoms of an ACUTE asthma attack. - Antihistamines are used to treat allergic attacks/reactions. Antihistamines block the binding of histamines to receptor sites in airways, to reduce symptoms of an allergic reaction. - Beta adrenergic agonists are used to reduce bronchospasm that you'd get in an ACUTE asthma attack. They create smooth muscle relaxation to bronchodilate airways. - Antitussives are used to suppress coughing associated with common cold

Answer 95

Answer: C Explain: - Ely's is for quad tightness (Rectus Femoris) - Phelp's is when pt is prone with knees extended. The hips are first abducted maximally, then the knees are flexed. If there is further hip abduction after flexing the knees, the test is positive for shortening of the gracilis muscle. - Ober's is for TFL / IT Band - Thomas is for hip flexors

Answer 96

Answer: D . (surgical amputation) Explain: Wagner scale is grading foot ulcers based on depth, infection, gangrene. It is a 6 point grading scale, from 0-5, higher scores indicating greater wound involvement and severity. A grade 4 is presense of partial gangrene. - Pulsed lavage: more used for necrotic tissue that requires debridement. - Total contact casting is casting designed to relieve pressure to plantar portion of foot. Used for superficial ulcers (grade 1) or pre-ulcerative lesions to allow better healing. Not used for gangrene. - Oral antibiotics may help fight infection, and typically used when it is grade 3 where bone has become infected, or grade 2 where skin is exposed. - Grade 4 is partial gangrene, and if it is gangrene, it needs to be amputated.

Answer 97

Answer; C Explain: Diuretics remove fluid from body to reduce symptoms of CHF. It thus reduces blood plasma volume (more water excreted), so the pt gets orthostatic hypotension.

Answer 98

Answer: B (hemangioma) Explain: - Dermatitis is a rash (accompanyed by pruritus and erythema) - Hemangioma is benign tumor that appears like a red-purple birthmark. Often found in newborns - Nevus is a mole. Small dark skin growth - Rosacea is an inflammatory skin disorder that causes facial erythema. You'll see flushing and erythema.

Answer 99

Answer: B (intermittent claudication) Explain: Doppler ultrasound is a noninvasive instrument used to assess arterial blood flow. *** It uses sound waves to show blood moving. As velocity of blood flow changes, the pitch or sound wave bouncing back changes. So it helps show blood movement through a vessel. - Nerves are tested with nerve conduction velocity testing - Cardiac arrythmias wold be assessed over EKG - Bursitis can be seen via ultrasound, but typically diagnosed using radiography

Answer 100

Answer: C (permeability of skin) Explain: Phonophoresis is using ultrasound to deliver medication through skin to injured area (superficial area). It gets drugs to a specific localized spot. Ultrasound increases the ability for a drug to penetrate the skin, so permeability of stratum corneum layer (outer layer) changes and allows more diffusion.

Answer 101

Answer: D (v-tach) Explain: Absolute indications to terminate exercise include v-tach, angina, ST elevation, no Q waves, cyanosis, ataxia, dizziness, pt requests to stop, etc. - Diastolic BP would have to be 120+ - It said it needed to be 250 mmHg for you to stop exercise for systolic (I'd do 200, but it says 250) - PVC's are not good, but may still do light exercise constantly monitoring EKG's - V-tach you STOP exercise

Answer 102

Answer: B (5) ``` Explain: FIM is 18 item assessment to assess person in acute setting to assess physical, psychological, social function. 7 is totally independent, and 1 is totally dependent. 7 - Independent 6 - Modified Ind (use AD) 5 - Supervision 4 - Min A 3 - Mod A 2 - Max A 1 - Total A 0 - Couldn't complete ```

Answer 103

Parkinson's These pt's you do BIG training (large body movements). These pt's have trouble initiating or stopping movements due to low dopamine levels in basal ganglia (substantia nigra). Gait, posture, balance are all impaired. They are rigid, have tremors, freeze on gait.

Answer 104

Answer: A (CHF) Explain: Compression therapy is used to improve fluid flow/balance in body to improve circulation, prevent skin breakdown, prevent wounds, etc. You would use compression therapy for control of edema, lymphedema, post surgery, prevent DVT's, treat venous stasis, after amputation, burn patients, etc. - You do NOT do compression for CHF, cause that will send more fluid to the heart, and the heart is failing and should NOT get more fluid. - Compression following TKA helps prevent DVT's and help with blood flow as their muscles aren't working as pumps for venous return - Burn patients benefit by not getting too much scar formation - Compression helps amputees to shape residual limb, help limb fit into prosthesis, and control edema

Answer 105

Answer: B (increased pain threshold) Explain: Cryotheraputic agents are ice packs, ice massage, cool whirlpool, cold sprays, etc. There are physiological effects ... blood vessels narrow, thus blood is restricted to area to reduce inflammation. Also, gate control theory applies to reduce pain ... THUS increasing pain threshold. - Cryotherapy decreases spasticity and muscle spasm - It increases pain threshold (gate control theory), by reducing sensation of pain - Cryotherapy decreases nerve conduction velocity of both sensory and motor nerves - Cryotherapy decreases metabolic reactions in body

Answer 106

1) L4 2) Myotome 3) Dermatome is area of skin that nerve root innervates, myotome is muscles that nerve root innervates 4) S1 5) L5

Answer 107

Answer: A (K+) Explain: Cardiac arrythmia is a disturbance in heart rate and rhythm as a result of abnormal electrical conduction system in the heart. Dysrhythmias are common complications of MI because of the interruption to the cardiac conduction system. - Potassium (K+) is a major ion responsible to generate action potential in the heart. Hypokalemia (low K+ levles) and hyperkalemia (high K+ levels) can result in arrythmias. - Hemoglobin is protein that O2 binds to to get O2 to cells. Normal ranges for men is 12-16 ish, women is 12-15 ish - Hematocrit is % of RBC's in total blood volume. Elevated hematocrits means you are dehydrated, low hematocrit means you are anemic. Normal amounts is 39-49 ish. Lower than 25% is concerning (don't exercise) - Platelets are for blood clotting. 150,000-400,000 is normal. Less than 20,000 is very concerning and they can bleed.

Answer 108

Answer: B (hyperalgeisa) Explain: - Allodynia: pain produced by a stimulus that does NOT usually provoke pain. Pt's with fibromyalgia, migraine HA's, and neuropathies are at greater risk to experience allodynia. It is pain from a NON-noxious stimulus. - Hyperalgesia is an exaggerated or heightened reaction to a painful stimulus that normally is not that painful. It is heightened pain to a noxious stimulus. - Hyposthesia is a decreased sensitivity to sensory stimuli. The pt has a diminished capacity for physical sensation. - Analgesia: absence of pain in response to a stimulation (noxious) that should normally be painful.

Answer 109

Answer: D (amputation) Explain: Wagner Ulcer System grades foot ulcers. It assesses depth of wound, presense of infection, presense of gangrene, etc. It is a 6 point grading scale (from 0-5). 0 - Foot at risk due to callus 1 - Superficial ulcer 2 - Deep ulcer (deep but not to bone, but could be infected) 3 - Absessed deep ulcers (deep to bone and infected, some necrosis) 4 - Limited gangrene 5 - Extensive gangrene - Pulsed lavage is a light debridement of infected areas of a wound, so around a grade 2-3 - Total contact casting is designed to releive pressure so pt isn't on wound (especially plantar side of foot). So these are used for grade 0, 1, or possible grade 2 ulcers - Oral antibiotics are when ulcer is infected, so grade 3 ulcers (even grade 2) - A grade 4 is partial gangrene, and gangrene always needs to be amputated off

Answer 110

Answer: D (101.6) Explain: 98.6 deg F is normal average BODY temp (body regulating homeostasis temp). + or - 1 degree from this value is normal. Rectal temp is typically a bit higher than an oral temp taken (usually 0.5 to 1 deg higher than whatever oral temp was taken).

Answer 111

Answer: A (congenital heart defects) Explain: Congenital heart defects are common in kids with down syndrome (as is ligament laxity and being overweight, but these 2 won't cause developmental delays). But heart defects can delay gross motor development. Kids with Down Syndrome don't typically get seizures though.

Answer 112

Answer: B (measure for 60 secs) Explain: An irregular pulse rate is feeling beats at varying intervals. This is abnormal. Because beats are irregular, it is hard to be accurate if you just check it for 15 seconds. So just count how many there are in a full 60 seconds to be more exact. You could check pulse at different artery, but you'll get same information. And you'll of course document it, but that won't help you get a better measurement.

Answer 113

Answer: A (opposite side first, 20 degrees) Explain: Thessaly is the meniscus test where they stand on one leg and you spin/rotate with them to grind the meniscus. Meniscus tears are manifest by joint line discomfort, catching/locking/popping, unable to walk or weight bear, etc. First, try the test on the GOOD side to know what is normal. Test is done in 20 degrees of knee flexion to grind more of the meniscus

Answer 114

Answer: D (eschar) Explain: Red-Yellow-Black system uses a wound's surface color to direct treatment. Red is the best since it means granulation and healing. Yellow is slough or infection. Black is eschar or dead/necrosis tissue.

Answer 115

Answer: B (hydraulic lift) Explain: Hydraulic lifts are the best and safest when you have a dependent pt who needs help transferring and are overweight. Most times, it can be done with only ONE PT. Slide board would be next, but they'd need UE strength, trunk control, etc.

Answer 116

Answer: D (walking with alterations in speed) Explain: Dysmetria refers to an inability to modulate movement where patient's will either overestimate or underestimate their targets. The cerebellum is normally responsible for the timing, force, extent, and direction of the limb movement in order to correctly reach a target. - Drawing a circle or figure 8 requires the pt to connect a line to established end point (which they could under or over shoot) - Pointing past something makes sense (they'd struggle with this) - Placing feet on markers makes sense (they'd struggle with this) - Walking with alterations in speed would confirm dysdiadochokinesia.

Answer 117

Answer: D (the one who is symptomatic) Explain: You want to be SAFE. If someone has a heart condition and you want to be safe, you may get physician to monitor. Usually you'd do this if the pt has some symptoms and other risk factors of CAD. If they have risk factors but no symptoms, that is something to be cautious about and monitor, but if someone is symptomatic (with or without risk factors), you better watch them very closely.

Answer 118

Answer: A (dorsal of proximal phalanx)

Answer 119

Answer: D Explain: Collection bags should be LOWER allowing graity to help it collect and not cause some UTI.

Answer 120

Answer: C (triceps) - Biceps is C5-C6, Deltoid is also C5-C5, Diaphragm is C3-C5 (3,4,5 keeps you alive). Triceps is C7.

Answer 121

Answer: B (highboy tank) Explain: Whirlpools are tanks that hold water with a turbine that produces movement of the water. Some whirlpools are bigger (for bigger limbs), and some are smaller (for smaller limbs). - Hubbard: is full body immersion. These are big - Highboy: immerse larger body parts, but can't fully extend leg. It is high, just not wide. - Lowboy: is for immersing larger body parts, but pt can extend LE's in these. - Walk tank: allows near full body immersion in an upright posture to do functional activities.

Answer 122

Answer: B (dehydrated) Explain: Hematocrit is % of RBC's to total blood. Thus if it is high, means your plasma level is low, so you are dehydrated, been vomitting, or have diahreah. Low hematocrit is when you are anemic or have blood loss. A high hematocrit could also be from polycythemia vera where the body produces too many new RBC's.

Answer 123

Answer: A (IT band)

Answer 124

Answer: C (cervical radiculopathy) Explain: - A/C joint arthritis would be more likely to present with pain in the superior shoulder region. Pain during cross arm adduction where A/C joint is compressed.

