quiz 1 Flashcards
A physical therapist in an outpatient clinic is evaluating a 23-year-old female patient for general weakness and fatigue. The patient discloses that she was recently hospitalized and on a ventilator for 10 days. In addition to physical limitations, which of the following impairments should the physical therapist screen for?
A) Mental health
B) Both cognitive and mental health
C) None; there is no reason to suspect non-physical impairments.
D) Cognitive
Correct Answer: B) Both cognitive and mental health
A physical therapist should always wash hands with soap and water rather than hand sanitizer after treating a patient who has which of the following conditions?
A) Tuberculosis
B) C. difficile
C) COVID-19
D) Human immunodeficiency virus (HIV)
Correct Answer: B) C. difficile
this is 100% right based on my knowledge
Which of the following precautions should a physical therapist take when treating a patient who has an endotracheal tube?
A) Ask the bedside nurse if the tube can be disconnected prior to mobilization.
B) Check the depth of tube insertion prior to and following mobilization.
C) Ensure that the transducer is at the phlebostatic axis during mobilization.
D) Perform only bed level activities with this patient.
Correct Answer: B) Check the depth of tube insertion prior to and following mobilization
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Which of the following lists is presented in the correct order for REMOVAL of PPE?
A) Gloves, eye protection, mask, gown
B) Gown, gloves, eye protection, mask
C) Gown, eye protection, mask, gloves
D) Gloves, gown, eye protection, mask
Correct Answer: D) Gloves, gown, eye protection, mask
Pretty sure this is correct
What is the name of the deformity shown in the picture in the 5th digit?
A) Mallet finger
B) Digitorum edematous
C) Swan neck
D) Boutonniere
Correct Answer: D) Boutonniere
D) Boutonniere
this is correct based on my knowledge
A physical therapist is reviewing the medical chart of a patient in intensive care. The patient is currently on a moderate dose of norepinephrine (Levophed), a vasopressor medication. Given this information, which of the following additional questions is MOST important for the therapist to ask the bedside nurse or obtain from the chart?
A) What has been the trend of the medication dose over the last few hours and days?
B) What is the patient’s Richard Agitation and Sedation Scale (RASS) score?
C) Did the patient pass the spontaneous breathing trial (SBT) this morning?
D) Can the dose of the medication be reduced in order to improve the patient’s hemodynamic stability for therapy?
Correct Answer: A) What has been the trend of the medication dose over the last few hours and days?
This is changed from D to A
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Which of the following statements BEST describes the prognosis of post-intensive care syndrome (PICS)?
A) The physical deficits are irreversible; however, cognitive impairments are transient in nature.
B) This condition is usually fatal.
C) Recovery is slow and often incomplete.
D) Recovery typically occurs within days following hospital discharge, and most patients do not need ongoing services.
C) Recovery is slow and often incomplete
Answer: C) Recovery is slow and often incomplete.
Explanation:
Post-Intensive Care Syndrome (PICS) refers to the constellation of physical, cognitive, and psychological impairments that persist after a patient survives a critical illness requiring intensive care. These impairments can significantly impact the quality of life and functional independence of survivors.
Option A: The physical deficits are irreversible; however, cognitive impairments are transient in nature.
Incorrect. While PICS can involve persistent physical deficits, they are not necessarily irreversible. With appropriate rehabilitation, patients can make significant physical improvements, although they may not return fully to their pre-illness baseline.
Cognitive impairments in PICS are often long-lasting and can persist for months to years. Issues like memory deficits, decreased attention, and executive dysfunction are common and may not be transient.
Option B: This condition is usually fatal.
Incorrect. PICS itself is not typically fatal. It represents the ongoing impairments after survival from critical illness.
The syndrome affects survivors and is characterized by lingering deficits rather than causing death.
Option C: Recovery is slow and often incomplete.
Correct. Recovery from PICS is frequently protracted, involving months to years of rehabilitation.
Many patients experience persistent deficits in physical strength, cognitive function, and psychological well-being.
