SUSieg 2015 Set A Only Flashcards
A patient has undergone surgery and subsequent immobilization to stabilize the olecranon process. The patient now exhibits an elbow flexion contracture. In this case, an absolute CONTRAINDICATION for joint mobilization would be:
a. Empty endfeel
b. Soft endfeel
c. Springy endfeel
d.. Firm endfeel
a. Empty endfeel
An empty endfeel (no real endfeel) may be indicative of severe pain and muscle guarding associated with pathological conditions
Incorrect Choices:
Springy and firm endfeels may be expected after elbow surgery. Soft endfeel is an indication of range limitation because of tissue compression (eg. knee flexion, there is contact between the posterior leg and the posterior thigh). None of these is a contraindication for mobilization.
A PT is instructing a student in proper positioning to prevent the typical contractures in a patient with a transfemoral amputation. The PT stresses positioning the patient in:
a. sidelying on the residual limb
b. A wheelchair with a gel cushion and adductor roll
c. Prone lying with the residual limb in neutral rotation
d. Supine lying with the residual limb resting on a small pillow
Correct answer: c. Prone lying with the residual limb in neutral rotation
The typical contractures with a transfemoral amputation are hip flexion (typically from too much sitting in a wheelchair). The residual limb also rolls out into abduction and external rotation. When in bed, hip extension should be emphasized (eg prone-lying). When sitting in the wheelchair, neutral hip rotation should be emphasized (eg. using an abductor roll)/ Time in extension (prone, supine, or standing) should counterbalance time sitting in a wheelchair.
incorrect choices:
Resting in supine with the residual limb resting on a small pillow in a position of hip flexion is contraindicated, as is an adductor roll in wheelchair sitting. Sidelying on a residual limb has no benefit for this patient, and may also position the hip in flexion.
In treating a patient with a diagnosis of right shoulder impingement syndrome, the FIRST intervention the PT should consider is to:
a. Instruct the patient in proper postural alignment
b. Complete AROM in all shoulder motions
c. Implement a stretching program for the shoulder girdle musculature
d. Modulate all pain
Correct Answer: a. Instruct the patient in proper postural alignment
Without regaining normal postural alignment and scapular-humeral rhythm, the patient will continue to impinge the supraspinatus and/or biceps tendon at the acromion and never regain normal function of the shoulder.
Incorrect choices:
It is unlikely that all pain would be controlled. Appropriate AROM exercises and/or stretching could be the focus after posture has been corrected.
A patient with parkinson’s disease (PD) demonstrates a highly stereotyped gait pattern characterized by impoverished movement and a festinating gait. the intervention that would be MOST beneficial to use with this patient is:
a. Locomotor training using a motorized treadmill and body weight support harness
b. braiding with light touch-down support of hands
c. Standing and reaching with a body weight support harness
d. Locomotor training using a rolling walker
Correct Answer: a. Locomotor training using a motorized treadmill and body weight support harness
The patient with PD typically presents with postural deficits of forward head and trunk, with hip and knee flexion contractures. Gait is narrow-based and shuffling. A festinating gait typically results from persistent forward posturing of the body near the forward limits of stability. Task-specific training using body weight support and treadmill training (BWSTT) is the best choice.
Incorrect Choices:
A rolling walker is contraindicated because it would increase forward postural deformities and festinating gait. Braiding is a complex gait activity that most likely exceeds this patient’s abilities. Standing and reaching with body weight support is an important lead-up activity.
A patient is experiencing sensory changes secondary to left CVA. Upon testing, the patient is unable to detect pin prick or temperature in the right hand, leading to disuse and increased safety risk. These changes are BEST documented as “Patient is experiencing”:
a. allodynia
b. Abarognosis
c. Anesthesia
d. Analgesia
Correct Answer: d. Analgesia
Analgesia refers to a complete loss of pain sensibility (in this case).
Incorrect choices:
Anesthesia is a more global term referring to loss of sensation. Abarognosis refers to an inability to recognize weight. Allodynia refers to pain produces by a non-noxious stimulus (eg. light touch).
A patient is on the cardiac unit following admission for CHF nd a history of an MI. The patient is currently compensated by pharmacological management and is comfortable, alert, and oriented at rest with a normal HR and BP. The telemetric ECG depicts the rhythm shown in the figure. The PT’s appropriate interpretation and action is: (Picture)
a. ST segment depression; alert emergency medical personnel
b. Ventricular tachycardia; alert emergency medical personnel
c. Normal sinus rhythm; continue to monitor during activity progression
d. ST segment depression; check medical record for baseline ECG
Correct Answer: d. ST segment depression; check medical record for baseline ECG
The ECG shows ST segment depression. If ST segment depression is present during comfortable, stable rest in a patient with a history of MI, it likely represents the presence of a non-transmural MI and is the patient’s baseline ECG. However, this should be confirmed to rule out silent ischemia.
Incorrect choices:
This is not normal sinus rhythm, or ventricular tachycardia. ST segment depression alone is not an indication to alert emergency medical personnel.
A 14-year-old girl complains of
subpatellar pain after participation in an
aerobic exercise program for 2 weeks.
The PT’s examination shows a large Q
angle, pain with palpation at the inferior
pole of the patella and mild swelling at
both knees. The BEST intervention for
this situation is:
a. Hamstring strengthening
b. Vastus medialis (VM) muscle
strengthening
c. Vastus lateralis (VL) strengthening
d. Taping to increase lateral patellar
tracking
Correct Answer: B
Q angles of greater than 15° could be
indicative of abnormal lateral patellar
tracking. VM muscle strengthening can
reduce the tendency for the patella to track
laterally.
Incorrect Choices:
VL strengthening can promote greater lateral
patellar tracking and further irritation of the
patellofemoral joint. VL strengthening may
promote an outward pull or dislocation of the
patella. Hamstring strengthening does not
directly affect tracking of the patella. In the
closed chain, problems at the hip or foot can
also contribute to patellofemoral pain
syndrome. Taping to increase lateral patellar
tracking will exacerbate the problem.
A patient is referred to a physical
therapist with a diagnosis of Bell’s palsy.
Which cluster of examination findings
below would the PT expect to find?
a. Decreased sensation to the forehead,
cheek and jaw; absence of a gag
reflex; and deviation of the tongue to
one side
b. Ptosis, weakness in the temporalis
and masseter muscles and deviation
of the tongue to one side
c. Ptosis, decreased abduction of the
eye and excessive tearing
d. Decreased closure of one eye,
drooping of the mouth, and inability to
raise the eyebrow
Correct Answer: D
Decreased function of the facial nerve
(cranial nerve VII) is associated with motor
weakness of the muscles of facial
expression, which could result in a
decreased ability to close the eye tightly,
raise the eyebrow, and raise the corner of
the mouth as in a smile. Other functions of
the facial nerve include taste to the anterior
tongue, tearing, salivation, and dampening
sound.
Incorrect Choices:
Ptosis is related to decreased function in the
oculomotor nerve (CN lll). Motor function to
the muscle of mastication and sensation to
the face are functions of the trigeminal nerve
(CNV). Motor function of the tongue is a
function of the hypoglossal nerve (CN XII).
The gag reflex is a function of the
glossopharyngeal (CN IX) and vagus (CN X)
nerves in which touching of the pharynx
elicits contraction of the pharyngeal msucles.
Abduction of the eye is a function of the
abducens nerve (CN VI).
The cardiac rehabilitation team is
conducting education classes for a group
of patients. The focus is on risk factor
reduction and successful lifestyle
modification. A participant asks the PT to
help interpret cholesterol findings. Total
cholesterol is 220 mg/dL, high-density
lipoprotein (HDL) cholesterol is 24 mg/dL
and low-density lipoprotein (LDL) is 160
mg/dL. Analysis of these values reveals:
a. The levels of HDL, LDL and total
cholesterol are all abnormally low
b. LDL and HDL cholesterol levels are
within normal limits, and total
cholesterol should be below 200
mg/dL
c. The levels of HDL, LDL and total cholesterol are all abnormally high
d. the levels of LDL and total
cholesterol are abnormally high, and
DL is abnormally low
Correct Answer: D
Increased total blood cholesterol levels (>
200 mg/dL) and levels of LDLs (>130 mg/dL)
Increase the risk of coronary artery disease
(CAD); conversely, low concentrations of
HDLs (<40 mg/dL for men and <50mg/dL for
women) are also harmful. The link between
CAD and triglycerides is not as clear.
Incorrect Choices:
The other choices are not accurately
interpreted. In choice 1, the HDL is
abnormally low, not high. In choices 2,
neither the LDL nor the HDL is within normal
limits. In choice 3, the LDL and total
cholesterol are abnormally high, not low
An elderly patient is being treated for
depression following the death of her
husband. She is currently taking a
tricyclic antidepressant medication
(amitriptyline) and has a recent history of
a fall. The PT suspects the precipitating
cause of the fall is the medication
because it can cause:
a. Hyperalertness
b. Postural hypotension
c. Dyspnea
d. Hypertension
Correct Answer: B
Most tricyclic antidepressants have
significant anticholinergic and sedative
properties and may cause lethargy, sedation,
arrhythmias, hypotension and blurred vision,
thus increasing fall risk. The elderly are
particularly susceptible to adverse drug
effects because of a multitude of factors
Incorrect Choices:
Hypertension, tachycardia and convulsions
can result when tricyclic antidepressants are
used in combination with monoamine
oxidase (MAO) inhibitors. Hyperalertness
and dyspnea are not expected adverse
reactions/side effects of this medication.