Answer 125

Arterial Blood Gases PROCESS: 1) First, look at the pH. Is it between 7.35-7.45? Is it below or above (acidotic or alkalotic). - If it is between 7.35-7.45 and all other values are in a normal range, body is in homeostasis. - If it is below 7.35, then determine if it is respiratory acidosis (the PaCO2 will be going UP since pH is going down), or is it metabolic acidosis (HCO3 will go down since pH is going down). So, for respiratory: pH and PaCO2 move in opposite directions. For metabolic, HCO3 and pH move in the same direction. Examples: - If pH is 7.21 and PaCO2 is 63, this is respiratory acidosis since 7.21 is low pH and 63 is a high PaCO2 (moving in opposite directions). - If pH is 7.21 and HCO3 is 12, they both are low, so must be metabolic acidosis. High pH and high HCO3 is metabolic alkalosis. - If it is above 7.45, then determine if it is respiratory alkalosis (PaCO2 will be going DOWN since pH is going UP), or is it metabolic alkalosis (HCO3 will go UP since pH is going up). - If however, the pH is in a normal range but other values are off – this is compensated. If pH is off and other values are off, this is uncompensated. - How to know if it is compensated? - To determine if the patient’s primary respiratory process has been compensated for by the renal system, look at HCO3. - To determine if the patient’s primary metabolic process has been compensated for by the respiratory system, look at PCO2 - A high HCO3 in respiratory acidosis indicates compensated respiratory acidosis. - A low HCO3 in respiratory alkalosis indicates compensated respiratory alkalosis. GO REVIEW PRACTICE DOCUMENT

Answer 126

Answer: C (speak with dietician) Explain: Giving handouts is good and won't hurt, but better to be more proactive and actually do something difinitive to help this pt.

Answer 127

Answer: C (ind. with bathroom adaptations) Explain: T5 means they have full UE and some upper trunk control. A slide board is just adding an unnecessary risk. Adaptations like a grab bar or higher seat are appropriate.

Answer 128

Answer: A (keep dentures in) Explain: If you remove the dentures, the alignment of the TMJ may be altered causing pressure through the mandible. Leave dentures in to help forces travel properly through c-spine, not TMJ

Answer 129

Answer: A Explain: PVD (peripheral vascular disease) is typically most commonly manifested in atherosclerosis, so blood flow is compromised. An ABI of 0.55 means there is VERY SEVERELY poor arterial blood flow to the LE's, and since they have pain on walking relieved with rest - this is intermittent claudication

Answer 130

Answer: B (flexion) Explain: Extension can go up to 70 deg, and flexion up to about 80 deg, radial about 20, and ulnar about 30

Answer 131

Answer: A Explain: You want them to NOT be dependent on another person to do these skin checks. And this ? is assuming not all pt's have access to a video camera (even though we all have phones :)

Answer 132

Answer: A Explain: Nerve conduction velocity (NCV) tests can help detect lesions of a peripheral nerve via abnormalities of the speed of the electrical impulse. Neurapraxia is a class 1 nerve injury that involves some local compression or blockage of the nerve. It could happen from trauma and result in entrapment of the nerve. So a neurapraxia injury to a nerve will cause the NCV to be diminished or altered or even absent. Conduction above the site of injury will be normal. And it won't impact areas that nerve doesn't innervate.

Answer 133

Answer: B (decreased hip flexion) Explain: To test iliopsoas, you need the hamstrings on slack to avoid PASSIVE INSUFFICIENCY. Passive insufficiency occurs when a two-joint muscle is lengthened over both joints simultaneously. Placing the HS's in midrange is typically sufficient to avoid passive insufficiency when testing the hip flexors.

Answer 134

Answer: C (25%) Explain: Friction refers to the force that arises to oppose the motion. A significant amount of the overall traction force is necessary to overcome friction between the pt's body and the surface of the traction table.

Answer 135

Answer: D Explain: Certain conditions (cardio or pulmonary) change our breathing patterns. - Kussmaul's: deep and fast breathing often associated with metabolic acidosis. It is distressing dyspnea / panting - Eupnea: term for NORMAL breathing (normal RR) - Orthopnea: this is dyspnea lying down that is relieved by sitting up. Usually orthopnea happens in cardiovascular conditions. - Cheyne-Stokes: Cycles of breathing where RR increases then decreases, then even apnea. It is from CNS damage or severe CHF.

Answer 136

Answer: A (right sidelying to test R hip adductors)

Answer 137

Answer: A (supine) Explain: Pelvic floor m's follow the same general strengthening principles as other muscles in the body. Thus, the 1st easiest position should eliminate gravity. As the pt progresses and improves strength, you progress exercise to make it harder. - These are KEGAL exercises (isometric, or concentric contractions of pelvic floor m's ... holding in urine or bowel movement). - If they did a bridge, technically it would be easier for the pelvic floor m's (since it is going WITH gravity) ... but bridge position would be hard to hold based on core / low back / hip m's working hard. - Sitting is next hardest, then tall kneeling, then standing is hardest.

Answer 138

Answer: D (rigidity is sign of Parkinson's) Explain: Parkinson's is a degenerative disorder in CNS where dopamine neurotransmitter of the basal ganglia is diminished which impacts movement. s/s of Parkinson's include: hypokinesia, rigidity, shuffled gait, freeze on gait, bradykinesia, poor posture, cogwheel rigidity - Aphasia is a communication disorder, but Parkinson's don't have injury to that portion of the brain, so speaking would be fine. - Ballistic movements are LARGE amplitude movements. Parkinson's have opposite - you want them to work on doing BIG movements. - Severe muscle atrophy is more a LMN s/s

Answer 139

Answer: A (sodium hydroxide at cathode) Explain: - Cathode: black or negative electrode (what provides the charge/shock) - Anode: red or positive electrode - Pt may have an alkaline reaction from ionto as a result of sodium hydroxide forming in cathode (the negative electrode). - Acidic reaction is hydrochloric acid accumulating at the anode - Alkaline reaction happens with accumulation of sodium hydroxide at cathode.

Answer 140

Answer: C (hypotension due to decreasing fluid levels from the diuretic) Explain: Diuretics help REDUCE blood pressure by getting rid of excess fluids. Thus blood plasma volume will decrease. Orthostatic HYPOtension (not hypertension) is thus a side effect of a diuretic.

Answer 141

Answer: A (first metacarpal) Explain: The opponens pollicis muscles goes from the flexor retinaculum and trapezium and attaches on the 1st metacarpal bone. Thus it moves the carpometacarpal joint (of the thumb).

Answer 142

Answer: D (83 yr old female) Explain: Alzheimer's disease is a progressive neurological disorder that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain. The loss of neurons results from the breakdown of several processes that would normally sustain brain cells. It is more common in women, and with older age. To remember for the boards ... females are more prone to than males, and 83 is older than 81 (seriously, they said you look for the OLDEST age for a female ... that is the answer).

Answer 143

Answer: C (DVT) Explain: Warfarin is an anticoagulant that inhibits platelet or thrombus (clot) formation. Many pt's following some surgery will be given this medication to prevent DVT's (and thus PE's). An INR was developed to see how fast clotting factors form, to see how fast a blood clot forms. Normal range is 2.0-3.0, so a HIGHER value means blood clotting is SLOWER, so more bleeding. PT would NOT be done if INR is around 4.0 or higher. An INR of 1.2 is low, so blood is clotting too fast, so at risk of DVT.

Answer 144

Answer: A (8-10 hours at night) Explain: Scoliosis is lateral curvature of the spine. It is quantified using the Cobb method using a radiograph. Idiopathic (unknown reason) is about 80% of scoliosis cases. Scoliosis Cobb angle of 25-40 degrees requires a spinal orthosis and PT intervention for posture, flexibility, strengthening, respiratory function, and proper utilization of orthosis. - Charleston brace is a nocturnal (night time) brace, so forces are applied to the spine during sleep, so the effects of gravity are minimized. Thus, pt's can do normal activities without restrictions of a brace during the day. - Milwaukee and Boston braces are DAY time braces worn during the day (typically by kids). These braces are worn all day (even part of the night, and removed when getting wet).

Answer 145

Answer: D (MS) Explain: Optic neuritis is inflammation that damages to optic nerve (CN II), and since CN II is an extension of the cerebral cortex, it is susceptible to demyelination in the CNS .. thus MS.

Answer 146

Answer: B Explain: A PT should always ask a pt to describe their pain (helping the PT know what is the source of pain).

Answer 147

Answer: D (fatigue) Explain: Anemia is a reduction in RBC's or reduction in hemoglobin.

Answer 148

Answer: A (brace the incision) Explain:

Answer 149

Answer: C (intra) Explain: INTRA is within yourself (or same tester), INTER is between people (more than one person recording).

Answer 150

Answer: B (C7) Explain: It is the most caudal (highest) segment where you have both sensory and motor intact.

Answer 151

Answer: B (grade III sprain) Explain: Grade I is slight stretch of ligament, grade III is complete rupture of ligament *** SPRAIN is for ligament. STRAIN is for muscle/tendon tear ***

Answer 152

Answer: D (hypotension) Explain: - Spinal shock is the response at 30-60 mins after injury and can last a few weeks. It is flaccid paralysis and loss of reflexes below injury. - Autonomic dysreflexia: some noxious stimulus below level of injury triggers autonomic nervous system response (sympathetic n.s. response) so blood pressure rises. It is serious, so if not treated, can lead to convulsions, hemmorage, and even death. It usually happens with pt's who have a SCI at T6 or above. THIS PT IN THIS CASE HAD A DROP IN BLOOD PRESSURE. - Orthostatic hypotension (or postural hypotension) is reduction in blood pressure when moving positions ... which is what happened with this pt.

Answer 153

Answer: B (negative pressure) Explain: Vacuum-assisted closure devices creates negative pressure (called NWPT: negative wound pressure therapy). The negative pressure helps facilitate growth and granulation tissue in wound bed.

Answer 154

Answer: C Explain: THe case manager manages and communicates with all on the team about mental illness / suicide issues.

Answer 155

Answer: A (bone scan) Explain: Bone scans shows high bone mineralization (following an injury or during metastsis of cancer). - MRI's are more for soft tissue like muscle, ligament, meniscus, tumor, organs, etc. - Telethermography shows thermal / heat alterations in body - US uses sound waves to show soft tissue imaging

Answer 156

Answer: A (severe hypotension) Explain: A pt using a Hubbard tank and taking a calcium channel blocker is at risk of severe hypotension. Calcium channel blockers decrease blood pressure by causing vasodilation, and the whirlpool perpetuates this physiological effect making Hypotension worse.

Answer 157

Answer: D (pool therapy) Explain: Remember that posterolateral precautions for THA are hip flexion greater than 90, IR, and adduction. - They can and should do ER, but NOT IR - Doing stairs is fine if they don't exceed 90 deg hip flexion - Pool therapy is fine (if no open wound). BUT, because they have Graves disease, they have an accelerated metabolic rate and are often intolerant to warm environments.

Answer 158

Answer: B (ordinal) Explain: Know these 4 ways to describe a questionaire: - Nominal: category scale, so things placed into categories (names, symbols, places, etc.) - Ordinal: Ranking numbers on a scale (like a 0-10 scale) - Interval: - Ratio: ROM, height, weight, force are examples

Answer 159

Answer: D (muscle atrophy) Explain: LMN are axons are at/below the brainstem and outside spinal cord where a lesion where s/s include: flaccidity, weakness of muscles, atrophy, decreased tone (hypotonia), fasiculations, decreased/absent reflexes. - LMN's would also have impairments with NCV studies - Fasciculation is a term for a weak and involuntary contraction or twitching of a group of fibers that typically indicates LMN pathology. They are NOT found with UMN lesions. - Both UMN and LMN lesions get atrophy, but especially LMN

Answer 160

Answer: D Explain: Osteoporosis is a common disease in older adults. Diabetes or hyperparathyroidism can increase the risk of developing osteoporosis. Vertebral compression fractures are a common finding in patients with osteoporosis. - Paget's disease is a condition related to excessive bone absorption and deposition. Symptoms include MS pain and bone deformities like Kyphosis, coxa varus, bowing of the long bones, and vertebral compression. - Lung neoplasm can cause mid-thoracic pain, but this is unlikely in this patient since they would be having difficulty breathing, would be a smoker, have a persistent cough, weight loss, and wheezing. - Costochondritis is pain in ribs where ribs meet costal cartilage, so this would be in the FRONT of the thorax. Spinal flexion wouldn't impact this. - Osteoporotic fracture occurs due to bone degredation and spinal motions would be painful (mostly during flexion).

Answer 161

Answer: A Explain: Alzheimer's is a progressive neurodegenerative disease in the brain. Plaques form in / on the nerves, and thus impact memory and difficulty learning new things. There is compelling evidence that physical activity can improve memory and delay decline. - Stretching is important for pt's with contractures or lack of flexibility (hypertonia) - Coordination training is appropriate for pt's with ataxia, nystagmus, balance impairments, etc. And usually people with Alzheimer's are fine with these things. - Pulmonary therapy is for pt's with compromised pulmonary system and may need airway clearance, ventilation, breathing techniques, etc.