Studies have shown that even after one year, many survivors still report significant impairments affecting daily living and quality of life.
Functional recovery may plateau before reaching the individual’s pre-illness baseline, making it often incomplete.
Option D: Recovery typically occurs within days following hospital discharge, and most patients do not need ongoing services.
Incorrect. Recovery from PICS does not occur within days; it is a long-term process.
Most patients require ongoing rehabilitation services such as physical therapy, occupational therapy, cognitive rehabilitation, and psychological support.
Early discharge does not equate to quick recovery; the complexities of PICS necessitate extended care beyond hospitalization.
Summary:
Post-Intensive Care Syndrome leads to prolonged and sometimes permanent deficits in multiple domains.
Option C accurately reflects the typical prognosis, emphasizing that recovery is slow and often incomplete, requiring sustained rehabilitation efforts.
When treating a patient with influenza, what personal protective equipment is MOST appropriate for the physical therapist to wear, in addition to gloves?
A) Mask and eye protection
B) Gown, eye protection, and respiratory (N95) mask
C) Mask
D) Mask and gown
C) Mask
Answer: C) Mask. Changed from B.
Explanation:
When treating a patient with influenza, the primary concern is preventing the transmission of the virus to healthcare workers and other patients. Influenza is primarily transmitted through droplet transmission, which involves large respiratory droplets generated when an infected person coughs, sneezes, or talks. These droplets typically travel short distances (up to about 3 feet) and can infect others through contact with mucous membranes of the nose, mouth, or eyes.
Personal Protective Equipment (PPE) Guidelines for Influenza:
Standard Precautions: These are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status. They include hand hygiene and the use of personal protective equipment like gloves when exposure to blood, body fluids, or contaminated surfaces is possible.
Droplet Precautions: In addition to standard precautions, droplet precautions are required for infections like influenza. The key PPE for droplet precautions is a surgical mask worn when within 3 feet (approximately 1 meter) of the patient. This mask helps prevent inhalation of large respiratory droplets.
Evaluation of Options:
Option A: Mask and eye protection
Eye protection (goggles or face shield) is generally recommended when there is a risk of splashes or sprays of blood, body fluids, secretions, or excretions, which could occur during aerosol-generating procedures (e.g., suctioning, intubation).
For routine care of a patient with influenza, eye protection is not typically required unless performing such procedures.
Option B: Gown, eye protection, and respiratory (N95) mask
An N95 respirator mask is used for airborne precautions, which are necessary for infections transmitted via airborne particles (e.g., tuberculosis, measles, varicella). Influenza does not require airborne precautions under normal circumstances.
Gown and eye protection are not routinely required for droplet precautions unless there’s a high risk of contamination or exposure to bodily fluids.
Option C: Mask
A surgical mask is the essential PPE for droplet precautions.
Worn to protect mucous membranes of the nose and mouth from contact with respiratory droplets.
Most appropriate for routine care of a patient with influenza in addition to gloves.
Option D: Mask and gown
A gown is primarily used under contact precautions to protect clothing from contamination when dealing with infections spread by direct or indirect contact (e.g., MRSA, VRE).
Not routinely required for droplet precautions unless there’s a likelihood of significant contact with the patient’s secretions or excretions.
Conclusion:
The most appropriate PPE for a physical therapist treating a patient with influenza, in addition to gloves, is a mask (Option C).
This aligns with the droplet precautions recommended by infection control guidelines.
Additional PPE like gowns, eye protection, or N95 respirators are not typically necessary unless specific procedures or circumstances increase the risk of exposure.
A 30-year-old female patient reports having “pain everywhere.” Her medical history includes hypothyroidism, depression, and sleep disorder. Which of the following diagnoses is MOST likely?
A) Chronic fatigue syndrome
B) Rheumatoid arthritis
C) Osteoarthritis
D) Fibromyalgia syndrome
D) Fibromyalgia syndrome
This is correct based on o1
Answer: D) Fibromyalgia syndrome
Explanation:
The patient’s symptoms and medical history are most consistent with fibromyalgia syndrome.