- As the result of blunt trauma to the
quadriceps femoris muscle, a patient
experiences loss of knee function. The
BEST choice for early physical therapy
intervention is:
a. Gentle AROM exercises in weight
bearing
b. Aggressive soft tissue stretching to
remove blood that has accumulated
in soft tissues
c. Aggressive open-chain strengthening
of the quadriceps femoris to regain
normal lower extremity strength
d. Gentle PROM exercises in non-
weight bearing to regain normal knee
motion
Correct Answer: A
Gentle weight-bearing AROM exercises to
patient’s tolerance will minimize the chance
of myositis ossificans and promote improved
function.
Incorrect Choices:
Aggressive soft tissue stretching and
strengthening can promote myositis
ossificans. Gentle PROM exercises in a non-
weight-bearing position is not likely to
maintain knee function as well as AROM and
weight bearing.
A patient with active tuberculosis (TB) is
referred for physical therapy. The patient
has been hospitalized and on appropriate
antituberculin drugs for 3 weeks. During
treatment, what precautions should the
therapist observe?
a. The patient must be treated in a
private, negative-pressured room
b. The therapist must wear personal
protective equipment at all times
The patient can be treated in the PT
gym, without precautions
d. The patient must wear a tight-fitting
mask at all times
Correct Answer: C
C.
Primary disease lasts approximately 10 days
to 2 weeks. Two weeks on appropriate
antituberculin drugs renders the host
noninfectious. The patient can be safely
treated in the PT gym without precautions.
Medication is taken for prolonged periods (9-
12 months).
Incorrect Choices:
When the patient is diagnosed with active
primary TB, the patient should be in a
private, negative-pressured room. The room
Is considered a potentially infective
environment. The therapist should observe
all standard precautions (wearing personal
protective equipment). The patient need only
wear a mask when leaving the room.
However, this patient is noninfectious.
With a traction injury to the anterior
division of the brachial plexus, the PT
would expect to see weakness of the
elbow flexors, wrist flexors, and forearm
pronators. The PT would also expect to
find additional weakness in:
a. Wrist extension
b. Thumb abduction
c. Forearm supination
d. Lateral rotation of the shoulder
Correct Answer: B
Thumb abductors are innervated by the
median nerve, primarily by the C6 nerve root.
The anterior divisions contribute to the
nerves that primarily serve flexors and, in this
case, the thumb.
Incorrect Choices:
All other choices are innervated by nerves off
the posterior division. Wrist extensors include
the extensor carpi radialis longus (ECRL),
extensor carpi radialis brevis (ECRB),
innervated by the radial nerve C6-7 and the
extensor carpi ulnaris (ECU), innervated by
the radial nerve C6-8. Supination results
from action of the biceps brachii
(musculocutaneous nerve C5-6) and the
supinator (radial nerve C6)
A patient complains of right buttock pain
after slipping. The right hip had been
forced into internal rotation. Lumbar
active motion testing is full and pain free.
Neurological findings are unremarkable.
S1 provocation testing is unremarkable.
Passive hip internal rotation is limited with
pain and pulling noted in the right buttock
region. Resisted external rotation
produces pain in the same region. Based
on these finding, the MOST LIKELY
diagnosis would be:
a. Piriformis strain
b. Quadratus lumborum strain
c. Lumbar disc herniation at L5/S1
d. Sacroiliac sprain/strain
Correct Answer: A
Forceful hip internal rotation would
overstretch and potentially strain the
piriformis muscle. Limited passive hip
internal rotation would reproduce symptoms
from a tight or tense piriformis. Pain with
resisted external rotation would suggest a
contractile problem with the piriformis.
Incorrect Choices:
Unremarkable sacroiliac provocation testing
would rule out the sacroiliac joint as a cause
of symptoms. Full pain-free lumbar AROM
would rule out a quadratus lumborum strain.
Negative neurological findings and neural
tension would assist in ruling out an L5/S1
disc herniation.
A patient with MS demonstrates strong
bilateral lower extremity extensor
spasticity in the typical distribution of
antigravity muscles. This patient would be
expected to demonstrate:
a. Skin breakdown on the ischial
tuberosities and lateral malleol
b. Sitting with both hips abducted and
externally rotated
c. Sacral sitting with increased
extension and adduction of lower
extremities
d. Sitting with the pelvis laterally tilted
and both lower extremities in
windswept position
Correct Answer: C
Spasticity is typically strong in antigravity
muscles. In the lower extremities, this is
usually the hip and knee extensors,
adductors, and plantarflexors: Strong
extensor tone results in sacral sitting with the
pelvis tilted posteriorly. This results in a
rounded upper spine (kyphotic) and forward
head.
Incorrect Choices:
A laterally tilted pelvis with both lower
extremities in a windswept position is likely
the result of asymmetrical spasticity. Hips are
typically adducted and internally rotated, with
extended lower extremities (scissoring
position). Skin breakdown can occur on the
ischial tuberosities with sacral sitting;
breakdown on the lateral malleoli is not likely.
A computer programmer with no
significant past medical history presents
to the emergency room with complaints of
fever, shaking chills, and a worsening
productive cough. Complaints of chest
pain over the posterior base of the left
thorax are made worse on inspiration. An
anteroposterior x-ray shows an infiltrate
on the lower left thorax at the posterior
base. This patient’s chest pain is MOST
LIKELY caused by:
a. Inflamed tracheobronchial tree
b. Angina
c. Trauma to the chest
d. Infected pleura
Correct Answer: D
The case is supportive of a pulmonary
process as evidenced by radiography and
history. Because the radiographic findings
and the pain are in the same vicinity and
worsen with inspiration, the likelihood is that
this pain is pleuritic in origin.
Incorrect Choices:
Angina is not the most likely cause because
the cardiac system is not involved. There is
no history of trauma to the chest and no
trauma was found radiographically making it
unlikely as the source of pain. An inflamed
tracheobronchial tree would not usually
reflect pain in the posterior base of the left
thorax.
The posture of a patient’s forefoot is an
inverted position relative to the rearfoot
while in subtalar neutral. What is the PT’s
BEST choice to document this finding?
a. Forefoot varus
b. Medial column equinus
c. Metatarsus abductus
d. Forefoot valgus
Correct Answer: A
When observing the position of plantar
aspect of the forefoot relative to the neutral
posture of the rearfoot (subtalar neutral), an
inverted forefoot is described as a forefoot
varus.
Incorrect Choices:
Forefoot varus can be the result of
developmental failure of the talar neck to
derotate, osseous abnormality of the
midtarsal joints, or as a result of increased
muscle activity of muscles that invert the
foot. Metatarsus adductus is a deformity in
the transverse plane, whereas forefoot varus
Is a deformity in the frontal plane. Medial
column equinus does not exist.
During a sensory examination, a patient
complains of a dull, aching pain and is not
able to discriminate a stimulus as sharp
or dull. Two-point discrimination is
absent. Based on these findings, the
pathway that is intact is the:
a. Dorsal columns/neospinothalamic
systems
b. Anterior spinothalamic tract
c. Fasciculus gracilis/medial lemniscus
d. Lateral spinothalamic tract
Correct Answer: B
Sensations interpreted as dull, aching pain
travel in the anterior (paleo) spinothalamic
tract.
ncorrect Choices:
Discriminative, fast pain is carried in the
ateral (neo) spinothalamic tract.
Discriminative touch is carried in the
proprioceptive pathways (fasciculus
gracilis/cuneatus, medial lemniscus)
A patient is hospitalized in an intensive
care unit following a traumatic SCI
resulting in C3 tetraplegia (ASIA A). the
patient is receiving endotracheal
suctioning, following development of
significant pulmonary congestion. The
recommended time duration for
endotracheal suctioning is:
a. 1-b seconds
b. 10-15 seconds
c. 5-10 seconds
d. 15-20 seconds
Correct Answer: B
The recommended time duration for
endotracheal suctioning is 10-15 seconds.
Incorrect Choices:
Any longer time (15-20 sec) risks serious
hypoxemia, any shorter (1-5 or 5-10 sec) and
the risk is ineffective secretion removal.
A patient presents with pronounced
muscle weakness and wasting in the
lower extremities, hypertension and a
moon-shaped face with truncal obesity.
The PT recognizes these symptoms as
characteristic of:
a. Hypoparathyroidism
b. Type ll diabetes
c. Addison’s disease
d. Cushing’s syndrome
Correct Answer: D
Cushing’s syndrome causes a variety of
signs and symptoms including hypoglycemia,
hypokalemia, hypertension, muscle
weakness, and wasting. Abnormal fat
distribution (moon-shaped face, truncal, or
central obesity) is a visible clinical feature.