Answer 162

Answer: C (80) Explain: You take how many QRS complexes in a 6 second strip and times it by 10 to get heart rate or bpm (beats per minute)

Answer 163

Answer: B Explain: - Voltage is electrical force - Hertz is unit of measure which describes the number of cycles p/sec when using an alternating current - A coulomb is the amount of electrical charge transported in one second by a steady current of one ampere - Pulses p/sec is utilized to describe the frequency of pulsed current

Answer 164

Answer: B Explain: KNOW about types of exudate in wound healing - Sanguineous exudate is red with thin watery consistency. It is fragile granular tissue - Serosanguineous exudate is light red or pink with thin watery consistency. It is present during inflammatory phase of healing - Serous exudate is clear and light in color with thin watery consistency - Seropurulent exudate is yellow to tan with cloudy appearance. This is sign of infection.

Answer 165

Answer: C Explain: I put all notes in my excel doc of ankle conditions. Review ALL those excel docs of each joint with all those conditions.

Answer 166

Answer: B (eschar) Explain: Negative Pressure Wound Therapy (NPWT) is the process of applying negative pressure to a wound through the use of a vacuum device. NPWT is used on diabetic ulcers, venous statis ulcers, surgical wounds, traumatic wounds, burns, and even skin grafts. The negative pressure helps reduce edema, promote formation of granulation tissue, and remove exudate and infectious material. - Serosanguineous exudate is pink, and you'd use NPWT for this - Presense of eschar or necrotic tissue is CONTRAINDICATION for NPWT. Before doing NPWT, you need to debride any eschar or necrotic tissue. - Skin grafts are NOT a contraindication for NPWT. It is often used for burns and wounds with a skin graft. - If muscle and tendon are exposed, NPWT can still be used (remember lady in Iowa where you could see ribs). *** Do NOT place NPWT dressings on nerves, or blood vessels, or organs though.

Answer 167

Answer: C Explain: The Berg has maximum score of 54, and scores less than 45 indicate increased ROF - Answer A is talking about the FIM - ANswer B is about the functional reach tests - Answer C is about Berg, and a score of 39 means that pt is at risk for falling, thus not safe to go home. - Answer D is the Barthel index about amount of assistance needed during ambulation **** Go through all major balance / functional tests and know the total scores and cut off scores for risk of falls

Answer 168

Answer: B (heart rate) Explain: A deconditioned pt will experience rapid heart rate increases. They will experience some increase in blood pressure yes, but deconditioned pt's experience less stroke volume and orthostatic hypotension and diminished cardiac output.

Answer 169

Answer: D (CN VI) Explain: CN's II, III, IV and VI are all involved in function of the eye. (*** REVIEW CN's and functions). Damage to these CN's impact the eye. - CN II is optic nerve, and is just sensory, so sensation of sight and visual fields - CN III is oculomotor nerve and is motor, so it innervates eyelid levator muscle, sup/inf/medial recti muscles, and inf. oblique muscle of eye. So it elevates eye, moves eye up, down, and medially - CN IV is trochlear nerve and innervates sup oblique muscle, so damage means difficulty with downward and inward gaze - CN VI is abducens and does LATERAL RECTUS muscle movement.

Answer 170

Answer: A Explain: Syncope refers to a loss of consciousness often resulting from insufficient blood flow to the brain. The condition is characterized by a fast onset, short duration, spontaneous recovery. - Going from supine to sitting temporarily reduces blood flow to the brain and increases chance of syncope. This could be a result of medications, dehydration, bleeding, or infection. - Riding a stationary bike at 50 revolutions p/min is not too intense. The consistency of the activity reduces chance for syncope (more likely to get syncope during a sudden change of position). - LAQ's and Walking is fairly consitent not hard activity.

Answer 171

Answer: C (superficial) Explain: Nociceptive pain is pain response to an immediate noxious stimulus (pain). Neurogenic pain is pain response to general damage to the central or peripheral nervous system. - Deep somatic pain is damage to bone or muscle or connective tissues. Pain can present as cramping, pressing, or aching. This is a vague pain and reproduced with movement. And can refer. - Visceral pain is from damage to organs. Pain is often referred to other areas and very poorly localized vague pain. - Superficial pain is damage to skin or subcutaneous tissues. Pain is localized, stabbing, and burning. It is targeted. - Central neurogenic pain is damage to spinal cord and CNS.

Answer 172

Answer: C Explain: Motions are described as occuring around 3 cardinal planes: frontal, sagittal, and longitudinal. Movements however occur around axes: anterior-posterior, medial-lateral, and vertical. The axis of any cardinal plane movement is always found perpendicular to its corresponding plane. - MOTIONS in the FRONTAL plane occur around an anterior-posterior AXIS of MOVEMENT - Medial and Lateral rotation (which is transverse plane) occur around a vertical axis

Answer 173

Answer: D Explain: ABI is a measure of arterial blood flow in the LE's. You take an ABI by taking the higher systolic blood pressure from the two LE's and dividing it by the higher systolic blood pressure from the 2 UE's. In a normal patinet, a value of 1.0 is normal. A value of 0.5 is low, and 0.36 is very very low suggesting arterial disease. - This is a circulation problem, not a nerve (paresthesias( problem - They'll have weaker calf muscles yes, but not necessarily result in low ABI reading - Intermittent claudication is common in pt's with arterial disease. But a pt with a 0.36 would most likely not participate in activity. - Claudication pain at rest is often associated with markedly low ABI values. This finding is extremely serious and is a contraindication to exercise. Resting pain often first develops in the feet and toes. Ulcers often develop at this level of arterial disease, and lack of circulation makes healing very hard.

Answer 174

Answer: B Explain: Claudication refers to leg pain from vascular disease, but could be from arterial or venous. It comes on with walking/activity, and subsides with rest. It is from muscle ischemia (not enough blood getting to working muscle tissue). Arterial is immediate, whereas venous pain would occur hours after exercise and relief would not be immediate. - Doppler ultrasoundography can evaluate blood flow in major arteries or veins. Since this pt's pain is immediate upon walking and goes away with rest, it is arterial - so do an arterial doppler ultrasound to see blood flow within artery. - Clinical Electromyography is EMG to determine neuromuscular activation, or records action potentials in skeletal muscle. - ECG studies electrical conduction of the heart.

Answer 175

Answer: D (metabolic alkalosis) Explain: Oral potassium chloride is often administered when potassium levels are extremely low and need to be replenished. Acid-base disorders are often related to respiratory and/or metabolic disorders. - Respiratory acidosis is characterized by elevated PaCO2 and low pH due to hypoventilation. Patient's with respiratory acidosis are treated by managing the underlying cause, supporting ventilation, and correcting any electrolyte imbalance. - Respiratory alkalosis refers to a state in which the pH is abnormally high and PaCO2 is low indicating alkalemia. Pt's with respiratory alkalosis are treated by managing the underlying cause and increasing carbon dioxide retention. - Metabolic acidosis is a condition that occurs when there is an accumulation of acids due to an acid gain or biocarbonate loss. Pt's with metabolic acidosis are treating by managing the underlying cause, correcting any coexisting electrolyte imbalances, and administering sodium biocarbonate. - Metabolic alkalosis is a condition that occurs when there is an increase in pH and biocarbonate accumulation or an abnormal loss of acids. Patients with metabolic alkalosis often experience hypokalemia and may therefore be treated with oral potassium chloride.

Answer 176

Answer: C (be in room wear gown and gloves) Explain: MRSA requires CONTACT precautions. Don't go to gym since someone could contact equiptment they touch, so stay in their room. No need for a mask since MRSA is only contact precautions. Wearing a mask is only necessary when there is an airborne or droplet concern.

Answer 177

Answer: C (pick out forks) Explain: Perception is the mechanism by which the brain interprets sensory information received from the environment. Perception is commonly altered in pt's sustaining a stroke involving the right hemisphere. - Figure-ground discrimination dysfunction involves difficulty distinguishing the foreground from the background in a complex visual array.

Answer 178

Answer: A (facet pathology) Explain: Facet joint pain will be localized pain, and not radiate down the leg typically. Thus flexion will gap the joint making it feel better. Disc issues would be worse during flexion. Vascular issues will be the same no matter the movement.

Answer 179

Answer: D (monitor vitals) Explain: Ideally you want pt in a safe position, but don't restrain them (it can cause injury to pt and PT). Unless the pt stops breathing, don't do CPR. You want the airway to remain open, but don't place something in there that could potentially become a choking hazard. Just make sure pt is still breathing.

Answer 180

Answer: B (posterior of L lower lobe) Explain: Postural drainage is when pt is placed in position that allow gravity to drain secretions in the lungs. Goal is to mobilize secretions from smaller airways to larger airways to be coughed out. *** TRENDELENBERG means HEAD DOWN position, which may be contraindicated in certain patient populations (like uncontrolled hypertension). - Apical segment is the top portion up by 1st rib, so pt can be sitting up (which is fine) - Posterior segments of the lower lobes require the Trendelenberg position, which is contraindicated with this pt who has hypertension. - Treating the anterior segment of upper lobe requires pt to be supine, which is fine. - To treat superior segement of LOWER lob, pt is prone, which is fine.

Answer 181

Answer: A (knee hyperextension) Explain: Spastic diplegia is cerebral palsy where both lower limbs are spastic - The child's foot will be in a position of increased PF due to shortened achilles. The child is most likely to hyperextend the knee to try and drive the heel into the ground and achieve a flat foot position. - Knee flexion causes more plantarflexion, which pulls heel up more. - They will not do DF causing more stress on achilles - The child may circumduct the leg when walking because of increased plantarflexion (to clear foot), but the wouldn't do that to try to get a flat foot on the ground.

Answer 182

Answer: B (cerebellar) REVIEW spinal tracts Explain: MS is demyelination of CNS nerves. Thus nerve impulses get impaired and don't transmit properly. Symptoms vary based on what nerves are damaged (depends on the tract). - Corticospinal tract s/s present with paresis, spasticity, excessive tendon reflexes, spasms, clonus, babinski - Cerebellar tract s/s present with ataxia, postural and intention tremors, hypotonia, and truncal weakness - Frontal lobe s/s would show as cognitive impairments, difficulty concentrating or attention, memory, personality, processing - Spinothalamic tract s/s result in sensory deficits and neuropathic pain

Answer 183

Answer: B (down syndrome) Explain: - Muscular dystrophy is the absense of the dystrophin gene, and is progressive. You need to stretch and strengthen their m's. - Down syndrome (trisomy 21) is an extra 21st chromosome and these kids have atlantoaxial instability or ligament laxity, thus passive stretching is dangerous. - Juvenile RA is inflammation of joints and connective tissues - Cystic Fibrosis is inherited disease where exocrine glands are impaired in body systems (especially respiratory system).

Answer 184

Answer: D (90) Explain: The patellofemoral joint is where patella slides superior during knee extension - At 0 degrees, the patella is too high and doesn't hit femure - At 30 deg's, the inferior aspect of the patella starts to hit femoral condyles. - At 60 deg's, the superior part of patella is now hitting femur - At 90 deg's, the entire patella is in the femoral groove

Answer 185

Answer: C (tie shoe) Explain: Total hip precautions are in place to prevent hip dislocation following surgery. Posterior approach precautions are: No hip flexion > 90 º, no hip internal rotation or adduction beyond neutral

Answer 186

Answer: A (ankle pumps) Explain: Venous insuff. results in edema, but elevating leg is bad for this pt due to them also having arterial insuff. So you need blood flow down to LE's, but work on reducing edema. So this is a mixed case, making it more complicated. - Ankle pumps in supine would be best since pt has both venous and arterial insuff. Moving ankle pumps blood back via muscle pump, but without elevating or compressing leg which would be bad for the arterial insuff.

Answer 187

Answer: C (soft ... soft tissue like elbow or calf is a soft end feel. Ligaments, tendons, capsules are firm. Bone on bone is hard).

Answer 188

Answer: A (complete T9) Explain: - Posterior Cord Syndrome: a lesion on posterior part of spinal cord (usually spinal artery severed). You'd lose proprioception, two point discrimination, stereognosis. Motor function is preserved. - Brown-Sequard's: incomplete lesion by a stab wound that hemisects the spinal cord. So one side is injured. You'd lose vibratory and position sense on the same side, and loss of pain and temp on opposite side. - Cauda Equina: this is below level of L1/L2 where spinal cord ends. Usually these injuries are not complete since there are so many cords that would have to be severed, so you'd lose bowel/bladder function, become flaccid distal, some motor or sensory loss.