Key Features Supporting Fibromyalgia Syndrome:
Widespread Pain:
The patient reports having “pain everywhere,” which is a hallmark symptom of fibromyalgia.
Fibromyalgia involves chronic, widespread musculoskeletal pain affecting multiple areas of the body.
Age and Gender:
Fibromyalgia is more common in women than men.
It often develops in young to middle-aged adults. The patient is a 30-year-old female, fitting the typical demographic.
Associated Conditions:
Hypothyroidism:
Hypothyroidism can exacerbate fibromyalgia symptoms and is sometimes seen concurrently.
Depression:
There is a strong association between fibromyalgia and mood disorders like depression.
Sleep Disorder:
Sleep disturbances are a common feature of fibromyalgia, including difficulties with non-restorative sleep and insomnia.
Why Other Options Are Less Likely:
A) Chronic Fatigue Syndrome (CFS):
While CFS shares symptoms like fatigue and sleep disturbances, the primary complaint is profound fatigue lasting at least six months, not generalized pain.
Pain may be present but is typically not as widespread or as prominent as in fibromyalgia.
B) Rheumatoid Arthritis (RA):
RA is an autoimmune disorder characterized by symmetrical joint pain, swelling, and stiffness, particularly in the small joints of the hands and feet.
It usually presents with specific joint involvement rather than “pain everywhere.”
RA can occur at 30 years old but is less likely without specific joint symptoms.
C) Osteoarthritis (OA):
OA is a degenerative joint disease more common in older adults.
It involves joint pain and stiffness due to cartilage breakdown but is typically localized to weight-bearing joints like the knees and hips.
Generalized pain is not characteristic of OA.
A physical therapist arrives to treat a patient and learns that the patient has just been placed on the pressure support mode of ventilation for the first time. With this mode, there is no set respiratory rate or tidal volume. Prior to this, the patient was on a mode that controlled the patient’s ventilation. Which of the following considerations is MOST important for the treatment?
A) It is not appropriate for the therapist to treat the patient while on this mode of ventilation.
B) The patient will have to be heavily sedated to tolerate this mode of ventilation.
C) The therapist should monitor the patient closely for increased work of breathing.
D) This mode of ventilation should allow the patient to have improved activity tolerance.
C) The therapist should monitor the patient closely for increased work of breathing.
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Answer: C) The therapist should monitor the patient closely for increased work of breathing.
Explanation:
When a patient is switched to pressure support ventilation (PSV), it indicates a significant change in their ventilatory support. Understanding how this mode affects the patient is crucial for safe and effective physical therapy intervention.
Understanding Pressure Support Ventilation (PSV):
Patient-Initiated Breaths: In PSV, the patient must initiate each breath on their own.
No Set Respiratory Rate or Tidal Volume: Unlike controlled modes, PSV does not provide mandatory breaths or set volumes. The ventilator delivers a preset level of positive pressure to assist with each spontaneous breath.
Weaning Mode: PSV is often used as a step towards weaning the patient off mechanical ventilation, encouraging them to take over more of the work of breathing.
Key Considerations for the Physical Therapist:
Increased Work of Breathing:
Patient Effort: The patient now has to generate the effort to initiate breaths and control their own respiratory rate and tidal volume.
Risk of Fatigue: This increased demand can lead to respiratory muscle fatigue, especially in patients who have been on controlled ventilation modes.
Monitoring Signs: The therapist should closely observe for signs of increased work of breathing, such as:
Tachypnea (increased respiratory rate)
Use of accessory muscles
Shortness of breath
Decreased oxygen saturation
Changes in mental status (e.g., confusion, agitation)
Adjustment of Therapy Intensity:
Activity Tolerance: The patient may have decreased activity tolerance due to the additional respiratory workload.
Therapy Modifications: Interventions may need to be adjusted to accommodate the patient’s current respiratory status, possibly focusing on less intensive activities or incorporating rest periods.