Incorrect Choices:
Addison’s disease, primary adrenal
Insufficiency, causes insufficient release of
cortisol and aldosterone from the adrenal
glands with widespread clinical
manifestations, including hypotension,
weakness, anorexia, and nausea, and
vomiting. Type ll diabetes also causes
weakness and fatigue along with polyuria,
and other symptoms. It is associated with
abdominal obesity but not moon-shaped
face. Mild hypoparathyroidism is
asymptomatic while chronic
hypoparathyroidism produces hypocalcemia
and neuromuscular irritability (tetany).
During which phases of the gait cycle
would a PT expect to observe an everted
posture of the calcaneus?
a. Terminal stance (heel-off) to preswing
(toe-off)
b. Initial swing (acceleration) through
midswing
c. From midstance through heel-off (toe-
off)
d. From initial contact (heel strike)
through loading response (foot-flat)
Correct Answer: D
Calcaneal eversion is a component of the
triplanar motion described as rearfoot
pronation. During the gait cycle, rearfoot
pronation, caused by normal ground reaction
forces, occurs from initial contact (heel strike)
through loading response (foot-flat)
Incorrect Choices:
Following loading response (foot-flat) the
examiner should observe the calcaneus
reversing its position from its earlier everted
posture. The examiner would not expect to
observe an everted posture of the calcaneus
following midstance.
A patient with right hemiparesis has
difficulty clearing the more affected foot
during the swing phase of gait. An
appropriate physical therapy intervention
for the right lower extremity might include:
a. Pushing backward while sitting on a
rolling stool
b. Sitting on a therapy ball, alternating
lateral side steps and back to neutral
c. Assumption of bridging
d. Forward step-ups in standing, using
graduate height steps
Correct Answer: D
Decreased foot clearance during swing may
result from weak hip and knee flexors or from
a drop foot (weak dorsiflexors or spastic
plantarflexors). Step-ups represent the best
choice to functionally strengthen the hip and
knee flexion using task-specific training.
ncorrect Choices:
Bridging promotes knee flexion with hip
extension. The sitting activities promote hip
abduction (therapy ball) and knee extension
(pushing backward)
A researcher reviewed current literature
related to moderate exercise for
maintaining independence without
accelerating disease progression in
persons with amyotrophic lateral sclerosis
(ALS). The search yielded nine studies:
two clinical case reports, two cohort
studies, three single randomized
controlled trials (RCT’s) and two
multicenter RCT’s. According to levels of
evidence, which studies provide the
BEST evidence for support of exercise in
persons with ALS?
a. Case series without controls
b. Multicenter RCTs
c. Single-center RCTs
d. Cohort/comparison studies
Correct Answer: B
According to recognized Levels of Evidence,
multicenter RCTs (level | RCT) provide the
best evidence
Incorrect Choices:
Level ll studies (single randomized clinical
trials) are followed by level lll
(nonrandomized cohort/comparison studies).
Level IV includes nonrandomized case
control studies, whereas level V includes
case series or case reports without controls.
A sports PT is working with a local high
school football team. During the game, a
player is tackled violently and incurs a
blow to the head. The PT determines that
the player is unresponsive with normal
respirations. The IMMEDIATE course of
action should be to:
a. Stabilize the neck, and flip back the
helmet face mask
b. Use the chin-lift method to improve
the airway
c. Summon Emergency Medical
Services
d. Ask for help to log-roll the player onto
his back, while stabilizing his neck
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During a finger-to-nose test, a patient
demonstrates hesitancy in getting started
and is then unable to control the
movement. The moving finger slams into
the side of the face and misses the nose
completely. The therapist documents
these findings as moderate impairment in:
a. Dyssynergia
b. Dysmetria
c. Response orientation
d. Dysdiadochokinesia
Correct Answer: B
Dysmetria refers to impaired ability to judge
the distance or range of movement.
Incorrect Choices:
Response orientation refers to the ability to
select the correct movement in response to a
stimulus. Dysdiadochokinesia refers to
impaired ability to perform rapid alternating
movements. Dyssynergia refers to impaired
ability to associate muscles together for
complex movement (decomposition of
movement).
A patient with complete C6 tetraplegia
(ASIA A) should be instructed to initially
transfer with a sliding board using:
a. Shoulder extensors, external rotators,
and anterior deltoid to position and
lock the elbow
b. Serratus anterior to elevate the trunk
with elbow extensors stabilizing
c. Pectoral muscles to stabilize the
elbows in extension and scapular
depressors to lift the trunk
d. Shoulder depressors and triceps,
keeping the hands flexed to protect
tenodesis grasp
Correct Answer: A
The patient with complete C6 tetraplegia will
lack triceps (elbow extensors), and should be
taught to lock the elbow for push-up transfers
by using shoulder external rotators and
extensors to position the arm; the anterior
deltoid locks the elbow by reverse actions (all
of these muscles are functional).
Incorrect Choices:
Triceps are not functional in this patient.
Pectoral muscles cannot be used to stabilize
the elbows in extension
.A Pt has been treating a patient for
chronic subluxation of the patella in the
outpatient clinic. The patient is now
scheduled for a lateral release and is
worried about any complications of the
surgical procedure. The patient asks the
Pt to describe any potential
complications. The PT’s BEST response |
to:
a. Refer the patient to a physical
therapy colleague who specializes in
knee problems
b. Suggest that the patient speak with
surgeon
c. Do an internet search and print out
the information desired by the patient
d. Explain how previous patients that
the therapist treated responded to the
surgery
Correct Answer: B
It is within the surgeon’s scope of practice to
discuss the indications and problems that
could arise from this surgical procedure
Incorrect Choices:
It is not within the PT’s scope of practice to
be the expert that discusses problems
associated with surgery. Referral should be
made to the physician, not another therapist.
A patient is unable to perform overhead
activities because of a painless inability to
reach past 80° of right shoulder
abduction. The “empty can” test was
positive. Early subacute physical therapy
intervention should focus on:
a. Resistance exercises for the affected
muscles
b. Modalities to reduce pain and
inflammation
c. Superior translatory mobilizations to
Increase glenohumeral
arthrokinematics motion
d. Active assistive pulley exercises
Correct Answer: D
The patient is most likely suffering from a
supraspinatus tear or impingement. Acute PT
intervention should focus on reduction of
pain and inflammation. During the early
subacute phase, active assistive pulley
exercises would be indicated to promote
healing of the supraspinatus muscle and
maintain AROM of the glenohumeral joint.
ncorrect Choices:
Performing a superior glide of the
glenohumeral joint would not be beneficial to
improve elevation of the arm. Use of
modalities is not the focus at this point of
intervention. Resistance exercise would be
too difficult and not beneficial to promote
healing of the injured tissues.
The PT is reviewing the medical history of
a new patient being seen for balance
deficits and general deconditioning. Prior
to admission, the chief finding by the
physician, 3 days ago, was a positive
fecal blood test. Which laboratory value
would confirm that the patient is safe for
balance re-training activities?
a. Erythrocyte sedimentation rate (ESR)
7 mm/1 h.
b. Leukocyte count 7,000
c. Hematocrit 42%
d. Platelet count 70,000
Correct Answer: C
The stated hematocrit value is within the
normal range for both males and females,
and indicates the fecal blood loss is not
significant at treatment time.
Incorrect Choices:
The other choices (leukocyte count, platelet
count, and ESR) are not indices of Gl
bleeding
A middle-aged patient is recovering from
surgical repair of an inguinal hernia and is
experiencing persistent discomfort in the
groin area. Patient education should
focus on:
a. Avoiding sitting too long in any one
position
b. Avoiding straining or turning in bed
c. Closed-mouth breathing during any
lifting
d. Proper lifting techniques and
precautions against heavy lifting
Correct Answer: D
Patients should be educated about proper
lifting techniques and precautions against
heavy lifting
Incorrect Choices:
Closed-mouth breathing during lifting is
contraindicated, due to increased risk of
intra-abdominal pressure with Valsalva’s
maneuver. Avoiding excessive staining is
important. Turning in bed and sitting are part
of daily functions.
A computer programmer in her second
trimester of pregnancy was referred to
physical therapy with complaints of
tingling and loss of strength in both of her
hands. Her symptoms are exacerbated if
she is required to use her keyboard at
work for longer than 20 minutes. The
MOST beneficial physical therapy
intervention is:
a. Ice packs to the carpal tunnel
b. Hydrocortisone iontophoresis to the
volar surfaces of both wrists
c. Placing the wrists in resting splints
d. Dexamethasone phonophoresis to
the carpal tunnel
Correct Answer: C
Gestational carpal tunnel syndrome (CTS) is
not an unusual phenomenon, and results
from extra fluid retention. The most effective
intervention would be to place the wrists in a
neutral position in splints. The carpal tunnel
Is, therefore, not compromised by poor hand
positioning while at work.