Answer 189

Answer: D (calf) Explain: The prinicple is you measure how much subcutaneous fat in proportion to total body fat. It is a better estimate of body fat % (yet hydrostatic weighting is gold standard). - You do it at iliac crest. You do it at inferior angle of scapula. You do it at triceps. But NOT at lateral calf, but at MEDIAL calf. ***

Answer 190

Answer: C (multiple myeloma) Explain: MOST blood cancers originate in the bone marrow where blood cells are formed. 3 types of blood cancers are: leukemia, lymphoma, and myeloma. - Leukemia: when WBC's (leukocytes) change into malignent cells. They will spread to lymph nodes, liver, spleen, and other areas of body. - Lymphoma: cancer in lymphatic system. It can be Hodgkins or non-Hodgkins. Immune system weakens. - Multiple Myeloma: cancer of the PLASMA CELLS. Abnormal plasma cells accumulate in bone marrow and interfere with production of other blood cells, and weaken immune system. - Hodgkins disease is a type of lymphoma, and is one of the most curable cancers.

Answer 191

Answer: B (increased HR, decreased SV)

Answer 192

Answer: B (every 3-5 mins)

Answer 193

Answer: A (volume) Explain: Volume is done by water immersion of the limb, and is most effective way to measure edema. You measure GOOD side, then compare to edema side and minus the difference. - Girth and circumferential are synonymous terms - Anthropometric combines height, weight, BMI, waist-to-hip ratio, and % of body fat.

Answer 194

Answer: C (radial nerve)

Answer 195

Answer: B (rooting) *** REVIEW THE PRIMITIVE REFLEXES Explain: Most primitive reflexes 'integrate' within the first year. - Moro: present at 28 weeks gestation through 5 months old. It is stimulated by getting baby's head into extension and baby will abduct arms with fingers open followed by arms crossing the trunk into adduction and crying - Rooting: Present at 28 weeks gestation through 3 months old. Helps feeding with mother's breast - Startle: Present at 28 weeks through 5 months. Stimulated by a loud, sudden noise. The response is similar to Moro response, but elbows and hands are closed. - Righting: group of reflexes responsible for upright posture of baby.

Answer 196

Answer: C (blood tests) Explain: RA is an autoimmune disease with unknown etiology. The disease presents with a chronic inflammatory reaction in the synovial tissues of a jt that results in the erosion of cartilage supporting structures within the capsule. RA is diagnosed based on the clinical presentation of involved joints, the presence of blood rheumatoid factor, and radiographic changes. - Pain profile tells you nothing - Description of joint symptoms is helpful (like stiffness, pain, how many joints, etc.) - BEST option is blood tests to rule in rheumatoid factors in the blood

Answer 197

Answer: D (compression garment during day) Explain: Lymphedema is a chronic, incurable condition and is characterized by protein rich fluid (called lymph) in the body. Stage II is known as the spontaneously irreversible lymphedema stage. Edema in this stage is non-pitting and does not change with elevation and rest. The skin begins to demonstrate fibrotic changes and the risk of infection increases. Stemmer's sign is positive at this stage. - Short stretch bandages are used for Stage 1 during day (and at night during stage II) - Long stretch (like ace wraps) are not recommended for treating lymphedema since they have low working pressure. - Compression garments have higher pressure than short stretch bandages, so used in later stages of lymphedema. But compression garments should NOT be used during long periods on inactivity. - Stage 1 is treatment stage. Stage II is maintenance phase. Phase 1 uses short stretch bandages. Phase II uses compression garments during day and short stretch bandage at night.

Answer 198

Answer: C (assess their cognition first) Explain: Cognitive status can vary greatly between different Alzheimer's patients. Check it first to determine what approach to take for this patient. - So you should give verbal and written instructions, and frequently repeat instructions with these pt's, but the depth depends on their cognitive status.

Answer 199

Answer: B (diaphragmatic) Explain: Lymphatic drainage exercises can help improve lymph flow (improve muscle pump to improve lymph flow). - Segmental breathing: also known as localized breathing or thoracic expansion is intended to improve regional ventialation. Asmmetrical chest wall motions are a result of some pathology, so with proper verbal cues, hand placement, and education you can retrain proper breathing. - Diaphragmatic breathing should be performed prior to lymphatic drainage as it assists with the movement of lymphatic flow as the diaphragm descends during inspiration and ab muscles contract to help do muscle pump to move lymphatic fluid. - Paced breathing: strategy to decrease the work of breathing and prevent dyspnea during activity. It allows anyone who experiences shortness of breath to become less fearful of activity and exercise. SOB is not typically associated with lymphedema. - Inspiratory Muscle Training (IMT): attempts to strengthen the diaphragm and intercostal muscles. When inspiratory muscles are impaired, this focusses on strengthening them to improve ventilation. Not necessary to do this for lymphatic drainage.

Answer 200

Answer: C (2) Explain: Modified Ashworth Scale assesses muscle spasticity. - Grade 0: absense of spasticity - Grade 1: slight increase in tone (catch and release) - Grade 1+: slight increase in tone (catch, but then resistance after throughout rest of ROM) - Grade 2: Increase in tone throughout entire ROM, but extremity can still move fine - Grade 3: Considerable increase in tone, and not easily moved throughout ROM - Grade 4: Rigidity

Answer 201

Answer: C (triquetrum) Explain: So long the pinky, here comes the thumb - Distal row is hamate, capitate, trapezoid, trapezium

Answer 202

Answer: C (CP) Explain: Spasticity happens when the corticospinal pathway becomes injured (like in an upper motor neuron injury). Spasticity will influence developmental milestones. - Down Syndrome: these kids won't have spasticity - Spina Bifida: affects Lower Motor Neurons, not UMN's, thus an infant with Spina Bifida would have flaccid weakness - CP: this is an upper motor neuron condition manifesting with spasticity. Common m's demonstrating spasticity are HS's, adductors, and PF's - SCI's: these are NOT common in infancy, and yet if someone has a SCI - their spasticity will manifest in flexor or extensor patterns, not in specific muscle groups.

Answer 203

Answer: D (RR)

Answer 204

Answer: A (quadruped and sitting) Explain: - Laying supine or hooklying could compress the vena cava with weight of the baby. - Trendelenburg position refers to a position where the head is lower than the feet. So like a surgery where blood rushes to head.

Answer 205

Answer: C (lean w/c back)

Answer 206

Answer: B (active movement)

Answer 207

Answer: C (time for resolution of symptoms) Explain: A TIA is a small clot that lead to interruption of blood flow to brain. TIA's don't cause permanent damage, but indicates future risk of a stroke. - Aura's are associated with migraine HA's - Initial symptoms of a TIA and stroke are often similar (FAST ... numbness of one side of face, slurred speech, vision problems, weakness of one side of body, dizzy, HA, confusion, lose consciousness, etc.). - The effects of a TIA resolve quickly (within minutes or up to a day). Symptoms of a stroke may resolve with time, but takes time and may not resolve. - Both have vision and speech problems, but again, if they resolve quickly = TIA

Answer 208

Answer: A (vital capacity) Review these and what they mean and rough amounts

Answer 209

Answer: C (macerated = wet) Explain: - Gangrene is dead tissue (could be wet or dry) - Macerated is when tissue is exposed to moisture too long - Induration refers to an abnormal firmness or hardening of the skin, usually due to inflammation or edema in the peri-wound area.

Answer 210

Answer: C (5:1) Explain: An on:off time ratio is simply a method to show the relative duration of the on time vs. the off time. The muscle contracts during the on time and relaxes during the off time. The greater the on time in relation to the off time, the more the muscle will fatigue.

Answer 211

Answer: A (distal end of humerus)

Answer 212

Answer: B (sensation) Explain: Post-polio syndrome is a term used to describe symptoms that occur years after the onset of poliomyelitis. The condition is characterized by a weakening of the muscles that were originally affected by poliomyelitis. Symptoms include progressive muscle weakness, fatigue, and muscle atrophy. Sensation is not typically affected.

Answer 213

Answer: D (wheezes) Explain: - Wheezes are HIGH pitched (weeeee) heard on exhalation - Crackles are discontinuous adventitious (abnormal) breathe sounds due to fluid accumulation in airways - Rales are synonymous with crackles ** - Rhonchi are low pitched adventitious breathe sounds due to secretions in airways.

Answer 214

Answer: B (obesity) Explain: Metabolic Syndrome is an aggregation of multiple cardiovascular risk factors that place an individual at risk of atherosclerotic cardiovascular disease. Criteria for getting metabolic syndrome is obesity, elevated waist circumference, reduced levels of high-density lipoprotein cholesterol, increased blood pressure, elevated serum triglyceride levels, and elevated fasting blood glucose levels. - Metabolic syndrome doesn't have a genetic origin - Obesity is main risk factor - Decreased thyroid secretion (hypothyroidism) is not associated with metabolic syndrome - It would be INCREASED blood glucose levels

Answer 215

Answer: B (it is too high) Explain: Should be about 20 ish degrees of elbow flexion to be right height.

Answer 216

Answer: B (genetics) Explain: Osteogenesis imperfecta can present vary differently. There are 4 types of this diagnosis. And it is diagnosed based on diagnostic imaging and genetic testing.

Answer 217

Answer: C (to the right) Explain: Homonymous hemianopsia is a condition where the visual field is impaired due to damage to the MIDDLE CEREBRAL ARTERY. Thus vision loss results. So a pt with RIGHT homonymous hemianopsia would have difficulty seeing objects on the RIGHT side.

Answer 218

Answer: B (eccentric of quads) Explain:

Answer 219

Answer: D (sex chromosome disorder) Explain: Aneuploidy is the presence of an abnormal number of chromosomes in a cell. Klinefelter syndrome is a genetic condition that results when a male is born with at least 1 extra copy of the X sex chromosome. Klinefelter syndrome is a common genetic condition affecting males, and is not diagnosed until adulthood.

Answer 220

Answer: C (contact the nurse) Explain: Patient-controlled analgesia allows the pt to manage their pain by delivering an intravenous analgesic dose. Opioids are often self-administered meds

Answer 221

Answer: A Explain: Internal obliques help with crunches (lumbar flexion) and lateral bending and rotation of spine/abdomen. Thus it will help decrease chest cavity during exhalation

Answer 222

Answer: A (osteoporosis) Explain: pt's taking glucocorticoids (corticosteroids ... when prednisone is) are at risk of developing osteoporosis.

Answer 223

Answer: C (Sudafed) Explain: - Amlodipine (Norvasc) is a calcium channel blocker, so they slow conduction to SA node to decrease myocardial contraction. - Cyclobenzaprine (Flexeril) is a muscle relaxor to relieve muscle spasms to decrease CNS excitability to relax muscles. - Pseudoephedrine (Sudafed) is an alpha 1 agonist used to relieve cold symptoms. It is a vasoconstrictor so it reduces blood flow to an area. - Nitroglycerine (Nitrostat) is a nitrate used to decrease ischemia to heart and smooth muscle. It vasodilates, which is opposite of what question says (enhance heating effects)

Answer 224

Answer: B Explain: A bankart lesion involves detachment of the anterior labrum due to a shoulder dislocation. A bankart repair is a surgical procedure to reattach and repair the torn labrum and joint capsule. Usually it always dislocates anteriorly. So, you want to work on stabilizing G/H and scapular shoulder motions most.

Answer 225

Answer: B (Tegretol) Explain: Anticonvulsant meds generally attempt to inhibit firing of certain cerebral neurons, and have side effects like dizziness, drowsiness, fatigue, sedation, nausea, and cardiac arrythmias. - Dilantin is used to treat epilepsy - Tegretol is used to treat epilepsy but main side effect is cardiac arrythmias - Klonopin treats epilepsy - Neurontin treats epilepsy but has a GABA effect

Answer 226

Answer: C (standing frame) Explain: Orthostatic hypotension is a sudden decrease in blood pressure that occurs with movement (ie: sitting or standing). Change in position causes pooling of blood in LE veins and reduces cardiac output. Often it manifests in pt's who have been immobile for a while. - Stockings would help get blood back to the heart - Tilt table helps pt's adjust slower to an upright position - Standing frame is an assistive device to support someone who can't stand (are in a w/c or something). - Abdominal binder is a compression garment around the torso. It is used with orthostatic hypotension since it compresses blood in vessels to increase venous return.