Communication with Medical Team:
Coordination of Care: Collaborate with the respiratory therapist and medical team to understand the patient’s readiness for activity and any precautions.
Immediate Reporting: Any signs of distress or increased work of breathing should be promptly communicated.
Why Other Options Are Less Appropriate:
Option A: It is not appropriate for the therapist to treat the patient while on this mode of ventilation.
Incorrect. Physical therapy can be beneficial during PSV to assist with weaning and improving functional status.
Early Mobilization: Evidence supports the safety and benefits of mobilizing patients on ventilatory support, including PSV, with appropriate monitoring.
Option B: The patient will have to be heavily sedated to tolerate this mode of ventilation.
Incorrect. PSV requires the patient to be awake enough to initiate breaths.
Reduced Sedation: Patients are often less sedated during PSV to facilitate spontaneous breathing and weaning efforts.
Option D: This mode of ventilation should allow the patient to have improved activity tolerance.
Incorrect. While PSV is a positive step toward ventilator weaning, the patient’s activity tolerance may initially decrease due to the increased respiratory workload.
Potential for Fatigue: The patient may tire more easily during physical activities because they are now performing more of the work of breathing.
Conclusion:
Monitoring the patient closely for increased work of breathing is the most important consideration when treating a patient who has just been placed on pressure support ventilation. This ensures patient safety, allows for timely adjustments to therapy, and facilitates effective communication with the medical team.
A 39-year-old female patient presented to a physical therapy evaluation with pain in the right hip after hiking one week ago. She has a diagnosis of systemic lupus erythematosus, and her current medications include a corticosteroid, NSAID, and a multivitamin. Which of the following causes of hip pain is MOST likely?
A) Osteomyelitis
B) Osteoarthritis
C) Trochanteric bursitis
D) Femoral head avascular necrosis
D) Femoral head avascular necrosis
This is correct checked with chat gpt o1
Answer: D) Femoral head avascular necrosis
Explanation:
The patient’s presentation and medical history suggest that femoral head avascular necrosis (AVN) is the most likely cause of her right hip pain.
Key Factors Supporting Femoral Head Avascular Necrosis:
Systemic Lupus Erythematosus (SLE):
SLE is an autoimmune disease that can affect multiple organ systems.
Patients with SLE have an increased risk of developing AVN due to vasculitis and thrombotic tendencies affecting blood supply to bones.
Corticosteroid Use:
The patient is currently taking corticosteroids.
Corticosteroid therapy is one of the most significant risk factors for AVN.
Steroids can lead to fat embolism, increased intraosseous pressure, and reduced blood flow to the femoral head.
Sudden Onset of Hip Pain:
AVN often presents with acute or subacute onset of pain in the hip or groin area.
Pain may be exacerbated by weight-bearing activities, such as hiking.
Age and Gender:
Although AVN can occur at any age, it is more common in adults between 30 and 50 years old.
Both men and women are affected, but certain risk factors like SLE and corticosteroid use increase the risk in women.
Why Other Options Are Less Likely:
A) Osteomyelitis:
Osteomyelitis is an infection of the bone.
It is less likely without signs of systemic infection (fever, elevated white blood cell count).
The patient lacks a history of recent surgery, open fracture, or infection that could seed bacteria to the bone.
B) Osteoarthritis (OA):
OA is a degenerative joint disease characterized by cartilage breakdown.
It develops gradually over time, usually in older adults.
The patient’s age (30 years old) makes OA less likely.
OA pain typically worsens with prolonged activity and improves with rest, without sudden onset after a specific event.
C) Trochanteric Bursitis:
Inflammation of the bursa over the greater trochanter causing lateral hip pain.
While hiking could contribute to bursitis due to overuse, the patient’s significant risk factors (SLE and corticosteroid use) point more strongly toward AVN.
Trochanteric bursitis pain is usually localized to the lateral aspect of the hip and may not account for deeper joint pain.