Incorrect Choices:
Modalities that use steroids are
contraindicated for pregnant women.
Although ice packs may relieve discomfort,
they do little to correct the source of the
problem.
A PT has decided to refer a 2-year-old
child to a neurologist after the initial
evaluation. The PT has concluded that
the child may be autistic. The MOST
PERTINENT factor to include in the
referral is that the child is:
a. Delayed in gross motor skills
b. Quiet and did not want to separate
from the mother
c. Defensive when touched
d. Responsive to most but not all
commands
Correct Answer: C
Not tolerating being touched would signal a
possible sensory integration issue that is
common in children with autism. Although a
referral for autism diagnosis should have
additional information, this would be the most
important factor from the choices given.
Incorrect Choices:
Since this was the initial evaluation it is not
uncommon for a child this age to be quiet,
shy and fearful of the PT. This behavior may
not have anything to do with autism, but that
of being wary of strangers. A delay in gross
motor skills does not necessarily indicate
autism. This child could have mild cerebral
palsy or just be delayed for no apparent
reason. Responsive to most commands
would be a positive outcome when dealing
with a 2-year-old child. A child with autism
may not respond to commands due to issues
with cognition, lack of focus, or verbal
deficits.
A patient was instructed to apply
conventional (high-rate) transcutaneous
electrical nerve stimulation (TENS) to the
low back to modulate a chronic pain
condition. The patient now states that the
TENS unit is no longer effective in
reducing the pain in spite of increasing
the intensity to maximum. The PT should
now advise the patient to:
a. Switch to modulation-mode TENS
b. Increase the treatment frequency
c. Decrease the pulse duration
d. Switch to low-rate TENS
Correct Answer: A
Because of the long-term, continuous use of
TENS, the sensory receptors accommodated
to the continuous current, and no longer
responded to the stimuli. Changing to
modulation mode (i.e., burst modulation),
which periodically interrupts the current flow,
does not allow accommodation to occur.
Incorrect Choices:
None of the other choices decreases
accommodation. Low-rate TENS is a motor
level stimulation, not sensory. Increasing
treatment frequency would result in
accommodation occurring more quickly.
Decreasing the pulse duration would require
increasing the intensity to get a response,
and the patient has already maximized the
intensity.
After performing an ergonomic
examination of a computer programmer
and workstation, the most appropriate
recommendation for achieving ideal wrist
and elbow positioning would be to:
a. Maintain the keyboard in a position
that allows a neutral wrist position
b. Add armrests
c. Elevate the keyboard to increase
wrist flexion
d. Lower the keyboard to increase wrist
extension
Correct Answer: A
Work involving increased wrist deviation from
a neutral posture in either flexion/extension
or radial/ulnar deviation has been associated
with increased reports of CTS and other wrist
and hand problems.
Incorrect Choices:
Increasing wrist flexion or extension can be
harmful. Adding armrests does not solve the
wrist position problem.
An elderly patient receiving outpatient PT
as a result of a stroke (cerebrovascular
accident) presents with left hemiparesis.
The patient requires moderate assistance
for ADL and transfers. The patient lives
with and is cared for by a single adult
daughter. The patient arrives for a
physical therapy session and the PT
notes multiple bruises on the patient’s
face and arms. When asked about the
bruises, the patient hesitates and says
she does not know. Later in the session,
the patient reports that her daughter is
under a great deal of stress. In this case,
what should the PT do?
a. Document and treat the bruises as
necessary and assess whether the
bruises are resolved at the next visit
b. Contact the appropriate jurisdiction
and file a report for suspected
abuse/neglect
c. Call the police and have the daughter
arrested for elder abuse
d. Counsel the daughter on how to
handle stress and advise her to hire a
personal care attendant to help care
for her mother and prevent falls
walang sagot sa book rev
Following major surgery of the right hip, a
patient ambulates with a Trendelenburg
gait. Examination of the right hip reveals
abductor weakness (gluteus medius 3/5)
and ROM limitations in flexion and
external rotation. As part of the
intervention, the PT opts to include
functional electrical stimulation to help
Improve the gait pattern. Stimulation
should be initiated for the:
a. Left abductors during stance on the
right
b. Right abductors during stance on the
right
c. Left abductors during swing on the
right
d. Right abductors during swing on the
right
Correct Answer: B
During the stance phase of gait, the hip
abductors of the support limb are activated to
maintain the pelvis in a relatively horizontal
position. This allows the opposite foot to
clear the floor during swing.
Incorrect Choices:
Stimulation of the right abductors throughout
swing or the left hip abductors during swing
or stance would not compensate for the
weakness of the right hip abductors during
the support period.
An 18-month-old child with Down
syndrome and moderate developmental
delay is being treated at an Early
Intervention Program. Daily training
activities that should be considered
include:
a. Locomotor training using body weight
support and a motorized treadmill
b. Stimulation to postural extensors in
sitting using rhythmic stabilization
c. Rolling activities, initiating movement
with stretch and tracking resistance
d. Holding and weight shifting in sitting
and standing using tactile and verbal
cueing
Correct Answer: D
Children with Down syndrome typically
present with generalized hypotonicity. The
low tone is best managed by weight-bearing
activities in antigravity postures. Typical
responses include widened base of support
and co-contraction to gain stability. Verbal
cueing for redirection is generally the best
form of feedback to use, along with visually
guided postural control
Incorrect Choices:
Proprioceptors are not in a high state of
readiness, and the child may be slow to
respond to proprioceptive facilitation
techniques (i.e., stretch, resistance, rhythmic
stabilization). With developmental delay, this
child is not ready for intensive locomotor
training. Rolling is probably not age
appropriate for this child. The child should
already possess this skill since most children
with Down syndrome walk at 24 months of
age.
A high school wrestler has been taking
anabolic-androgenic steroids for the past
6 months to build muscle and improve
performance. The PT working with the
team suspects illegal drug use and
examines the athlete for:
a. Rapid weight gain, marked muscular
hypertrophy and mood swings
b. Rapid weight loss with
disproportionate muscular
enlargement
c. Changes in personality, including
passivity and anxiety
d. Hypotension, edema, and rapid
muscular enlargement
Correct Answer: A
Signs and symptoms of anabolic steroid use
include rapid weight gain, elevated BP, acne
on the face and upper back, and changes in
body composition with marked muscular
hypertrophy, especially in the upper body.
Additional signs include frequent bruising,
needle marks, male breast enlargement, or
In females, secondary male characteristics
and menstrual irregularities. With prolonged
use, jaundice or changes in personality
(mood swings, rages) may develop
Incorrect Choices:
The other choices are not characteristic of
anabolic steroid use.
While driving the ball during a golf match,
a patient felt an immediate sharp pain in
the right lower back. The following
morning, the patient reported stiffness,
with easing of pain after taking a shower.
Based on this information, the source of
the pain is MOST LIKELY:
a. Diminished blood supply to the spinal
cord
b. Facet joint impingement
c. A stress fracture
d. Nerve root compression
Correct Answer: B
Facet joint dysfunction is exacerbated with
sustained positions, and eases with
movement. Progressive increase in activity
intensifies the pain
Incorrect Choices:
Stress fracture pain is worse when weight-
bearing, and is not necessarily worse in the
morning. Nerve root involvement would
cause radiating pain to the extremity. The
spinal cord has no innervation and is not a
source of pain
A PT is performing the maximal cervical
quadrant test to the right with a patient
with right C5-C6 facet syndrome. The
patient would most likely complain of:
a. Pain in the right cervical region
b. Referred pain to the left midscapular
region
c. Radicular pain into the right upper
limb
d. Tightness in the right upper trapezius
Correct Answer: A
The test position would consist of right
cervical side-bending with extension. This
shortens the upper trapezius and stresses
the right cervical facets. When a pathological
cervical facet is provoked, the result will
cause pain in the ipsilateral cervical region,
with referred pain to the ipsilateral scapular
region. The test might also compress the
nerve root, creating radicular signs, but only
on the right side.
Incorrect Choices:
This test would shorten the upper trapezius
so it will not cause tightness in the muscle.
Radicular pain would be consistent with
dysfunction of a spinal nerve, not a facet joint
syndrome. Referred pain to the left
midscapular region would be caused by a
test that was applied to the structures on the
left side.
A 62-year old patient has chronic,
obstructive pulmonary disease (COPD).
Which of these pulmonary test results will
NOT be increased when compared with
those of a 62-year-old healthy individual?
a. Functional residual capacity
b. FEV1/FVC (forced vital capacity) ratio
c. lotal lung capacity
d. Residual volume
Correct Answer: B
An obstructive pattern on pulmonary function
tests includes increased total lung capacity,
caused by destruction of alveolar walls. This
same destruction causes an increased
residual volume, with a resulting increased
functional residual capacity and decreased
vital capacity. The GOLD (global Initiative for
Obstructive Lung Disease) classification of
an FEV1/FVC ratio below 70% is indicative of
COPD.
