SUSIEG 2018 A Flashcards

Question

Following a reattachment of the flexor tendons of the fingers. the patient is in a splint. One physical therapy goal is to minimize adhesion formation. What should the physical theranist teach the patient to perform after 72 hours post-surgery? A. Passive extension and active flexion of the interphalangeal joints B. Active extension and flexion of the interphalangeal joints C. Active extension and passive flexion of the interphalangeal joints D. Gentle passive extension and flexion of the interphalangeal joints

Answer 1

Correct Answer: C Severe edema increases tendon drag and likelihood of rupture. Therefore, wait until 48 to 72 hours postop prior to initiating range of motion (ROM therapy. This patient is a few days postop and can begin passive finger flexion with caution so as not to disrupt the repair. Begin by blocking the metacarpophalangeal (MCP) in full flexion and actively extend interphalangeal (IP) joints, followed by passive proximal interphalangeal (PIP) flexion and active extension.

Answer 2

Correct Answer: D Although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Sometimes, the brain memory of pain is retained and is interpreted as pain regardless of signals from injured nerves. In addition to pain in the phantom limb, some people experience other sensations such as tingling, cramping, heat, and cold in the portion of the limb that was removed. The question describes pain in the heel. Nerve supply to the heel is by the calcaneal branch of the tibial nerve.

Answer 3

Correct Answer: D The acetate ion has a negative charge, and thus a negative pole will be needed to repel the drug into the tissue. Direct current will continuously drive the acetate into the tissue during the treatment time.

Answer 4

Correct Answer: B The above scenario describes one of the most common mechanisms of injury of the PCL, the "dashboard iniury." This occurs when the knee is flexed, and an object forcefully strikes the proximal anterior tibia and displaces it posteriorly. It is called a "dashboard injury" because it can occur in automobile collisions when the tibia forcefully hits the dashboard. The PCL attaches from the lateral aspect of the medial femoral condyle to just posterior to the posterior horn of the medial meniscus. It is the primary restraint to posterior displacement of the tibia on the femur.

Answer 5

Correct Answer: D Patellofemoral syndrome ("runner's knee") is the most common overuse iniury among runners. It occurs due to mistracking of the patella within the intercondylar groove. It generallv occurs in younger, recreational runners and is more common in women The main symptom of patellofemoral pain syndrome is knee pain, especially when sitting with knee flexion. This is known as the theater sign or movie-goer's knee. Squatting, jumping, or using the stairs (especially going down stairs) will also be painful. There may also be occasional buckling of the knee.

Answer 6

Correct Answer: C The external pressure caused by the compression garment essentially increases the amount of pressure on the tissue. This causes a relative increase in the hydrostatic pressure in the extravascular space compared with the intravascular space.

Answer 7

Correct Answer: D Right TMJ, inferior glide. In the photo, the chin has deviated to the right at terminal opening. The active range of motion (AROM) will be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with a TMJ capsular pattern of restriction.

Answer 8

Correct Answer: D Freezing of gait (episodes of akinesia) is typically associated with a trigger (e.g., turning, changing direction or speed, doorways). Identification of triggers is helpful in developing the plan of care.

Answer 9

Correct Answer: B Metabolic abnormalities seen in adrenal insufficiency include hyponatremia (decreased sodium concentration in the blood) secondary to renal loss of sodium ions. A decrease in cortisol results in an inability to regulate potassium and sodium.

Answer 10

Correct Answer: A Hepatitis B is transmitted in blood, body fluids, or body tissues. Precautions should include avoiding direct contact with blood or blood-contaminated equipment.

Answer 11

Correct Answer: B Screening is most commonly done on adolescents. Females achieve adolescence about two years before males and are afflicted with scoliosis requiring treatment three to four times more frequently than males. The adam's forward bend test is the standard screening test for scoliosis. During the test, the child will bend forward with feet together, knees straight, and arms hanging free. The therapist observes child from the back. Looking for a difference in the shape of the ribs on each side. A spinal deformity is most noticeable in this position.

Answer 12

Correct Answer: D The patient may have a deep vein thrombosis (DVT) based on increased swelling, temperature, tenderness, and pain in the calf with weight bearing 2 weeks after surgery, so referral to the surgeon is the best intervention at this time.

Answer 13

Correct Answer: A Continuous ultrasound (US) is used for its thermal effects, and the higher the intensity, the greater the probability of causing a tissue temperature rise that would result in an increased metabolic rate in the area applied.

Answer 14

Correct Answer: C During a dynamic activity such as the performance of a bilateral active straight leg raise, the weight of the limbs lifted produces an anterior torque on the pelvis. During this dynamic activity, excessive lordosis typically is associated with excessive anterior pelvic rotation. Normally muscles that control anterior pelvic rotation (posterior pelvic rotators) act to counter the anterior torques produced by the mass of the lower limbs lifted off the table, helping to prevent unwanted sagittal plane movements of the lumbar spine. Contractile activities of the anterior trunk muscles (rectus and obliques) provide a posterior rotation movement on the pelvis, helping to stabilize the pelvis. Fatigue weakness of the anterior trunk muscles in this patient could result in poor control of sagittal plane rotation of the pelvis, leading to the observed increasing lumbar lordosis.

Answer 15

Correct Answer: B Stage 3 Lyme disease (late or chronic Lvme disease is characterized by intermittent arthritis with marked pain and swelling, especially in thelarge joints) Permanent joint damage can occur.

Answer 16

Correct Answer: B S3 is an abnormal third heart sound due to poor ventricular compliance and turbulence, It is heard as a low frequency sound during early diastole.

Answer 17

Correct Answer: D A full-term infant in the NICU can have low Apgar scores, respiratory distress, or any one of a number of specific diagnoses (none listed in this case). Initial tone and posturing involve some flexion of the limbs. At 1 month, decreased flexion can be expected.

Answer 18

Correct Answer: D Extensor stabilization exercises in weight-bearing postures provide the best stimulus to bone (e.g., standing, holding against resistance, standing partial squats).