Conclusion:
Given the patient’s:
Diagnosis of SLE
Use of corticosteroids
Presentation of hip pain after activity
Femoral head avascular necrosis is the most probable diagnosis. Early recognition is crucial because AVN can lead to joint collapse and may require surgical intervention if not managed promptly.
Next Steps for the Physical Therapist:
Referral for Imaging:
Recommend the patient undergo imaging studies, such as MRI, which is sensitive for detecting early AVN.
Activity Modification:
Advise limiting weight-bearing activities to reduce stress on the femoral head.
Interdisciplinary Communication:
Communicate findings to the patient’s medical team for further evaluation and management.
Which of the following statements BEST describes the role of the physical therapist in implementing the ABCDEF bundle?
A) The therapist should ensure that family members are not present in the room during therapy sessions, as it may be traumatic for them.
B) The therapist should educate the physician about appropriate sedative medications to administer to patients.
C) The therapist should decide when the spontaneous awakening trial and spontaneous breathing trials occur.
D) The therapist should be a member of the interdisciplinary team and an advocate for early mobility and practices supporting early mobility.
D) The therapist should be a member of the interdisciplinary team and an advocate for early mobility and practices supporting early mobility.
this sounds right
A 45-year-old female patient reports chronic fatigue along with pain in both hands and feet. Pain is worse at night after working all day, and the patient also notes swelling at night. Upon examination, the physical therapist observes moderate bilateral ulnar drift, and laboratory results show an elevated level of rheumatoid factor. Which of the following conditions is MOST likely?
A) Osteoarthritis
B) Fibromyalgia syndrome
C) Chronic fatigue syndrome
D) Rheumatoid arthritis
D) Rheumatoid arthritis
Explanation:
Rheumatoid arthritis (RA): The patient’s symptoms, including chronic fatigue, bilateral hand and foot pain, swelling, worse pain at night, and ulnar drift, strongly suggest RA. The elevated rheumatoid factor further supports this diagnosis.
Osteoarthritis (OA): OA typically presents with pain localized to weight-bearing joints and does not usually cause ulnar drift or elevated rheumatoid factor. Morning stiffness may improve with activity, unlike RA’s persistent inflammation.
Fibromyalgia syndrome: This condition often causes widespread musculoskeletal pain and fatigue but does not involve joint swelling, ulnar drift, or elevated rheumatoid factor.
Chronic fatigue syndrome: While this condition explains fatigue, it does not involve joint pain, swelling, or specific hand deformities such as ulnar drift.
When evaluating a patient who is on mechanical ventilation, the ventilator begins alarming “high pressure.” Which of the following actions should the physical therapist take FIRST?
A) Discontinue the PT session and notify the respiratory therapist.
B) Check all ventilator connections.
C) Call for the bedside nurse to silence the alarm.
D) Have the patient rest and assess for potential suctioning needs.
B) Check all ventilator connections.
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Explanation:
High-pressure alarms on a ventilator indicate increased resistance to airflow. This can result from issues such as tubing kinks, obstructions (e.g., secretions), or patient-related factors like coughing or bronchospasm.
Option Breakdown:
A) Discontinue the PT session and notify the respiratory therapist: This might be necessary if the issue persists, but checking the ventilator connections is a more immediate and proactive step.
B) Check all ventilator connections: This is the FIRST action because it addresses common and easily correctable mechanical issues like disconnections or tubing kinks.
C) Call for the bedside nurse to silence the alarm: Silencing the alarm without investigating the cause is inappropriate and delays intervention.
D) Have the patient rest and assess for potential suctioning needs: Suctioning may be needed if secretions are causing obstruction, but it is not the first step—connections should be checked first.
Which of the following interventions is typically BEST to include INITIALLY when treating a patient who has fibromyalgia syndrome?
A) Aquatic therapy
B) Endurance training, ultrasound, and deep tissue massage
C) Circuit training, deep tissue massage, and iontophoresis
D) Resistance training, stretching, and deep tissue massage
A) Aquatic therapy
this is right based on the notes immuno pathologies UPDF