Incorrect Choices:
The other choices are all increased with
COPD.
A patient with a grade 2 quadriceps strain
returns to physical therapy after the 1st
exercise session, complaining of muscle
soreness that developed later in the
evening and continued into the next day.
The patient is unsure whether to continue
with the exercise. The PT can minimize
the possibility of this happening again by
using:
a. Eccentric exercises, 3 sets of 10, with
gradually increasing intensity
b. Concentric exercises, 3 sets of 10,
with gradually increasing intensity
c. Eccentric exercises, 1 set of 10, lifting
body weight (sit-to-stand)
d. Concentric exercises, 3 sets of 10, at
80% of maximal intensity
Correct Answer: B
This patient is experiencing delayed-onset
muscle soreness (DOMS) as a result of
vigorous exercise or muscular overexertion.
It typically begins 12-24 hours after exercise,
peaks in 24-48 hours, and can last up to 5-7
days.
ncorrect Choices:
DOMS is usually greater after muscle
engthening or eccentric exercise. It can be
essened by gradually increasing intensity
and duration of exercise, and not starting at
80% of maximal intensity.
A patient with multiple sclerosis (MS)
exhibits moderate fatigue during a 30-
minute exercise session. When the
patient returns for the next regularly
scheduled session 2 days later, the
patient reports going right to bed after the
last session. Exhaustion was so severe,
the patient was unable to get out of bed
until late afternoon of the next day. The
PT’s BEST strategy is to:
a. Utilize a distributed practice schedule
b. Utilize a massed practice schedule
c. Treat the patient in a warm, relaxing
environment
d. Switch the patient to exercising in a
warm pool
Correct Answer: A
Common problems in MS include fatigue and
heat intolerance. Exercise intensity should be
reduced, and a distributed practice schedule
should be used, in which rest times equal or
exceed exercise times.
Incorrect Choices:
A massed practice schedule in which the
exercise time exceeds the rest time is
contraindicated as is a warm environment or
warm pool, which can increase fatigue.
A patient has lumbar spinal stenosis
encroaching on the spinal cord. The PT
should educate the patient to avoid:
a. Use of a rowing machine
b. Bicycling using a recumbent cycle
ergometer
c. Swimming using a crawl stroke
d. Tai chi activities
Correct Answer: C
Continuous positioning in spinal extension
Increases symptoms in patients with spinal
stenosis. Activities such as swimming using
a crawl stroke place the spine in this position.
Incorrect Choices:
All other activities described do not require
the patient to maintain a continuous
extended spinal position.
A PT is performing clinical research in
which a specific myofascial technique is
applied to a patient with chronic back
pain. She is using a single-case
experimental design with an A-B-A-B
format. Her research hypothesis states
that pain-rating scores will decrease with
the treatment intervention. Acceptance of
this hypothesis would be indicated if:
a. Bisless than A
b. Bis greater than A at the 1.0 level
c. Bis greater than A at the 0.05 level
d. Bisequalto A
Correct Answer: A
In an A-B-A-B single-subject design, A
represents multiple baseline measurements,
and B represents multiple posttreatment
measurements. If the hypothesis is accepted,
the pain-rating scores will be lower following
treatment compared with the baseline
measurements.
Incorrect Choices:
Any choice in which B is equal to or greater
than A Is incorrect. That would indicate that
there was no change in pain or that it
increased after treatment.
An individual with a body mass index
(BMI) of 33 kg/m is referred to an
outpatient exercise program. The PT in
charge of the program recognizes this
patient is at increased risk for:
Increased anxiety and depression
Hypothermia during exercise
c. Rapid weight loss during the initial
weeks
d. Hyperthermia during exercise
Correct Answer: D
A patient with a BMI of 33 kg/m is obese
(BMI >30 kg/m) and is at increased risk for
hyperthermia during exercise (as well as
orthopedic injury).
Incorrect Choices:
Weight loss is the result of a complex
interplay between diet and exercise, and not
the result of exercise alone. A balanced
program of exercise and diet will produce
effects over time, not just in the initial weeks.
An appropriately prescribed exercise
program should decrease anxiety and
depression. Hypothermia is not typical with
obesity.
A patient with a recent modified radial
mastectomy for breast cancer is referred
to physical therapy. The therapist
recognizes that an important predictor for
lymphedema after treatment for breast
cancer is:
a. Adiet low in sodium
b. Obesity
c. Mild strength loss in the affected
extremity
d. Use of diuretics
Correct Answer: B
Obesity is consistently reported as a
predictor of lymphedema after modified radial
mastectomy for breast cancer. Weight
management should be an integral part of
patient education.
Incorrect Choices:
Diuretics are sometimes used, and even
though they do not change the accumulation
of protein in the interstitial spaces, they are
not a predictor of lymphedema. Diet is
thought to be very important, but there are no
recommended diets except one that is
healthy and low in sodium; it is not predictive,
however. It is common to have strength loss
after a surgery, and although strength loss is
associated with lymphedema in the more
advanced stages, it is not predictive of
lymphedema.
An elderly patient has been confined to
bed for 2 months, and now demonstrates
limited ROM in both lower extremities.
Range in hip flexion is 5°-115°, and knee
flexion is 10°-120°. The MOST beneficial
intervention to improve flexibility and
ready this patient for standing is:
a. Hold-relax techniques followed by
passive range of motion (PROM), 10
repetitions, two times per day
b. Mechanical stretching using traction
and 5-lb weights, 2 hours, two times
per day
c. Manual passive stretching, 10
repetitions each joint, two times per
day
d. Tilt-table standing, 20 minutes, daily.
Correct Answer: B
Prolonged mechanical stretching involves a
low-intensity force (generally 5 to 15 |b)
applied over a prolonged period (30 minutes
to several hours). It is generally the most
beneficial way to mange long-standing
flexion contractures.
Incorrect Choices:
Manual passive stretching and tilt-table
standing are shorter-duration stretches that
are not likely to be as effective in this case.
Hold-relax techniques can be used to
improve flexibility in the presence of
shortening of muscular elements, but are not
likely to be effective in this case because of
the short duration and long-standing
contracture affecting connective tissue
elements.
During a home visit, a PT is providing
postural drainage in the Trendelenburg
position to an adolescent with cystic
fibrosis. The patient suddenly complains
of right-sided chest pain and shortness of
breath. On auscultation, there are no
breath sounds on the right. The therapist
should:
a. Call emergency medical services
because it may be a pneumothorax
b. Continue treating as it is possibly a
mucous plug
c. Reposition patient with the head of
the bed flat because the
Trendelenburg position is causing
shortness of breath
d. Place the right lung in a gravity-
dependent position to improve
perfusion
Correct Answer: A
The combined signs and symptoms of
absent breath sounds, sudden onset of chest
pain and shortness of breath indicate a
pneumothorax, especially in an adolescent
(growth spurt) with pathological changes of
ung tissue. This is an emergency situation.
ncorrect Choices:
The other interventions (continuing treating
reposition the patient) do not adequately
address the emergency nature of this
situation, given the symptoms presented.
Potential harm can come to this patient.
A patient is 5 days’ postmyocardial
infarction and is referred for inpatient
cardiac rehabilitation. Appropriate criteria
for determining the initial intensity of
exercise include:
a. >1 mm ST segment depression,
horizontal or downsloping
b. HR < 120 bpm and rate of perceived
exertion (RPE) <13
c. Systolic BP < 240 mm Hg or diastolic
BP <110 mm Hg
d. HR resting plus 30 bpm and RPE <
14
Correct Answer: B
Intensity of exercise is prescribed using HR
and RPE and monitored using HR, RPE and
signs of exertional intolerance. For post-Ml
patients, an RPE < 13 (6-20 scale) and a HR
< 120 beats/min (or HR resting plus 20 bpm)
Is recommended.
Incorrect Choices:
HR plus 30 beats/min is recommended for
postsurgery patients. Signs and symptoms
for an upper limit of exercise intensity include
choices 1 and 3 along with onset of angina,
and ECG disturbances (ventricular
arrhythmias, second-or third-degree
atrioventricular block, atrial fibrillation, etc).
(Source: American College of Sports
Medicine, guideline for exercise testing and
prescription.)
A PT examines a patient with a right CVA
and determines that the patient has a
profound deficit of homonymous
hemianopsia. The BEST INITIAL strategy
to assist the patient in compensating for
this deficit is to:
a. Provide constant reminders, printed
notes on the left side, telling the
patient to look to the left
b. Teach the patient to turn the head to
the affected left side
c. Place items such as eating utensils
on the left side
d. Rearrange the room so that while the
patient is in bed, the left side is facing
the doorway.
Correct Answer: B
A patient with homonymous hemianopsia
needs to be made aware of the deficit and
instructed to turn the head to the affected left
side (a compensatory training strategy).
Incorrect Choices:
Initial strategies include placing items on the
right (unaffected side), not the left side, so
that the patient can successfully interact with
the environment. Later, as there is ability to
compensate, items can be moved to midline,
and finally to the affected left side.