Answer 19

Correct Answer: B This patient is experiencing an arterial bleed most likely affecting the descending branch of the lateral circumflex femoral artery. Pressure should be applied over the wound and more proximally over the femoral artery, which is palpable in the femoral triangle just inferior to the inguinal ligament.

Answer 20

Correct Answer: B Weakness of severe spasticity of the quadriceps is the most likely cause of genu recurvatum.

Answer 21

Correct Answer: C Stemmer's sign is assessed by pulling up on the skin at the base of the second toe or finger, which the clinician is doing in this picture. If the skin is unable to be pulled up, then it is a sign of lymphedema, usually primary but also advanced secondary.

Answer 22

Correct Answer: D A posterior rollator walker with four wheels is the best choice to improve upright posture, energy efficiency, and velocity.

Answer 23

Correct Answer: A Pain and tenderness with palpation over McBurney's point are associated with acute appendicitis. McBurney's point is located half the distance between the anterior superior iliac spine (ASIS) and the umbilicus in the right lower abdominal quadrant.

Answer 24

Correct Answer: A A beta-blocker will decrease the sympathetic response to activity. This will decrease the heart rate at rest and will blunt the heart rate response to activity.

Answer 25

Correct Answer: D Early signs receiving the top Apgar score of 2 each include heart rate over 100 bpm, good respiration and cring, active movements, cough or sneeze, and pink color (total of 10). Apgar scores of 8 to 10 at 1 minute are considered normal.

Answer 26

Correct Answer: B The test is positive if dizziness or nvstagmus occurs, indicating that the opposite side artery is affected. Current evidence demonstrates some limitations in use of this test; however, not performing it prior to cervical manual therapy could be considered a breach of the standard of care.

Answer 27

Correct Answer: C With decerebrate posturing (decerebrate rigidity), the upper and lower extremities are held rigidly in extension.

Answer 28

Correct Answer: C Heartburn is a common symptom of gastrosophageal reflux disease (GERD) and can be aggravated by positioning in supine, prone, or bridging. Modifying the patient's position to upright can alleviate the symptoms and demonstrate to the patient the therapist's concern.

Answer 29

Correct Answer: D Positioning the head/neck in slight extension will counteract the expected pull of the head into flexion with contracture development.

Answer 30

Correct Answer: C The Berg Balance Test (BBT is a test of static and dynamic balance in sitting and standing, includes transitional items of sit-to-stand and stand-to-sit. It does not include items or gait. Turning while walking is an item on both the Tinetti Performance-Oriented Mobility Assessment and the Dynamic Gait Index.

Answer 31

Correct Answer: D The term "clubfoot" (talipes equinovarus) refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. It describes a range of foot abnormalities usually present at birth in which the infant's foot is twisted into an equinovarus deformity. Stretching should be opposite the direction of the deforming position; therefore, stretch is into dorsiflexion and eversion.

Answer 32

Correct Answer: D Pursed lip breathing gives increased resistance to the airwavs on exhalation. The resistance causes increased pressure, which helps to prevent airway collapse (likely sequelae given the pathophysiology of emphysema). This occurs via collateral ventilation through pores of Kohn and canals of Lambert.

Answer 33

Correct Answer: D The hamstring muscles primarily control the forward swing of the leg during terminal swing. Loss of function may result in abrupt knee extension and increased hip flexion.

Answer 34

Correct Answer: C The loose-packed position of the humeroulnar ioint is 70 degrees of flexion. The loose-packed position for the radiohumeral oint is 70 degrees of flexion, 35 degrees of supination. The loose-packed position is basically the resting position where the joint capsule and ligaments are most relaxed.

Answer 35

Correct Answer: B The patient with tetraplegia at the C6 level does not have triceps to assist in transfers. Independent transfers can be achieved using muscle substitution and positioning to lock the elbow. The hands are positioned anterior to the hips; the shoulders are externally rotated with elbows and wrists extended, forearms supinated, and fingers flexed. Strong contraction of the anterior deltoid, shoulder external rotators, and clavicular portion of the pectoralis major flexes and adducts the humerus, causing the elbow to extend.

Answer 36

Correct Answer: C Wound exudate (drainage) is purulent (containing pus) on the basis of the yellow-green discharge.

Answer 37

Correct Answer: B During the motions of flexion and abduction, concentric muscle activity of the serratus anterior occurs, providing upward scapular rotation. However, concentric activity of the serratus anterior would also induce abduction of the scapula due to its line of action. Excessive scapular abduction can be controlled through muscle actions from those that can provide scapular adduction. The primary scapular adductors acting eccentrically to control excessive scapular abduction include the rhomboid and the trapezius muscle groups. Inadequately controlled lengthening of the rhomboids could contribute to hyperabduction of the scapula during the mid and later phases of shoulder flexion and abduction.

Answer 38

Correct Answer: D Symptoms of a stress fracture may include pain and swelling, particularly with weight bearing on the injured bone. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome.

Answer 39

Correct Answer: D It is important to determine etiology of the pain. If it is angina. having the patient stop will reduce the myocardial demand. Gathering timely vital signs will help determine if the patient was maintaining his or her cardiac output. If not, the demand of the activity may have been too great.

Answer 40

Correct Answer: D Reliability coefficients above 0.75 lemonstrate good reliability. This test demonstrated good reliability both for test-retest and interrater comparisons.

Answer 41

Correct Answer: A Lower extremity edema is usually due to incompetent valves. which causes the edema. Longstanding edema causes staining of the legs because of increased iron from pooling blood.

Answer 42

Correct Answer: C These signs and symptoms are characteristic of anterior cerebral artery (ACA) svndrome, with contralateral hemiplegia and lower extremities more affected than upper extremities.

Answer 43

Correct Answer: D This is sinus bradycardia. There are no restrictions on proceeding with exercise in this patient.

Answer 44

Correct Answer: A A patient with a platelet count of 30,000 is at increased risk for bleeding. Percussion may cause microtraumas and increased bleeding risk.