Answer 227

Answer: 20 mins (B) Explain: Hydrocollator is a hot pack. YOU MUST HAVE 6-8 towel layers (this will be on test). Hot packs require 15-20 mins to have physiological effect.

Answer 228

Answer: A (Thoracodorsal n.) Explain: Thoracodorsal n. comes off posterior cord of brachial plexus and innervates latissimus dorsi muscle. The lats extend, adduct, and IR shoulder. THus lats are weak due to thoracodorsal nerve lesion. - Suprascapular n. innervates supraspinatus and infraspinatus m's - Spinal accessory n. is a CN (CN XI) innervates SCM and traps. - Axillary n. innervates deltoid and teres minor MUST MUST REVIEW NERVES OF EACH MUSCLE GROUP

Answer 229

Answer: C (align goni) Steps for goni measureing: - Put pt in testing position - Stabilize proximal joint segment - Palpate bony landmarks - Move through ROM and determine end-feel - Measure with goni

Answer 230

Answer: B (in response to speech) Explain: Glasgow scale is used to determine extent of a TBI to determine level of consciousness and severity. GSC is scaled based on verbal response, motor response, and ability to open eyes. A total score of 8 or less correlates to severe brain injury and coma. Scores of 9-12 indicate moderate TBI, and scores from 13-15 indicate mild brain injuries. - Eyes opening part is scored from 1-4. So a score of 4 is spontaneous eye opening. A 3 is in response to speech. A 2 is in response to pain. A 1 is someone who doesn't open eyes.

Answer 231

Answer: A (articular changes) Explain: This is a high ankle sprain. The syndesmotic ligaments are the interosseous lig, and ant and post tibiofibular ligs. Signifiant tears require surgery to repair. If lig's are not repaired, it can cause damage to articular cartilage surfaces (leading to arthritis). - Myositis ossificans is a condition of calcification of the muscle. This is caused by neglecting to properly treat a muscle strain or contusion. An x-ray is the primary imaging study to diagnosis this.

Answer 232

Answer: D (knee-ankle-foot with walker) Explain: Continuation of standing and walking requires a lot of support. Ankle-foot is not enough.

Answer 233

Answer: C (adult with 5 degrees) Explain: Remember the acetabular faces inferior, lateral, and slightly anterior. The head of femur also faces anterior, but superior. Normal anterversion means the angle straight out laterally to a line straight through femoral head. Should be about 8-15 degrees anteriorly angled. If it is more or less than that, it creates hip instability. - At birth, normal anteversion is 30 deg's and then gradually diminishes through skeletal maturity. A child with 20 degrees is thus typical, however would be unlikely to represent the most stable hip. A child with 30 deg's is thus not as stable. - *** Adults have more stable hip joints than kids *** An adult with 5 deg's is MOST stable of these options. Thus, 25 is too far forward, and thus more instable.

Answer 234

Answer: A (use increased lighting) Explain: Sundowning is a term used to describe disorientation, agitation, or general worsening of mental symptoms that occur specifically at dusk or nightfall. Sundowning is extremely common among individuals with dementia. It is thought to be associated with impaired circadian rhythm, environmental factors, stress, and impaired cognition. THUS, try to do interventions earlier on in the day with these pt's

Answer 235

Answer: C (cervical radiculopathy) Explain:

Answer 236

Answer: A (Abs) Explain: REVIEW the ankle, hip, stepping, and reaching strategies. Remember muscle groups activate in a specific pattern for each. Ankle is first, then hip, then stepping, then reaching. Ankle strategy uses PF's, hip uses hip flexors and abs. - *** Ankle utilizes DISTAL to proximal muscles (distal first). PF's utilized first, then HS's, then paraspinals. - *** Hip strategy utilizes proximal to distal muscles (proximal first). So hip strategy does abs and hip flexors, then quads, then DF's, etc. - Paraspinals or DF's acting first means you have a backward sway

Answer 237

Answer: D (hypotension) Explain: ACE inhibitors decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II. Dr's use ACE inhibitors to treat pt's with HTN and CHF. Common side effects thus are hypotension. - Bradycardia is a side effect for those taking beta-blockers - Dehydration is a side effect for those taking a diueretic - Hypokalemia refers to low levels of potassium (and that leads to muscle cramps, weakness, fatigue). HYPERkalemia is a side effect of ACE inhibitors.

Answer 238

Answer: C (flexion of arms and legs) Explain: The tonic labyrinth reflex is a reflex that occurs based on body positioning. The stimulus for this reflex is the position of the labyrinth in the inner ear, which is effected by head position. Prone positioning increases flexor tone, while supine positioning increases extensor tone. This reflex begins at birth and is typically integrated by 6 months of age. - If a baby's head is flexed, they'll do flexion of arms and extension of legs - If a baby's head is extened, they'll extend arms and flex legs - Flexing arms and legs happens when baby is placed in prone and still has the labyrinth reflex present - Extension of arms and legs happens when baby is in supine (if they have the labyrinth reflex still)

Answer 239

Answer: D (upper trap) Explain: Muscle length testing involves elongating the muscle in the direction opposite of the muscle's action. Usually you need to stabilize the bony prominence where muscle orginiates

Answer 240

Answer: A (scoliosis) Explain: RLD (restrictive lung disease) includes any condition that results in a reduction of lung volume and chest wall compliance. RLD can have a pulmonary or extrapulmonary etiology. A pt with RLD may present with decrased chest mobility, decreased breath sounds, SOB, hypoxemia, a rapid and shallow breathing pattern (tachypnea), ineffective cough, and increased use of accessory muscles. - Scoliosis is a potential extrapulmonary etiology for RLD. Since the spine curves, the deformity impacts the ribcage and thus lungs causing RLD. - Chronic bronchitis results in MORE or increased total lung capacity, residual volume.

Answer 241

Answer: B (Boston) Explain: Scoliosis can be idiopathic or congenital. Medical management is determined by progression of the scoliosis (magnitude of the curve). Girls and boys can get this, but girls are more likely to get larger curves. - Halo vest is an invasive cervical-thoracic orthosis that restricts cervical motion (metal ring with 4 posts with pins through skull) - A pt with scoliosis range of 25-40 deg's requires some orthosis like a Boston brace. - A curve greater than 40 deg's requires spinal surgery (fusion with a rod)

Answer 242

Answer: D (circumflex artery) Explain: Review artery's of the heart. The R and L coronary artery branch off the aorta and supply blood to the heart. Occlusion causes a MI. - R coronary artery supplies R heart and is smaller since it pumps deoxygenated blood to lungs - The posterior descending artery is a branch of the R coronary artery. It supplies blood to the posterior portion of the interventricular septum and inferior walls of both ventricles - The L anterior descending artery is a branch of the L coronary artery and supplies blood to the anterior portion of L ventricle (most common site for a MI) - Circumflex artery is a branch of the L coronary artery, and supplies blood to lateral portion of L ventricle. Damage or occlusion causes damage to posterolateral L ventricle.

Answer 243

Answer: A (striking 2 blocks together) Explain: Striking 2 blocks together happens around 8-9 months. This takes coordination - Holding an object in one hand and using the other to strike it happens around ages 5-6 months - Transferring an object between hands happens around 6-7 months (this happens before striking 2 objects together) - Shaking a held object happens around 4 months

Answer 244

Answer: C (anterior) Explain: ER is the MOST restricted motion in the capsular pattern of the G/H joint, followed by abduction, then IR. Thus, ER motion you'd want to do anterior glide to increase ER motion. - Posterior glide helps with flexion, IR, and hor add - Inferior glide helps with abduction, flexion - Anterior glide helps with ER and extension, and hor abd - Superior glide is not normally done

Answer 245

Answer: A (centrilobular emphysema) Explain: Emphysema is when air accumulates in lungs (in COPD) and elastin in alveoli are destroyed so the air sacs are enlarged and damaged. There are 3 classifications of emphysema: centrilobular, panlobular, and paraseptal. - Centrilobular: Most common type of emphysema and typically destroyes upper lobes of lungs while alveolar sacs remain in tact. Smoking is main cause of this type of emphysema. - Paraseptal: this is in the lower lobes of the lungs, and destroys alveolar sacs (air pockets). It is least common form of emphysema. - Pneumonia is inflammation of air sacs in one or both lungs. Caused by bacteria, virus, fungus, parasite, infection. Children are most prone to get pneumonia. - Pulmonary fibrosis is a RESTRICTIVE lung disease where damage to alveoli creates scarring on tissues (scar tissue). Cause is idopathic, but could be from dust, asbestos, animal droppings, etc.

Answer 246

Answer: C (heel lift during midstance)

Answer 247

Answer: A (delayed response time to ?s) Explain: Aphasia is a neurological impairment of processing for receptive and/or expressive language. The condition is the result of a brain injury, head trauma, CVA, tumor, infection, etc. Diagnosis is based on site of the lesion in the brain and the blood vessels involved. Abulic aphasia is a finding associated with occlusion of anterior cerebral artery, along with potential akinetic mutism (conscious unresponsiveness). - Abulic aphasia is reduces spontaneous speech and delayed response time to ?s. People with this will also struggle socially or avoid social circumstances. - Broca's would manifest in limited speech production and jumbled words. Broca's is expressive aphasia (and most common type of aphasia). Broca's is in the front portion of the brain and gets blood from middle cerebral artery. - Inability to understand ?s being asked is usually Wernicke's aphasia. Wernicke's is "receptive aphasia", and Wernecke's area is temporal lobe and gets blood from middle cerebral artery. - Inability to produce or comprehend language is referred to as global aphasia. So this would be from a stroke that impacts frontal, temporal, and parietal lobes (Broca's and Wernicke's)

Answer 248

Answer: C (slide board) Explain: Transfers range from completely dependent to independent. - Sliding transfer is dependent and often used from transfering a pt from supine position from one bed/table to another. Put sheet under pt to slide to new table. - hydraulic lift used for obese pt's - Slide board is not dependent on therapist

Answer 249

Answer: B (elevated protein levels) Explain: Guillain-Barre Syndrome (GBS) is a temporary inflammation and demyelination of the myelin sheaths of peripheral nerves. A physical and neurological examination, strength testing, and review of medical history are all important to help diagnose GBS. It can be diagnosed through a cerebralspinal fluid (CSF) test where you'd find elevated levels of protein without an increase in leukocytes. Additionally, electromyography tests will result in abnormal or slowed nerve conduciton. - CSF samples should not have erythrocytes (RBC's), and very low levels of leukocytes (WBC's). High levels of RBC's means some spinal cord injury - GBS pt's will demonstrate high levels of protein in CSF samples (called albumin) from inflammation of the nerves - Gamma Globulin is a type of blood protien produced by lymphocytes and plasma cells during an immune response. High levels of gamma globulin in CSF indicates MS (Multiple Sclerosis) *** but not found in GBS. - Low glucose levels in CSF is just due to hypoglycemia (low blood sugar) or bacterial infection or meningitis.

Answer 250

Answer: B (80)

Answer 251

Answer: A (decrease at point of lesion) Explain: Nerve conduction velocity (NCV) tests can help detect lesions of a peripheral nerve via abnormalities in the speed of the electrical impulse. Neurapraxia is the mildest form of nerve injury that involves some local compression or blockage of the nerve. Nerve fibers are not damaged and there is no evidence of nerve degeneration. These injuries can be caused by trauma to or entrapment of the nerve. - *** Look up degrees / levels of nerve injury - A neuropraxia injury will result in decreased NCV along the area of compression /injury. It typically affects the nerve along the locaiton of the lesion only. Distal nerve conduciton is fine. - It does NOT impact nerve conduction distal to lesion. If it effects distal, it is a higher degree of injury (like axonotmesis). - A complete loss of electrical conduciton at all points distal is the most severe degree (neurotmesis). ALl motor and sensory distal is gone and permanent due to complete lesion. - Decreased NCV only at points proximal to lesion would not be expected.