A patient with a 10-year history of
Parkinson’s disease (PD) has been taking
levodopa (Sinemet) for the last 5 years.
The patient presents with deteriorating
function and is no longer able to walk
Independently due to constant and
uncontrolled involuntary movements.
During the examination, the PT observes
that the patient is restless, with constant
dancing, hyperkinetic movements of his
legs. The PT’s BEST course of action is
to:
a. Complete the treatment session,
focusing specifically on documenting
the effects of rigidity
b. Document the observations and refer
the patient back to the physician for
possible medication adjustment
c. Examine for additional signs of
chronic levodopa therapy, such as
dizziness and headache
d. Talk to the spouse to see if the
patient is taking any drugs with
hallucinogenic effects, such as
selegiline.
Correct Answer: B
Dyskinesias (involuntary movements) are
caused by an adverse effect of prolonged
use of dopamine. Other changes include
gastrointestinal disturbances (nausea,
vomiting) and mental disturbances
(restlessness, general overactivity, anxiety,
or depression). Medication adjustment may
reduce some of these effects and improve
function.
Incorrect Choices:
Although the symptoms described in the
other choices may also occur with
pharmacological management of PD, they do
not adequately explain the presence of
adventitious or involuntary movements.
Selegiline is used in early PD; its main
adverse effects include nausea, dry mouth,
dizziness, anxiety, and hallucinations. Failure
to notify the physician of these documented
adverse effects can jeopardize the patient’s
functional outcomes and safety.
A patient with stasis dermatitis secondary
to venous insufficiency is being examined
by the PT. Visual inspection of the skin
can be expected to reveal:
a. Extensive erosions with serous
exudate
b. Pruritus, erythema and edema
c. Hemosiderin staining
d. Plagues with scales
Correct Answer: C
Hemosiderin staining is indicative of venous
insufficiency. It is characterized by dark
pigmentation (bluish-red color) and result
from leakage of hemosiderin (the by-product
of red cell hemolysis) in the presence of
blood stasis and incompetent valves.
Incorrect Choices:
The other choices are not characteristic of
stasis dermatitis secondary to venous
insufficiency. Red, oozing crusting rash;
erosions; exudate; and pruritic vesicles are
characteristic of eczema.
A 24-year-old woman who is 12 weeks’
pregnant asks a PT if it is safe to continue
with her aerobic exercise. Currently, she
jogs 3 miles, three times a week, and has
done so for the past 10 years. The
Therapist’s BEST answer is:
a. Jogging is safe at mild to moderate
Intensities, whereas vigorous
exercise is contraindicated
b. Jogging is safe as long as the target
HR does not exceed 140 beats/min
c. Continue jogging only until the fifth
month of pregnancy
d. Swimming is preferred over walking
or jogging for all phases of pregnancy
Correct Answer: A
According to the American College of Sports
Medicine, women can continue to exercise
regularly (three times a week) at mild to
moderate intensities throughout pregnancy if
no additional risk factors are present. After
the 1st trimester, women should avoid
exercise in the supine position because this
position is associated with decreased cardiac
output. Prolonged standing with no motion
should also be avoided.
Incorrect Choices:
Non-weight bearing exercise (swimming) is
an acceptable alternative to walking or
jogging. However, this patient’s interests and
skills are with jogging, making it the most
appropriate choice. Exercise prescription
should be specific to the individual. Using a
target HR of 140 or a target date of the fifth
month of pregnancy does not allow for this
A patient is able to stand feet together,
unassisted, with eyes open. When asked
to close the eyes, the patient immediately
loses balance and has to take a step and
grab onto the table to keep from falling.
The PT documents this finding as:
a. Ataxic posture
b. Positive Romberg test
c. Negative Romberg test
d. Positive Dizziness Handicap
Inventory
Correct Answer: B
In a positive Romberg test, the patient
demonstrates instability during the eyes
closed (EC) condition but not during the eyes
open (EO) condition; commonly seen in
dorsal column disease.
Incorrect Choices:
In a negative Romberg test, the patient
would be able to maintain balance equally
well under both conditions (EQ and EC). The
Dizziness Handicap Inventory is a scale of
self-perceived handicap as a result of
vestibular disorders. An ataxic posture can
be seen in cerebellar disease and refers to
instability and increased postural sway,
present during the EO and EC condition.
A patient is referred for rehabilitation after
a middle cerebral artery stroke. Based on
this diagnosis, a PT can expect that the
patient will present with:
a. Contralateral hemiparesis and
sensory deficits, with the leg more
involved than the arm
b. Contralateral hemiplegia with central
poststroke pain and involuntary
movements
c. Contralateral hemiparesis and
sensory deficits, with the arm more
involved than the leg
d. Decreased pain and temperature to
the face and ipsilateral ataxia, with
contralateral pain and thermal loss of
the body
Correct Answer: C
A CVA affecting the middle cerebral artery
will result in symptoms of contralateral
hemiparesis and hemisensory deficits with
greater involvement of the arm than the leg.
Incorrect Choices:
The findings presented in choices 1 are
characteristic of a CVA affecting the posterior
cerebral artery syndrome (central territory).
The findings presented in choice 3 are
characteristic of a CVA affecting the vertebral
artery, and posterior inferior cerebellar artery
(lateral medullary syndrome). The findings
presented in choice 4 are characteristic of a
CVA, affecting the anterior cerebral artery.
A patient complains of pain (7/10) and
limited range of motion (ROM) of the right
shoulder as a result of chronic overuse.
The PT elects to use procaine
hydrochloride iontophoresis as part of the
intervention for this patient’s problems. To
administer this substance, it would be
appropriate to use:
a. Continuous monophasic current, with
the medication under the anode
b. Continuous biphasic current, with the
medication under the anode
c. Interrupted biphasic current, with the
medication under the cathode
d. Continuous monophasic current, with
the medication under the cathode
Correct Answer: A
Because like charges are repelled, the
positively charged medication would be
forced into the skin under the positive
electrode (anode). A continuous,
unidirectional current flow is very effective in
repelling ions into the skin. Procaine is a
positive medicinal ion, and will be repelled
from the anode (positive pole).
Incorrect Choices:
A pulsed, interrupted or bidirectional current
generates less propulsive force owing to the
discontinuous nature of the current. The
cathode is not an appropriate choice to
administer this medication
A patient fractured the right mid tibia in a
skiing accident 3 months ago. After cast
removal, a severe foot drop was noted.
The patient wants to try electrical
stimulation orthotic substitution. The PT
would set up the functional electrical
stimulation to contract the appropriate
muscles during:
a. Mid swing
b. Late stance at push-off
c. Early stance at foot-flat
d. Late stance at toe-off
Correct Answer: A
Foot drop is a swing phase deficit.
Stimulation of the dorsiflexor muscles during
the swing phase places the foot in a more
neutral position and prevents the toes from
contracting the ground and interfering with
the gait pattern
Incorrect Choices:
Plantarflexors are active from heel strike to
foot-flat, and from heel-off to toe-off
A patient who is terminally ill with cancer
Is In tears, unable to cope with the
changes in life and current
hospitalization. The PT has a referral for
gait training so that the patient can be
discharged to home under hospice care.
The BEST approach is to:
a. Encourage denial so the patient can
cope better with life’s challenges
b. Ask the patient questions in order to
obtain a detailed history
c. Take time now to allow the patient to
express fears and frustrations
d. Ignore the tears and focus on
therapy, but in a compassionate
manner
Correct Answer: C
It is important to be supportive of a patient
who is experiencing losses and resentment.
Allow the patient to fully verbalize feelings
and frustrations.
Incorrect Choices:
Ignoring the patient’s responses or
encouraging denial will not allow for healing
and acceptance. In an emotional state, the
patient may be unable to give an accurate
history.
A patient with multiple sclerosis (MS) has
been on prednisolone for the past 4
weeks. The medication is now being
tapered off. This is the third time this year
that the patient has received this
treatment for an MS exacerbation. The
PT recognizes that possible adverse
effects of this medication are:
a. Weight gain and hyperkinetic
behaviors
b. Muscle wasting, weakness and
osteoporosis
c. Spontaneous fractures with
prolonged healing or malunion
d. Hypoglycemia and nausea or
vomiting
Correct Answer: B
This patient is receiving systemic
corticosteroids to suppress inflammation and
the normal immune system response during
an MS attack. Chronic treatment leads to
adrenal suppression. Numerous adverse
reactions/side effects can occur. Those
affecting the patient’s capacity to exercise
include muscle wasting and pain, weakness
and osteoporosis. Weight loss is common
(anorexia) with nausea and vomiting.
ncorrect Choices:
Adrenal suppression produces
hyperglycemia, not hypoglycemia.
Spontaneous fractures are not typical.
Hyperkinetic behavior is not an expected
adverse effect.