Answer 45

Correct Answer: A The two classical capsular patterns at the him are FAME and MEAL. FAME stands for loss of flexion, abduction, internal (medial) rotation, and extension. MEAL is loss of medial (internal) rotation, extension, and abduction. According to the American Physical Therapy Association (APTA) hip pain practice guidelines, patients were classified as having hip osteoarthritis (A) if they (1) reported experiencing hip pain and (2) present with either one of the following clusters of clinical findings: (a) hip internal rotation less than 15 degrees, along with hip flexion less than or equal to 115 degrees and age greater or equal to 15, along with pain with hip internal rotation, duration of morning stiffness of the hip less than or equal to 60 minutes, and age greater than 50 years.

Answer 46

Correct Answer: D Spondvlolisthesis is defined as forward translation of a vertebral body with respect to the vertebra below. Spondvlolvsis, a break in the vertebra typically in the region of the pars interarticularis, may or may not be associated with a spondylolisthesis. If the pars defect is bilateral, it may allow slippage of the vertebra, typically L5 on S1, resulting in spondylolisthesis. Most cases are thought to result from minor overuse trauma, particularly repetitive hyperextension of the lumbar spine.

Answer 47

Correct Answer: D The physical therapist provided an exercise program, and it is appropriate for the PTA to continue to follow it.

Answer 48

Correct Answer: C Sensory testing should be performed next, including somatosensations from the feet and ankles, visions, and visual proprioception, and vestibular sensations. Once the primary sensations have been tested, the clinical Test for Sensory Interaction in Balance can reveal valuable information about the patient's ability to use sensory information under changing balance conditions.

Answer 49

Correct Answer: C Accurate analysis will depend on the therapist's ability to consistently measure ROM using standardized techniques on multiple measurement trials (intrarater reliability).

Answer 50

Correct Answer: C Finger position marked by extension of the metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints with flexion of the proximal interphalangeal (PIP) joints. Through injury or disease, the central extensor tendon (extensor digitorum communis [EDC]) of the involved finger ruptures. The tendon then displaces palmarly relative to the PIP joint (volar slippage). The lateral bands become tight and are attached to the distal phalanx, extending it. The flexor digitorum profundus (FPD) is now unopposed, and it pulls the PIP joint into flexion. The result is a deformity that looks like a "buttonhole" or boutonniere in French.

Answer 51

Correct Answer: D Recent pulmonary function test results will give the therapist information regarding the severity of the lung disease. This information will assist in determining how much the patient will progress.

Answer 52

Correct Answer: D Prosthetic causes of circumduction include a long prosthesis, locked knee unit, loose knee friction, inadequate suspension, small or loose socket, and plantar flexed foot.

Answer 53

Correct Answer: C Chermitte's sign is sudden, transient. electric-like shocks spreading down the body when the head is flexed forward. It occurs chiefly in patients with multiple sclerosis but can also be seen in compression disorders of the cervical spine (tumor, cervical spondylitic myelopathy).

Answer 54

Correct Answer: C Postoperative adverse effects on the cardiac, pulmonary, and neuromuscular systems and on cognitive function are the main concerns for elderly surgical patient who are at high risk. Postoperative delirium is characterized by incoherent thought and speech, disorientation, impaired memory, and attention. Elderly patients usually manifest delirium following a lucid interval of 1 postoperative day or more, a condition known as interval delirium, Symptoms are often worse at night. Alternatively, the condition can be silent and unnoticed, or misdiagnosed as depression. However, the effects of elderly postoperative delirium are evident in increased morbidity, delayed functional recovery, and prolonged hospital stay. Fortunately, the postoperative cognitive dysfunction is a reversible condition in the majority of elderly surgical patients. Preoperative risk factors of bilateral total knee arthroplasty are associated with a significantly higher incidence of acute delirium than unilateral total knee arthroplasty in patients over 80 vears. Failing to recognize the therapist after three visits is an indication of a declining mental condition. This would definitely be a safety consideration as the patient may not be able to follow all the precautions and may also put himself or herself in danger by walking without an ambulatory aid, etc. Wound infection is also a consideration. Contacting the surgeon is necessary.

Answer 55

Correct Answer: C The physical therapist's unique contribution to the team is in addressing the concerns of individuals with disabilities or special needs.

Answer 56

Correct Answer: B The fractured ribs will cause the patient to have pain and therefore not take deep breaths. More importantly, the pneumothorax will cause an increasing positive pressure on the lung, not allowing it to inflate. The result will be minimal air movement and decreased or absent breath sounds.

Answer 57

Correct Answer: D Given the pathology of CF, it is important to clear all secretions as often as possible to assist with clearing the infection. It will also assist with maximizing gas exchange.

Answer 58

Correct Answer: B The physical therapist's first course of action is to check for responsiveness.

Answer 59

Correct Answer: C The typical location of an Arterial ulcer is the distal lower leg (toes. foot), the lateral malleolus, or the anterior tibial area.

Answer 60

Correct Answer: D The sacroiliac (SI) oints are most often affected in pregnancy, resulting in pain.

Answer 61

Correct Answer: B Nitroglycerin increases coronary blood flow by dilating coronary arteries and improving flow to ischemic areas. In low doses it produces vasodilation (venous greater than arterial) and is used in the acute and long term prophylactic management of angina pectoris.

Answer 62

Correct Answer: D This patient is obese. A bariatric wheelchair with heav-duty, extra-wide wheels is necessary. The rear axle is displaced forward compared to the standard wheelchair to allow for more efficient arm push.

Answer 63

Correct Answer: B The goal of treatment is to remove the otoconia that have become dislodged and are free-floating in the semicircular canal (SCC), or canalithiasis. The patient's head is guided through a series of movements to move the debris out of the involved SCC and into the vestibule. Once moved, the symptoms should resolve. Canalith repositioning maneuver (modified Epley) is used for canalithiasis.

Answer 64

Correct Answer: A Positioning is opposite) the expected posturing and spastic patterns of the more affected upper extremity (UE). This includes shoulder protraction with abduction and external rotation, elbow extension, wrist neutral, and fingers in extension.

Answer 65

Correct Answer: B Prone, with a pillow under the hips and the bed flat will raise the posterior basal segments up to facilitate drainage.

Answer 66

Correct Answer: B The anterior talofibular ligament is the most frequently inured ligament in the ankle, which occurs with an inversion sprain.