Answer 252

Answer: B (seepage) Explain: A hot pack consists of a canvus or nylon covered pack filled with hydrophilic silicate gel that provides a moist heat. THe size and shape of the hot pack varies depending on the size and contour of the treatment area. - A power failure would result in the water temp being low - A disruption in the canvas case may cause small quantities of the silicate to be released into the water, so it appears cloudy - An ineffective heating element won't heat the water - A thermostat that is set too low wound not heat heat pack

Answer 253

Answer: B (retinacular ligaments) Explain: There are several structures within the hand that can limit a pt's AROM or PROM including ligaments, tendons, joint capsules, etc. - The Haines-Zancolli test can be used to determine which structure is affecting ROM at the DIP jt of the hand. - The distal interphalangeal joint capsule is a one-joint structure which would affect mobility at the DIP joint. Thus, it shouldn't change even if the other joints change. If the pt has a tight DIP joint capsule, it would limit DIP flexion even if PIP is flexed. - The oblique and transverse retinacular ligaments cross the volar aspect of the PIP joint, but cross the dorsal aspect of the DIP joint as they insert into the common extensor mechanism. Because of this unique orientation, the structure most limiting when the PIP joint is extended and the DIP joint is flexed. If the PIP joint is flexed, the structure will be put on slack and there will be more available ROM at the DIP joint. - The extensor digitorum muscle crosses the dorsal aspect of both the PIP and DIP joints, thus, when both are in flexion it would limit this ROM. - The flexor digitorum profundus muscle crosses the volar aspect of both the PIP and DIP joints. Because of this orientation, this muscle would only limit extension, not flexion.

Answer 254

Answer: Direct (A) Explain: Ionto is transcutaneous delivery of ions into the body for theraputic purposes using electrical current. - Direct current is characterized by an uninterrupted flow of electrons toward the positive pole. This is necessary to move the ions to the dermal barrier. Polarity remains constant - Alternating current is characterized by the bidirectional (constantly changing) continuous flow of electrons. Electrons flowing in an alternating current move from the negative to positive pole, reversing direction when the polarity is reversed. - Pulsatile current is characterized by three or more pulses grouped together and may be unidirectional or bidirectional. A series of unidirectional pulses is known as monophasic pulsed current and a series of bidirectional pulses is known as biphasic pulsed current. - INterferential current combines two high frequency alternating waveforms that are biphasic. The two waveforms are delivered through two sets of electrodes through seperate channels in the same stimulator.

Answer 255

Answer: B (AROM)

Answer 256

Answer: D (prolonged PR interval) Explain: MUST review EKG excel spreadsheet you put together. - EKG's are used to determine presence of ischemia or infarction in the heart, though it is also used to detect disturbances in heart rate and rhythm. A heart block occurs when there is a blockage in the electrical conduction system of the heart (commonly at the AV junction between atria and ventricles). There are 4 types of heart blocks: first degree, second degree type I (mobitz I), second degree type II (mobitz II), and 3rd degree. - Second degree type I (mobitz I) would appear as a progressively longer PR interval with one missing eventually. - ST segment elevation shows heart ischemia or infarction. ST segment elevation is usually sign of heart ischemia / MI and is an emergency. - Wide QRS complex is in ventricular arrythmia's like v-tach or PVC's. - First degree heart block is a prolonged PR interval (so delay of signal from AV node to SA node, but prolonged PR interval is consistently long.

Answer 257

Answer: D (Lean forward) Explain: - Lying in supine with LE's elevated is similar to trendelenberg and then there is increased weight on abdominal contents pushing on diaphragm, so diaphragm wouldn't move as well. - Trendelenberg is laying with head lower than LE's, so same concept as above point. Not good for a weak diaphragm. - Semi-fowler position is lying in bed in supine with head of bed elevated approx 30 deg's. This position is often used for pt's with CHF or cardiac conditions. But not the best for helping with dyspnea. - Leaning forward allows pecks to elevate rib cage so diaphragm doesn't have to work as hard, so helps with dyspnea.

Answer 258

Answer: D (amputate) Explain: Wagner Scale is for foot ulcers. It grades depth of wound and presense of infection. It is a 6 point scale (0-5 grades), and higher scores are more severe. A grade 4 is gangrene and would need amputation. - Pulsed lavage is NOT used on gangrene, it is used on necrotic tissue. - Total-contact casting helps relieve pressure on plantar foot to take pressure off ulcer. It is used for superficial ulcers (grade 1). - Oral antibiotics help when wound is infected, like grade 3 ulcers (or even grade 2) - Grade 4 is gangrene partially, so it just needs to be removed.

Answer 259

Answer: A (swayback) Explain: Plumb line goes through ear, shoulder, lumbar vertebrae, hip jt, knee jt, and lateral malleolus. - Swayback posture is flattening of lumbar spine and posterior displacement of upper trunk - Genu recurvatum is knee hyper extention

Answer 260

Answer: B (internal intercostals) Explain: Spinal cord injuries obviously impact breathing. - External intercostals are innervated by T1-T12, but external intercostals are involved in INSPIRATION, not expiration - Internal intercostals work during EXPIRATION (especially used during forced expiration) ... abs are used for forced expiration too. - *** REMEMBER that the diaphragm is innervated by C3-C5 (3,4,5 keeps you alive), so diaphragm would work great. - Quadratus lumborum is an accessory muscle during forced expiration, but it is innervated by L1-L3, so wouldn't work on this pt.

Answer 261

Answer: B (loading response) Explain: - Terminal swing begins when the tibia is perpendicular to the floor and ends when foot touches the ground. Ankle is in neutral, so can't tell anything about PF. - Loading response is time between initial contact and beginning of swing phase for other leg. The ankle needs to do at least 15 degrees of PF during this phase. - Initial contact is when foot strikes ground and ankle is still in neutral position. - Midstance is when foot is on floor during midstance so body is over limb, and the ankle moves from PF into neutral into DF.

Answer 262

Answer: B (decreased cardiac output) Explain: As we age, we get a reduction in cardiac pacemaker cells, increased cardiac afterload, and diminished arterial elasticity. This results in reduced cardiac output (SV x HR) and increase in SYSTOLIC blood pressure. - Diastolic BP generally will stay the same or decrease with age, while systolic BP increased due to vascular rigidity with aging. - With increased age, cardiac output decreases making older adults less tolerant to exercise activity and fatigue easy. - Cardiac afterload (measure of blood remaining after the ventricles contract) increases with age. This is due to atherosclerosis (especially in the aorta) that happens with age. - Arterial patency decreases with aging due to plaque deposits and diminished elasticity of arterial walls. This results in an increased systolic BP. That is why older adults are more prone to stroke, CAD, CHF, etc.

Answer 263

Answer: C (beta-adrenergic agonist) Explain: Asthma is an obstructive respiratory condition where airway gets inflammed, bronchospasms, and mucus plugging. Symptoms include SOB, wheezing, and coughing. Exercise, allergens, pollution, or stress can trigger asthma attacks. - Mucolytics drugs are used to treat secretion build up in airways. Used on pt's with chronic asthma to reduce mucus buildup, thus not effective in an ACUTE asthma attack. - Antihistamines are used for allergic reactions. Antihistamines block binding of histamine to its receptor sites in airways, so decreasing symptoms of an allergic reaction. - Beta-adrenergic agonist are used to reduce effects of bronchospasms (like you'd have in an acute asthma attack). These drugs activate the beta 2 receptors so smoothe muscles (airways) relax. - Antitussives are used to suppress coughing when someone has a common cold or throat irritations. Coughing is a symptom of an asthma attack, but these drugs would not reverse the bronchospasms thus not helping with SOB.

Answer 264

PARKINSONS

Answer 265

Answer: D (metabolic alkalosis) Explain: Oral potassium choloride is often administered when potassium levels are extremely low and need to be replenished. Acid-base disorders are often related to respiratory and/or metabolic disorders. - Respiratory acidosis is characterized by elevated PaCO2 and below normal pH due to hypoventilation. - Respiratory alkalosis refers to a state in which the pH is abnormally high indicating alkalemia. They are treated by increasing carbon dioxide retention. - Metabolic acidosis is a condition that occurs when there is an accumulation of acids due to an acid gain or bicarbonate loss. You administer sodium bicarbonate. - Metabolic alkalosis is a condition that occurs when there is an increase in bicarbonate accumulation or abnormal loss of acids. They experience hypokalemia (less potassium) and thus need a oral supplement of potassium chloride.

Answer 266

Answer: B (Deep peroneal / fibular)

Answer 267

Answer: C (speak with dietician)

Answer 268

Answer: C (stereognosis) Explain: There are several types of sensation that a PT may evaluate including superficial, deep, cortical (combined sensations). A PT should examine superficial and deep sensations first, followed by cortical. - Graphesthesia is the ability to identify a number or letter drawn on the skin without visual input. Use a pen cap or tip of reflex hammer. - Vibration is a DEEP sensation done with a tuning fork over a bony prominence. - Stereognosis refers to the ability of a pt to identify objects placed in the hand without visual assistance (like Brian did in class). Objects like a coin, comb, paper clip, pen, leaf, etc. - Barognosis refers to recognition of weight. Pt is asked to compare objects of different sizes / weights. Combs would thus not be used in this test.

Answer 269

Answer: A (potassium) Explain: Cardiac arrythmia is a disturbance in heart rate and rhythm as a result of abnormal electrical conduction of the heart. Dysarrythmia's are a common form of a MI - Potassium is very important to nerve and muscle function, especially cardiac muscle. Increased potassium in blood is due to kidney disease. Increased potassium is hyperkalemia, and can cause arrythmia's.

Answer 270

Answer: C Explain: One MET (metabolic equivalent) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2/kg/min. MET's are used as a comparison between resting energy cost and the energy cost of an activity. - Systolic BP does increase as MET's increase, but isn't the measurement - HR also goes up, but also isn't the measurement of a MET - 1 MET is at rest, so MET of 5 indicates physical activity 5x what they do at rest. - Pulse pressure is difference between systolic and diastolic blood pressure. As exercise increase, pulse pressure will increase (since systolic goes up while diastolic doesn't change much)

Answer 271

Answer: A (wide BOS with exaggerated mvmts) Explain: An ataxic gait is often caused by damage to the cerebellum, which controls muscular coordination (but could be from alcohol, stroke, MS, etc.) - Ataxia is defined as the presence of abnormal, uncoordinated movements. An ataxic gait pattern is characterized by staggering and unsteadiness. Usually it has a wide BOS and mvmts that are exaggerated. - legs crossing midline is scissoring gait pattern. Usually with spastic cerebral palsy. - Parkinson's shows signs of small shuffling, forward flexed trunk, quick small steps, and festinating. -

Answer 272

Answer: B (Distal femur) Explain: An osteochondroma is most common type of benign bone tumor. It can occur in any bone, but usually is around the knee (distal femur). It essentially is a growth plate that seperates and continues growing independently.

Answer 273

Answer: B (ant deltoid) Explain: MMT is done in a variety of positions, but you start against gravity. A grade of "fair" indicates that the muscle can hold the test position against gravity but can't hold if even a little pressure is added. - According to PT365, they said the Lats are tested with a pt in prone (arm in ext and IR). - The others are not tested in sitting

Answer 274

Answer: A (Glasgow coma scale, score of 4) Explain: Glasgow coma scale is a neurological assessment tool used after an injury to determine cognitive function. It assesses eyes open, verbal responses, motor responses, etc. The Rancho Los Amigos Level of Cognitive Functioning Scale is used to determine the cognitive and behavioral recovery the individual is in following a TBI as they emerge from a coma. - A score of 8 or less on the Glasgow is severe brain injury. A score of 4 is bad. - Glasgow coma scale score of 9-12 is moderate brain injury, score of 13-15 is mild, score of 14 or more is no real trauma/injury. - Level IV of Rancho scale is pt is in heightened state of activity. Nonpurposeful behavior and uncooperative. - Level VIII in Rancho means the pt is near normal cognitive functioning again (only slight mild impairments remain)

Answer 275

Answer: C (Stage III) Explain: Stages of malignancy is a 5 point scale, from 0 to stage IV. - Stage I: cancer that is limited to the tissue origin without lymph node involvement or metastasis. - Stage II: cancer that has spread into adjacent tissues. Lymph nodes only have minimal involvement. - Stage III: cancer that has spread to adjacent tissues, but involvement of lymph nodes. - Stage IV: cancer that has spread beyond the primary site to other areas of the body.