A patient is 4 weeks’ post-myocardial
infarction (MI). Resistive training using
weights to improve muscular strength and
endurance is appropriate:
a. Only during post-acute phase 3
cardiac rehabilitation
b. During all phases of rehabilitation, if
judicious monitoring of heart rate is
used
c. If exercise intensities are kept below
85% maximal voluntary contraction
d. If exercise capacity is greater than 5
metabolic equivalents (METs) with no
angina symptoms/ST segment
depression
Correct Answer: D
Resistance training is typically initiated after
patients have completed 4-6 weeks of
supervised cardio respiratory endurance
exercise. Lower intensities are prescribed.
Careful monitoring of BP is necessary
because BP will be higher and HR lower than
for aerobic exercise. Patients should
demonstrate an exercise capacity greater
than 5 METs without angina symptoms or ST
segment depression.
Incorrect Choices:
The common use of a percentage of 1 RM
(repetition maximum) estimates intensity,
and should be used only as a general
guideline. Intensity should be assessed using
perceived intensity. Exercise should be
terminated at a rate of perceived exertion
(RPE; Borg Scale 6-20) of 15-16. During
resistance training. HR response is
disproportionate to oxygen consumption and
should not be used as a measure of
intensity. Resistance training is not restricted
to phase 3 programs, as long as proper
guideline are followed.
To test for maximal passive tibiofemoral
internal or external rotation the knee
should be placed in:
a. 45° of knee flexion
b. 60° of knee flexion
c. 90° of knee flexion
d. 30° of knee flexion
Correct Answer: C
Rotation of the tibia on the femur is
influenced by sagittal knee position. Rotation
of the knee increases with increasing flexion
up to 90°. After 90°, the soft tissues behind
the knee restrict further increases in rotation
at the knee.
Incorrect Choices:
Placing the knee in 30°, 45°, or 60° of flexion
will not allow for maximal tibiofemoral
rotation.
An adolescent female is referred to
physical therapy with a diagnosis of
anterior knee pain. Positive findings
include pes planus, lateral tibial torsion,
and genu valgum. The position that the
femur will be in is excessive:
a. Retroversion
b. Lateral rotation
c. Abduction
d. Medial rotation
Correct Answer: D
Common abnormal postural findings
consistent with anterior knee pain in an
adolescent female include pes planus, lateral
tibial torsion, and genu valgum. These are
compensatory changes that occur when the
femur is in excessive medial rotation.
Incorrect Choices:
Abduction is associated with coxa valga (an
increase in the angle of the femoral head to
the neck ), which is not commonly associated
with knee pain. Lateral femoral rotation is
commonly observed with genu varum.
Retroversion of the hip is an abnormally
small angle between the femoral neck and
the condyles, and is not affected by posture.
A therapist is examining a patient with
superficial partial-thickness burns over
20% of the trunk. The correct
identification of this burn type by surface
appearance characteristics includes:
a. A dry surface with no blisters
b. Intact blisters and a moist, weeping
surface if blisters are removed
c. A wet surface with broken blisters
d. Parchment-like, leathery, and dry
surface
Correct Answer: B
The surface appearance of a superficial
partial-thickness burn is characterized by
intact blisters and moist, weeping or
glistening surface when blisters are removed.
Incorrect Choices:
A dry surface with no blisters is characteristic
of a superficial burn. A wet surface with
broken blisters is characteristic of a deep
partial-thickness burn. Parchment-like,
leathery, and dry surface is characteristic of
a full-thickness burn.
A 10-year-old presents with pain (4/10)
and limited knee ROM (5°-95°) following
surgical repair of the medial collateral
ligament and ACLs. In this case, the
modality that can be used with
PRECAUTION is:
a. premodulated interferential current
b. continuous shortwave diathermy
c. low-dose ultrasound (US)
d. high-rate transcutaneous electrical
stimulation
Correct Answer: C
Because the epiphyseal plates do not close
until the end of puberty, US energy should be
applied with caution around the epiphyseal
area due to its potential to cause bone
growth disturbances. However, there is no
documented evidence that US creates any
direct untoward effects on the growth plates,
especially if applied at low dosage.
Incorrect Choices:
Electrical stimulation or deep thermotherapy
would have no deleterious effects on the
epiphyseal plates because no mechanical
effects on hard tissue are associated with
their use.
A CONTRAINDICATION to initiating
extremity joint mobilization on a patient
with chronic pulmonary disease may
include:
a. Reflex muscle guarding
b. Long-term corticosteroid therapy
c. Concurrent inhalation therapy
d. Functional chest wall immobility
Correct Answer: B
Very often, patient with chronic pulmonary
disease have been managed using
corticosteroid therapy. Long-term steroid use
has the catabolic effects of osteoporosis,
weakened supporting joint structures and
muscle wasting, making joint mobilization
contraindicated.
Incorrect Choices:
There would not be any increase in reflex
muscle guarding in a patient with pulmonary
disease over that in other patient
populations. Inhalation therapy, even with a
corticosteroid, has minimal systemic uptake
of the drug and, therefore, would not be a
contraindication to performing joint mobility.
A functionally limited thorax may be
considered when deciding on the starting
body position for joint mobility, but will not
change the stability to perform the task.
Manual glide of the talus posteriorly within
the ankle joint mortise can be used as a
technique to increase:
a. Tibiotalar dorsiflexion motion
b. Talocalcaneal supination
c. Talocalcaneal pronation
d. Distal tibiofibular joint extensibility
Correct Answer: A
Based on the arthrokinematic convex-
concave rules of motion, ankle joint
dorsiflexion is described as occurring through
a combination of anterior roll and posterior
translation of the talus within the mortise
joint. Dorsal glide of the talus would be
utilized to improve ankle joint dorsiflexion if
posterior translation of the talus is limited.
Incorrect Choices:
Posterior glide of the talus is not a technique
to improve subtalar joint motions or distal
tibiofibular joint extensibility.
A patient with spastic hemiplegia is
referred to physical therapy for
ambulation training. The patient is having
difficulty in rising to a standing position
due to cocontraction of the hamstrings
and quadriceps. The therapist elects to
use biofeedback as an adjunct to help
break up this pattern. For knee extension,
the biofeedback protocol should consist
of:
a. High-detection sensitivity, with
electrodes placed far apart
b. High-detection sensitivity, with
electrodes placed close together
c. Low-detection sensitivity, with
electrodes placed close together
d. Low-detection sensitivity, with
electrodes placed far apart
Correct Answer: C
When the electrodes are close together, the
likelihood of detecting undesired motor unit
activity from adjacent muscles (crosstalk)
decreases. By setting the sensitivity (gain)
ow, the amplitude of signals generated by
the hypertonic muscles would decrease and
Keep the EMG output from exceeding a
visual or auditory range.
ncorrect Choices:
The other choices do not achieve these
goals. The wider the spacing of electrodes,
the more volume of the muscle is monitored.
Thus, when targeting a specific muscle, a
narrow spacing should be used. When the
focus is not on a specific muscle but instead
to encourage a generic motion such as
shoulder elevation, then a wider spacing of
electrodes can be used. In addition, when
working with weakness of a muscle where
there is a decreased ability to recruit motor
units or a decrease in the size and number of
motor units, then a wider spacing and a high
sensitivity would be used in order to create
an adequate visible signal.
A baseball pitcher was seen bya PT
following surgical repair of a SLAP
(superior labral, anterior posterior) lesion
of his pitching arm. In follow-up care, the
therapist needs to pay attention to the
pitching motion. The phase of the
throwing motion that puts the greatest
stress on the anterior labrum and capsule
a. Wind-up
b. Acceleration
c. Deceleration
d. Cocking
Correct Answer: D
During the cocking phase, the arm is taken
into the end-range of humeral external
rotation. At that point, the anterior aspects of
the capsule and labrum are acting as
constraints to prevent excessive anterior
glide of the humerus.
Incorrect Choices:
The other phases of the throwing motion do
not place the same degree of strain on the
anterior labrum and capsule.
A frail, elderly patient has recently been
admitted to a skilled nursing facility
following a fall-related injury (fractured hip
with open reduction, internal fixation). The
patient lived alone on the second floor
and was unable to return home. The
patient is extremely agitated over being in
a nursing facility and demonstrates early
signs of dementia, exclaiming to the PT,
“Leave me alone, | just want to get out of
here!” An important approach to take
while working with this patient is to:
a. Firmly state what the patient is
expected to perform
b. Be calm and supportive, and use only
one-or two-level commands
c. Minimize verbal communication and
maximize guided movements
d. Promise anything to calm the patient
down, as long as some walking
occurs
Correct Answer: B
An agitated patient with dementia does not
process information easily. A calm and
supportive approach with low-level
commands (one or two actions) provides the
best approach for this patient.
Incorrect Choices:
Establishing rules, confrontation and making
unrealistic promises that cannot be kept may
Increase agitation. Guided movements may
help, but communication should be
maintained.