Answer 67

Correct Answer: C A small percentage of patients (<5%) who take statins (atorvastatin such as Lipitor, or others) can experience myalgia, cramps, stiffness, spasm, or weakness affecting exercise tolerance. The patient needs to see the primary care physician to have the dose or medication changed.

Answer 68

Correct Answer: D A spastic or reflex (upper motor neuron [UMN]) bladder contracts and reflexively empties in response to a certain level of filling pressure. Reflex empting can be triggered by manual stimulation techniques (e.g., stroking, kneading, or tapping the suprapubic area.

Answer 69

Correct Answer: C A stage III ulcer is characterized by full-thickness skin loss with damage to or necrosis of subcutaneous tissue. It presents clinically as a crater.

Answer 70

Correct Answer: C Centralization describes the phenomenon hy which distal limb pain, coming from the spine although not necessarily felt there, is immediately or eventually abolished in response to loading strategies. During centralization, the response to therapeutic loading strategies is assessed. Pain is progressively abolished in a distal to proximal direction with each progressive movement until all symptoms are abolished. In back pain only, the pain moves from a widespread to a more central location and then abolishes. Centralization has been proved to be a good indicator of a positive outcome in patients with low back pain.

Answer 71

Correct Answer: B The posterior thigh does not touch the table, and the knee can be flexed as many degrees beyond 80 degrees as the hip is flexed. The Thomas test is utilized to test for hip flexor length and to distinguish between one joint and two joint hip flexor tightness. With low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table. Normal tow joint hip flexor length would be 80 degrees of knee flexion.

Answer 72

Correct Answer: C Duchenne' MD is a rapidly progressive disorder characterized by muscle wasting and atrophy. Contractures of the hips, knees. plantar flexors, and iliotibial band are common. Scoliosis occurs at around age 11 or 12. The main focus is preventing contractures, maintaining activities of daily living (ADL), energy conservation, family education, and positioning.

Answer 73

Correct Answer: A An increased valgus deformit can result in a greater lateral disnlacement force on the patella, which can disrupt patella tracking and could even lead to subluxation. The theory behind the lateral buttress brace is that it provides support to help prevent subluxation and tries to maintain the normal patella tracking.

Answer 74

Correct Answer: D Both a moist environment and heat can accelerate bacterial growth. Hot packs would be contraindicated in this case.

Answer 75

Correct Answer: B Relaxation can be achieved using slow rocking (slow vestibular stimulation).

Answer 76

Correct Answer: A The concave-convex rule dictates roll and slide in the same direction. Joint mobilization to increase knee extension should emphasize anterior tibial glide. Anatomically, the medial femoral condyle is longer (has more articular surface) than the lateral; therefore, for the tibia to maintain maximum contact during the last 30 degrees (most evident during the last 5 degrees) of knee extension, external rotation of the tibia on the femur occurs in an open-chain movement. This happens because the shorter lateral tibial plateau/condyle pair completes its rolling and sliding motion before the longer medial articular surface does. The continued anterior motion of the medial tibial condyle results in external rotation of the tibia on the femur.

Answer 77

Correct Answer: D This is a prospective (forward-in-time) stud. A group of participants (cohort) with a similar condition is followed for a defined period of time. This is a cohort study.

Answer 78

Correct Answer: D Hamstring/auadriceps torque generation at various speeds in 15-to-45-year-old males: * 65% at 60 degrees/sec * 69% at 180 degrees/sec * 71% at 300 degrees/sec

Answer 79

Correct Answer: A 1 MHz requency is recommended for target tissue deeper than 2 cm, and 1.5 watts/cm2 would increase the rate of heating, allowing it to be treated in a reasonable time frame.

Answer 80

Correct Answer: D Hydrocolloidal dressings are typically changed every 3 to 5 days or when drainage leaks out. An odor and yellowish color is to be expected as the dressing material melts.

Answer 81

Correct Answer: A The carpometacarpal joint of the thumb is considered a saddle joint in which the articular surface geometry is generally concave in one plane and convex in a plane perpendicular to the other. The proximal joint surface of the first metacarpal is generally convex in the palmar to dorsal direction and concave in the medial to lateral direction. The articular surface of the base of the first metacarpal typically presents as the convex member of this joint when movement occurs in palmar abduction. Thumb palmar abduction thus involves a convex metacarpal surface moving on the concave surface of the trapezium. Following the traditional concave/convex rules of motion, one would expect a combination of palmar roll and dorsal translator motion of the metacarpal on the trapezium during palmar abduction. In this case, a therapist would be sure to evaluate dorsal glide of the metacarpal on the trapezium.

Answer 82

Correct Answer: D A patient with a right hemisphere lesion (left hemiplegia) will tend to ignore items or body parts on the left side while favoring items or body parts on the right side.

Answer 83

Correct Answer: C Supracondylar fractures are the most common pediatric elbow fracture, occurring most commonly between 3 and 10 years of age. Extension fractures account for about 95% of supracondylar fractures. The mechanism of injury is a fall on an outstretched hand with elbow hyperextended. Type Is a nondisplaced fracture across the growth plate. Type iNsupracondylar fractures are angulated and displaced fractures across the growth plate and continuing up through the shaft of the bone(Type IN fractures may be displaced in three directions: posteromedial (the most common pattern), posterolateral, or anterolateral. A type III fracture also starts through the growth plate but turns and exits through the end of the bone and into the adjacent joint. Type I is a fracture through all three elements of the bone: the growth plate, metaphysis, and epiphysis (10% incidence). Type IV growth plate fracture starts above the growth plate, cross the growth plate, and exit through the joint cartilage. These injuries can affect the joint cartilage and may impair normal growth. Complete growth retardation or partial growth arrest may result in progressive limb-length discrepancies. Complete growth arrest is uncommon and depends on when the injury to the physis occurs in relation to the remaining skeletal growth potential. The younger the patient, the greater is the potential for problems associated with growth. Premature partial growth arrest is far more common and can appear as peripheral or central closures.