Answer 276

Answer: A (postural hypotension) Explain: Calcium channel blockers decrease entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demand of the heart. These meds can be used to treat hypertension, angina, arrhythmias, and CHF.

Answer 277

Answer: B (Basal ganglia) Explain: Cerebral Palsy (CP) is a permanent neurologic condition that occurs as a result of a defect or lesion to the immature brain. This insult to the developing brain can occur in utero, during birth, or even shortly after birth. CP is characterized by movement abnormalities, with the specific abnormality being based on the brain structure effected. CP can be classified as spastic, dyskinetic, ataxic, or mixed. - Spastic CP is caused by damage to the motor cortex (and results in spasticity) - Dyskinetic CP is caused by damage to basal ganglia, and can be athetoid or dystonic. Athetoid is slow, writhing, continuous movements. Dystonic is involuntary sustained or intermittent muscle contractions. - Ataxic CP is from damage to cerebellum. They will have difficulty coordinating movement. - Damage to the brainstem is not associated with CP. Brainstem is where all cranial nerves exit, thus damage here results in brain death or whatever CN was impacted.

Answer 278

Answer: B (Diastasis recti) Explain: Diastasis recti is seperationg of the rectus abdominis muscle along the linea alba (often happens during pregnancy). It is diagnosed if the distance is greater than 2 fingers. Try to reduce major ab activity until this has corrected

Answer 279

Answer: B (charcot-marie-tooth disease) Explain: Charcot-Marie-Tooth is a genetically inherited condition characterized by motor and sensory neuropathy, progressive muscle wasting, and diminished reflexes. You'll see distal muscle weakness and a steppage gait pattern. - Guillain-Barre and Post-Polio are both from some viral infection. Guillain-Barre also manifests with proximal muscle weakness

Answer 280

Answer: C (debride) Explain: The Red-Yellow-Black system uses a wound's surface color to direct treatment. A red wound is most desirable, followed be yellow (infected), and then black (dead). Black = eschar or necrosis. - Red = Granulation, that is good so protect wound. - Yellow = Infected or have slough (remove the necrotic infected tissue).

Answer 281

Answer: B (tilt in space) Explain: C4 means they will have traps / top of shoulder innervation and myotome and above (neck), but nothing below. - Removable armrests are necessary for those pt's that do slide board transfers (which would be a low thoracic or lumbar spinal cord injury) - Tilt in space frame allows pt to change position to avoid ulcers. It helps with weight shifting since the pt can't with C4 injury - Handrims and rim projections are necessary for pt with grip deficits (C4 they'll have nothing in UE) - Handheld joystick - C4 has not innervation to hold a joystick

Answer 282

Answer: D (side plank - hip hikes)

Answer 283

Answer: C (v-tach) ****** must review major arrythmia's *******

Answer 284

Answer: C (report to nurse) Explain: This could mean the pt has a urinary tract infection (UTI). You should report this. The physician does need to know yes, but the physician is typically NOT the first health care provider that would be involved in addressing this, the nurse would.

Answer 285

Answer: D (hydraulic lift)

Answer 286

Answer: B (midstance)

Answer 287

Answer: C (35 yrs) Explain: Cystic fibrosis is an inherited disease of the exocrine glands that effects the respiratory system. They will live typically to their mid 30's

Answer 288

Answer: A (gait training) Explain: Use an AD to take weight off pubic symphysis. Don't do ab work out in such an acute phase of post-partum. Lumbar stabilization and resistive exercises are good, but not as necessary as gait training when in hospital.

Answer 289

Answer: A (Hydromorphone)

Answer 290

Answer: D Explain: - Central Cord: Happens with hyper ext and presents with greater involvement in LE's and more motor deficits (not sensory) - Conus Medularis: Injury around L1 results in LE weakness and sensory loss bilaterally - Anterior Spinal Artery: Damage to artery from severe flexion. Lose temp and motor function (corticospinal and spinothalamic damage) - Cauda Equina: Below L1 level - damage to nerve roots. This is where you get saddle area sensation loss and bowel and bladder dysfunction

Answer 291

Answer: D Explain: ABI assesses arterial blood flow in LE's. You take BP from LE's and divide over BP of UE's. In normal pt, the value is 1.0. So a value of 0.36 is very low. Thus you'd see dramatic signs

Answer 292

Answer: B Explain:

Answer 293

Answer: B (every 2 hours) Explain: Repositioning is vital to prevent pressure ulcers, contractures. - The reason 30 mins is not right answer is that is a lot, and places burden on nursing staff (although it wouldn't hurt pt)

Answer 294

Answer: C (greater trochanter) Explain: The pt needs 20-25 deg's of elbow flexion while grasping cane. Remember a cane helps with balance, but NOT used for partial weight bearing.

Answer 295

Answer: C (ind with bathroom adaptations) Explain: Pt with T5 should be able to do bathroom transfers with just bathroom adaptations. - *** Using a slide board on a tub or toilet is a risk as it is not sturdy.

Answer 296

Answer: A (perceived exertion). Explain: Remember beta blockers decrease HR, so perceived exertion can help translate to what the actual / normal HR would be. - Another name of the perceived exertion scale is "Borg's Scale"

Answer 297

Answer: B Explain: The lateral pivot shift test is a commonly utilized special test designed to assess the integrity of the ACL. A positive test is indicated by a palpable shift or clunk occuring between 20 and 40 deg's of flexion, and suggests anterolateral rotatry instability.

Answer 298

Answer: A (temporal arteritis) Explain: - Polymyalgia Rheumatic (PMR) is characterized by joint pain and stiffness that is progressive. This condition is typically treated with systemic corticosteroids. Some pt's with PMR may also have temporal arteritis (giant cell arteritis), that can cause blindness or stroke. - Temporal arteritis, or giant cell arteritis, is a life threatening condition characterized by headache and visual disturbances. - Migraine headaches can cause visual disturbances, however, the condition is not commonly associated with polymyalgia rheumatica - Cervicogenic headahces can be present with shoulder and neck pain, however, visual disturbances are not common with these HA's - Transient Ischemic Attacks (TIA's) can present with HA and visual disturbances, however, the condition is not commonly associated with polymyalgia rheumatica

Answer 299

Answer: D (alter pulse rate and width) Explain: Sometimes pt's get TENS units for home, and PT's need to educate them on how to use them properly. PT's must teach what parameters are and how to adjust them.

Answer 300

Answer: B (C7) Explain: Obviously anything BELOW is impaired. So if C7 is where motor is intact, then C8 and below has no MOTOR innervation. C8 was lowest sensory. THUS, C7 must be neurologic level since that is the lowest level with both motor and sensory.

Answer 301

Answer: D Explain: Remember the rating of percieved exertion is a SUBJECTIVE tool

Answer 302

Answer: B (daily standing program) Explain: DMD is a disease where kids are missing the dystrophin protien. And it is a progressive condition. Kids with DMD are likely to develop contractures. - Manual stretching is good, but NOT enough. The hold times of a few min's stretch isn't enough. A daily standing program where child stands in a standing frame for 30-40 mins is what is required to prevent contractures.

Answer 303

Answer: C (visual analog scale) Explain: - Descriptor Differential Sccale: consists of 12 descriptor items each centered over 21 horizontal dashes. At the extreme left dash is a minus sign, and at extreme right is a plus sign. Pt's are asked to rate the magnitude of their pain in terms of each descriptor. - Verbal Rating Scale: People are to describe their pain (ie: sharp, agonizing, burning) - Visual Analog Scale: uses a 10-15cm line with the left saying NO pain, and right saying "worst pain." You mark on line where you are at. - Numerical rating scale: asks pt's to rate their pain level on an intensity of 0-10 or 0-100. 10 being horrible pain.

Answer 304

Answer: 12 months

Answer 305

Answer: D (rigidity) Explain: You'd see severe atrophy in a LMN condition like polio, ALS, GBS, MD, etc.

Answer 306

Answer: B (post. med. malleolus)

Answer 307

**** THERE WILL BE A QUESTION ON THE BOARDS OF THE WAGNER SCALE Answer: C (3) Explain: Wagner Ulcer Classification is a scale used to grade foot ulcers. It bases the grade on wound depth and infection or gangrene. It is a 6 point scale (from 0-5) with a 5 meaning full gangrene, and 0 is fine. - Grade 0: no open wound at all - Grade 1: superficial ulcer without any subcutaneous tissue involvement. - Grade 2: Ulcer that penetrates the subcutaneous tissue with possible bone / tendon / ligament / joint capsule exposure - Grade 3: Everything from above, but now infection (abcess, osteomyelitis, infection) - Grade 4: Partial gangrene - Grade 5: Extensive gangrene

Answer 308

Answer: B (120) Explain: Remember the abduction motion is partly G/H joint, and partly scapular movement. It is a 2:1 pattern. The G/H joint does the 2, the scapula does the 1. So it does (should) get 180 deg's of passive abduction, but 120 of that is G/H, and 60 is scapula (or scapulothoracic). ***

Answer 309

Answer: A (Rhythmic initiation) Explain: Kinesthesia refers to the ability to identify the direction and extent of movement of a joint or body part. Proprioceptive neuromuscular facilitaiton (PNF) techniques typically involve movement patterns that follow diagonals that possess a flexion, extension, and rotary compontent and are directed toward or away from midline. PNF techniques can be used to develop muscle strength, endurance, stability, mobilty, neuromuscular control, and coordination. The appropriate technique is dependent on the goal of treatment. - Rhythmic initiation is a PNF technique used to initiate movement and help a pt learn a movement pattern. Movement progresses from passive (let me move you) to active assist (help me move you) to active to resistive. - Rhythmic stabilization is an alternating isometric force used to improve strength/stability. - Hold-Relax is more for stretching a muscle.

Answer 310

Answer: A (higher)

Answer 311

Answer: D (Pressure) Explain: Braden Scale is a scoring system used to assess a pt's RISK for developing a pressure injury. It factors in 6 elements: sensory perception, level of mobility, exposure to moisture, activity level, nutrition status, and exposure to friction and shear. All risk factors are scored 1-4 (friction and shear category is only 1-3) for a total of 23 points. The lower the score the higher the risk of developing a pressure injury. - Neuropathic ulcers are scored using Wagnar scale - Arterial ulcers are scaled using the ABI (Ankle-Brachial Index)

Answer 312

Answer: B (arrhythmias) Explain: - *** Muscle wasting or atrophy is a side effect from corticosteroids / glucocorticoids - Joint pain and swelling is an expected side effect of DMARD's (disease modifying anti-rheumatic drugs) - Respiratory depression is a side effect of opioids

Answer 313

Answer: B (dizziness) Explain: Digoxin has a positive inotropic effect. It will increase the force but decrease HR. It is used to treat heart failure. - You can get bradycardia from this, but won't get hemmorrhage. Bleeding would be from a thrombolytic agent (or anticoagulant or antiplatelet) - Involuntary movements and tremors are side effects of antipsychotic agents

Answer 314

Answer: B (slight angle) Explain: You want the bed height and w/c height basically equal. - You only need to remove one armrest. - Both elbows should be extended

Answer 315

Answer: D (under the seat)

Answer 316

Answer: C (anterior glides of talus) Explain: A capsular pattern refers to the predictable limitation of joint motion when the joint capsule is limiting the motion. Joint restrictions in a capsular pattern are typically caused by adhesions in the joint capsule following inflammation or immobilization for a prolonged time. The capsular pattern of the talocrural joint is greater loss in PF than DF. That is why you'd do an anterior glide of the talus to promote more PF.