Upon examining a patient with vague hip
pain that radiates to the lateral knee, the
PT finds a negative FABERE test, a
negative grind test and a positive Noble’s
compression test. The dysfunction is
MOST LIKELY due to:
a. DJD of the hip
b. Sl joint dysfunction
c. Irritation of the L5 spinal nerve root
d. An iliotibial band friction disorder
Correct Answer: D
A positive Noble’s compression test is an
indication of an indication of an iliotibial band
friction disorder
Incorrect Choices:
A Negative FABERE test can rule out Sl joint
dysfunction. A negative grind test eliminates
DJD at the hip. There were no findings to
implicate the LS nerve root.
What common compensatory postures
would a PT expect for a patient
diagnosed with fixed severe forefoot
varus?
a. Toeing-in and lateral rotation of the
femur
b. Excessive midtarsal supination and
lateral rotation of the tibia
c. Subtalar pronation and medial
rotation of the tibia
d. Excessive ankle dorsiflexion and
medial rotation of the femur
Correct Answer: C
In order to maintain the center of gravity over
the base of support, the subtalar joint must
pronate, and the entire lower quarter must
medially rotate.
Incorrect Choices:
Because the expected compensation is
pronation of the ankle the medial rotation of
the tibia, the responses with dorsiflexion
and/or external rotation are incorrect.
A weight lifter exhibits marked
hypertrophy after embarking on a
strength training regime. Hypertrophy can
be expected to occur following at least:
a. 3-4 weeks of training
b. 1-2 weeks of training
c. 2-3 weeks of training
d. 6-8 weeks of training
Correct Answer: D
Hypertrophy is the increase in muscle size as
a result of resistance training and can be
observed following at least 6-8 weeks of
training. Individual muscle fibers are
enlarged, contain more actin and myosin and
have more, larger myofibrils.
Incorrect Choices:
The other choices are too brief a time interval
to show demonstrable changes. Some
strengthening can occur, but no obvious
hypertrophy.
A patient with a diagnosis of chronic
prostatitis is referred for physical therapy.
As part of a multidisciplinary treatment
program , the therapist considers
performing manual therapy compression
techniques applied to tender, tight pelvic
floor muscles. Which of the following
muscles should the therapist target in this
case?
a. Piriformis, gluteus medius, and
pubococcygeus
b. Pubococcygeus, gluteus medius, and
obturator internus
c. Obturator internus, gluteus medius,
and piriformis
d. Obturator internus, pubococcygeus,
and piriformis
Correct Answer: D
Most men with chronic prostatitis have
tenderness and tightness of the striated
muscles of the pelvic floor. The goal of
manual therapy compression techniques is to
relax and lengthen those muscles, as well as
to relieve the pain associated with palpable
tender points (trigger points). Striated
muscles of the pelvic floor that are frequently
tight and painful in men with chronic
prostatitis are the pubococcygeus. Obturator
internus, and piriformis. The perineal body
and bulbospongiosus muscle are also
frequently tender.
Incorrect Choices:
The gluteus medius, which appears in three
of the answers, is not a pelvic floor muscle. It
does attach to the external surface of a
pelvic bone (ilium), but it is not by definition a
part of the pelvic floor. Interestingly, tender
points of this mucle are a common finding in
men with chronic prostatitis.
An elderly patient is being examined by
the PT. The PT notes an irregular, dark-
pigmented ulcer over the medial
malleolus. The patient states this is not
painful. The MOST LIKELY diagnosis is:
a. Arterial ulcer
b. Diabetic ulcer
c. Venous ulcer
d. Arterial insufficiency
Correct Answer: C
This patient is demonstrating signs and
symptoms of a venous ulcer: irregular, dark
pigmentation; usually shallow, and appearing
on the distal lower leg (medial malleolus is
the most common area). There is little pain
associated with venous ulcers.
Incorrect Choices:
Arterial ulcers also have irregular edges, but
are not typically dark. They are painful,
especially if the legs are elevated, and are
common in the distal lower leg (toes, feet
lateral malleolus, anterior tibial area).
Diabetic ulcers are associated with arterial
disease and peripheral neuropathy. They
appear in locations where arterial ulcers
appear, and are typically not painful. Signs
and symptoms of arterial insufficiency
include decreased or absent pulses and pale
color. Intermittent claudication is common in
early disease, whereas in late stages,
patients exhibit rest pain and ischemia.
A patient with COPD is sitting in a
bedside chair. The apices of the lungs in
this position compared with other areas of
the lungs in this position would
demonstrate:
a. Increased volume of air at REEP
b. The highest changes in ventilation
during the respiratory cycle
c. Increased perfusion
d. The lowest oxygenation and highest
carbon dioxide content in blood
exiting this zone
Correct Answer: A
The gravity-independent area of the lung in
the upright sitting position refers to the
apices of the lungs, which house the most air
at resting end expiratory pressure (REEP).
The gravity-dependent area of the lungs in
the upright sitting position refers to the bases
of the lungs, which will house the most
pulmonary perfusion. The relative increase in
blood in the pulmonary capillaries around the
alveoli in the bases results in less room for
air in those alveoli. Because there is a
relative decrease in blood in the pulmonary
capillaries around the alveoli in the apices,
there is more room for air.
Incorrect Choices:
The apices of the lungs in that position have
the least perfusion because of the effects of
gravity on blood flow. The apices also have
the smallest change in ventilation during the
respiratory cycle because they are the most
full at rest, and that area has the least ROM
of the thorax. The apices of the lung have the
highest oxygenation and lowest carbon
dioxide content as a result of the small blood
volume that passes by these alveoli.
Therefore, a relatively small amount of
oxygen is extracted from the alveolar air, and
a relatively small amount of carbon dioxide is
given off into the alveolar air.
An elderly patient is referred to physical
therapy following a recent compression
fracture at T8. The medical history
includes osteoporosis and
gastroesophageal reflux diease (GERD).
The patient is currently taking antacids.
Which of the following is MOST important
for the therapist to consider in the POC?
a. Schedule therapy sessions at least
90 minutes after eating
b. Recommend an over-the-counter
proton pump inhibitor (PPI)
medication
c. Include sit-ups in supine to
strengthen abdominals
d. Ensure that the patient eats a small
snack before starting exercise
Correct Answer: A
Gastric contents reflux into the esophagus in
GERD. Scheduling therapy at least 90
minutes after eating reduces the possibility of
food remaining in the stomach and
aggravating the esophagus during therapy.
Incorrect Choices:
Concentric abdominal exercises (sit-ups) are
contraindicated in recent thoracic
compression fractures. Eating right before a
therapy session may aggravate GERD.
Recommending a medication change is
outside the scope of a PT.
1n a patient demonstrating early lift-off
during the preswing phase of gait, the
mobility of which joints of the ankle and
foot are important for assessing the ability
to maintain forward progression of the
foot?
a. Talocrural and first
metatarsophalangeal joints
b. Talocruaral and talonavicular joints
c. Subtalar and talonavicular joints
d. Subtalar and first matatarsophalangeal joints
Correct Answer: A
The primary motions of the talocrural and
first metatarsophalangeal joints are
plantarflexion and dorsiflexion in the sagittal
plane. Normal forward progression of the
ankle and foot during late stance period
(terminal stance and preswing) requires
ankle and great toe dorsiflexion.
Incorrect Choices:
The primary motions of the talonavicular and
subtalar joints are pronation and supination
in the frontal plane. Although important for
normal gait, deficits in the fronal plane do not
limit forward progression.
An elderly patient with a transfemoral
amputation is having difficulty wrapping
the residual limb. The PT’s BEST course
of action is to:
a. Apply a temporary prosthesis
immediately
b. Consult with the vascular surgeon
about the application of an Unna’’s
paste dressing
c. Use a shrinker
d. Redouble efforts to teach proper Ace
bandage wrapping
Correct Answer: C
A shrinker is a suitable alternative to elastic
wraps. It is important to select the right size
shrinker to limit edema and accelerate
healing.
Incorrect Choices:
An Unna’s paste dressing is applied at the
time of initial surgery. Use of a temporary
prosthesis should be a prosthetic team
decision and is based on additional factors
such as age, balance, strength, cognition,
and so forth. Continuing to teach elastic
bandage wrapping may be inefficient and
ultimately fruitless, since the patient is
elderly.
A patient is being treated for secondary
lymphedema of the right arm as a result
of a radical mastectomy and radiation
therapy. The resulting edema (stage 1)
can BEST be managed in physical
therapy by:
a. Isometric exercises, extremity
positioning in elevation, and
compression bandaging
b. Intermittent pneumatic compression,
extremity elevation, and massage
c. AROM and extremity positioning in a
functional arm/hand position
d. Isokinetics, extremity positioning in
elevation, and massag
Correct Answer: B
Lymphedema after surgery and radiation is
classified as secondary lymphedema. Stage
1 means that there is pitting edema that is
reversible with elevation. The arm may be
normal size first thing in the morning, with
edema developing as the day goes on. It can
be effectively managed by external
compression and extremity elevation. Manual
lymph drainage (massage and PROM) are
also appropriate interventions.
Incorrect Choices:
Exercise and positioning alone would not
provide the needed lymph drainage;
Isometric exercise is contraindicated.