Answer 84

Correct Answer: C It has been established that in order to generate collateral circulation in patients with ischemia (i.e., claudication), patients need to exercise with at least moderate claudication pain. This level of blood and oxygen deprivation over time initiates the generation of collateral circulation. This correlates to 2 out of 4 on the claudication scale.

Answer 85

Correct Answer: A Hypertrophied scalene muscles can result in thoracic outlet syndrome due to their close anatomical relationship to the neurovascular structures. The neurovascular bundle passes between the anterior and middle scalene muscles and could be under pressure from hypertrophied scalenes. The anterior and middle scalenes attach to the first rib, and tightness in these muscles could result in elevation of the first rib, thereby compressing the neurovascular bundle. Neurogenic (neurological) thoracic outlet syndrome is characterized by compression of the brachial plexus. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic. Signs and symptoms of neurological thoracic outlet syndrome often include wasting in the thenar area, numbness or tingling in the fingers, pain in the shoulder and neck, ache in the arm or hand, and weakening grip.

Answer 86

Correct Answer: C Full chest immersion in a pool can result in increased work of breathing as a result of increased hdrostatic pressure.

Answer 87

Correct Answer: B Hamstrings need to be fully ranged to 110 degrees in the supine position. This allows for function in the longsitting position (e.g., dressing, leg management during transfers).

Answer 88

Correct Answer: B The muscles involved in opening include the lateral ptergoid, anterior head of the digastric muscle, and suprahyoid muscles.

Answer 89

Correct Answer: D Reflexes are average, normal (2+) on the left and very brisk, hyperactive, and abnormal (4+) on the right.

Answer 90

Correct Answer: B Systematic review including meta-analysis of randomized controlled trials (RCTs) provides the best research evidence of effectiveness of an intervention.

Answer 91

Correct Answer: B If a patient presents with four out of five criteria listed in the examination findings, the patient has a 95% chance of benefiting from manipulation using the lumbopelvic regional thrust manipulation technique.

Answer 92

Correct Answer: D Pancreatitis occurs midline or to the left of the epigastrium, just below the xiphoid process. Pain is referred to the middle or lower back and rarely to the upper back.

Answer 93

Correct Answer: B Open skills are motor skills (e.g., walking) that can be performed in a variable, changing environment (a busy hospital lobby).

Answer 94

Correct Answer: C Caregiver training with safety instruction in contact guarding during level walking and stairs is the best choice to keep this patient functional in the home environment.

Answer 95

Correct Answer: C Slightly bluish, grayish, slate-colored discoloration of the skin along with clubbing of the nails is characteristic of chronic hypoxia.

Answer 96

Correct Answer: A Range of motion (ROM exercises and prevention of deformity are important elements of the plan of care.

Answer 97

Correct Answer: B Initial postpartum interventions (days 1 to 3) should include breathing, coughing, and pelvic floor exercises.

Answer 98

Correct Answer: D The Vest Airway Clearance System provides high-frequency chest wall compression (HFCWC). It allos for control of inspiratory and expiratory flow rates. The device can be used in any position regardless of the patient's cognitive status.

Answer 99

Correct Answer: C The C6 root supplies the palmar surface of the thumb and distal radial forearm.

Answer 100

Correct Answer: C The bedside commode is the best choice to improve function.

Answer 101

Correct Answer: A This picture depicts a positive Trendelenburg sign. Weakness of the left hip abductors (gluteus medius) results in dropping of the pelvis on the opposite side. A normal response would be no dropping of the pelvis during the standing test.

Answer 102

Correct Answer: A Fluent aphasia is characterized by impaired auditory comprehension and fluent speech that is of normal rate and melody (e.g., Wernicke's aphasia).

Answer 103

Correct Answer: D This patient demonstrates good functional recovery. Motor learning for the autonomous stage of motor learning should utilize variable practice in variable environments.

Answer 104

Correct Answer: D Neural tension tests are used to determine neural mobility in relation to its surrounding tissue. It should be noted that patients will experience symptoms even when normal neural tissue is tensioned. It is paramount for the examiner to understand the expected normal responses with tension testing. A tension test can be considered positive if it reproduces the patient's symptoms, the test response can be altered by movement of distant body parts, and there are differences when comparing the left side to the right side. Neural mobilization techniques including gliders/sliders and tensioners are interventions used to decrease adverse mechanical tension on nerves. A straight leg raise with plantarflexion and inversion is the optimal position for neural tissue provocation of the peroneal (fibular) nerve.

Answer 105

Correct Answer: B MRI is highly sensitive for detecting MS plaques in the white matter of the brain and spinal cord. Cesions are seen as areas of increased signal intensity (bright spots). Contrast-enhanced scans are used for more long term disease activity.

Answer 106

Correct Answer: C These are signs and symptoms of urinary tract infection. Evidence of fever is especially significant. The physician should be informed.

Answer 107

Correct Answer: B The phrenic nerve arises from the neck (C3-5) and innervates the diaphragm. The diaphragm is responsible for 45% of the air that enters the lungs during quiet breathing. During quiet breathing, the predominant muscle of respiration is the diaphragm. As it contracts, pleural pressure drops, which lowers the alveolar pressure and draws in air down the pressure gradient from mouth to alveoli. Expiration during quiet breathing is predominantly a passive phenomenon; as the respiratory muscles relax, the elastic lung and chest wall return passively to their resting volume. With paralvsis of the diaphragm, the accessory muscles of respiration should be strengthened. These include the scalenes and sternocleidomastoid.

Answer 108

Correct Answer: B Rhythmic stabilization is proprioceptive neuromuscular facilitation (PNF) technique designed to improve stability. The high kneeling position is a good choice to begin with for the patient with pronounced ataxia. The posture is upright; while the center of mass (COM) is lowered, the degrees of freedom are reduced by kneeling (foot and ankle control not required and the base of support (BOS) is increased over standing.