Answer 317

Answer: A (anterior basal segm of L lower lobe) Explain: GERD (gastroesophageal reflux) is the result of an incompetent lower esophageal sphincther that allows reflux of gastric contents. This backwards movement of stomach acids can cause esophageal injury over time. - Treating the lower lobe causes the pt to be in trendelenberg position, so can cause reflux - Apical means tip, basal means base - Treating upper apical segment causes pt to be in sitting which would NOT cause reflux

Answer 318

Answer: A (LE and gait) Explain; Know the blood supply of the ACA, MCA, and PCA, and deficits manifested with injury to each. Occlusion to the ACA will produce contralateral hemiparesis and sensory loss with greater involvment in LE's (think of the homonculus). Could even impact personality as frontal lobe effected. - UE and facial m's (even UE spasticity) would be more from MCA injury - Coordination and balance deficits is more injury in cerebellum - Aphasia's are more involving the MCA

Answer 319

Answer: C (sublingual) Explain; - Enteral administration of drugs involves the mouth, esophogus, stomach, and intestines. Most common enteral routes are oral, sublingual, and rectal. - Parenteral are all administration methods that do not involve the GI tract - Intrathecal is a parenteral method - injecting drug into a sheath or meningeal layer (drug into CNS w/o having to pass blood-brain barrier) - Subcutaneous is a parenteral form of drug administration of injecting drug under skin into subcutaneous tissue to get into bloodstream - Sublingual is an enteral form of drug administration (done under the tongue, or in cheecks). Then drugs dissolves into blood stream. - Transdermal is a parenteral form of medication applied to surface of the skin to allow absorption of drug into skin into bloodstream

Answer 320

Answer: A (temporal arteritis) Explain: - Polymyalgia Rheumatica (PMR) is an inflammatory disorder characterized by progressive joint pain and stiffness, especially in the neck and shoulders. Typical onset of PMR occurs in women ages 50-80. Most get temporal arteritis (giant cell arteritis) that can cause blindness or stroke if left untreated. - Temporal arteritis, or giant cell arteritis, is a potentially life threatening condition characterized by HA's and visual disturbances. It is associated with polymyalgia rheumatica. - Trigeminal neuralgia is from irritation of the trigeminal nerve (CN V). You get sharp pain in jaw, teeth, gums, lips, etc. - Myofascial pain syndrome (MPS) is often mis-diagnosed as fibromyalgia. It is a localized musculoskeletal condition that is specific to a muscle and is characterized by trigger points, rather than the tender points associated with fibromyalgia. MPS is usually caused by overuse or repetitive motions. - TIA (or mini stroke) can have HA symptoms and visual disturbances, but it is NOT associated with polymyalgia rheumatica. **** Temporal Arteritis is associated with Polymyalgia Rheumatica .... HA's and visual disturbances.

Answer 321

Answer: C (anterior glide) Explain; Capsular patterns are joint restrictions of the joint capsule in a predictable pattern due to adhesions in the joint capsule following injury or immobilization. Capsular pattern of the talocrural joint is greatest loss in plantar flexion than dorsiflexion. - Doing an anterior glide of the talus promotes PF - You want to do CKC and strengthening exercises, but only after you've restored ROM

Answer 322

Answer: C (pacing ... because they fatigue so easily with Fibromyalgia) Explain: - Fibromyalgia Syndrome (FMS) is classified as a rheumatology syndrome or a nonarticular rheumatic condition. Pain is the primary symptom caused by tender points within muscles, ligaments, and tendons. FMS is best treated with a multi-discplinary approach including education, medical managment, exercise, etc. Pt's should NOT work through pain, and often requires short exercise sessions due to becoming fatigued. - Desensitization activities are more for pt's with CRPS (complex regional pain syndrome). - Strengthening and stretching are good - but exercise is best (so long as you pace and don't over-due it and fatigue pt)

Answer 323

Answer: D (calcium agent) Explain: stage III pressure injury is full thickness. Seropurulent drainage is yellow/tan and early sign of infection. - Transparent film dressings are thin and water resistant but allows you to see in / see the wound. These are for superficial wounds with minimal drainage. - Impregnated gauze is a guaze with silver impregnated into it, but used for minimally exuding wounds. - Hydrocolloid dressings consist of gel-forming polymers (gelatin). These are used for partial or full thickness wounds, but are less absorptive than alginate dressings. - Alginate dressings, like calcium agents, are for highly permeable wounds (like venous insuff. ulcers) with excessive drainage.

Answer 324

Answer: B (traction) Explain: You want to centralize symptoms. The movement system impairment (MSI) based classification model is used for interventions of directional preference. Treatment categories in this system are traction, extension, flexion, and stabilization, mobilization, and exercise approach(es). - Use stabilization exercises for pt's with spinal instability or hypermobility (like a spondy) - Traction is for disk herniation pt's - Flexion is for pt's who peripheralize during flexion (like stenosis pt's). Didn't have enough info to know what centralized pain for this pt - Extension is for disk pt's, but in standing (extension) it was painful

Answer 325

Answer: B (eccentric) - Concentric is when m's shorten - Eccentric is when m's work but lengthen (slowly lower) - Isometric is both sides contract to hold position - Isokinetic: m's move at consistent speed

Answer 326

Answer: C Explain: T5 means they have full UE and some upper trunk control. A slide board is just adding an unnecessary risk. Adaptations like a grab bar or higher seat are appropriate.

Answer 327

Answer: B (flexion) Explain: - Ext is 0-70 - Flexion is 0-80 - Rad Dev: 0-20 - Uln Dev: 0-30

Answer 328

Answer: B (C7) Explain: C6 is in tact, but it is not the most caudal segment where both motor and sensory are in tact - that is C7. Can't be C8 since motor only goes to C7.

Answer 329

Answer: A (hypotension) Explain: Combining these two would create hypotension. Calcium channel blocker meds decrease blood pressure by increasing vasodilation, and then the whirlpool will also create same effect.

Answer 330

Answer: A (bone scan) Explain: Bone scans will identify areas of bone that is hypervascular or has increased bone mineral turnover. Bone scans thus can show a stress fracture. - MRI's are mainly for soft tissue (muscle, meniscus, lig's, tendons, organs, etc.) - Telethermography shows thermal alterations in the body. So a scan showing hyperthermic activity would happen when there is inflammation or injury. A hypothermic image would be around a degenerative joint or some compression of vessel, etc. - Ultrasound is more for soft tissues.

Answer 331

Answer: B (arterial doppler ultrasound) Explain: Claudication is leg pain that results from peripheral vascular disease. But it can be from arterial or venous origin (or insufficiency). Pain is from ischemia to the tissues of the LE. - **** Since the pain happens during exercise/walking/movement and subsides with rest, it would be arterial insufficiency. If the pt's pain was caused by venous insuff, the pain would likely occur several hours after exercise and relief would not be immediate. - Doppler ultrasound is the diagnostic test to view vascular issues (look at blood flow in major arteries and veins)

Answer 332

Answer: C (transfemoral) Explain: The higher the amputation, the more difficult it is to do gait, balance, more energy expenditure, etc. - Symes is amputation through ankle. Chopart is through transtarsal (mid tarsal) joint.

Answer 333

Answer: D (Cheyne-Stokes) Explain: Breathing patterns can change depending on different positions or situations. - Kussmaul's respiration includes deep and fast breathing that is associated with metabolic acidosis. This is panting labored breathing - Eupnea: normal breathing, normal rate, etc. - Orthopnea: dyspnea when laying, relieved by sitting up - Cheyne-Stokes: respiration that includes cycles of increasing and decreasing rate and depth of breathing with periods of apnea. Happens with CHF - Apnea: temporary cessation of breathing

Answer 334

Answer: C (3x p/wk) Explain: Hemodialysis is essentially an artificial kidney, a machine used to remove wastes and chemicals from blood/body. How often you go to dialysis depends upon what stage you are in of renal failure, how much fluids you intake, size of pt, etc. - 2 hours is not enough for a dialysis treatment session time, but 5 hours is too much. - 5x p/wk is too much. 3x p/wk is right for someone in end stage.

Answer 335

Answer: C (pericarditis) Explain: There are patterns of cardiac chest pain - MI occurs with prolonged with any prolonged ischemia to myocarium. It will present with sudden onset of pain that lasts up to 2 hours. You feel a crushing / squeezing / heavy chest pain. - Angina is also ischemia to myocardium, but feel a pain in chest and down left UE - Pericarditis is inflammation of the pericardium. You'd get a sharp sudden pain around sternum. *** IT INCREASES with INSPIRATION and DECREASES WITH FORWARD POSITIONING. And you can auscultate and heart it. - Myocarditis is inflammation of myocardium muscle. You do get a soreness in the chest, but pain is not typical and recovery is spontaneous.

Answer 336

Answer: A (atrophic gastritis) Explain: Vitamin deficiencies can mimic other medical conditions and are usually related to either malnutrition or an absorption issue. B12 can only be released from gastric acid, and the lack of acid can cause the described symptoms: - Atrophic gastritis is found in older adults that have decreased acid production. The acid is needed to produce Vitamin B12 - Delirium is when a pt is disoriented and irritable, but not associated with vitamin deficiency. Could happen from an infection - Dementia is a permanent condition related to cognitive impairment. These symptoms mimic dementia, but not caused by vitamin deficiency - Osteomalacia is a malabsorption condition where vitamin D is deficient (not Vitamin B12)

Answer 337

Answer: C (hypotension due to decrease) Explain: A diuretics help decrease fluid volumes for CHF pt's, so you get less blood plasma. Increasing blood plasma volume would increase blood pressure (hypertension)

Answer 338

Answer: B (TKA) Explain: Why height and age and gender are important is because it does impact vital capacity. Males have larger lungs than females, and the taller / larger you are, the more vital capacity you'll have. And the older you are, the LESS elastic your lungs would be.

Answer 339

Answer: A (altered sensation) Explain: Charcot's foot is a form of neuropathic arthropathy that involves bone destruction and absorption leading to an unstable joint. Sublaxation of the joints commonly results in a rocker-bottom foot deformity, which can cause ulcers due to the pressure. - *** Charcot's foot is usually seen in pt's with DM II, so they have neuropathy and loss of sensation. You'll see foot trauma and joint destruction. - Charcot's is MOST closely related to altered sensation in the foot *** Charcot's is NOT caused due to ulcers in the foot - Charcot would cause pes planus before pes cavus

Answer 340

Answer: B (figure 8) Explain: Pts with venous insuff are candidates for compression therapy to help reduce edema. But if someone also has arterial insuff, you have to be very careful. - Observing skin color, capillary refill, and palpating pulses would be appropriate to determine if doing compression was causing arterial issues. - But figure 8 measures only assess edema and don't assess circulation.

Answer 341

Answer: D (TKA)

Answer 342

Answer: B (ROM) Explain: all of these are important, but preventing a DVT and reducing inflammation are not really the main priorities of a PT, those are priorities of nursing and medical staff. And, ROM must come before strength, and not getting ROM causes long-term issues.

Answer 343

Answer: A Explain: Handrail (it is sturdier and more supportive) - Descending is harder since it requires more quad strength (ascending is easier)

Answer 344

Answer: C (splinting) Explain: RA has flare ups of inflammation in synovial tissues of a joint that result in erosion of cartilage and supporting structures within the capsule. Signs and symptoms include pain and tenderness of affected joints, morning stiffness, warm joints, malaise, and increased fatigue. RA has periods of exacerbation and remission.

Answer 345

Answer: B (ankle brace) - This is common that a pt will have a pain during this transition back to walking - it's normal. But instead of just telling them it is expected, give them a brace to help with the transition. - Remember the surgeon cleared them to get out of the boot, so imaging and going back to the boot is not necessary at this stage.

Answer 346

Answer: A. (67-year-old female with malabsorption syndrome) - Risk factors for developing osteoporosis include: older caucasian female; inactive lifestyle; diet inadequacies (Malabsorption syndrome); smoking; drugs; endocrine disorders - Metabolic Alkalosis is NOT associated with an increase in the risk of osteoporosis

Answer 347

Answer: D (decreased osteoblast, increased osteoclast) Explain: Osteoporosis is a metabolic bone disorder where the rate of bone resorption accelerates and rate of bone formation slows down. Osteoblasts are cells that help BUILD NEW BONE. B = B ... blasts build. Osteoclasts are cells that degrade bone material. So osteoclasts work and osteoblasts don't, leading to brittle bones.

Answer 348

Answer: A (cozen's) Explain: Cozen's test is the pt makes a fist, pronates arm, extends elbow and extends wrist against resistance. PT palpates CET and if their is pain = positive test. - Pinch grip test is for assessment of anterior interosseous nerve. Pt will pinch index and thumb pads together, and if there is weakness and pain = positive - Elbow-Flexion test is when pt flexes both elbows fully and extend wrists and holds this position for 3-5 minutes. It is a positive test if there is tingling, or paresthesia in the ulnar nerve distribution of hand. It assesses cubital tunnel syndrome. - Bunnel-Littler test is a test for intrinsic hand muscle weakness

Answer 349

Answer: C (kyphoplasty)

Answer 350

Answer: A (Cushing's) Explain: Osteopenia is associated with Cushings and HYPERparathyroidism