Answer 109

Correct Answer: A It is necessary to keep the residual limb wrapped to help shape it for possible prosthetic wear and to control swelling. It should be wrapped at all times except when bathing. Elastic wraps should be used initially. Wrap with the knee in as much extension as possible. Use two clean, rolled, bandages (4-6 inches wide). Use wraps that close with Velcro if possible or use tape to fasten rather than clips. Rewrap if the bandage is uncomfortable or if it slips. Make all turns diagonal, not circular. Circular turns could decrease circulation and produce discomfort. Make sure that the bandage is smooth, without wrinkles, and that all of the skin of the stump is covered and overlapped by ½ inch with each wrap. The pressure should be more at the bottom of the limb to help form the limb into a cylinder shape. To help prevent the wrap from slipping, continue the wrap above the knee one or two turns but finish the wrap on the residual limb.

Answer 110

Correct Answer: D The Noble compression test implicates iliotibial band friction syndrome. This test is performed with the patient supine. The examiner flexes the patients' knee and hip to 90 degrees and then applies pressure to the lateral femoral epicondyle with the thumb. While maintaining this position, the knee is passively extended. A positive test is reproduction of pain at approximately 30 degrees of knee flexion.

Answer 111

Correct Answer: D Soft tissues that were injured in a traumatic event initially develop a hematoma and subsequently can develop into myositis ossificans. Mvositis ossificans is a benign, ossifying soft-tissue lesion typically occurring within skeletal muscle. Patients are usually adolescents and young adults. Myositis ossificans is rare in children under 10 years of age. The most frequent symptoms and signs are pain and tenderness with a soft tissue mass. Approximately 80% of cases arise in the large muscles of the extremities.

Answer 112

Correct Answer: A Dysmetrid is an inability to judge the distance or range of movement. It includes both overestimation (hypermetria) and underestimation (hypometria) of the required range needed to reach the goal.

Answer 113

Correct Answer: A Stabilizing the unver extremities allows the latissimus dorsi to function such that it lifts the rib cage, thereby increasing negative pressure within the thorax and improving ventilation.

Answer 114

Correct Answer: C All applications of electrical stimulation are contraindicated in the presence of a pacemaker. Consultation with the referring physician is necessary.

Answer 115

Correct Answer: D Blood pressure can be expected to rise during isometrics and weightlifting and fall below resting levels after exercise ceases. This is a normal hemodvnamic response to exercise.

Answer 116

Correct Answer: D Lurching backward during stance is a compensation for weak hip extensors, commonly called a gluteus maximus gait. Leaning backward during loading response inclines the ground reaction force vector posteriorly from point of application at the hindfoot. Because the vector passes closer to the hip joint's lateral axis, its moment arm is shorter, and it produces a smaller hip flexors moment. If it falls behind the axis it can produce a hip extensor moment.

Answer 117

Correct Answer: A All of these medications lower blood pressure. If the dosage is too great for patients, they will be hypotensive and likely feel dizzy.

Answer 118

Correct Answer: D These are all signs of shunt blockage Emergency medical services are indicated.

Answer 119

Correct Answer: C Sitting, bilateral symmetrical UE PNF D2 flexion patterns using rhythmic initiation are the best choices to open up the chest and enhance lung function (restrictive lung function is common in patients with PD). The sitting posture is a good starting position for a patient with postural instability since the base of support (BOS) is wide and the center of mass (COM) is lowered compared to standing.

Answer 120

Correct Answer: A The first priority of the home physical therapist should be gait training with a cane to ensure safety. This compensatory strategy is necessary as this patient is demonstrating complications of diabetes, which are chronic and progressive.

Answer 121

Correct Answer: B Guideline for interval training call for performance of intermittent exercise of at least 10 minutes of duration (American College of Sports Medicine).

Answer 122

Correct Answer: D A steady increase in systolic pressure and either a slight increase or decrease in diastolic pressure is a normal response to ramp exercise protocol. With a continual, steady increase in exercise, the systolic blood pressure will continue to rise because the patient si not permitted to reach steady state.

Answer 123

Correct Answer: D The mandible can open partway without clicking because the condyle is able to push the dislocated disc in front of it until the ligaments become taut. Further opening causes the chin to deviate off to the affected side because the affected condyle stops moving forward while the condyle of the other side keeps moving forward. Further jaw opening requires the affected side to jump over the back end of the dislocated disc and onto its thin center, causing a click or pop. Thus the opening click occurs near wide opening because it doesn't occur until the ligaments attached to the backs of the disc become taut; and the closing click is softer and occurs when the jaw is more nearly closed because the disc doesn't re-dislocate until the condyle reaches the depth of the socket where the disc can no longer fit. In later stages of forward disc dislocation, the disc usually stops going back into place during mouth opening, and the mandible cannot open past the point where it used to click.

Answer 124

Correct Answer: B This patient is exhibiting signs and symptoms of pulmonary embolism. This is an emergency medical situation and a cause of death in a substantial number of patients.

Answer 125

Correct Answer: D A grade of 4 is given for affected parts) that are held rigid in flexion or extension.

Answer 126

Correct Answer: B The child with Down syndrome typically demonstrate hypotonia, developmental delay in postural stability, and poor muse of propriocention for postural control. Prone positioning on a large gymnastic ball and having the child look up (neck extension) and/or reach up is a good early intervention to activate the postural extensors.

Answer 127

Correct Answer: C Dyspraxia is an impairment of skilled learned movement (a disconnect between the idea for movement and its motor execution). Task-specific practice using familiar activities and progression from parts to whole is the best choice to enhance learning.

Answer 128

Correct Answer: C A Grade IV anterior to posterior glide of proximal carpal row on distal radius and ulnar is the correct choice because during wrist flexion, the proximal row moves dorsally on the distal radius and ulna.

Answer 129

Correct Answer: B These are all measure of static standing balance found on the Berg Balance Scale (BBS). The most difficult test is tandem standing (reduced based of support [BOS] with eyes closed (EC).

Answer 130

Correct Answer: B Slowly absorbed carbohydrates (crackers, bread, or pasta) can help prevent delaved-onset hypoglycemia.

Answer 131

Correct Answer: C Typically, AC sprains will have pain at extremes of active range of motion (AROM), especially horizontal adduction and full elevation and pain on passive horizontal adduction and elevation. There are three special tests for AC joint: * Acromioclavicular shear test: positive if abnormal movement of AC joint or pain at joint * Passive cross-chest adduction * O'Brien test

Answer 132

Correct Answer: C The Peabody Developmental Motor Scales is a norm-referenced, standardized assessment of gross motor and fine motor skill divided into six subtests with an age range of 1 to 72 months.

Answer 133

Correct Answer: B The posterior tibial tendon helps hold up the arch up and provides support when stepping off on the toes when walking. If this tendon becomes inflamed, overstretched, or torn, one may experience pain on the inner ankle and gradually lose the inner arch on the bottom of the foot, leading to flatfoot (posterior tibial tendon dysfunction (PTTD]).

Answer 134

Correct Answer: A The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater on x-ray. The condition isn't rare. It mainly affects girls, many of whom have mild forms of scoliosis, are never even aware of it, and never need treatment. Three to five children out of every 1,000 develop spinal curves that are considered large enough to require treatment. "idiopathic" simply means that there is no known cause. Common signs and symptoms of scoliosis may include: * Uneven shoulder heights * Head not centered with the rest of the body * Uneven hip heights or positions * Uneven shoulder blade height or positions * Prominent shoulder blade * When standing straight, uneven arm lengths * When bending forward, asymmetrical left and right sides of the back

Answer 135

Correct Answer: B Forceful PROM in the presence of spasticity increases the risk of developing HQ (osteogenesis typically occurring in the soft tissues adjacent to large joints).

Answer 136

Correct Answer: D Raynaud's disease is a vasospastic disorder characterized by intermittent episodes of small artery constriction of the digits of the fingers (rarely the toes), causing temporary pallor and cyanosis.

Answer 137

Correct Answer: C Platform crutches allow weight bearing on the forearms and are used for patients who are unable to bear weight through their hands, as in this case.

Answer 138

Correct Answer: C The best intervention is posterior glide of the humerus and horizontal adduction stretch with arm across chest. During glenohumeral internal rotation, there is a posterior glide of the humerus in the glenoid fossa. The best way to self-stretch the posterior capsule is to adduct the arm, putting the posterior capsule and soft tissues on stretch.

Answer 139

Correct Answer: A Passive range of motion (PROM) exercises can be taught to family members in order for them to participate in the care of the patient.

Answer 140

Correct Answer: D Pressure-tolerant areas of the typical transtibial residual limb include the patellar tendon, the medial tibial plateau, the tibial and fibular shafts, and the distal end.

Answer 141

Correct Answer: C Going up stairs foot-over-foot (reciprocal stair climbing) is a developmental skill normally achieved by 2 years.

Answer 142

Correct Answer: C It is possible to complete manual techniques in the area of the chest tube. It is often the area in most need of airway clearance. It is important to consider pain management when doing this intervention.

Answer 143

Correct Answer: D Extending the hip while flexing the knee will lengthen the rectus femoris and tensor fascia late, resulting in increased compressive forces at the patellofemoral joint. This position should be avoided if the goal is to minimize this force. At 25 degrees, the force at the patellofemoral joint is equal to that passing through the tibiofemoral joints.

Answer 144

Correct Answer: C A posterior rolling walker is used to promote an upright posture (eliminates the forward lean seen in use of the standard walker). The addition of wheels improves walking and reduces energy expenditure.

Answer 145

Correct Answer: C There is vasodilation while exercising to increase oxygen supply to peripheral tissues. The return to normal arterial dilatation is delaved in patients with heart failure, and a prolonged. gradual cool down is recommended.

Answer 146

Correct Answer: D The MFIS is an appropriate measure to examine the physical. cognitive and psychosocial functional limitations of fatigue in patients with MS.

Answer 147

Correct Answer: B RI is a proprioceptive neuromuscular facilitation (PNF) technique designed to improve mobility. Trunk rotation is particularly lacking in patients with PD and is a good activity to focus on in order to improve bed mobility.

Answer 148

Correct Answer: C Joint mobilization generally begins in the loose-pack position but with improvement can progress to more closed-pack positions of the joint. The loose-pack position of the glenohumeral ioint is from 30 to 40 degrees in the scapular plane.

Answer 149

Correct Answer: D The Thompson test is used to examine the integrity of the Achilles tendon. The patient lies prone with feet off the end of the plinth. The examiner squeezes the calf muscle. This should cause the toes to point downward as the Achilles pulls the foot. The foot will not move in a patient with a totally ruptured Achilles tendon (a positive Thompson test).

Answer 150

Correct Answer: B When treating the patient with a terminal illness, the therapist should provide support and understanding of the grief process, encourage expression of feelings and memories, and respect privacy, cultural, or religious customs.

Answer 151

Correct Answer: A Hip flexors are innervated and functional at the L2 (key muscle). Therefore, an L1 lesion would produce complete loss of this muscle function.

Answer 152

Correct Answer: D If a Pt accepts an individual for physical therapy services, the PT will be responsible for the examination, evaluation, and intervention of a patient. At the least, a systems review and brief plan of care should be formulated before intervening. Electronic medical records help to minimize difficulties in handwriting interpretation; however, systems aren't perfect.

Answer 153

Correct Answer: A The patient's memory impairment associated with AD will significantly impact management at this time. Significant others or home health aides will be necessary to maintain this patient's independence in the home.

Answer 154

Correct Answer: B Congenital muscular torticollis involves a shortened sternocleidomastoid (SCM) muscle with a weakened contralateral SCM muscle, with a resulting posture of lateral flexion of the head to be involved (right) side, tight SCM muscle side and rotation of the head to the noninvolved (left) side.

Answer 155

Correct Answer: A This patient is exhibiting several risk factors for osteoporosis: post-menopausal age, low body weight, loss of height, sedentary lifestyle, tobacco use, and hyperthyroidism (Graves' disease). Signs and symptoms include severe and localized thoracic-lumbar pain, increased pain with prolonged upright posture, decreased pain in hook-lying, loss of height, and kyphosis (dowager's hump). Her pain is most likely due to compression fractures, which can be confirmed on x-ray. Osteoporosis can be confirmed with a bone density scan.

Answer 156

Correct Answer: D Excessive foot pronation is known as pes plans or pes valgus- a "flat foot deformity." The foot remains in pronation at the subtalar joint during weight bearing. The slight pronation of both the subtalar and tranverse tarsal joints seen in normal stance is exaggerated.

Answer 157

Correct Answer: D Goals during the first few weeks include preventing tendon rupture and promoting tendon healing as well as edema and pain control. For scar management, perform active range of motion (AROM) flexion, isolated joint and tendon gliding (hook and straight fist). Perform passive extension via elastic recoil of the dynamic splint, 10 to 20 reps hourly. Begin active MP flexion to 30 to 40 degrees (via flexion block on dynamic splint). Progress MP flexion as tolerated. Perform wrist and digit passive range of motion (PROM) in extension and tenodesis out of splint 10 repetitions hourly. Avoid making a full fist as this may place too much stress on the repair. The wrist is splinted in 40 to 45 degrees extension with 0-20 degrees of MP flexion and 0 degrees of IP flexion.

Answer 158

Correct Answer: B An intermittent compression pump provides external pressure, increasing the external hydrostatic pressure, which encourages reabsorption of the edema and minimizes fluid outflow from vessels.

Answer 159

Correct Answer: A Rehab of the noninvolved joints should begin as early as possible to prevent circulatory stasis. atrophy, and contractures. In addition, exercise to the noninjured area will increase blood flow in the entire extremity and aid in healing and reducing edema. The benefits of range of motion (ROM exercise include prevention of contracture, decreased pain, synovial fluid distribution, cartilage nutrition, stimulation healing along the lines of stress, prevention of thrombus formation, kinesthesia, increased bone activity, and patient participation.

Answer 160

Correct Answer: D If the right ventricle fails, the increased fluid will back up. Traveling backward from the right ventricle, the edema goes into the right atrium and then the periphery. This causes dependent edema.

Answer 161

Correct Answer: B Electromyography (EMG) studies confirm that the supraspinatus prevents downward migration of the humeral head. Shoulder alignment problems also influence subluxation (a downwardly rotated scapula, relative abduction, and internal rotation of the humerus).

Answer 162

Correct Answer: D This case represents the typical presentation for juvenile rheumatoid arthritic (JRA)) The following are common symptoms of JRA: swollen, stiff, painful ioints usually worse in the morning; fatigue; fever; swollen Imph nodes; and poor weight gain/slow growth. Additionally, the physical therapist was unable to identify specific impairments that would be potentially contributing to the patient's complaints, warranting referral to physician for additional testing.

Answer 163

Correct Answer: A Neutral or extended position of the spine results in better separation of the disc space and should not exacerbate the posterior herniation.

Answer 164

Correct Answer: B Manual techniques and angle of pull have been determined primarily by palpating where the separation is coming from. However, one should be aware that there is conflicting evidence on angle of pull and vertebral separation. Generally it is believed that C1-2 separation would best be treated with a neutral (0-5 degree)

Answer 165

Correct Answer: D Contraction of the diaphragm causes the ribs to move outward, which is desired motion in this case.

Answer 166

Correct Answer: D The Ober test is for tightness of the tensor fascia late and iliotibial band. With the pelvis stabilized and the hip kept in neutral rotation, the Ober test would be considered normal if the thigh drops slightly below horizontal. Some sources say that the thigh should drop below the horizontal to the table.

Answer 167

Correct Answer: C A good choice for an initial intervention is therapeutic aquatics. The warmth of the water can ease muscle and joint pain, and the buoyancy can assist fatigued limbs. An initial exercise duration of up to 20 minutes per session in 2-to 4-minute intervals is recommended.

Answer 168

Correct Answer: B Circumduction is the most likely compensatory gait deviation when tibial advancement is limited (e.g., spasticity of plantar flexors).

Answer 169

Correct Answer: D Locomotor training using a personal listening device and 80 to 100 beats/min music has been shown to improve rhythmicity and decrease FOG episodes in patients with PD.

Answer 170

Correct Answer: D Treatment direction is generally indicated by the convex-concave rule. The convex-concave rule states that when a convex surface moves on a concave surface, the mobilization force is applied opposite to the angular movement of the bone. If the moving surface is concave, the mobilization force occurs in the same direction as bone movement. The non-weight-bearing subtalar joint motion is described strictly by calcaneal movement. Pronation consists of calcaneal eversion, calcaneal dorsiflexion, and calcaneal abduction (medial tilt), whereas supination involves calcaneal inversion, calcaneal plantar flexion, and calcaneal adduction (lateral tilt).

Answer 171

Correct Answer: C The patient will need an external force to facilitate a cough and to clear secretions.

Answer 172

Correct Answer: C CRPS includes symptoms of pain, vascular changes, and atrophy. Early signs Stage I include hyperalgesia (increased sensitivity to pain), allodynia (all stimuli are perceived as painful), and hyperpathia (increased intensity) with edema, increased sweating, and thin, shiny skin.

Answer 173

Correct Answer: A NCV provides the most useful measurement of demyelinization in polyneuronathy. Conduction time is measured by recording the evoked potential from either a motor or sensory nerve. Speed of nerve transmission is directly related to level of myelination.

Answer 174

Correct Answer: B When a forefoot is supinated, it can appear to be pronated because the body will get the forefoot onto the ground by pronating somewhere. The pronation that gets the foot on the ground actually occurs higher up the chain as at the rearfoot, ankle, knee, hip or pelvis, and lower back. When this occurs at the subtalar joint (STJ), for example, it is not uncommon to see the knees achieve a valgus position (knock knees). It is easy to confuse the appearance of pronation in the case of a forefoot varus, where the forefoot is effectively supinated.

Answer 175

Correct Answer: A A decrease in systolic blood pressure indicates an inability to maintain cardiac output. Exercise intensity should be immediatelv reduced or exercise stopped, depending upon the patient response.

Answer 176

Correct Answer: B Current recommendations for prevention of pressure ulcers in patients with spinal cord injury who are wheelchair users include 10 to 15 minutes of pressure relief (push-ups) for every 15 to 20 minutes of sitting.